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Carlos Zubaran, Katia Foresti, Investigating quality of life and depressive

symptoms in the postpartum period, Women and Birth, Volume 24, Issue 1,
March 2011, Pages 10-16, ISSN 1871-5192, 10.1016/j.wombi.2010.05.002.
Abstract: SummaryBackground
Mood disturbances represent the most frequent form of maternal psychiatric
morbidity in the postpartum period. Nevertheless, few studies have examined
the impact of postpartum depression on the mother's quality of life.
Research question or problem
The present study aims to assess the quality of life of a sample of mothers
in Southern Brazil, in order to investigate the association between
postpartum depression and quality of life (QoL) standards.
Participants and methods
This study investigates a sample of 101 adult volunteers who completed the
Portuguese version World Health Organization Quality of Life Assessment-
Bref (WHOQOL-Bref) and Multicultural Quality of Life Index (MQLI)
questionnaires. Postnatal depressive symptoms were evaluated through the
Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal
Depression Scale (EPDS). Multiple regression analyses were conducted to
predict the overall PDSS and EPDS scores. Pearson Product-Moment
Correlation coefficients were computed between the global scores of the
quality of life measurements and the screening questionnaires for postnatal
Both socio-economic status and quality of life have influenced
significantly the depressive symptomatology and correlated epiphenomena.
Significant correlations were observed among scores of postpartum
depression screening tools and quality of life questionnaires. The socio-
economic status of research participants was only significantly correlated
to the scores generated by the WHOQOL-Bref questionnaire.
These findings confirm that socio-economic deficiencies and low quality of
life can facilitate the expression of depressive symptomatology during the
postpartum period. The results also emphasize the salience of psychosocial
risk factors in the diathesis of postnatal depression.
Keywords: Quality of Life; Postpartum depression; Questionnaires; Brazil

Kalpana Upadhyay, Helen Scholefield, Risk management and medicolegal issues

related to postpartum haemorrhage, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 22, Issue 6, December 2008, Pages
1149-1169, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.08.007.
Abstract: Postpartum haemorrhage (PPH) is a major cause of maternal
mortality and morbidity. Despite several local and national guidelines and
recommendations, the incidence of major obstetric haemorrhage has not
declined significantly over the years. A high proportion of these cases
involve patient safety incidents. The major themes in such incidents are:
delay in diagnosis, failure to adhere to protocols, lack of consultant
supervision, communication and documentation problems, inefficient teamwork
and organizational failure. This chapter deals with ways of identifying the
major contributory factors for adverse events associated with PPH and
suggests solutions to minimize errors.
Keywords: postpartum haemorrhage; maternal morbidity; hysterectomy; risk
management; safety; adverse events; medicolegal

Hawley E. Montgomery-Downs, Salvatore P. Insana, Megan M. Clegg-Kraynok,

Laura M. Mancini, Normative longitudinal maternal sleep: the first 4
postpartum months, American Journal of Obstetrics and Gynecology, Volume
203, Issue 5, November 2010, Pages 465.e1-465.e7, ISSN 0002-9378,
Abstract: Objective
To describe the normative course of maternal sleep during the first 4
months postpartum.
Study Design
Sleep was objectively measured using continuous wrist actigraphy. This was
a longitudinal, field-based assessment of nocturnal sleep during postpartum
weeks 2 through 16. Fifty mothers participated during postpartum weeks 2
through 13; 24 participated during postpartum weeks 9 through 16.
Maternal nocturnal sleep time was 7.2 (SD 0.95) hours and did not change
significantly across postpartum weeks 2 through 16. Maternal sleep
efficiency did improve across weeks 2 (79.7%; SD 5.5) through 16 (90.2%;
SD 3.5) as a function of decreased sleep fragmentation across weeks 2
(21.7; SD 5.2) through 16 (12.8; SD 3.3).
Though postpartum mothers' total sleep time was higher than expected during
the initial postpartum months, this sleep was highly fragmented (similar to
fragmenting sleep disorders) and inefficient. This profile of disturbed
sleep should be considered in intervention designs and family leave
Keywords: actigraphy; maternal; normative; postpartum; sleep

Chia-Yen Li, Su-Chiu Chen, Chung-Yi Li, Meei-Ling Gau, Chiu-Mieh Huang,
Randomised controlled trial of the effectiveness of using foot reflexology
to improve quality of sleep amongst Taiwanese postpartum women, Midwifery,
Volume 27, Issue 2, April 2011, Pages 181-186, ISSN 0266-6138,
Abstract: Objective
to examine the effectiveness of using foot reflexology to improve sleep
quality in postpartum women.
Design and setting
randomised controlled trial, conducted at two postpartum centres in
northern Taiwan.
65 postpartum women reporting poor quality of sleep were recruited from
July 2007 to December 2007.
participants were assigned randomly to either an intervention or a control
group. Participants in both groups received the same care except for
reflexology therapy. The intervention group received a single 30-minute
foot reflexology session at the same time each evening for five consecutive
days. Sessions were administered by a certified nurse reflexologist.
Measures and findings
the outcome measure was the Pittsburgh sleep quality index (PSQI), and this
was performed at baseline and post test. Mean PQSI scores for both groups
declined over time between baseline and post test. Using a generalised
estimation equation to control several confounding variables, the changes
in mean PSQI were found to be significantly lower in the intervention group
(=2.24, standard error=0.38, p<0.001) than in the control group.
an intervention involving foot reflexology in the postnatal period
significantly improved the quality of sleep.
Implications for practice
midwives should evaluate maternal sleep quality and design early
intervention programmes to improve quality of sleep in order to increase
maternal biopsychosocial well-being. Midwives interested in complementary
therapies should be encouraged to obtain training in reflexology and to
apply it in clinical settings if it is allowed.
Keywords: Foot reflexology; Complementary medicine; Postpartum quality of
sleep; Randomised controlled trial
Marie-Pierre Bonnet, Catherine Deneux-Tharaux, Marie-Hlne Bouvier-Colle,
Critical care and transfusion management in maternal deaths from postpartum
haemorrhage, European Journal of Obstetrics & Gynecology and
Reproductive Biology, Volume 158, Issue 2, October 2011, Pages 183-188,
ISSN 0301-2115, 10.1016/j.ejogrb.2011.04.042.
Abstract: Objectives
In postpartum haemorrhage (PPH), as for other causes of acute haemorrhage,
management can have a major impact on patient outcomes. The aim of this
study was to describe critical care management, particularly transfusion
practices, in cases of maternal deaths from PPH.
Study design
This retrospective study provided a descriptive analysis of all cases of
maternal death from PPH in France identified through the systematic French
Confidential Enquiry into Maternal Death in 20002003.
Thirty-eight cases of maternal death from PPH were analysed. Twenty-six
women (68%) had a caesarean section [21 (55%) emergency, five (13%)
elective]. Uterine atony was the most common cause of PPH
(n = 13, 34%). Women received a median of 9 (range 264) units of
red blood cells (RBCs) and 9 (range 267) units of fresh frozen plasma
(FFP). The median delay in starting blood transfusion was 82 (range 0
320) min. RBC and FFP transfusions peaked 24 h and 1224 h
after PPH diagnosis, respectively. The median FFP:RBC ratio was 0.6 (range
02). Fibrinogen concentrates and platelets were administered to 18 (47%)
and 16 (42%) women, respectively. Three women received no blood products.
Coagulation tests were performed in 20 women. The haemoglobin concentration
was only measured once in seven of the 22 women who survived for more than
6 h. Twenty-four women received vasopressors, a central venous access
was placed in 11 women, and an invasive blood pressure device was placed in
two women. General anaesthesia was administered in 37 cases, with five
patients being extubated during active PPH.
This descriptive analysis of maternal deaths from PPH suggests that there
may be room for improvement of specific aspects of critical care
management, including: transfusion procedures, especially administration
delays and FFP:RBC ratio; repeated laboratory assessments of haemostasis
and haemoglobin concentration; invasive haemodynamic monitoring; and
protocols for general anaesthesia.
Keywords: Maternal death; Postpartum haemorrhage; Critical care management;
Resuscitation; Transfusion

Cindy-Lee Dennis, Postpartum depression peer support: Maternal perceptions

from a randomized controlled trial, International Journal of Nursing
Studies, Volume 47, Issue 5, May 2010, Pages 560-568, ISSN 0020-7489,
Abstract: Background
Peer support in the early postpartum period is effective in the prevention
of postpartum depression among women identified as high-risk.
To describe maternal perceptions of peer support received while
participating in a trial.
Cross-sectional survey of women participating in a randomized controlled
trial to evaluate the effect of peer support in the prevention of
postpartum depression.
Seven health regions across Ontario Canada.
701 women were recruited between November 2004 and September 2006. Women
eligible for the study were all mothers with an Edinburgh Postnatal
Depression Scale score >9 who were within 2 weeks postpartum, at least
18 years of age, able to speak English, had a live birth, and had been
discharged home from the hospital. Exclusion criteria included an infant
not discharged home with the mother and current use of antidepressant or
antipsychotic medication. Two hundred and twenty-one mothers completed the
mailed questionnaire.
Women were randomly allocated to receive usual postpartum care (control
group) or usual postpartum care plus telephone-based peer support
(intervention group). Maternal perceptions of peer support were evaluated
at 12 weeks postpartum using the validated Peer Support Evaluation
Interactions provided by the peer volunteer included the provision of
emotional (92.7%), informational (72.4%), and appraisal (72.0%) support.
Mothers reported high levels of positive relationship qualities such as
trust (83.6%) and perceived acceptance (79.1%). Most (80.5%) mothers
indicated they were very satisfied with their peer support experience.
Maternal satisfaction was associated with the number and duration of peer
volunteer contacts.
The majority of mothers perceived their peer volunteer experience
positively lending further support to telephone-based peer support as a
preventative strategy for postpartum depression. The following program
modifications were suggested: (a) adapt training to enhance the provision
of appraisal support; (b) improve matching of volunteers to participants
based on age, number of children, and breastfeeding status; and (c) ensure
participating mothers want to receive peer support in order to facilitate
the development of relationships with their assigned peers.
Keywords: Peer support; Postpartum depression; Prevention; Randomized
controlled trial

Caroline Homer, Vanessa Clements, Nolan McDonnell, Michael Peek, Elizabeth

Sullivan, Maternal mortality: What can we learn from stories of postpartum
haemorrhage?, Women and Birth, Volume 22, Issue 3, September 2009, Pages
97-104, ISSN 1871-5192, 10.1016/j.wombi.2009.02.002.
Abstract: Summary
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

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, 19942005.
Vignettes from the maternal mortality reports in Australia and the United
Kingdom are used to highlight the important lessons for providers of
maternity care.
Keywords: Maternal death; Maternal mortality; Midwives; Obstetricians;
Maternity; Obstetric haemorrhage; Postpartum haemorrhage

Lynn Sibley, Leila Caleb-Varkey, Jayant Upadhyay, Rajendra Prasad, Ekta

Saroha, Neerja Bhatla, Vinod K. Paul, Recognition of and Response to
Postpartum Hemorrhage in Rural Northern India, Journal of Midwifery &
Women's Health, Volume 50, Issue 4, JulyAugust 2005, Pages 301-308, ISSN
1526-9523, 10.1016/j.jmwh.2005.03.006.
Abstract: This study describes the results of a Morbidity and Performance
Assessment (MAP) conducted to provide insight into the medical factors
contributing to maternal and newborn morbidity and mortality in a rural
district of northern India, and to use these insights to develop a locally
appropriate, community-based safe motherhood program The MAP study was
based on verbal autopsy method. Five hundred ninety-nine women (or in the
case of 9 maternal deaths, a family member) participated in the study. This
article describes a subsample of women who reported signs or symptoms
suggesting excessive bleeding (n = 159). Findings include a poor knowledge
of danger signs; poor problem recognition during labor, birth, and the
immediate postpartum period; and a low level of health seeking that was
consistent with poor recognition. Maternal sociodemographic
characteristics, antenatal care use, and knowledge of danger signs were
generally not associated with problem recognition and health seeking. The
case fatality rate was 4%. These findings suggest an urgent need to
understand the phenomenon of problem recognition and to integrate this into
the design of interventions to reduce delays in health seeking.
Keywords: postpartum hemorrhage; maternal mortality; safe motherhood; birth
preparedness; health seeking behavior

Louise Seimyr, Barbara Welles-Nystrm, Eva Nissen, A history of mental

health problems may predict maternal distress in women postpartum,
Midwifery, Available online 18 January 2012, ISSN 0266-6138,
Abstract: Aim
to elucidate the effects of prior mental disorders on newly delivered
women's mental health and to compare the outcome of different instruments
to screen for maternal distress and depression after childbirth. The sample
of 232 Stockholm women responded to a questionnaire on background data and
three questionnaires, Beck Depression Inventory (BDI), Edinburgh Postnatal
Depression Scale (EPDS) and Postpartum Depression Symptoms Rating Scale
(PPDS) at 46 weeks and 1012 weeks after childbirth.
show that maternal distress was experienced by 20% of the women as assessed
by the BDI and the EPDS at 46 weeks postpartum, and by 1316% of the women
at 1012 weeks after childbirth. A regression analysis showed that a
history of mental health problems influenced maternal self-assessment at
both points-in-time. The following background data showed a small but
significant impact on maternal self-assessment; younger age, lower
educational level, and a short-term partner relationship. The most
important emotional responses were sadness, guilt and self-blame across all
three instruments at both points in time. Loss of pleasure, self-
accusations, irritability, anger, worry and somatic symptoms such as
muscular tension, headaches and stomach cramps also occurred.
women with prior mental health problems are more vulnerable for maternal
distress and midwives at the antenatal health clinics should encourage
pregnant women to express emotional issues during their transition to
motherhood in order to offer appropriate professional support and care.
Keywords: Previous mental disorders; Maternal distress; Depressive mood

Corinna Reck, Daniela Noe, Jakob Gerstenlauer, Eva Stehle, Effects of

postpartum anxiety disorders and depression on maternal self-confidence,
Infant Behavior and Development, Volume 35, Issue 2, April 2012, Pages 264-
272, ISSN 0163-6383, 10.1016/j.infbeh.2011.12.005.
Abstract: Low maternal self-confidence may damage the early motherinfant
relationship and negatively influence infant development. The goal of this
study was to test whether a current and previous history of DSM-IV anxiety
and depressive disorders is associated with maternal self-confidence two
weeks after delivery. Postpartum anxiety disorder and depression was
diagnosed according to DSM-IV criteria in a community sample of 798 women.
The data showed a significant link between current postpartum anxiety and
depressive disorders and maternal self-confidence. Furthermore, women with
a depression or anxiety disorder in their previous psychiatric history
scored lower in maternal self-confidence. There is a need for appropriate
preventive programmes to promote maternal self-confidence. With such
programmes it is possible to prevent infant developmental disorders which
might result from reduced feelings of maternal self-confidence and
associated maternal interaction behaviour.
Keywords: Maternal self-confidence; Anxiety disorder; Depression; DSM-IV-
criteria; Puerpartum; Previous psychiatric history

S.E.K. Bradley, N. Prata, N. Young-Lin, D.M. Bishai, Cost-effectiveness of

misoprostol to control postpartum hemorrhage in low-resource settings,
International Journal of Gynecology & Obstetrics, Volume 97, Issue 1,
April 2007, Pages 52-56, ISSN 0020-7292, 10.1016/j.ijgo.2006.12.005.
Abstract: Objective
To test the cost-effectiveness of training traditional birth attendants
(TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal
dose of misoprostol in areas with low access to modern delivery facilities.
A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000
women each giving birth with TBAs: one under standard treatment (TBA
referral to hospital after blood loss  500 ml), and one attended by
TBAs trained to recognize PPH and to administer 1000 g of misoprostol at
blood loss  500 ml.
The misoprostol strategy could prevent 1647 cases of severe PPH (range:
8102920) and save $115,335 in costs of referral, IV therapy and
transfusions (range: $13,991$1,563,593) per 10,000 births. By preventing
severe disease and saving money, it dominates the standard approach.
Training TBAs to administer misoprostol to treat PPH has the potential to
both save money and improve the health of mothers in low-resource settings.
Keywords: Maternal morbidity; Cost-effectiveness; Postpartum hemorrhage,
misoprostol; Traditional birth attendants

Ayfer Tezel, Sebahat Gzm, Comparison of effects of nursing care to

problem solving training on levels of depressive symptoms in post partum
women, Patient Education and Counseling, Volume 63, Issues 12, October
2006, Pages 64-73, ISSN 0738-3991, 10.1016/j.pec.2005.08.011.
Abstract: Objective
The aim of this study was to compare the effect of nursing intervention to
the effect of problem solving training on the level of postpartum
depressive symptom.
We utilized a pretestposttest mutual controlled semi experimental model
for this study. The study consisted of 62 women (30 in care group and 32 in
training group), all of who were at risk for postpartum depression, but
without major depressive symptoms. These women were not undergoing
pharmacologic or psychotherapeutic treatment, were all literate and
consented to join the study in Erzurum, Turkey. Participants
(N = 62), recruited over a 9 month, were randomly assigned to one
of two groups. Women in care group (average age = 21, 33.3%
primaparus) were given nursing care for her depressive symptoms. Women in
training group (average age = 25, 33.9% primaparus) were taught
problem solving skills.
Depressive symptoms were assessed before and after nursing interventions.
We found that nursing care was effective women for with depressive symptoms
(McNemar test, p < 0.001), and problem-solving training was
also effective (McNemar test, p < 0.05). When the
effectiveness of nursing care and the problem solving education was
compared utilizing the BDI, it was found out that the nursing care was more
effective than education alone (t = 4.529,
p < 0.05).
Results from this study suggest that nursing care and problem solving
training may be use confidently in the primary care setting by nurses for
women with postpartum depressive symptoms.
Practice implication
Nurses play on important role in its detection and can reduce depressive
symptoms. Public health nurses are equipped with care paths addressing
specific health needs of depressed women in the primary care setting. Our
finding indicate that these two programs of study can converge with
meaningful results, and perhaps future research could address these points
in a theoretical frame work.
Keywords: Postpartum depression; Depressive symptoms; Nursing care; Problem
solving training

Terri L. Liberto, Screening for Depression and Help-Seeking in Postpartum

Women During Well-Baby Pediatric Visits: An Integrated Review, Journal of
Pediatric Health Care, Volume 26, Issue 2, MarchApril 2012, Pages 109-117,
ISSN 0891-5245, 10.1016/j.pedhc.2010.06.012.
Abstract: Purpose
The purposes of this integrated review are to examine the literature on
screening for depression and help-seeking behaviors by postpartum women
during pediatric well-baby visits; to identify gaps in the literature
relating to depression and help-seeking behaviors; and to discuss
implications for practice and future research.
An extensive search of primary source documents was conducted in Academic
Search Premier, CINAHL, MEDLINE, Mental Measurements Yearbook, PsycINFO,
PsycARTICLES, and Women's Studies International using the key words
postpartum, postpartum depression (PPD), help seeking, and pediatric
setting or pediatrician. Thirty-five articles relevant to help seeking,
PPD, and screening in the pediatric setting were included in this review.
Research studies included both quantitative and qualitative articles.
PPD affects 10% to 15% of all women after birth. Postpartum women generally
do not seek help for depression. Untreated PPD has significant adverse
affects on parenting, maternal bonding, and the infant's emotional and
behavioral development. Interaction with the woman's obstetric provider
ends shortly after the baby's birth. However, interactions with the
pediatric office are initiated and continue throughout the infant's first
two years of life.
Early recognition of PPD and appropriate treatment are imperative for
positive maternal-infant outcomes. A majority of women do not seek help for
depression from any source. Because mothers have routine interactions with
pediatric office staff during the first few years after giving birth,
pediatric nurse practitioners and pediatricians have the perfect
opportunity to screen and educate women regarding symptoms, treatment, and
available resources for PPD.
Keywords: Postpartum; postpartum depression; help seeking; pediatric
setting; pediatrician

Laura J. Miller, Elizabeth M. LaRusso, Preventing Postpartum Depression,

Psychiatric Clinics of North America, Volume 34, Issue 1, March 2011, Pages
53-65, ISSN 0193-953X, 10.1016/j.psc.2010.11.010.
Keywords: Postpartum depression; Prevention; Preconception counseling

Nelli Fisher, Lewis A. Eisen, Jyothshna V. Bayya, Alina Dulu, Peter S.

Bernstein, Irwin R. Merkatz, Dena Goffman, Improved performance of
maternal-fetal medicine staff after maternal cardiac arrest simulation-
based training, American Journal of Obstetrics and Gynecology, Volume 205,
Issue 3, September 2011, Pages 239.e1-239.e5, ISSN 0002-9378,
Abstract: Objective
To determine the impact of simulation-based maternal cardiac arrest
training on performance, knowledge, and confidence among Maternal-Fetal
Medicine staff.
Study Design
Maternal-Fetal Medicine staff (n = 19) participated in a maternal arrest
simulation program. Based on evaluation of performance during initial
simulations, an intervention was designed including: basic life support
course, advanced cardiac life suppport pregnancy modification lecture, and
simulation practice. Postintervention evaluative simulations were
performed. All simulations included a knowledge test, confidence survey,
and debriefing. A checklist with 9 pregnancy modification (maternal) and 16
critical care (25 total) tasks was used for scoring.
Postintervention scores reflected statistically significant improvement.
Maternal-Fetal Medicine staff demonstrated statistically significant
improvement in timely initiation of cardiopulmonary resuscitation (120 vs
32 seconds, P = .042) and cesarean delivery (240 vs 159 seconds, P = .017).
Prompt cardiopulmonary resuscitation initiation and pregnancy modifications
application are critical in maternal and fetal survival during cardiac
arrest. Simulation is a useful tool for Maternal-Fetal Medicine staff to
improve skills, knowledge, and confidence in the management of this
catastrophic event.
Keywords: maternal cardiac arrest; obstetric simulation training;
simulation education

Kimberly Campbell-Voytal, Judith Fry McComish, Joan M. Visger, Carolynn A.

Rowland, Jacqueline Kelleher, Postpartum doulas: Motivations and
perceptions of practice, Midwifery, Volume 27, Issue 6, December 2011,
Pages e214-e221, ISSN 0266-6138, 10.1016/j.midw.2010.09.006.
Abstract: Objective
to describe the perceptions of a US cohort of experienced birth doulas who
were among the first in the country to be trained to provide postpartum
a qualitative, longitudinal study using ethnographic methods; participant
observation and semi-structured interviews.
midwestern, urban, US; postpartum home care over three months.
four postpartum doulas; 13 families.
participant observation during six postpartum home visits per family; 13
semi-structured interviews with doulas at the completion of each familys
care; four summative interviews with doulas at the end of the study.
when describing their postpartum practice, four themes emerged: supporting
women, taking the mothers perspective, empowering women and empowering
families. When speaking of the motivations, three themes emerged: being
called to practice, interest in preventing negative experiences, and
career development.
Key conclusions and implications for practice
in the US, new mothers see midwives and doctors sporadically after
discharge from the hospital. Postpartum doulas fill this gap in continuity
of care by providing support for families as they transition to life with
their new infant. Understanding the beliefs, values and practices of these
important paraprofessionals will help midwives effectively integrate
postpartum doula care into the care of women and infants.
Keywords: Postpartum doula; Qualitative analysis; United States; Postpartum

Suellen Miller, Hilarie B. Martin, Jessica L. Morris, Anti-shock garment in

postpartum haemorrhage, Best Practice & Research Clinical Obstetrics
& Gynaecology, Volume 22, Issue 6, December 2008, Pages 1057-1074, ISSN
1521-6934, 10.1016/j.bpobgyn.2008.08.008.
Abstract: The non-pneumatic anti-shock garment (NASG) is a first-aid device
that reverses hypovolaemic shock and decreases obstetric haemorrhage. It
consists of articulated neoprene segments that close tightly with Velcro,
shunting blood from the lower body to the core organs, elevating blood
pressure and increasing preload and cardiac output. This chapter describes
the controversial history of the predecessors of NASG, pneumatic anti-shock
garments (PASGs), relates case studies of PASG for obstetric haemorrhage,
compares pneumatic and non-pneumatic devices and posits why the NASG is
more appropriate for low-resource settings. This chapter discusses the only
evidence available about NASGs for obstetric haemorrhage two pre-post
pilot trials and three case series and describes recently initiated
randomized cluster trials in Africa. Instructions and an algorithm for ASGs
in haemorrhage and shock management are included. Much remains unknown
about the NASG, a promising intervention for obstetric haemorrhage
Keywords: anti-shock trousers; maternal mortality; postpartum haemorrhage

J. Swain, H.G. Dahlen, Putting evidence into practice: A quality activity

of proactive pain relief for postpartum perineal pain, Women and Birth,
Available online 8 May 2012, ISSN 1871-5192, 10.1016/j.wombi.2012.03.004.
Abstract: Background
Perineal pain associated with perineal trauma is often underestimated.
Offering regular pain relief may be advantageous compared to waiting for
women to request it. Changing clinical practice in a sustained way needs a
whole of team approach.
To reduce women's pain following perineal trauma in the first 48 h
following childbirth and to undertake this as multidisciplinary, quality
In November 2008 a questionnaire was distributed to 18 new mothers who had
sustained perineal trauma during the birth in order to assess pain levels
in the first 48 h and to investigate pain management therapies used.
Following this survey a multidisciplinary project team undertook a series
of brainstorming sessions, reviewed the literature and undertook staff
surveys to identify key factors impacting on women's perineal pain. A
process of decision making led to education and support of women and staff.
An evidence based guideline, which involved prescribing regular pain relief
for women and offering an ice pack within 1 h of giving birth was
implemented, and a brochure was designed for women. A follow up
questionnaire was distributed in June 2010 to 18 women and pain scores
before and after the change in policy were compared.
Prior to the practice change in 2008 67% of the women surveyed rated their
pain as moderate to a lot 48 h following the birth. Following the
change in practice and implementation of a new guideline a second survey in
2010 at 48 h postpartum found 60% of women in the post intervention
group rated their perineal pain as a lot to moderate. There had been a
33% increase in women's use of pain relief options compared to the pre-
intervention survey. The practice change was sustained and adopted by all
the staff.
By taking a multidisciplinary quality activity an effective practice change
was facilitated that appeared to decrease women's perineal pain in the
48 h following birth.
Keywords: Perineal; Pain; Postpartum; Quality activity; Trauma

Pamela Andreatta, Florence Gans-Larty, Domitilla Debpuur, Anthony Ofosu,

Joseph Perosky, Evaluation of simulation-based training on the ability of
birth attendants to correctly perform bimanual compression as obstetric
first aid, International Journal of Nursing Studies, Volume 48, Issue 10,
October 2011, Pages 1275-1280, ISSN 0020-7489,
Abstract: Background
Maternal mortality from postpartum hemorrhage remains high globally, in
large part because women give birth in rural communities where unskilled
(traditional birth attendants) provide care for delivering mothers.
Traditional attendants are neither trained nor equipped to recognize or
manage postpartum hemorrhage as a life-threatening emergent condition.
Recommended treatment includes using uterotonic agents and physical
manipulation to aid uterine contraction. In resource-limited areas where
Obstetric first aid may be the only care option, physical methods such as
bimanual uterine compression are easily taught, highly practical and if
performed correctly, highly effective. A simulator with objective
performance feedback was designed to teach skilled and unskilled birth
attendants to perform the technique.
To evaluate the impact of simulation-based training on the ability of birth
attendants to correctly perform bimanual compression in response to
postpartum hemorrhage from uterine atony.
Simulation-based training was conducted for skilled (N = 111) and
unskilled birth attendants (N = 14) at two regional (Kumasi,
Tamale) and two district (Savelugu, Sene) medical centers in Ghana.
Training was evaluated using Kirkpatrick's 4-level model.
All participants significantly increased their bimanual uterine compression
skills after training (p = 0.000). There were no significant
differences between 2-week delayed post-test performances indicating
retention (p = 0.52). Applied behavioral and clinical outcomes
were reported for 9 months from a subset of birth attendants in Sene
District: 425 births, 13 postpartum hemorrhages were reported without
concomitant maternal mortality.
The results of this study suggest that simulation-based training for
skilled and unskilled birth attendants to perform bi-manual uterine
compression as postpartum hemorrhage Obstetric first aid leads to improved
applied procedural skills. Results from a smaller subset of the sample
suggest that these skills could potentially lead to improved clinical
outcomes and additional study is merited.
Keywords: Bimanual uterine compression; Obstetric first aid; Maternal
mortality; Postpartum hemorrhage; Simulation-based training

Lisa M. Bodnar, Mary E. Cogswell, Thad McDonald, Have we forgotten the

significance of postpartum iron deficiency?, American Journal of Obstetrics
and Gynecology, Volume 193, Issue 1, July 2005, Pages 36-44, ISSN 0002-
9378, 10.1016/j.ajog.2004.12.009.
Abstract: The postpartum period is conventionally thought to be the time of
lowest iron deficiency risk because iron status is expected to improve
dramatically after delivery. Nonetheless, recent studies have reported a
high prevalence of postpartum iron deficiency and anemia among ethnically
diverse low-income populations in the United States. In light of the recent
emergence of this problem in the medical literature, we discuss updated
findings on postpartum iron deficiency, including its prevalence,
functional consequences, risk factors, and recommended primary and
secondary prevention strategies. The productivity and cognitive gains made
possible by improving iron nutriture support intervention. We therefore
conclude that postpartum iron deficiency warrants greater attention and
higher quality care.
Keywords: Postpartum; Iron deficiency; Anemia; Mass screening; Hemoglobin

Barbara E. Kwast, Quality of care in reproductive health programmes:

Education for quality improvement, Midwifery, Volume 14, Issue 3, September
1998, Pages 131-136, ISSN 0266-6138, 10.1016/S0266-6138(98)90027-4.
Abstract: The provision of high quality maternity care will make the
difference between life and death or lifelong maiming for millions of
pregnant women. Barriers preventing access to affordable, appropriate,
acceptable and effective services, and lack of facilities providing high
quality obstetric care result in about 1600 maternal deaths every day.

Education in its broadest sense is required at all levels and sectors of

society to enhance policy formulation that will strengthen programme
commitment, improve services with a culturally sensitive approach and
ensure appropriate delegation of responsibility to health staff at
peripheral levels.

This paper is the second in series of three which addresses quality of

care. The first (Kwast 1998) contains an overview of concepts, assessments,
barriers and improvements of quality of care. The third article will
describe selected aspects of monitoring and evaluation of quality of care.

Lynn M. Sibley, Lauren S. Blum, Nahid Kalim, Daniel Hruschka, Joyce K.

Edmonds, Marge Koblinsky, Womens Descriptions of Postpartum Health
Problems: Preliminary Findings from Matlab, Bangladesh, Journal of
Midwifery & Women's Health, Volume 52, Issue 4, JulyAugust 2007, Pages
351-360, ISSN 1526-9523, 10.1016/j.jmwh.2007.02.020.
Abstract: Complications of childbirth kill more than 500,000 women each
year. Postpartum hemorrhage (PPH) is the leading cause of death. Because
nearly half the women who give birth at home in developing countries are
cared for by unskilled attendants, it is critical to understand how women
and their caregivers recognize bleeding and decide to seek help when
needed. Using an approach that combined systematic qualitative data
collection and multivariate analysis, we identified local cultural theories
that women and traditional birth attendants in rural Bangladesh use to
recognize and care for postpartum problems, including PPH. These
preliminary findings will be used to further explore cultural norms related
to PPH and their possible modes of transmission. The overall approach may
be used to develop or improve birth preparedness and complication
readiness, a core global safe motherhood intervention.
Keywords: correspondence analysis; maternal morbidity; postpartum
hemorrhage; qualitative data analysis

Zeelha Abdool, Ranee Thakar, Abdul H. Sultan, Postpartum female sexual

function, European Journal of Obstetrics & Gynecology and Reproductive
Biology, Volume 145, Issue 2, August 2009, Pages 133-137, ISSN 0301-2115,
Abstract: Although many women experience sexual problems in the postpartum
period, research in this subject is under-explored. Embarrassment and
preoccupation with the newborn are some of the reasons why many women do
not seek help. Furthermore, there is a lack of professional awareness and
expertise and recognition that a prerequisite in the definition of sexual
dysfunction is that it must cause distress to the individual (not her
partner). Sexual dysfunction is classified as disorders of sexual desire,
arousal, orgasm and pain. However, in the postpartum period the most common
disorder appears to be that of sexual pain as a consequence of perineal
trauma. Health care workers need to be made aware of this silent affliction
as sexual morbidity can have a detrimental effect on a women's quality of
life impacting on her social, physical and emotional well-being.
Keywords: Sexual dysfunction; Sexual function; Childbirth; Postpartum

Piyanee Klainin, David Gordon Arthur, Postpartum depression in Asian

cultures: A literature review, International Journal of Nursing Studies,
Volume 46, Issue 10, October 2009, Pages 1355-1373, ISSN 0020-7489,
Abstract: Objectives
Postpartum depression (PPD), a major health concern, produces insidious
effects on new mothers, their infant, and family. This literature review
aims to explore risk factors for postpartum depression among women in Asian
cultures, which has not been fully elaborated.
Data sources
A literature search was undertaken by using various electronic research
databases. Studies were eligible for this review if they (a) examined risk
factors for PPD, (b) were conducted in Asian countries using quantitative
or qualitative methodologies, and (c) were published in English in peer-
reviewed journals between 1998 and 2008. A total of 64 studies from 17
countries were reviewed, summarised, and synthesised.
The prevalence of postpartum depression in Asian countries ranged from 3.5%
to 63.3% where Malaysia and Pakistan had the lowest and highest,
respectively. Risk factors for postpartum depression were clustered into
five major groups: biological/physical (e.g., riboflavin consumption),
psychological (e.g., antenatal depression), obstetric/paediatric (e.g.,
unwanted pregnancy), socio-demographic (e.g., poverty), and cultural
factors (e.g., preference of infants gender). Traditional postpartum
rituals were not found to provide substantial psychological benefits for
the new mothers.
This review informs a current state of knowledge regarding risk factors for
postpartum depression and has implications for clinical practice. Health
care professionals should be aware that the phenomenon is as prevalent in
Asian cultures as in European cultures. Women should be screened for
potential risk factors and depressive symptoms during pregnancy and
postpartum periods so that appropriate interventions, if needed, can be
initiated in a timely fashion.
Keywords: Postpartum depression; Risk factors; Asian cultures

Meeke Hoedjes, Durk Berks, Ineke Vogel, Arie Franx, Anke Oenema, Johannes
J. Duvekot, J. Dik F. Habbema, Eric A.P. Steegers, Hein Raat, Postpartum
physical activity after preeclampsia, Pregnancy Hypertension: An
International Journal of Women's Cardiovascular Health, Volume 2, Issue 2,
April 2012, Pages 143-151, ISSN 2210-7789, 10.1016/j.preghy.2012.01.003.
Abstract: Objective
After mild and severe preeclampsia, to assess whether women meet the
physical activity recommendation at 3 and 6 months postpartum, and
whether demographic, obstetric and anthropometric characteristics, mental
health, and health-related quality of life are associated with less
physical activity than recommended.
Study design
Prospective cohort study.
Main outcome measures
Self-reported physical activity in MET-min/week, percentage of women who
fail to meet the physical activity recommendation.
Of the 255 women diagnosed with preeclampsia invited to participate in this
prospective cohort study, 174 (68%) provided informed consent. Analyses
were restricted to 141 participants who completed the short form of the
International Physical Activity Questionnaire at 3 and/or 6 months
postpartum. Logistic regression analysis was used to evaluate changes in
physical activity level over time, and to establish which variables were
associated with failure to meet the postpartum physical activity
At both 3 and 6 months postpartum, 38% of women failed to meet the
physical activity recommendation. Failure was associated with severe
preeclampsia, cesarean section, admission to the neonatal intensive care
unit, low gestational age at delivery, and low birth weight (all
p < 0.05).
There seems to be a need to stimulate physical activity in about one third
of women after a pregnancy complicated by preeclampsia, particularly in
case of severe preeclampsia and other adverse pregnancy outcomes. Tailored
lifestyle interventions are needed for women who fail to meet the
Keywords: Pre-eclampsia [mesh]; Postpartum period [mesh]; Physical activity

Andrea Gonzalez, Jennifer M. Jenkins, Meir Steiner, Alison S. Fleming, The

relation between early life adversity, cortisol awakening response and
diurnal salivary cortisol levels in postpartum women,
Psychoneuroendocrinology, Volume 34, Issue 1, January 2009, Pages 76-86,
ISSN 0306-4530, 10.1016/j.psyneuen.2008.08.012.
Abstract: Summary
Early life adversity has been associated with hypothalamicpituitary
adrenal (HPA) axis dysfunction in both children and adults. However, in
adulthood, most studies have focused on the effects of early adversity on
HPA axis stress reactivity rather than the cortisol awakening response or
diurnal cortisol profiles. The goal of this study was to examine the
cumulative effects of early life adversity on the cortisol awakening
response (CAR) and diurnal cortisol profiles in a sample of postpartum
women. Ninety women between 2 and 6 months postpartum completed two
retrospective reports assessing adverse early life experiences
(maltreatment and consistency of care). Eighteen women reported having
experienced both parental loss and some form of childhood maltreatment and
36 women reported having experienced one type of early life adversity,
either parental loss or maltreatment. HPA axis function was assessed
through salivary cortisol collections over two consecutive days for
measurement of the cortisol awakening response (n = 61) and
diurnal cortisol rhythm (n = 90). Women who reported experiencing
adverse early life experiences exhibited a tendency towards higher levels
of awakening cortisol compared to women who reported no adverse early life
experiences (p = .07). These higher awakening cortisol levels
were sustained throughout the morning in the groups who experienced early
adversity, with all groups exhibiting the typical diurnal decline in the
afternoon and evening (p < .05). Women reporting early
adversity exhibited more heterogeneity in their diurnal cortisol levels
across the two collection days (p < .01). Our findings suggest
that in a community sample of postpartum women, early adversity is
associated with current HPA axis function. These findings may have
implications for the nature of motherinfant interactions.
Keywords: Diurnal cortisol; Awakening response; Early adversity; Postpartum

Barbara E Kwast, Postpartum haemorrhage: its contribution to maternal

mortality, Midwifery, Volume 7, Issue 2, June 1991, Pages 64-70, ISSN 0266-
6138, 10.1016/S0266-6138(05)80229-3.
Abstract: Postpartum haemorrhage is the major cause of maternal mortality
in the developing world. This paper presents the incidences and discusses
the causes and strategies for its prevention. The paper is based on one
originally given at the ICM/WHO/UNICEF pre-congress workshop in Kobe,
Japan, Oct, 1990.

Deborah F. Perry, Anna K. Ettinger, Tamar Mendelson, Huynh-Nhu Le, Prenatal

depression predicts postpartum maternal attachment in low-income Latina
mothers with infants, Infant Behavior and Development, Volume 34, Issue 2,
April 2011, Pages 339-350, ISSN 0163-6383, 10.1016/j.infbeh.2011.02.005.
Abstract: Although maternal attachment is an important predictor of infant
attachment security and other developmental outcomes, little is known about
the formation of maternal attachment in the first few months of the
infant's life, particularly among ethnic minority mothers. The current
study examined the predictors of postpartum maternal attachment in a sample
of 217 Latina women enrolled in a perinatal depression prevention trial.
Mothers attachment to their infants was measured at 68 weeks postpartum
using the Maternal Postnatal Attachment Scale. A variety of predictors of
early attachment were explored including: depressive symptoms during
pregnancy, pregnancy intention, feelings about the pregnancy, and the
quality of the partner relationship. The strongest predictor of lower
maternal attachment was depressive symptoms late in pregnancy; pregnancy
intention was marginally predictive of attachment, with lower scores being
associated with unwanted pregnancies. The study fills a critical gap in our
understanding of the role of depressive symptoms during pregnancy in
shaping mothers early attachment to their infants.
Keywords: Attachment; Perinatal depression; Latina immigrants

Marion Righetti-Veltema, Elisabeth Conne-Perrard, Arnaud Bousquet, Juan

Manzano, Risk factors and predictive signs of postpartum depression,
Journal of Affective Disorders, Volume 49, Issue 3, 1 June 1998, Pages 167-
180, ISSN 0165-0327, 10.1016/S0165-0327(97)00110-9.
Abstract: Background: Depressed new mothers usually do not seek and
therefore do not receive any psychiatric help. Methods: In order to assess
predictive signs of postpartum depression (PPD), an unselected sample of
570 women were seen by midwives during their pregnancy, using a
questionnaire elaborated by ourselves and Derogatis' Hopkins Symptom
Checklist. Three months after delivery each new mother was examined again
by the same midwife using Cox' Edinburgh Postnatal Depression Scale. The
medical files were also examined. Results: Of the new mothers, 58 (10.2%)
suffered from PPD. Most significant factors were socioprofessional
difficulties, multiparity, deleterious life events, depressive mood prior
to delivery, early motherchild separation and negative birth experience.
The coping abilities of the depressed mother were decreased and her
vulnerability to new stress factors increased. Conclusion: It is possible
to detect women at risk for PPD already during pregnancy. We therefore
elaborated a very simple, short predictive scale which is in the process of
validation. Limitation: Protective factors still have to be studied.
Clinical Relevance: Knowledge of these factors should help all caregivers
to recognize, during pregnancy, women at risk for PPD, in order to initiate
preventive and/or therapeutic measures.
Keywords: Postpartum depression; Risk factors; Pregnancy; Predictive signs

Ruth Feldman, Adi Granat, Clara Pariente, Hannah Kanety, Jacob Kuint, Eva
Gilboa-Schechtman, Maternal Depression and Anxiety Across the Postpartum
Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity,
Journal of the American Academy of Child & Adolescent Psychiatry,
Volume 48, Issue 9, September 2009, Pages 919-927, ISSN 0890-8567,
Abstract: Objective
To examine the effects of maternal depression on infant social engagement,
fear regulation, and cortisol reactivity as compared with maternal anxiety
disorders and controls and to assess the role of maternal sensitivity in
moderating the relations between maternal depression and infant outcome.
Using an extreme-case design, 971 women reported symptoms of anxiety and
depression after childbirth and 215 of those at the high and low ends were
reevaluated at 6 months. At 9 months, mothers diagnosed with a major
depressive disorder (n = 22) and anxiety disorders (n = 19) and matched
controls reporting no symptoms across the postpartum year (n = 59) were
visited at home. Infant social engagement was observed during motherinfant
interaction, emotion regulation was microcoded from a fear paradigm, and
mother's and infant's cortisol were sampled at baseline, reactivity, and
The infants of depressed mothers scored the poorest on all three outcomes
at 9 monthslowest social engagement, less mature regulatory behaviors and
more negative emotionality, and highest cortisol reactivitywith anxious
dyads scoring less optimally than the controls on maternal sensitivity and
infant social engagement. Fear regulation among the children of anxious
mothers was similar to that of the controls and their stress reactivity to
infants of depressed mothers. Effect of major depressive disorder on social
engagement was moderated by maternal sensitivity, whereas two separate
effects of maternal disorder and mother sensitivity emerged for stress
Pathways leading from maternal depression to infant outcome are specific to
developmental achievement. Better understanding of such task-specific
mechanisms may help devise more specifically targeted interventions.
Keywords: maternal depression; maternal anxiety disorder; social
engagement; emotion regulation; cortisol

Lisa Kane Low, Joanne Motio Bailey, Emma Sacks, Lilian Medina, Hector
Oqueli Lopez Pieda, Postpartum Hemorrhage Prevention: A Case Study in
Northern Rural Honduras, Journal of Midwifery & Women's Health, Volume
53, Issue 1, JanuaryFebruary 2008, Pages e1-e6, ISSN 1526-9523,
Abstract: Postpartum hemorrhage (PPH) is the leading cause of maternal
mortality globally. Safe Motherhood policies have been directed towards the
reduction of PPH by recommending active management of third-stage labor as
the standard of care. One component of active management involves routine
use of a uterotonic agent within 1 minute of the delivery of the baby. A
case study at Clnica Materno-Infantil, a free-standing public birth center
in Honduras, is presented, focusing on methods to reduce PPH. The nursing
staff was trained to estimate blood loss and in methods to manage PPH,
including elements of active management of the third stage of labor.
Medical records were reviewed and an analysis of PPH management compared to
estimated blood loss (EBL) was conducted. There was no significant
correlation between PPH management techniques and EBL (r = .060; P = .368).
There was a statistically significant (P < .001) correlation between
oxytocin administration and lower EBL (r = .232), indicating that there
was less blood loss when oxytocin was administered. At Clnica Materno-
Infantil, routine use of a uterotonic agent appears beneficial and further
implementation of active management of the third stage of labor appears
Keywords: Honduras; international maternal child health; postpartum
hemorrhage; Safe Motherhood; skilled birth attendants

Rafat Jan Rukanuddin, Tazeen Saeed Ali, Beth McManis, Midwifery Education
and Maternal and Neonatal Health Issues: Challenges in Pakistan, Journal of
Midwifery & Women's Health, Volume 52, Issue 4, JulyAugust 2007, Pages
398-405, ISSN 1526-9523, 10.1016/j.jmwh.2007.02.014.
Abstract: Although numerous health care interventions have been implemented
in Pakistan, the high maternal and neonatal mortality rates still remain a
challenge. Developed countries have reduced maternal and neonatal mortality
rates by improving the skill and knowledge levels of nurse-midwives. This
paper reviews maternal and neonatal health issues, challenges in current
midwifery education, and the role of government and international agencies
in Pakistan. The exact maternal and neonatal mortality rates in Pakistan
are unknown; a census has not occurred since 1998, and data provided in
more recent studies were presented in summary format. A number of factors
that contribute to the high mortality rate could easily be controlled by
using competent nurse-midwives throughout all levels of the Pakistani
health care system. A reduction in the maternal mortality rate is likely to
occur if the Pakistan government and international agencies work together
to implement specific recommendations in maternal and neonatal health.
These recommendations include: 1) holding an invitational conference; 2)
strengthening the existing midwifery and Lady Health Visitor curricula; 3)
pilot testing an expanded midwifery program; and 4) advocating for and
obtaining political commitments and resources for midwifery education.
Keywords: maternal and neonatal issues in Pakistan; midwifery in Pakistan;
midwifery education in Pakistan
Felicia Mancini, Cristina Carlson, Leah Albers, Use of the Postpartum
Depression Screening Scale in a Collaborative Obstetric Practice, Journal
of Midwifery & Women's Health, Volume 52, Issue 5, September 2007,
Pages 429-434, ISSN 1526-9523, 10.1016/j.jmwh.2007.03.007.
Abstract: Postpartum depression is a clinical depressive episode that
occurs in 13% to 20% of women after birth or miscarriage. This illness has
potentially devastating consequences for both mother and infant, and is
thought to be highly underreported and under-diagnosed. Our study examined
the use of the Postpartum Depression Screening Scale (PDSS) in a high-
volume collaborative obstetric and midwifery practice. The prevalence of
women with a positive screen for major postpartum depression in our study
was 16%, which is consistent with other studies. An additional 20% of the
participants had symptoms that indicated a potential postpartum depression.
Obstetric clinicians were willing to use the PDSS, and 15 of 20 clinicians
actively participated in the study. Women who had a positive screen at 6
weeks after birth were more likely to have not completed a high school
education, be unpartnered, be exclusively bottle feeding, and have a
history of depression. Two variables were statistically significant
predictors of screening positively with the PDSS following logistic
regression: history of depression (risk ratio, 4.8; 95% confidence
interval, 4.45.2) and exclusive bottle feeding (risk ratio, 2.0; 95%
confidence interval, 1.62.4).
Keywords: breastfeeding; depression; mental health; postpartum health;
screening tools

N.M.-C. Glangeaud-Freudenthal, A.-L. Sutter, A.-C. Thieulin, V. Dagens-

Lafont, M.-A. Zimmermann, A. Debourg, B. Massari, O. Cazas, R. Cammas, C.
Rainelli, F. Poinso, M. Maron, S. Nezelof, P.-Y. Ancel, B. Khoshnood,
Inpatient mother-and-child postpartum psychiatric care: Factors associated
with improvement in maternal mental health, European Psychiatry, Volume 26,
Issue 4, May 2011, Pages 215-223, ISSN 0924-9338,
Abstract: Purpose
This study assessed the underexplored factors associated with significant
improvement in mothers mental health during postpartum inpatient
psychiatric care.
This study analyzed clinical improvement in a prospective cohort of 869
women jointly admitted with their infant to 13 psychiatric Mother-Baby
Units (MBUs) in France between 2001 and 2007. Predictive variables tested
were: maternal mental illness (ICD-10), sociodemographic characteristics,
mental illness and childhood abuse history, acute or chronic disorder,
pregnancy and birth data, characteristics and mental health of the mother's
partner, and MBU characteristics.
Two thirds of the women improved significantly by discharge. Admission for
25% was for a first acute episode very early after childbirth. Independent
factors associated with marked improvement at discharge were bipolar or
depressive disorder, a first acute episode or relapse of such an episode.
Schizophrenia, a personality disorder, and poor social integration (as
measured by occupational status) were all related to poor clinical
Most women improved significantly while under care in MBUs. Our results
emphasize the importance of the type of disease but also its chronicity and
the social integration when providing postpartum psychiatric care.
Keywords: Affective disorders; Schizophrenia and psychosis; Personality
disorders; Psychiatry in Europe; Epidemiology; Social and cross cultural;
Postpartum disorders; Mother-baby unit
Therese A. Wiegers, Adjusting to motherhood: Maternity care assistance
during the postpartum period: How to help new mothers cope, Journal of
Neonatal Nursing, Volume 12, Issue 5, October 2006, Pages 163-171, ISSN
1355-1841, 10.1016/j.jnn.2006.07.003.
Abstract: The overall aim of postpartum care is to detect health problems
of the mother and/or baby at an early stage, to encourage breastfeeding and
to give families a good start. This paper presents an overview of recent
literature about postpartum care in several developed countries and
elaborates on the Dutch model, which consists of professional postnatal
care, provided by MCAs (maternity care assistants), who are supervised by
midwives. The most important tasks of the maternity care assistant are, by
becoming part of the family for a number of hours each day, being able to
detect possible health problems, and to instruct, observe, and support the
mother (and father) in establishing a new routine in their family life and
help them to become confident in their parenting.
Keywords: Maternity care assistance; Postpartum care; The Netherlands

Wolfgang Hannver, Jochen Ren Thyrian, Kathrin Rske, Julia Grempler,

Hans-Jrgen Rumpf, Ulrich John, Ulfert Hapke, Smoking cessation and relapse
prevention for postpartum women: Results from a randomized controlled trial
at 6, 12, 18 and 24 months, Addictive Behaviors, Volume 34, Issue 1,
January 2009, Pages 1-8, ISSN 0306-4603, 10.1016/j.addbeh.2008.07.021.
Abstract: Aim
To test the efficacy of an aid to cessation/relapse prevention intervention
for women postpartum.
Two-armed randomized controlled trial. Follow-ups at 6, 12, 18, and
24 months, screenings on maternity wards. Intervention group received face-
to-face counseling 40 days postpartum plus telephone counseling calls 4 and
12 weeks later. Control group received usual care plus self-help material
for each parent.
With regard to smoking cessation, 4 week point prevalence abstinent rates
were higher in the treatment group at 6, 12, and 18 months (7% vs. 1%, 7%
vs. 2%, and 9% vs. 1%, respectively). Sustained abstinence was higher in
the treatment group at 6 months follow-up (3% vs. 0%). No difference was
observed with regard to relapse prevention.
Regarding aid to cessation we observed small effects, regarding relapse
prevention no effect. In order to capitalize on the opportunity childbirth
poses with regard to smoking, theories on relapse prevention in smoking
cessation that guide in designing interventions are needed.
Keywords: Smoking; Smoking cessation; Relapse prevention; Postpartum;
Environmental tobacco smoke

Ann Starrs, Beverly Winikoff, Misoprostol for postpartum hemorrhage: Moving

from evidence to practice, International Journal of Gynecology &
Obstetrics, Volume 116, Issue 1, January 2012, Pages 1-3, ISSN 0020-7292,
Abstract: Clinical and operational evidence indicates that misoprostol is a
safe and effective technology for addressing postpartum hemorrhage, a major
cause of maternal death. This research has not yet been translated into
effective policies, programs, and practice in many parts of the world.
Efforts to expand evidence-based use of misoprostol are often complicated
by misoprostol's range of indications, insufficient availability, a lack of
evidence-based guidelines and provider training, and misconceptions about
the drug. The medical and health policy communities need to work together
to translate research findings into changes in policy, knowledge, and
clinical practice so that we can deliver on the world's promise to improve
maternal health.
Keywords: Misoprostol; Postpartum hemorrhage; Prevention; Treatment

Veena Jirapaet, Effects of an Empowerment Program on Coping, Quality of

Life, and the Maternal Role Adaptation of Thai HIV-Infected Mothers,
Journal of the Association of Nurses in AIDS care, Volume 11, Issue 4,
JulyAugust 2000, Pages 34-45, ISSN 1055-3290, 10.1016/S1055-3290(06)60394-
Abstract: The objective of this study was to explore strategies for
improving the appropriateness of a health care delivery model to meet HIV-
infected mothers' complex needs. A participatory action research paradigm
was used as a process for an empowerment program (EP) and to elucidate the
essential components of the program identified by these mothers. To test
the EP's effectiveness, a nonequivalent control group pretestposttest,
quasi-experimental design was used. The participants included 94 Thai HIV-
infected mothers rearing their own infants, with 46 in the 6-week
experimental group and 48 in the control group. Study findings showed that
the mothers in the EP group significantly increased levels of coping
ability, quality of life, and maternal role adaptation when compared to
mothers in the control group. In addition, data analysis revealed five
components of the EP that were identified by mothers as essential for HIV-
infected mothers' psychological well-being and their maternal role
adaptation. These interventions included peer group meetings, professional
support on infant rearing and maternal self-care, stress management, access
to available social support, and alternative medicine. The mothers reported
greater autonomy, accountability, collegiality, and more effective
communication by the implication process of the EP.
Keywords: empowerment; coping; quality of life; maternal role adaptation;
HIV infected; Thai mothers

Katherine Turner, Ada Piazzini, Albertina Franza, Cristina Fumarola,

Rosanna Chifari, Anna Maria Marconi, Maria Paola Canevini, Raffaele Canger,
Postpartum depression in women with epilepsy versus women without epilepsy,
Epilepsy & Behavior, Volume 9, Issue 2, September 2006, Pages 293-297,
ISSN 1525-5050, 10.1016/j.yebeh.2006.06.003.
Abstract: The goal of this study was to determine if there is a significant
difference in the rate of postpartum depression among patients with
epilepsy and healthy controls. All patients were recruited from the
Epilepsy Center and the Department of Obstetrics and Gynecology, University
of Milan, St. Paolo Hospital (Milan, Italy). Thirty-five pregnant women
with epilepsy and an equal number of pregnant women without epilepsy were
assessed with the Edinburgh Postnatal Depression Scale (EPDS), a clinical
interview used to screen for postpartum depression (PPD), and a
sociodemographic questionnaire. The rate of PPD in patients with epilepsy
was statistically significantly higher than that of the controls
(P < 0.05). PPD was present in 29% of the patients with
epilepsy and 11% of the controls. In conclusion, it is very important to
point out that in our pilot study, the rate of PPD was higher among women
with epilepsy than among women without epilepsy. In this regard, women at
higher PPD risk can be identified earlier and treated as soon as possible
to alleviate their symptoms and improve their quality of life.
Keywords: Postpartum depression; Epilepsy; Pregnancy; Edinburgh Postnatal
Depression Scale

Ricardo F. Muoz, Huynh-Nhu Le, Chandra Ghosh Ippen, Manuela A. Diaz, Guido
G. Urizar Jr., Jos Soto, Tamar Mendelson, Kevin Delucchi, Alicia F.
Lieberman, Prevention of Postpartum Depression in Low-Income Women:
Development of the Mams y Bebs/Mothers and Babies Course, Cognitive and
Behavioral Practice, Volume 14, Issue 1, February 2007, Pages 70-83, ISSN
1077-7229, 10.1016/j.cbpra.2006.04.021.
Abstract: A prenatal intervention designed to prevent the onset of major
depressive episodes (MDEs) during pregnancy and postpartum was pilot tested
at a public sector womens clinic. The Mams y Bebs/Mothers and Babies
Course is an intervention developed in Spanish and English that uses a
cognitive-behavioral mood management framework, and incorporates social
learning concepts, attachment theory, and socio-cultural issues. The four
goals of this project were to develop the intervention, assess its
acceptability, test the feasibility of conducting a randomized trial with
public sector patients, and obtain estimates of its effect size. Forty-one
pregnant women at high risk for developing MDEs were randomized to the
Mothers and Babies Course (n = 21) or a comparison condition (n = 20).
Assessments occurred during pregnancy and at 1, 3, 6, and 12 months
postpartum. Differences in terms of depression symptom levels or incidence
of MDEs between the two groups did not reach statistical significance in
this pilot trial. However, the MDE incidence rates of 14% for the
intervention condition versus 25% for the comparison condition represent a
small effect size (h = 0.28) that will be further examined in a larger
scale study. The intervention was well received by the participants and
implementation of a randomized trial appeared quite feasible as indicated
by our follow-up rate of 91% at 12 months. Implications for the continuing
development of preventive interventions for perinatal depression are

Pranee C. Lundberg, Trieu Thi Ngoc Thu, Vietnamese womens cultural beliefs
and practices related to the postpartum period, Midwifery, Volume 27, Issue
5, October 2011, Pages 731-736, ISSN 0266-6138, 10.1016/j.midw.2010.02.006.
Abstract: Objective
to describe cultural beliefs and practices related to the postpartum period
among Vietnamese women in Ho Chi Minh City.
a descriptive cross-sectional study using triangulation.
the Postpartum Clinic, Department of Obstetrics and Gynaecology of a
university hospital in Ho Chi Minh City, Vietnam.
115 Vietnamese women, 95 in the first group and 20 in the second group.
Data collection and analysis
a questionnaire was used with the first group and a semi-structured in-
depth interview was used with the second group. Both groups were subjected
to the same four open-ended questions. The data obtained were first
analysed separately by use of qualitative content analysis and then cross-
four categories were identified: hygiene, behavioural precautions (lying by
a fire, keeping warm after birth, staying indoors and resting in bed, and
avoiding house work and sexual activity), dietary precautions, and breast
feeding and lactation.
Key conclusion and implications for practice
traditional beliefs and practices, often beneficial to the women and their
babies but sometimes potentially harmful, greatly influenced the Vietnamese
women during the postpartum period. Therefore, health-care professionals
need to give appropriate information and care to the women and their
families while paying due attention to the cultural context. These demands
make it imperative that knowledge about cultural values be included in
their education, not least in Western countries which have become
Keywords: Culture; Belief; Practice; Postpartum; Vietnamese women

Zulfiqar A. Bhutta, Zohra S. Lassi, Ann Blanc, France Donnay, Linkages

Among Reproductive Health, Maternal Health, and Perinatal Outcomes,
Seminars in Perinatology, Volume 34, Issue 6, December 2010, Pages 434-445,
ISSN 0146-0005, 10.1053/j.semperi.2010.09.002.
Abstract: Some interventions in women before and during pregnancy may
reduce perinatal and neonatal deaths, and recent research has established
linkages of reproductive health with maternal, perinatal, and early
neonatal health outcomes. In this review, we attempted to analyze the
impact of biological, clinical, and epidemiologic aspects of reproductive
and maternal health interventions on perinatal and neonatal outcomes
through an elucidation of a biological framework for linking reproductive,
maternal and newborn health (RHMNH); care strategies and interventions for
improved perinatal and neonatal health outcomes; public health implications
of these linkages and implementation strategies; and evidence gaps for
scaling up such strategies. Approximately 1000 studies (up to June 15,
2010) were reviewed that have addressed an impact of reproductive and
maternal health interventions on perinatal and neonatal outcomes. These
include systematic reviews, meta-analyses, and stand-alone experimental and
observational studies. Evidences were also drawn from recent work
undertaken by the Child Health Epidemiology Reference Group (CHERG), the
interconnections between maternal and newborn health reviews identified by
the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS),
as well as relevant work by the Partnership for Maternal, Newborn and Child
Health. Our review amply demonstrates that opportunities for assessing
outcomes for both mothers and newborns have been poorly realized and
documented. Most of the interventions reviewed will require more greater-
quality evidence before solid programmatic recommendations can be made.
However, on the basis of our review, birth spacing, prevention of indoor
air pollution, prevention of intimate partner violence before and during
pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring
during pregnancy, insecticide-treated mosquito nets, birth and newborn care
preparedness via community-based intervention packages, emergency
obstetrical care, elective induction for postterm delivery, Cesarean
delivery for breech presentation, and prophylactic corticosteroids in
preterm labor reduce perinatal mortality; and early initiation of
breastfeeding and birth and newborn care preparedness through community-
based intervention packages reduce neonatal mortality. This review
demonstrates that RHMNH are inextricably linked, and that, therefore,
health policies and programs should link them together. Such potential
integration of strategies would not only help improve outcomes for millions
of mothers and newborns but would also save scant resources. This would
also allow for greater efficiency in training, monitoring, and supervision
of health care workers and would also help families and communities to
access and use services easily.
Keywords: reproductive health; maternal health; neonatal health;
intrapartum; postpartum; perinatal

Dwenda Gjerdingen, Wayne Katon, Deborah E. Rich, Stepped Care Treatment of

Postpartum Depression: A Primary Care-Based Management Model, Women's
Health Issues, Volume 18, Issue 1, JanuaryFebruary 2008, Pages 44-52, ISSN
1049-3867, 10.1016/j.whi.2007.09.001.
Abstract: Background and Purpose
Postpartum depression (PPD), the most prevalent serious postpartum
complication, is a devastating illness that negatively impacts not only the
mother, but also her infant, other family members, and work performance.
There is an extensive body of research addressing systems-based quality
improvement efforts for treatment of depression in primary care
populations; however, little of this research has been directed toward
postpartum populations. This paper presents a health care systems-based
quality improvement model for the treatment of PPD derived from research
outcomes in general primary care populations.
OVID/MEDLINE and PsychINFO searches were performed using the following
terms: depression, postpartum depression, mass screening, collaborative
care, stepped care, psychotherapy, cognitivebehavioral therapy,
interpersonal therapy, and education as keywords.
Main Findings
The PPD management model described herein includes screening and diagnosis,
initiation of active treatment, and use of collaborative care, which
includes primary care visits, case manager follow-up, and more intensive
care, through specialty consultation or referral, for complicated or
difficult cases.
Stepped care, a form of collaborative depression treatment, is proposed as
a practical, cost-effective method for improving PPD diagnosis and clinical

M.F. Chersich, S.M. Luchters, E. Yard, J.M. Othigo, N. Kley, M. Temmerman,

Morbidity in the first year postpartum among HIV-infected women in Kenya,
International Journal of Gynecology & Obstetrics, Volume 100, Issue 1,
January 2008, Pages 45-51, ISSN 0020-7292, 10.1016/j.ijgo.2007.06.053.
Abstract: Objective: To assess the effects of HIV infection on morbidity
and the needs of infected women for services in the first year postpartum.
Methods: A cross-sectional study with 500 women attending a child-health
clinic in Mombasa, Kenya. Results: Postpartum duration was a median of
3.3 months (interquartile range, 1.96.1 months). The 54 HIV-infected women
had a lower income and less financial support than the uninfected women,
and they were more likely to experience fever, dyspnea, and dysuria, and to
have genital warts (odds ratio [OR], 9.6; 95% confidence interval [CI],
2.635.6; P < 0.001), candidiasis (OR, 2.9; 95% CI, 1.26.8;
P = 0.012), and bacterial vaginosis (OR, 1.8; 95% CI, 0.953.3;
P = 0.066). Six (nearly 15%) of the HIV-infected women had low-
or high-grade squamous intraepithelial lesions, and 21 (42%) had an unmet
need for contraception. More than half of all women were anemic, and
normocytic anemia was predominant among the HIV infected. Conclusion:
Compared with uninfected women, morbidity was increased for HIV-infected
women during the year following delivery. This period could be used to
offer these, and all-women, family planning services, cervical cancer
screening, and treatment for anemia and reproductive tract infections.
Keywords: HIV-infected women; Kenya; Maternal morbidity; Postpartum

Noelita Melo de Sousa, Moussa Zongo, Were Pitala, Hamidou Boly, Laya
Sawadogo, Mahorobi Sanon, Jose Ricardo de Figueiredo, Paulo Bayard Dias
Gonalves, Bouchra El Amiri, Zsolt Pernyi, Jean-Franois Beckers,
Pregnancy-associated glycoprotein concentrations during pregnancy and the
postpartum period in Azawak Zebu cattle, Theriogenology, Volume 59, Issues
56, March 2003, Pages 1131-1142, ISSN 0093-691X, 10.1016/S0093-
Abstract: Specific RIA systems were developed and used to measure
pregnancy-associated glycoprotein (PAG) concentrations during gestation and
the postpartum period in Azawak Zebu cows. Twelve females were palpated per
rectum and diagnosed as pregnant. Blood samples were taken at 510-day
intervals from approximately Week 8 of gestation until Week 10 postpartum
(pp). One Zebu cow (Z15) initially diagnosed as pregnant showed PAG
concentrations lower than the assay sensitivity (<0.20 ng/ml) and
did not calve. Another cow (ZSand) showed abnormally high PAG
concentrations during gestation and was excluded from the general PAG
profile. The 10 other Zebu cows exhibited a very similar PAG profile. In
these animals, concentrations increased progressively from Week 8 to 35 of
gestation (from 6.04.2 to 196.034.8 ng/ml), remaining relatively
constant until Week 39 (210.874.8 ng/ml), when they increased sharply
to reach their highest level (1095.6607.2 ng/ml) at around
parturition. After delivery, PAG concentrations declined significantly
(P<0.05) until Week 2 postpartum (348.485.6 ng/ml) and slowly
until Week 10 postpartum. Our results revealed that the PAG pattern in Zebu
cattle was similar to those of taurine breeds during the first two
trimesters of pregnancy, but differed in the peripartum period.
Keywords: Azawak Zebu; PAG; RIA; Gestation; Postpartum

Jemima Petch, W. Kim Halford, Psycho-education to enhance couples'

transition to parenthood, Clinical Psychology Review, Volume 28, Issue 7,
October 2008, Pages 1125-1137, ISSN 0272-7358, 10.1016/j.cpr.2008.03.005.
Abstract: A substantial proportion of couples struggle to adapt to
parenthood, feel stress in caring for their infant, and experience a
significant decline in their couple relationship adjustment. Moreover,
there is a substantial association between effective parenting of infants
and sustaining a mutually satisfying couple relationship. This paper
reviews randomized controlled trials of psycho-education to assist new
parent couples with parenting and their couple relationship. The majority
of programs target either the couple relationship or parenting, with few
programs addressing both areas. The best outcomes seem to be achieved when
programs are accessible by couples at home, when skill-training is
provided, and possibly when programs target couples at high-risk of
maladjustment to parenthood.
Keywords: Couple interventions; Parenting interventions; Review;
Relationship education; Transition to parenthood

Yann Le Strat, Caroline Dubertret, Bernard Le Foll, Prevalence and

correlates of major depressive episode in pregnant and postpartum women in
the United States, Journal of Affective Disorders, Volume 135, Issues 13,
December 2011, Pages 128-138, ISSN 0165-0327, 10.1016/j.jad.2011.07.004.
Abstract: Background
Little is known about the prevalence and comorbidity of Major Depressive
Episode (MDE) during pregnancy in the general population. This study
presents nationally representative data on the prevalence, correlates, and
psychiatric comorbidities of depression in women during pregnancy and
postpartum in the United States.
Data were drawn from the 20012002 National Epidemiological Survey on
Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093
adults aged 18 years and older residing in households in the United
States of whom 14,549 were women 18 to 50 years old with known past-
year pregnancy status. Diagnoses of depression and other mood, anxiety, and
drug disorders were based on the Alcohol Use Disorder and Associated
Disabilities Interview Schedule DSM-IV version.
The overall prevalence of MDE during pregnancy was 12.4%. Among pregnant
and postpartum women, depression was associated with younger age, ethnicity
other than Latino, being widowed, divorced, separated or never married,
traumatic events within the past 12 months and pregnancy complication.
Strong associations were found between MDE during pregnancy and postpartum
and nearly all 12-month psychiatric disorders. Past-year depressed pregnant
and postpartum women were more likely than nondepressed pregnant women to
use substances (including alcohol, illicit drugs and cigarettes). Past-year
pregnant and postpartum women were significantly less likely to receive
past-year treatment for depression than nonpregnant women although not
after adjusting for background sociodemographic characteristics.
These results indicate that depression during pregnancy and postpartum is
associated with a large range of psychiatric disorders. The high frequency
of psychiatric comorbidities, the elevated use of any substances and the
high rate of unmet needs should be kept in mind when considering the
management of depression during pregnancy and postpartum.
Keywords: Pregnancy; Depression; NESARC; Survey

Corinna Reck, Eva Stehle, Katja Reinig, Christoph Mundt, Maternity blues as
a predictor of DSM-IV depression and anxiety disorders in the first three
months postpartum, Journal of Affective Disorders, Volume 113, Issues 12,
February 2009, Pages 77-87, ISSN 0165-0327, 10.1016/j.jad.2008.05.003.
Abstract: Background
Maternity blues have been described as a relevant risk factor for
postpartum depression. Information regarding the influence of maternity
blues on the onset and course of clinical postpartum anxiety disorders is
scarce. The goal of this study was to determine whether maternity blues
significantly predict postpartum depression and anxiety disorders in the
first 3 months after delivery in a German sample. Demographic, psychiatric,
and obstetric correlates of maternity blues were also investigated.
Maternity blues were assessed 2 weeks after delivery in a community sample
of 853 women using a telephone interview and the Patient Health
Questionnaire-Depression. Depression and anxiety disorders were diagnosed
according to DSM-IV criteria over the first 3 months following delivery. A
two-stage screening procedure was applied. In a first stage, the Patient
Health Questionnaire-Depression, the Edinburgh Depression Scale, and two
anxiety-screening instruments were employed. In the case of clinically
relevant scores, the Structured Clinical Interview for DSM-IV was
administered in a second stage.
The estimated prevalence rate of maternity blues among German women was
55.2%. We found a significant association between maternity blues and
postpartum depression (odds ratio: 3.8) and between maternity blues and
anxiety disorders (odds ratio = 3.9).
Based on our predominantly middle class low-risk sample, maternity blues
prevalence may be underestimated. Retrospective assessment of maternity
blues 2 weeks postpartum might lead to biased results.
Women with maternity blues should be carefully observed in the first weeks
postpartum with the aim of identifying those at risk of developing
postpartum depression/anxiety disorders and providing treatment at an early
stage of the disorder.
Keywords: Maternity blues; Postpartum depression; Anxiety disorder;

Bridget O. Akin-Otiko, Busisiwe R. Bhengu, Client education experiences and

expectations of women at the first level of maternal and child care in
Kaduna state, Nigeria, Midwifery, Available online 13 January 2012, ISSN
0266-6138, 10.1016/j.midw.2011.11.011.
Abstract: Purpose
to explore the client education experiences of women at first level
maternal and child health-care facilities in Kaduna State Nigeria. The lack
of access to appropriate information to assist women in making decisions
about their health and utilize available services is recognized as a major
contributory factor to the unabated high maternal and child mortality rates
in Nigeria.
a qualitative descriptive study was conducted. Nine focus group discussions
were held with 65 women across the three senatorial zones of Kaduna State,
Nigeria. Participants were recruited using maximum variation sampling
technique. Audio recordings of the discussions were transcribed and the
content analysed. The themes were determined by a priory approach and
findings compared across groups through manually developed data matrices.
midwives were the major source of useful health information to the women
who wished the midwives could cover more issues. The information provided
by the midwives was skewed towards children and postnatal care, and some
midwives ignored, or considered some of the women's questions interrupting.
The harshness of midwives in emphasizing the need for prompt care, to women
who came late to register or deliver, kept some women away. Women who never
delivered in the facilities were not aware that the nurses at the clinics
were midwives, and desired to know more about midwifery in the facilities
being tired of traditional birth attendants.
the desire of women for more information and to know the midwife suggests
a gap between what the women expected and what they were provided.
Implication for practice
it is important to expand the scope of client education to include critical
pregnancy and labour related issues and friendly midwifery practices in the
Keywords: Prenatal classes; Midwife; Nigeria; Kaduna

Helen I Lugina, Kyllike Christensson, Siriel Massawe, Lennarth Nystrom,

Gunilla Lindmark, Change in maternal concerns during the 6 weeks postpartum
period: a study of primiparous mothers in Dar Es Salaam, Tanzania, Journal
of Midwifery & Women's Health, Volume 46, Issue 4, JulyAugust 2001,
Pages 248-257, ISSN 1526-9523, 10.1016/S1526-9523(01)00133-7.
Abstract: The purpose of this study was to describe the postpartum concerns
of primiparas. A cohort study included 79 mothers in Dar es Salaam,
Tanzania. Mothers sorted topics into worry, interest, and confidence.
Trends of decreasing worry and increasing interest and confidence for baby-
related and mother-related topics were observed from 1 to 6 weeks. At 1
week mothers worried about babys eyes, respiration, temperature, safety,
and crying; but, at 6 weeks only crying was a problem. Need for information
was constant about general health, baby behavior, and care of the baby. At
1 week mothers worried about swollen perineum, and feeling tired and
nervous. They wanted information about preventing hemorrhage and infection
and taking care of the perineum, breasts, and nipples. Trends of increasing
worry and decreasing confidence were observed with respect to family
relationships. At 6 weeks, mothers worried about the husband/partners
reaction to themselves and to the baby. Confidence in relatives reaction
to themselves and the baby decreased. Being aware of the changes in the way
concerns are expressed may guide nursing/midwifery interventions for
mothers as to the content and timing.

Paloma Toledo, Robert J. McCarthy, Carol A. Burke, Kristopher Goetz,

Cynthia A. Wong, William A. Grobman, The effect of live and web-based
education on the accuracy of blood-loss estimation in simulated obstetric
scenarios, American Journal of Obstetrics and Gynecology, Volume 202, Issue
4, April 2010, Pages 400.e1-400.e5, ISSN 0002-9378,
Abstract: Objective
Visual estimation of blood loss has been shown to be inaccurate. The
objective of this study was to evaluate the impact of a didactic training
program on the accuracy of the estimation of blood loss and to compare the
effectiveness of training provided by a web-based vs live session.
Study Design
Multidisciplinary labor and delivery unit personnel participated in live or
web-based training. Both sessions comprised a 5-station pretest and
posttest. The primary outcome was the accuracy of estimated blood loss in
the pretest compared with the posttest with the use of the Mann-Whitney U
Among 372 providers, the median improvement between pre- and posttest
results was 34% (95% confidence interval, 1057%; P < .001). This
improvement did not differ significantly between the live sessions and web-
based sessions (4%; 95% confidence interval, 10% to 12%).
Our study supports the use of live or web-based training to improve blood
loss estimation accuracy.
Keywords: education; estimated blood loss; postpartum hemorrhage

A. Lalonde, B.A. Daviss, A. Acosta, K. Herschderfer, Postpartum hemorrhage

today: ICM/FIGO initiative 20042006, International Journal of Gynecology
& Obstetrics, Volume 94, Issue 3, September 2006, Pages 243-253, ISSN
0020-7292, 10.1016/j.ijgo.2006.04.016.
Abstract: Postpartum hemorrhage (PPH) is the main cause of maternal
mortality. Yet, even though solutions have been identified, governments and
donor countries have been slow to implement programs to contain the
problem. While poverty and low educational level remain the underlying
cause of PPH, the current literature suggests that active management of the
third stage of labor can prevent it. The International Confederation of
Midwives (ICM) and the International Federation of Gynecology and
Obstetrics (FIGO) are attempting to address the chronic PPH crisis by
educating their members on best practices and on troubleshooting where
resources are inadequate. Some studies found oxytocin to be preferable to
misoprostol in settings where active management is the norm. However,
secondary clinical effects may prove more troublesome with oxytocin than
with misoprostol, and misoprostol may prove to be more practical and
equally effective in low-resource settings. Two new interventions are also
proposed, the anti-shock garment and the balloon tamponade.
Keywords: Postpartum hemorrhage; Active management of the third stage of
labor; Misoprostol; Tamponade; Anti-shock garment

John A. Yozwiak, Postpartum Depression and Adolescent Mothers: A Review of

Assessment and Treatment Approaches, Journal of Pediatric and Adolescent
Gynecology, Volume 23, Issue 3, June 2010, Pages 172-178, ISSN 1083-3188,
Abstract: Postpartum depression (PPD) affects a significant proportion of
adolescent mothers. Adolescence presents unique challenges that may make
the young mother more vulnerable than her adult counterparts to PPD. PPD
impacts a mother's ability to care for her infant and has been associated
with adverse effects on child development. A review of the literature on
adolescent PPD was undertaken. The prevalence and the effects of PPD are
reviewed, common screening instruments for PPD are compared, and the
results of treatment outcome studies are highlighted. There is a need for
randomized controlled studies of interventions for adolescents with PPD.
Findings from treatment outcome studies with adults with PPD and pregnant
adolescents who are depressed suggest that psychosocial interventions may
also be effective for adolescents with PPD. Issues in assessment and
treatment of PPD among adolescents are considered.
Keywords: Adolescent; Depression; Postpartum Period; Assessment; Treatment

Sarah Salway, Sufia Nurani, Uptake of contraception during postpartum

amenorrhoea: Understandings and preferences of poor, urban women in
Bangladesh, Social Science & Medicine, Volume 47, Issue 7, 1 October
1998, Pages 899-909, ISSN 0277-9536, 10.1016/S0277-9536(98)00154-3.
Abstract: In urban Bangladesh, as in many other settings, an immediate
postpartum family planning strategy prevails, where providers seek to
promote and provide contraception at 4045 days following birth to women
regardless of their breastfeeding or menstrual status. Despite such
practices, the majority of women choose to delay the initiation of
contraception until menses resumes, often several months after birth. The
present paper seeks to explain this discrepancy by describing poor, urban
women's understandings regarding the chances of conception and the risks
associated with contraceptive use in the postpartum period. Findings from
in-depth interviews reveal that the majority of women perceive no personal
risk of pregnancy during amenorrhoea, though most do not recognise an
association between this diminished risk of conception and breastfeeding.
In addition, the data illustrate that women are primarily concerned with
their own and their newly born child's health and well-being in the period
following childbirth, both of which are perceived to be extremely
vulnerable. These perceptions, plus an understanding that modern methods of
contraception are strong and potentially damaging to the health, mean
that the majority of women are reluctant to adopt family planning methods
soon after birth, particularly during postpartum amenorrhoea. The paper
advocates that, since breastfeeding affords good protection against
pregnancy for six to nine months following birth, efforts should be made to
actively incorporate lactational amenorrhoea into postpartum family
planning strategies in Bangladesh. Recommendations are also made for ways
in which women may be encouraged to adopt contraception during amenorrhoea
beyond the period of high natural protection. The paper highlights the
importance of taking the client's perspective into consideration in
attempts to improve the quality and effectiveness of family planning
Keywords: postpartum contraception; lactational amenorrhoea; Bangladesh

Truls stbye, Nancy L. Zucker, Katrina M. Krause, Cheryl A. Lovelady, Kelly

R. Evenson, Bercedis L. Peterson, Lori A. Bastian, Geeta K. Swamy, Deborah
G. West, Rebecca J.N. Brouwer, Kids and Adults Now! Defeat Obesity (KAN-
DO): Rationale, design and baseline characteristics, Contemporary Clinical
Trials, Volume 32, Issue 3, May 2011, Pages 461-469, ISSN 1551-7144,
Abstract: Background
Prevention of childhood obesity is a public health priority. Parents
influence a child's weight by modeling healthy behaviors, controlling food
availability and activity opportunities, and appropriate feeding practices.
Thus interventions should target education and behavioral change in the
parent, and positive, mutually reinforcing behaviors within the family.
This paper presents the design, rationale and baseline characteristics of
Kids and Adults Now! Defeat Obesity (KAN-DO), a randomized controlled
behavioral intervention trial targeting weight maintenance in children of
healthy weight, and weight reduction in overweight children. 400 children
aged 25 and their overweight or obese mothers in the Triangle and Triad
regions of North Carolina are randomized equally to control or the KAN-DO
intervention, consisting of mailed family kits encouraging healthy
lifestyle change. Eight (monthly) kits are supported by motivational
counseling calls and a single group session. Mothers are targeted during a
hypothesized teachable moment for health behavior change (the birth of a
new baby), and intervention content addresses: parenting skills ((e.g.,
emotional regulation, authoritative parenting), healthy eating, and
physical activity.
The 400 motherchild dyads randomized to trial are 75% white and 22% black;
19% have a household income of $30,000 or below. At baseline, 15% of
children are overweight (85th95th percentile for body mass index) and 9%
are obese ( 95th percentile).
This intervention addresses childhood obesity prevention by using a family-
based, synergistic approach, targeting at-risk children and their mothers
during key transitional periods, and enhancing maternal self-regulation and
responsive parenting as a foundation for health behavior change.
Keywords: Overweight; Obesity; Randomized controlled trial; Parenting;
Children; Postpartum period

Robert T. Ammerman, Frank W. Putnam, Nicole R. Bosse, Angelique R. Teeters,

Judith B. Van Ginkel, Maternal depression in home visitation: A systematic
review, Aggression and Violent Behavior, Volume 15, Issue 3, MayJune 2010,
Pages 191-200, ISSN 1359-1789, 10.1016/j.avb.2009.12.002.
Abstract: Depression is prevalent in new mothers and has been shown to have
profound negative impacts on parenting, maternal life course, and child
development. High rates of maternal depression have been found in home
visitation, a widely disseminated prevention approach for high risk mothers
and their children. This paper reviews the emerging literature on the
prevalence, impact, and treatment of depression in the context of home
visitation. Findings are synthesized and methodological and design
limitations are considered in interpretation of results. Promising
approaches to addressing maternal depression and supporting home visitors
in working with this clinical population are described. Recommendations for
research and practice are offered that build upon the strong foundation of
current efforts in this area.
Keywords: Maternal depression; Home visitation; Screening; Prevention

Bobbie Posmontier, The Role of Midwives in Facilitating Recovery in

Postpartum Psychosis, Journal of Midwifery & Women's Health, Volume 55,
Issue 5, SeptemberOctober 2010, Pages 430-437, ISSN 1526-9523,
Abstract: Postpartum psychosis, an emergency psychiatric condition
affecting one to two women per 1000 after childbirth, can result in a
significant increased risk for suicide and infanticide. Symptoms of
postpartum psychosis, such as mood lability, delusional beliefs,
hallucinations, and disorganized thinking, can be frightening for the women
who are affected and for families and obstetric care providers of those
women. Women experiencing postpartum psychosis are often thrust into a
mental health system that does not capitalize on the close relational bond
that forms between midwives and the women they care for over the course of
prenatal care. The purpose of this article is to propose using the Recovery
Advisory Group Model of mental illness as a theoretical framework for care
of women with postpartum psychosis, to assist midwives in recognizing
symptoms, define the role of the midwife in treatment, and learn the
importance of becoming part of the psychiatric mental health care team in
order to facilitate optimum recovery for women with postpartum psychosis.
Keywords: midwives; postpartum psychosis; recovery

K. Doyle, J. Heron, G. Berrisford, J. Whitmore, L. Jones, G. Wainscott, F.

Oyebode, The management of bipolar disorder in the perinatal period and
risk factors for postpartum relapse, European Psychiatry, Available online
15 September 2011, ISSN 0924-9338, 10.1016/j.eurpsy.2011.06.011.
Abstract: Aims
The perinatal period is a time of high risk of relapse for women with a
history of bipolar affective disorder (BPAD). We describe the pregnancy
management of women with BPAD and identify risk factors for postpartum
The case records of 78 women with BPAD referred to perinatal mental health
services before conception, during pregnancy or the postpartum period,
between 1998 and 2009 in Birmingham UK, were screened. In women who were
managed during pregnancy, those who relapsed in the postpartum were
compared with those who remained well.
Forty-seven percent of women with BPAD referred in pregnancy suffered
postpartum relapse. Women who were unwell at referral, younger, with
unplanned pregnancy, previous perinatal episodes or a family history of
BPAD were more likely to suffer postpartum illness.
Identifying risk factors for postpartum relapse enables us to individualise
the estimation of a woman's risk and modify care plans accordingly.
Duration of wellness prior to pregnancy is not associated with a lower risk
of postpartum illness and so it is imperative that all women with BPAD
receive referral in pregnancy.
Keywords: Bipolar disorder; Postpartum relapse; Risk factors; Management;
Pregnancy; Perinatal psychiatry

Ana Victoria Montoya Arizabaleta, Lorena Orozco Buitrago, Ana Cecilia

Aguilar de Plata, Mildrey Mosquera Escudero, Robinson Ramrez-Vlez,
Aerobic exercise during pregnancy improves health-related quality of life:
a randomised trial, Journal of Physiotherapy, Volume 56, Issue 4, 2010,
Pages 253-258, ISSN 1836-9553, 10.1016/S1836-9553(10)70008-4.
Abstract: Question
Does supervised aerobic exercise during pregnancy improve health-related
quality of life in nulliparous women?
Analysis of secondary outcomes of a randomised trial with concealed
allocation, blinded assessors, and intention-to-treat analysis.
64 nulliparous, pregnant women attending for prenatal care at one of three
tertiary hospitals.
The experimental group completed a 3-month supervised exercise program,
commencing at 16 to 20 weeks of gestation. Each session included walking
(10 min), aerobic exercise (30 min), stretching (10 min), and relaxation
(10 min). The control group continued usual activities and performed no
specific exercise.
Outcome measures
The primary outcome was health-related quality of life assessed by the
Colombian version of the Medical Outcome Study Short-Form Health Survey at
baseline and immediately after the 3-month intervention.
Fifty women completed the study. After the 3-month intervention, the
experimental group had improved their health-related quality of life more
than the control group in the physical component summary of the
questionnaire by 6 points (95% CI 2 to 11), the physical function domain (7
points, 95% CI 0 to 14), the bodily pain domain (7 points, 95% CI 1 to 13)
and the general health domain (5 points, 95% CI 1 to 10).
A supervised 3-month program of primarily aerobic exercise during pregnancy
improves health-related quality of life.
Trial registration
Keywords: Aerobic exercise; Pregnant women; Health-related quality of life;
Randomised trial; Physiotherapy

Lynn Sibley, Deborah Armbruster, Obstetric first aid in the community

partners in safe motherhood a strategy for reducing maternal mortality,
Journal of Nurse-Midwifery, Volume 42, Issue 2, MarchApril 1997, Pages
117-121, ISSN 0091-2182, 10.1016/S0091-2182(97)00022-0.
Abstract: The unacceptably high levels of maternal mortality that are
prevalent throughout the developing world are a product of many factors;
most notably, these include nonexistent, inaccessible or inadequate
facility-based emergency care, poorly developed referral linkages,
predominance of home-based care by attendants and family members who are
poorly equipped to respond to emergencies, and the complexities of problem
recognition and decision making during emergencies leading to inappropriate
or delayed action. This paper describes an innovative community-oriented
strategy that has been designed to reduce maternal mortality and that
targets women, families, and traditional birth attendants (TBAs) using two
complimentary training interventions. The strategy reflects the authors'
conviction that the training of professional and paraprofessional health
workers in emergency care is essential, but that it must be complemented by
the education and mobilization of families, communities, and TBAs who must,
in turn, come to common perceptions on the need for and means of
intervening to prevent a maternal death. Collaborating with partners in the
US Agency for International Development-funded Primary Providers Training
and Education in Reproductive Health Project, Special Project staff of the
American College of Nurse-Midwives will lead development and testing of the
strategy through operations research activities in selected countries.

Marion Righetti-Veltema, Elisabeth Conne-Perrard, Arnaud Bousquet, Juan

Manzano, Postpartum depression and motherinfant relationship at 3 months
old, Journal of Affective Disorders, Volume 70, Issue 3, August 2002, Pages
291-306, ISSN 0165-0327, 10.1016/S0165-0327(01)00367-6.
Abstract: Background: This paper is part of a prospective, epidemiologic
study concerning postpartum depression (PPD). The women were first examined
during pregnancy; after delivery they were seen with their infants at 3 and
18 months. The present study focuses on the 3-months-postpartum results.
Methods: A sample of 570 women and their infants were examined 3 months
after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox
et al., 1987. Br. J. Psychiatry 150:782786), 10.2% of these new mothers
presented PPD. The focus of the study concerned the effects of this
neurotic disorder on the mother, the infant and on the motherinfant
relationship. Results: The deleterious effects concerning the infant were
functional disorders such as eating or sleeping difficulties. The
depressed dyads presented less vocal and visual communications, less
corporal interactions and less smiling. Conditions surrounding delivery and
tiredness at 3 months are linked to difficulties in motherinfant
relationship for the non-depressed mothers. Logistic models showed that
primiparous PPD mothers have difficulties bathing their infants, whereas
multiparous PPD mothers are more tired. Limitation: This study did not take
into account either protective factors or the effects of the infant
himself. Clinical relevance: Knowledge of the mothers and infants
difficulties may help caregivers to detect these at-risk dyads and initiate
therapeutic measures.
Keywords: Postpartum depression; Motherinfant relationship; Infant
Janice M. Morse, Corinne Jehle, Diane Gamble, Initiating breastfeeding: a
world survey of the timing of postpartum breastfeeding, International
Journal of Nursing Studies, Volume 27, Issue 3, 1990, Pages 303-313, ISSN
0020-7489, 10.1016/0020-7489(90)90045-K.
Abstract: A survey of the Human Relations Area Files and ethnographic
infant feeding literature from all cultures on the timing of infant feeding
revealed that the practice of withholding colostrum from the infant was
widespread. Data obtained from 120 cultures showed that in 50 cultures this
delay in implementing breastfeeding was more than two days. In many groups,
substitute prelacteal feeds were given, while in others, practices such as
the use of purgatives exacerbated the risk of dehydration in the infant.
The authors warn that nurses and midwives must be aware of the practice of
withholding colostrum from the infant, and note that if a mother does not
wish to breastfeed in the immediate postpartum, this does not necessarily
mean that she wishes to bottle feed the infant.

Tara L. Hicks, Susan Forester Goodall, Evelyn M. Quattrone, Mona T. Lydon-

Rochelle, Postpartum sexual functioning and method of delivery: Summary of
the evidence, Journal of Midwifery & Women's Health, Volume 49, Issue
5, SeptemberOctober 2004, Pages 430-436, ISSN 1526-9523,
Abstract: Short-term postpartum sexual problems are highly prevalent,
ranging from 22% to 86%; however, there are few studies that address how
mode of delivery affects sexual functioning after childbirth. The objective
of this study was to perform a systematic review of the literature on
selected postpartum sexual function outcomes as affected by cesarean,
assisted vaginal, and spontaneous vaginal delivery. We searched PubMed,
CINAHL, and Cochrane databases from January 1990 to September 2003 and
focused on mode of delivery and the most commonly reported sexual health
outcomes, which included perineal pain, dyspareunia, resumption of
intercourse, and self-reported perception of sexual health/sexual problems.
The studies all showed increased risks of delay in resumption of
intercourse, dyspareunia, sexual problems, or perineal pain associated with
assisted vaginal delivery. Some studies showed no differences in sexual
functioning between women with cesarean delivery and those with spontaneous
vaginal delivery, whereas others reported less dyspareunia for women with
cesarean delivery. A systematic review of the literature suggests an
association between assisted vaginal delivery and some degree of sexual
dysfunction. Reported associations between cesarean delivery and sexual
dysfunction were inconsistent. Continued research is necessary to identify
modifiable risk factors for sexual problems related to method of delivery.
Keywords: postpartum sexual functioning; postpartum sexual health;

Colleen Keller, Kathie Records, Barbara Ainsworth, Michael Belyea, Paska

Permana, Dean Coonrod, Sonia Vega-Lpez, Allison Nagle-Williams, Madres
para la Salud: Design of a theory-based intervention for postpartum
Latinas, Contemporary Clinical Trials, Volume 32, Issue 3, May 2011, Pages
418-427, ISSN 1551-7144, 10.1016/j.cct.2011.01.003.
Abstract: Background
Weight gain in young women suggests that childbearing may be an important
contributor to the development of obesity in women. Depressive symptoms can
interfere with resumption of normal activity levels following childbirth or
with the initiation of or adherence to physical activity programs essential
for losing pregnancy weight. Depression symptoms may function directly to
promote weight gain through a physiologic mechanism. Obesity and its
related insulin resistance may contribute to depressed mood
physiologically. Although physical activity has well-established beneficial
effects on weight management and depression, women tend to under
participate in physical activity during childbearing years. Further, the
mechanisms underpinning the interplay of overweight, obesity, physical
activity, depression, and inflammatory processes are not clearly explained.
This report describes the theoretical rationale, design considerations, and
cultural relevance for Madres para la Salud [Mothers for Health].
Design and methods
Madres para la Salud is a 12 month prospective, randomized controlled trial
exploring the effectiveness of a culturally specific intervention using
bouts of physical activity to effect changes in body fat, systemic and
fat tissue inflammation, and postpartum depression symptoms in sedentary
postpartum Latinas.
The significance and innovation of Madres para la Salud includes use of a
theory-driven approach to intervention, specification and cultural
relevance of a social support intervention, use of a Promotora model to
incorporate cultural approaches, use of objective measures of physical
activity in post partum Latinas women, and the examination of biomarkers
indicative of cardiovascular risk related to physical activity behaviors in
postpartum Latinas.
Keywords: Latinas; Hispanics; Physical activity; Intervention; Social
support; Overweight; Obesity; Culture; Postpartum; Exercise

Columba K. Mbekenga, Helen I. Lugina, Kyllike Christensson, Pia Olsson,

Postpartum experiences of first-time fathers in a Tanzanian suburb: A
qualitative interview study, Midwifery, Volume 27, Issue 2, April 2011,
Pages 174-180, ISSN 0266-6138, 10.1016/j.midw.2009.03.002.
Abstract: Objectives
to explore postpartum experiences of first-time fathers in a multicultural,
low-income, suburban Tanzanian setting.
Design, setting and participants
individual qualitative interviews with ten first-time fathers, four to ten
weeks post partum in Ilala suburb, Dar es Salaam, Tanzania.
these first-time fathers enjoyed fatherhood and revealed a sincere concern
for the well-being of the mother and infant during the postpartum period.
They described themselves as active in mother and infant care and household
chores; however, they were limited by breadwinning responsibilities. The
families were supported by relatives or laypersons. The mothers and
infants nutrition had high priority but poverty was an obstacle. Timing of
resumption of sex after childbirth was problematic as traditions prescribed
abstinence while the woman is breast feeding. The risk of contracting HIV
to the family was a concern. Reproductive and child health care often
excluded fathers and gave unclear information.
these new fathers struggled to gain confidence and experience while
engaging in family matters during post partum. Changing gender roles in the
suburban Tanzanian society in general and their personal experiences of
transition to fatherhood both facilitated and made the postpartum period
problematic. The health sector does not respond with respect to fathers
concerns for family health and needs for support.
these findings call for programmes on gender relations, which are
supporting constructive masculinities and facilitate new fathers active
participation and responsibilities in parenting, family health and their
relations with their partners. Such programmes should not only target
people in childbearing age but also their potential support persons. Health
workers should welcome fathers and discuss strategies for good family
health during post partum. Counselling couples together could facilitate
their support for each other in optimising health post partum.
Keywords: Post partum; Fathers; Experiences; Qualitative; Interviews;

Vanessa Reid, Mikki Meadows-Oliver, Postpartum Depression in Adolescent

Mothers: An Integrative Review of the Literature, Journal of Pediatric
Health Care, Volume 21, Issue 5, SeptemberOctober 2007, Pages 289-298,
ISSN 0891-5245, 10.1016/j.pedhc.2006.05.010.
Abstract: Research on adolescent mothers has revealed increasing rates of
depressive symptoms in the postpartum period. This review integrated 12
research-based articles to provide a better understanding of depression
among adolescent mothers in the first year postpartum. The results revealed
that more family conflict, fewer social supports, and low self-esteem all
were associated with increased rates of depressive symptoms in adolescent
mothers during the first postpartum year. To prevent adverse outcomes
associated with depression, it is important that nurse practitioners
working with these families screen adolescent mothers for depression and
refer them for treatment as needed.

Nathan L. Hale, Janice C. Probst, Jihong Liu, Amy Brock Martin, Kevin J.
Bennett, Saundra Glover, Postpartum Screening for Diabetes among Medicaid-
Eligible South Carolina Women with Gestational Diabetes, Women's Health
Issues, Volume 22, Issue 2, MarchApril 2012, Pages e163-e169, ISSN 1049-
3867, 10.1016/j.whi.2011.08.003.
Abstract: Purpose
To examine the rate of timely postpartum screening for diabetes among
Medicaid-eligible women with gestational diabetes mellitus (GDM).
We examined a retrospective cohort of Medicaid women with a live birth
between 2004 and 2007. Women with singleton live births at greater than 28
weeks gestation were included in the cohort and their screening receipt
tracked. Only the first qualifying pregnancy within the observation period
was assessed. Birth certificate records were linked with hospital discharge
data, outpatient prenatal care claims to identify women with GDM (n =
6,239). Medicaid postpartum claims for these women were examined to
determine receipt of postpartum screening for diabetes within 5 to 13
weeks. Women with any indication of a dedicated plasma glucose test
identified by CPT codes 82947, 82950, 82951, and 82952 during this time
period were considered to meet the definition of screening.
Approximately 3.4% of women identified as having GDM were screened for
diabetes postpartum. Adjusted analysis found women not attending the
postpartum visit (odds ratio [OR], 0.58; 95% confidence interval [CI],
0.370.91) and women receiving inadequate prenatal care (OR, 0.57; 95% CI,
0.340.95) were less likely to receive postpartum screening for diabetes.
Conversely, women 20 to 34 years of age (OR, 1.79; 95% CI, 1.212.66) and
women who were obese (OR, 2.28; 95% CI, 1.563.32) were more likely to be
Medicaid is a primary source of insurance for many women; however, for most
coverage ends at 60 days postpartum, leaving a narrow window of opportunity
for postpartum screening. Extended periods of coverage may be beneficial in
ensuring the opportunity to receive adequate postpartum care, including
screening for diabetes.

Lynn Sibley, Theresa Ann Sipe, What can a meta-analysis tell us about
traditional birth attendant training and pregnancy outcomes?, Midwifery,
Volume 20, Issue 1, March 2004, Pages 51-60, ISSN 0266-6138, 10.1016/S0266-
Abstract: Objective:
to summarise the available published and unpublished studies on traditional
birth attendant (TBA) training effectiveness.
a meta-analysis.
Study sample:
sixty studies (n=60) spanning 19711999 from 24 countries and three
the effect size index, Cohen's h for each outcome; the variance-weighted
mean effect size and 95% confidence interval for sub-group of outcomes;
homogeneity tests on the distribution of the weighted mean effect sizes;
and sensitivity analysis to detect the presence of publication bias.
TBA training was associated with significant increases in attributes such
as TBA knowledge (90%), attitude (74%), behaviour (63%) and advice
(90%) over the untrained TBA baseline. Results for behaviour and advice
in specific content areas related to peri-neonatal health outcome, however,
reveal sources of variability and underscore the conflicting evidence on
TBA training. TBA training was also associated with small but significant
decreases in peri-neonatal mortality (8%) and birth asphyxia mortality
(11%). Incomplete reporting limited the assessment of neonatal mortality
due to tetanus and acute respiratory infection, maternal mortality, as well
as assessment of the relationship between intervention characteristics and
outcomes. The quality of studies included in the meta-analysis lack
sufficient rigour to address the question of causality. Thus, while the
data suggest that TBA training is effective in terms of the outcomes
measured, we are unable to demonstrate that it is a cost-effective
skilled attendance at birth is a distant reality in many developing
countries and effective community-based strategies are needed to help
reduce high levels of mortality. Given the magnitude of peri-neonatal
mortality, the associations observed between TBA training peri-neonatal and
birth asphyxia mortality, and TBA attributes in content relevant to peri-
neonatal survival, we suggest that these strategies may usefully include
TBA training in appropriate settings. If TBAs are to be trained, however,
it is imperative that their training be adequately evaluated in order to
develop the strong evidence base that is lacking to-date and that is
necessary for sound policy and programming.

Isobel R. Contento, Jill S. Randell, Charles E. Basch, Review and Analysis

of Evaluation Measures Used in Nutrition Education Intervention Research,
Journal of Nutrition Education and Behavior, Volume 34, Issue 1, January
February 2002, Pages 2-25, ISSN 1499-4046, 10.1016/S1499-4046(06)60220-0.
Abstract: The purpose of this review is to provide a summary of the kinds
of evaluation measures used in 265 nutrition education intervention studies
conducted between 1980 and 1999 and an analysis of psychometric issues
arising from such a review. The data are summarized in terms of tables for
interventions with each of six key population groups: preschool children,
school-aged children, adults, pregnant women and breastfeeding promotion,
older adults, and inservice preparation of professionals and
paraprofessionals. Measures evaluating knowledge and skills or behavioral
capabilities were most widely used in studies with preschool, school-aged,
and inservice populations (50%85%) and less widely used in studies with
the other groups, particularly breast-feeding promotion (5%). Measures of
potential psychosocial mediators or correlates of behavior such as outcome
expectancies, self-efficacy, or behavioral intention were used in 90% of
behaviorally focused studies with school-aged children and in about 20% of
studies with adults. Dietary intake measures were used in almost all
studies, primarily food recalls, records, and quantitative food frequency
questionnaires. Short frequency instruments involving only foods targeted
in the intervention such as fruits and vegetables are increasingly being
used. Measures of specific observable behaviors are also increasingly being
used. Physiologic parameters were used in about 33% of behaviorally focused
interventions with school-aged children and adults, 20% with older adults,
and 65% with pregnant women and/or their infants. Criterion validity of
newly developed intake instruments and content validity of instruments
measuring mediating variables were reported in the majority (range 50%90%)
of studies. Reliability and stability of measures of mediating variables
were reported in 50% to 75% of studies, with reliability coefficients
mostly about .6 to .7. Two major conclusions from this review are that
evaluation measures should be appropriate to the purpose, duration, and
power of the intervention and that measures should have adequate validity
and reliability in relation to both the outcomes and characteristics of the
target audience. Major implications are that considerable preliminary work
needs to be done before any intervention study to develop and test
evaluation instruments so that they are appropriate and have adequate
psychometric properties, and cognitive testing of published instruments
with each new target audience is essential. We will then be better able to
make judgments about the effectiveness of nutrition education.
Keywords: evaluation; nutrition education; interventions

Sheela Saravanan, Gavin Turrell, Helen Johnson, Jennifer Fraser, Carla

Maree Patterson, Re-examining authoritative knowledge in the design and
content of a TBA training in India, Midwifery, Volume 28, Issue 1, February
2012, Pages 120-130, ISSN 0266-6138, 10.1016/j.midw.2011.04.006.
Abstract: Since the 1990s, the TBA training strategy in developing
countries has been increasingly seen as ineffective and hence its funding
was subsequently reallocated to providing skilled attendants during
delivery. The ineffectiveness of training programmes is blamed on TBAs
lower literacy, their inability to adapt knowledge from training and
certain practices that may cause maternal and infant health problems.
However most training impact assessments evaluate post-training TBA
practices and do not assess the training strategy. There are serious
deficiencies noted in information on TBA training strategy in developing
countries. The design and content of the training is vital to the
effectiveness of TBA training programmes.

We draw on Jordan's concept of authoritative knowledge to assess the

extent to which there is a synthesis of both biomedical and locally
practiced knowledge in the content and community involvement in the design
of TBA a training programme in India.
The implementation of the TBA training programme at the local level
overlooks the significance of and need for a baseline study and needs
assessment at the local community level from which to build a training
programme that is apposite to the local mother's needs and that fits within
their comfort zone during an act that, for most, requires a forum in
which issues of modesty can be addressed. There was also little scope for
the training to be a two way process of learning between the health
professionals and the TBAs with hands-on experience and knowledge. The
evidence from this study shows that there is an overall authority of
biomedical over traditional knowledge in the planning and implementation
process of the TBA training programme. Certain vital information was not
covered in the training content including advice to delay bathing babies
for at least six hours after birth, to refrain from applying oil on the
infant, and to wash hands again before directly handling mother or infant.
Information on complication management and hypothermia was not adequately
covered in the local TBA training programme.
Key conclusions
The suggested improvements include the need to include a baseline study,
appropriate selection criteria, improve information in the training manual
to increase clarity of meaning, and to encourage beneficial traditional
practices through training.
Keywords: TBA training content and design; Authoritative knowledge;
Birthing practices

Zulfiqar A Bhutta, Samana Ali, Simon Cousens, Talaha M Ali, Batool Azra
Haider, Arjumand Rizvi, Pius Okong, Shereen Z Bhutta, Robert E Black,
Interventions to address maternal, newborn, and child survival: what
difference can integrated primary health care strategies make?, The Lancet,
Volume 372, Issue 9642, 1319 September 2008, Pages 972-989, ISSN 0140-
6736, 10.1016/S0140-6736(08)61407-5.
Abstract: Summary
Several recent reviews of maternal, newborn, and child health (MNCH) and
mortality have emphasised that a large range of interventions are available
with the potential to reduce deaths and disability. The emphasis within
MNCH varies, with skilled care at facility levels recommended for saving
maternal lives and scale-up of community and household care for improving
newborn and child survival. Systematic review of new evidence on
potentially useful interventions and delivery strategies identifies 37 key
promotional, preventive, and treatment interventions and strategies for
delivery in primary health care. Some are especially suitable for delivery
through community support groups and health workers, whereas others can
only be delivered by linking community-based strategies with functional
first-level referral facilities. Case studies of MNCH indicators in
Pakistan and Uganda show how primary health-care interventions can be used
effectively. Inclusion of evidence-based interventions in MNCH programmes
in primary health care at pragmatic coverage in these two countries could
prevent 2030% of all maternal deaths (up to 32% with capability for
caesarean section at first-level facilities), 2021% of newborn deaths, and
2940% of all postneonatal deaths in children aged less than 5 years.
Strengthening MNCH at the primary health-care level should be a priority
for countries to reach their Millennium Development Goal targets for
reducing maternal and child mortality.

Ponndara Ith, Angela Dawson, Caroline S.E. Homer, Anna Klinken Whelan,
Practices of skilled birth attendants during labour, birth and the
immediate postpartum period in Cambodia, Midwifery, Available online 16
February 2012, ISSN 0266-6138, 10.1016/j.midw.2012.01.010.
Abstract: Objective
maternal and perinatal morbidity and mortality rates in Cambodia are high.
The provision of quality care by skilled birth attendants (SBAs) in a
supportive working environment is an important strategy to reduce morbidity
and mortality. There has been little emphasis on examining this issue in
Cambodia. The objective of this study was to establish SBA reported
practices during labour, birth and the immediate postpartum periods and the
factors affecting this.
a descriptive qualitative design was employed using in-depth interviews and
focus group discussions with midwives, nurses and doctors with midwifery
skills in two health centres and three referral hospitals in one province
of Cambodia. Data were analysed using a thematic framework.
SBA practice is not always consistent with evidence-based standards known
to reduce morbidity and mortality. Ten inter-related themes emerged, which
described patterns of SBA practice, were identified. These were: skills in
the care of labouring women; provision of support in labour; interventions
in the second stage of labour; management of the third stage of labour;
cleanliness during birth; immediate care of the newborn infant and
immediate postnatal care; lack of policy and authority; fear of litigation;
workload and lack of human resources; and financial incentives and socio-
economic influences.
a gap exists between evidence-based standards and current SBA practice
during labour, birth and the immediate postpartum care. This is largely
driven by the lack of a supportive working environment.
Implications for practice
the findings of this research provide maternal health services, workforce
planners and policy makers with valuable information to contribute to the
continuous quality improvement of maternity care. The findings highlight
implications for practice that may improve the quality of maternal health
care. Recommendations for decision makers were made and further research is
needed in order to develop theories and recommendations to improve SBA
practice in Cambodia, to the benefit of the Cambodia women and newborn
Keywords: Practices; Skilled birth attendant; Birth; Cambodia

Brian E. Vaugn, Leslie Crichton, Bryon Egeland, Individual differences in

qualities of caregiving during the first six months of life: antecedents in
maternal and infant behavior during the newborn period, Infant Behavior and
Development, Volume 5, Issue 1, January 1982, Pages 77-95, ISSN 0163-6383,
Abstract: A large sample of infants and mothers from an ecnomically
disadvantaged population was assessed during the first two weeks of life
with two instruments, a rating of the mothers and infants completed by the
nurses in the newborn nursery, and the Neonatal Behavioral Assessment Scale
(NBAS). At three-and six-months postpartum, observations were made on these
mother-infant paris during feeding and play situations. Additional ratings
of the quality of maternal caregiving were made at six monthas. The data
were examined both within and across time periods. Ratings of how
relaxed/skilled the mother appeared in the newborn nursery were unrelated
to the assessments of newborn infant behavior, however, multiple regression
analyses indicated that both the ratings of maternal variables and the
assessments of newborn behavioral organization added signifacantly to the
prediction of the quality of maternal caregiving during the first six
montha of lfe. Separate analyses of these data by gender of the infant
revealed a small, but possibly important, difference favoring females on
NBAS performance. Further, the organization of newborn behavior increased
the predictions to later maternal behavior for males somewhat more than for
female infants. The results sare interpreted as evidence for the validity
of both the NBAS, and of the rating scale completed by the nurses in the
neonatal nursery. The results are also seen as consistent with a
transactional perspective on development, indicatinig that neonatal
behavioral organization is important in eliciting optimal transactions with
the caregiver

Sheela Saravanan, Gavin Turrell, Helen Johnson, Jenny Fraser, Carla

Patterson, Traditional birth attendant training and local birthing
practices in India, Evaluation and Program Planning, Volume 34, Issue 3,
August 2011, Pages 254-265, ISSN 0149-7189,
Abstract: Training birth attendants (TBAs) provide essential maternal and
infant health care services during delivery and ongoing community care in
developing countries. Despite inadequate evidence of relevance and
effectiveness of TBA training programmes, there has been a policy shift
since the 1990s in that many donor agencies funding TBA training programmes
redirected funds to providing skilled attendants during delivery. This
study aimed to assess the ways in which a TBA training programme in India
has been successful in disseminating evidence-based knowledge on birthing
practices. TBAs practicing within 16 villages targeted by training
programme initiatives were administered with structured questionnaires. The
post training birthing practices of trained (24) and untrained (14) TBAs
was compared and birthing practices adopted by women assisted by trained
(16) and untrained (9) TBAs was analysed. Positive post training practices
were hand washing, use of a clean blade for cutting the cord, immediate
breastfeeding and weighing of babies. Nevertheless, the training could be
further improved with up to date and evidence-based information and more
comprehensive instructions. The findings suggest an integration of local
and evidence-based knowledge is needed to improve the training. Raising
community awareness of public health measures related to maternal and child
health is also recommended.
Keywords: Maternal and infant health; Traditional birth attendants
training; Traditional birthing practices; Home births; Warm chain;
Hypothermnia; Community awareness

Jennifer Foster, Angela Anderson, Jennifer Houston, Maya Doe-Simkins, A

report of a midwifery model for training traditional midwives in Guatemala,
Midwifery, Volume 20, Issue 3, September 2004, Pages 217-225, ISSN 0266-
6138, 10.1016/j.midw.2004.01.004.
Abstract: Objective:
to describe the specific characteristics of one model of training
traditional birth attendants (TBAs) in Guatemala.
participant observation, unstructured and semi-structured interviews
undertaken between 1997 and 2003 to gather the data to report on the
characteristics of this training programme as it is evolving in the field.
the birth centre site of Ixmucane in Antigua, Guatemala, as well as
community sites in the Departments of Saquetepequez, Chimaltenango, and
Quetzaltenango in the western highlands of Guatemala.
traditional midwives, certified nurse-midwives and certified professional
midwives, as well as many allied health professionals and volunteers.
training philosophy, participant selection, curriculum content, intensity,
and planned follow-up are the key components of the training programme
Measurement and findings:
93 TBAs have received training through the development of a 150 hrs contact
course for self-selected TBAs in the Midwives for Midwives Program. Formal
evaluation of this training is underway but results are not yet available.
Key conclusions and implications for practice:
the value of incorporating midwifery philosophy and praxis in TBA training
has received scant attention in the TBA literature. This report suggests
that TBA training programme characteristics are important considerations in
any evaluation of training efficacy of TBAs to improve maternalchild
Keywords: Traditional midwives; Guatemala; TBA training; Maternal-baby;
Justin Oliver Parkhurst, Syed Azizur Rahman, Life saving or money wasting?:
Perceptions of caesarean sections among users of services in rural
Bangladesh, Health Policy, Volume 80, Issue 3, March 2007, Pages 392-401,
ISSN 0168-8510, 10.1016/j.healthpol.2006.03.015.
Abstract: Bangladesh has a high level of maternal mortality, corresponding
to one of the world's lowest rates of use of skilled birth attendance
(12.1%), and a similarly low rate of caesarean births (2.4%). While
increasing the proportion of women who deliver with professional medical
care is essential to prevent maternal deaths, past work has identified
distrust of caesarean procedures in Bangladesh. The reasons behind this
distrust can manifest itself in health seeking behaviour around maternal
care. This paper presents findings from a qualitative study of 30 women in
a rural district of Bangladesh who recently delivered in a health facility.
It finds that the distrust in doctor's recommendations for surgery stemmed
from high costs incurred and a belief that it was used when not medically
justified. This could lead to women avoiding or leaving medical facilities
in extreme cases. Some women's experiences further illustrated disagreement
among medical staff as to whether or not a caesarean procedure should be
done, with conflicting financial incentives for doctors to perform
caesarean deliveries, and for nurses and midwives to conduct normal
deliveries. Policy makers must recognise that the fears women hold of
caesarean deliveries may not simply be rooted in ignorance and may, in
fact, reflect legitimate concerns with medical practice. Ultimately, it
will be essential to address problems in the health systems environment,
which may promote improper service provision.
Keywords: Maternal health; Caesarian sections; Health seeking behaviour;
Skilled attendance; Bangladesh

Eleni Tsigas, Laura A. Magee, Advocacy organisations as partners in pre-

eclampsia progress: patient involvement improves outcomes, Best Practice
& Research Clinical Obstetrics & Gynaecology, Volume 25, Issue 4,
August 2011, Pages 523-536, ISSN 1521-6934, 10.1016/j.bpobgyn.2011.03.001.
Abstract: Optimal maternal and neonatal health requires the expertise of
maternity-care providers who base their decisions on solid research.
Optimal care, however, also requires active patient participation, which is
best accomplished through advocacy organisations that represent the
perspective of diverse patient populations. Patients who come together
under the auspices of a patient advocacy organisation, sometimes called
consumer groups, can have a unique and powerful voice to advance the goals
(or overcome the inertia) of the healthcare system. For pre-eclampsia, a
condition that still carries the burden of no cure and seriously adverse or
deadly outcomes, all three components care providers, researchers and
patients are required to realise progress. In this chapter, we briefly
describe the effect of pre-eclampsia on women, discuss the role of patient
advocacy organisations, and propose a six-point call to action that can
serve as a compass for patients to collaborate with practitioners,
investigators, funders, non-governmental organisations, and policy makers
on a set of articulated and comprehensive goals.
Keywords: patient advocacy; pre-eclampsia; eclampsia; hypertensive
disorders; cardiovascular disease; maternal outcome; public advocacy;
health education; patient education as topic; prenatal care; pregnancy;
public policy; consumer groups

Eugene J. Kongnyuy, Grace Mlava, Nynke van den Broek, Facility-Based

Maternal Death Review In Three Districts In The Central Region of Malawi:
An Analysis of Causes and Characteristics of Maternal Deaths, Women's
Health Issues, Volume 19, Issue 1, JanuaryFebruary 2009, Pages 14-20, ISSN
1049-3867, 10.1016/j.whi.2008.09.008.
Abstract: Purpose
We sought to determine the causes and characteristics maternal deaths that
occur in health facilities in Malawi.
Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in
Central Malawi over a 1-year period. Causes and avoidable factors of
maternal deaths were identified during the review, and recommendations made
and implemented.
Main Findings
There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect
obstetric deaths. The major causes of maternal deaths were postpartum
hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured
uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum
hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were
referred either from another health facility (51.2%) or by a traditional
birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on
admission. Four groups of factors that contributed to maternal deaths were
identified: 1) health worker factors, 2) administrative factors, 3)
patient/family factors, and 4) TBA factors. The major health worker factors
were inadequate resuscitation (69.8%), lack of obstetric life-saving skills
(60.5%), inadequate monitoring (55.8%), initial assessment incomplete
(46.5%), and delay in starting treatment (46.5%). The most common
administrative factor was lack of blood for transfusion (20.9%). The major
problems encountered include shortage of staff and other resources,
difficulty in maintaining anonymity, poor quality of data, and difficulty
in implementing recommendations.
Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and
raising community awareness could be important factors for reducing
maternal mortality in Malawi and countries with similar socioeconomic

Donna Vivio, Judith T. Fullerton, Rosha Forman, Reuben Kamoto Mbewe, Masuka
Musumali, Patrick M. Chewe, Integration of the Practice of Active
Management of the Third Stage of Labor Within Training and Service
Implementation Programming in Zambia, Journal of Midwifery & Women's
Health, Volume 55, Issue 5, SeptemberOctober 2010, Pages 447-454, ISSN
1526-9523, 10.1016/j.jmwh.2010.02.015.
Abstract: Introduction
Postpartum hemorrhage (PPH) is the leading cause of pregnancy-related
mortality (cited at 591 per 100,000 Zambian women), and is responsible for
up to 60% of maternal deaths in developing countries. Active management of
the third stage of labor (AMTSL) has been endorsed as a means of reducing
the risk of PPH. The Ministry of Health/Zambia has incorporated the use of
AMTSL into its reproductive health guidelines.
Midwives employed in five public hospitals and eight health centers were
interviewed (N = 62), and 82 observations were conducted during the second
through fourth stages of labor.
Data from facilities in which oxytocin was available (62 births in 11
settings) indicated that a uterotonic was used in 53 of the births (85.5%);
however, AMTSL was conducted in strict accord with the currently
recommended protocol (a time-specific use of the uterotonic, controlled
cord traction, and fundal massage) in only 25 (40.4%) of births.
Midwives have concerns about risks of maternal to newborn HIV blood
transfusion; it is doubtful that they will adopt the currently recommended
practice of delayed cord clamping and cutting. Infrastructure issues and
supply shortages challenged the ability to correctly and safely implement
the AMTSL protocol; nevertheless, facilities were generally ready to
support it.
Keywords: active management of the third stage of labor; midwifery care;
postpartum hemorrhage; reproductive health

Hind A. Beydoun, Ban Al-Sahab, May A. Beydoun, Hala Tamim, Intimate Partner
Violence as a Risk Factor for Postpartum Depression Among Canadian Women in
the Maternity Experience Survey, Annals of Epidemiology, Volume 20, Issue
8, August 2010, Pages 575-583, ISSN 1047-2797,
Abstract: Purpose
Intimate partner violence is a worldwide public health concern that
predominantly affects women of reproductive age. The purpose of this study
was to evaluate the effect of exposure to intimate partner violence before,
during, or after pregnancy on postpartum depression in a nationally
representative sample of Canadian women.
A cross-sectional analysis was performed with the use of data from the
Maternity Experience Survey conducted by Statistics Canada in 2006. A
population-based sample of 8542 women 15 years and older who delivered
singleton live births was selected from all Canadian provinces and
territories; of those, 6421 completed a computer-assisted telephone
interview. Recent experiences with and threats of physical or sexual
violence by an intimate partner were examined in relation to postpartum
depression assessed through the Edinburgh Postpartum Depression Scale.
The prevalence of postpartum depression was 7.5% (95% confidence interval,
6.88.2). Controlling for confounders, odds of postpartum depression were
significantly greater among women who reported partner violence in the past
two years as opposed to those who did not (adjusted odds ratio, 1.61; 95%
confidence interval, 1.062.45).
Intimate partner violence is positively associated with postpartum
depression among Canadian women. Implications for healthcare practice are
Keywords: Intimate Partner Violence; Postpartum Depression; Pregnancy;

Ian Brockington, Postpartum psychiatric disorders, The Lancet, Volume 363,

Issue 9405, 24 January 2004, Pages 303-310, ISSN 0140-6736, 10.1016/S0140-
Abstract: Summary
This review summarises the psychiatry of the puerperium, in the light of
publications during the past 5 years. A wide variety of disorders are seen.
Recognition of disorders of the motherinfant relationship is important,
because these have pernicious long-term effects but generally respond to
treatment. Psychoses complicate about one in 1000 deliveries. The most
common is related to manic depression, in which neuroleptic drugs should be
used with caution. Post-traumatic stress disorder, obsessions of child
harm, and a range of anxiety disorders all require specific psychological
treatments. Postpartum depression necessitates thorough exploration.
Cessation of breastfeeding is not necessary, because most antidepressant
drugs seem not to affect the infant. Controlled trials have shown the
benefit of involving the child's father in therapy and of interventions
promoting interaction between mother and infant. Owing to its complexity,
multidisciplinary specialist teams have an important place in postpartum
Judith M. O'Heir, Midwifery education for safe motherhood, Midwifery,
Volume 13, Issue 3, September 1997, Pages 115-124, ISSN 0266-6138,
Abstract: Objective: to determine the useability (relevance, clarity and
quality of content), applicability (ease of use) and accessibility
(structure and form) of a series of new safe motherhood midwifery education

Design: questionnaire survey and focus group discussions, preceded by a two

week clinical skills course and an eight day orientation to using the

Setting: nursing and midwifery education institutions, regional training

centres, acute-care hospital facilities and community settings in Ethiopia,
Fiji, Lesotho, Mozambique and Nepal.

Participants: thirty-six teachers, 82 midwives, nurse-midwives and

auxiliary nurse-midwives from practice settings, and 60 post basic
midwifery students.

Key findings: overall it was found that the introductory information and
the technical content of the modules were easy to understand and use as
were the instructions for both teachers and students. The presentation of
the material was orderly and easy to follow; the language was
comprehensible; and the illustrations were appropriate, clear and
facilitated teaching. The teachers found that they were able to use most of
the teaching/learning methods, teach most of the skills in the modules, and
use the guidelines for assessing competence. The main difficulties
encountered included adherence to the recommended time frame for some of
the classroom sessions; the limited availability of clinical cases for
teaching the specific skills in the modules and time limitations in the
clinical area for practising the skills; and the provision of transport for
community visits, data to complete community profiles, and time to complete
other planned community activities. The students identified the need for a
set of learning materials which they could take with them for future
reference, and both teachers and students expressed concern about resources
to support, and legislation to cover, the application of the skills

Key conclusions: the modules have the potential to strengthen and support
the education of midwives in developing countries, enabling them to make
motherhood safer and contribute to a reduction in maternal mortality by
providing better midwifery care.

Joy M. Camp, Norma Finkelstein, Parenting training for women in residential

substance abuse treatment: Results of a demonstration project, Journal of
Substance Abuse Treatment, Volume 14, Issue 5, SeptemberOctober 1997,
Pages 411-422, ISSN 0740-5472, 10.1016/S0740-5472(97)00004-4.
Abstract: This paper presents findings on the impact of implementing a
parenting component in two urban residential treatment programs in
Massachusetts for pregnant and parenting chemically-dependent women. The
parenting component consisted of multiple services for both women and their
infants while they were in residential treatment as well as aftercare
services after discharge from treatment. Findings presented focus on: (a)
the characteristics of the 170 pregnant and parenting women who
participated in the parenting component during its 48 months of
implementation; (b) changes in the parenting skills and self-esteem of
women who completed parenting training; (c) the quality of mother-child
interaction; and (d) the participants' perceptions about the impact of the
parenting training. Women in both programs made dramatic improvements in
self-esteem and experienced significant gains in parenting knowledge and
attitudes. The participants were also overwhelmingly positive about the
impact of the parenting training on their lives. Study findings underline
the importance of parenting services for pregnant and parenting women in
residential substance abuse treatment.
Keywords: parenting training; pregnant women; drug treatment; self-esteem;
residential treatment

Fariyal F Fikree, Tazeen Ali, Jill M Durocher, Mohammad H Rahbar, Health

service utilization for perceived postpartum morbidity among poor women
living in Karachi, Social Science & Medicine, Volume 59, Issue 4,
August 2004, Pages 681-694, ISSN 0277-9536,
Abstract: To explore traditional beliefs and practices, to assess puerperal
morbidity, and to understand care-seeking behaviors, a qualitative and
quantitative study was conducted in low socio-economic settlements of
Karachi, Pakistan. Five focus group discussions and 15 in-depth interviews
were conducted in July and August 2000. 525 Muslim women, who were 68
weeks post-partum, were then interviewed at home. Maternal care was
relatively goodmore than three-quarters of recent mothers sought antenatal
care and more than half (267/525) delivered in a hospital or maternity
home. Counseling to attend post-partum clinics among facility deliveries
was 16% (43/267), of which only 26% (11/43) attended. Practices during the
delivery and puerperium, such as massaging the vaginal walls with mustard
oil during labor to facilitate delivery and inserting vaginal or rectal
herbal pessaries to facilitate shrinkage of the uterus and/or
strengthening of the backbone, were pervasive.

The core symptoms that are clinically significant during the puerperium are
heavy vaginal bleeding and high fever, since they are potentially fatal
symptoms if appropriate and timely care is not sought. About half of the
study women (53.3%) reported at least one illness symptom, high fever
(21.1%), heavy vaginal bleeding (13.9%), and foul smelling vaginal
discharge (9.6%). Women did not know the underlying biologic cause of their
perceived post-partum morbidity; weakness was frequently mentioned. Women
sought care initially from close relatives or traditional healers and if
they continued to suffer from their morbidity they finally approached a
trained health care (allopathic) provider. The high prevalence of perceived
post-partum morbidity illustrates the demand for post-partum community-
based health care programs. We suggest promoting maternal health education
that encourages women to seek appropriate and timely care by accessing
public or private health services.
Keywords: Traditional practices; Care-seeking behavior; Pakistan; Post-
partum morbidity; Puerperium; Socioeconomic status,Karachi

Charles Ameh, Adetoro Adegoke, Jan Hofman, Fouzia M. Ismail, Fatuma M.

Ahmed, Nynke van den Broek, The impact of emergency obstetric care training
in Somaliland, Somalia, International Journal of Gynecology &
Obstetrics, Volume 117, Issue 3, June 2012, Pages 283-287, ISSN 0020-7292,
Abstract: Objective
To provide and evaluate in-service training in Life Saving Skills
Emergency Obstetric and Newborn Care in order to improve the availability
of emergency obstetric care (EmOC) in Somaliland.
In total, 222 healthcare providers (HCPs) were trained between January 2007
and December 2009. A beforeafter study was conducted using quantitative
and qualitative methods to evaluate trainee reaction and change in
knowledge, skills, and behavior, in addition to functionality of healthcare
facilities, during and immediately after training, and at 3 and
6 months post-training.
The HCPs reacted positively to the training, with a significant improvement
in 50% of knowledge and 100% of skills modules assessed. The HCPs reported
improved confidence in providing EmOC. Basic and comprehensive EmOC
healthcare facilities provided 100% of expected signal functionscompared
with 43% and 56%, respectively, at baselinewith trained midwives
performing skills usually performed by medical doctors. Lack of drugs,
supplies, medical equipment, and supportive policy were identified as
barriers that could contribute to nonuse of new skills and knowledge
The training impacted positively on the availability and quality of EmOC
and resulted in up-skilling of midwives.
Keywords: Evaluation; Maternal mortality; Skilled birth attendance; Task
shifting; Training in emergency obstetric and newborn care

Fabio Uxa, Alberta Bacci, Viviana Mangiaterra, Gian Paolo Chiaffoni,

Essential newborn care training activities: 8 years of experience in
Eastern European, Caucasian and Central Asian countries, Seminars in Fetal
and Neonatal Medicine, Volume 11, Issue 1, February 2006, Pages 58-64, ISSN
1744-165X, 10.1016/j.siny.2005.10.006.
Abstract: Summary
There is still an alarming gap in neonatal healthcare and outcome between
Western and Eastern European countries and the former USSR countries in
particular. Most of the causes of neonatal mortality and morbidity can be
prevented or managed by simple cost-effective interventions aimed at
improving quality of healthcare, health system organisation and family and
community participation. Training of health professionals and health
policy-makers in the field of essential neonatal care and breastfeeding
promotion is one of the cornerstones of the World Health Organization (WHO)
initiatives Making Pregnancy Safer (MPS) and Promoting Effective Perinatal
Care (PEPC) the latter specifically tailored to the European Region
aimed at ensuring safe pregnancy and childbirth through ensuring the
availability, access and use of quality skilled care. After 8 years of
experience of training in essential neonatal care, positive changes in
planning for and delivering neonatal care are taking place, even in
challenging contexts, and this model of intervention should be further
implemented in the region.
Keywords: Neonatal health; Newborn health; Neonatal mortality rate; Newborn
deaths; Neonatal survival; Newborn survival; Maternal, newborn and child
health (MNCH); Essential neonatal care training; Essential newborn care
training; Former USSR countries; New independent states

Michelle Dynes, Sandra T. Buffington, Mary Carpenter, Anna Handley, Maureen

Kelley, Lelisse Tadesse, Hanna Tessema Beyene, Lynn Sibley, Strengthening
maternal and newborn health in rural Ethiopia: Early results from frontline
health worker community maternal and newborn health training, Midwifery,
Available online 16 February 2012, ISSN 0266-6138,
Abstract: Objective
to describe early results from the Community Maternal and Newborn Health
(CMNH) training programme of the Maternal and Newborn Health in Ethiopia
Partnership (MaNHEP) project.
a non-experimental, descriptive design was employed to assess training
six rural districts of Amhara and Oromiya regions, Ethiopia.
91 Health Extension Workers (HEWs) and 626 Guide Team members including
Traditional Birth Attendants (TBAs) and volunteer Community Health
Promoters (vCHPs).
CMNH is one aspect of a broader strategy to improve maternal and newborn
health at the community level in rural areas of Ethiopia where pregnant
women have limited access to health facilities.
performance testing of HEWs, TBAs, and vCHPs was conducted to assess
transfer of knowledge and skills from CMNH Master Trainer level to CMNH
Trainer level, and from CMNH Trainer level to CMNH Guide Team (GT) level on
the topic areas of Prevent Problems before Baby is Born and Prevent
Problems after Baby is Born.
post-training performance scores were significantly higher than immediate
pre-training scores for Amhara and Oromiya regions on both topic areas
(p<0.001). For HEWs and GT members, respectively, average scores
increased over 250% and 300% for Prevent Problems before Baby is Born, and
over 300% and 400% for Prevent Problems after Baby is Born.
Key conclusions
CMNH was successful in transferring knoweldge to HEWs at the CMNH Trainer
level and to Guide Team members at the community level. In order for gains
to be realised and sustained, the CMNH programme will be nested within an
enabling environment created through behaviour change communication to
increase demand for CMNH services, emphasising evidence-based maternal and
newborn care practices, teamwork among frontline health workers, and an
enhanced role of HEWs in provision of safe care during pregnancy, birth,
and the early postnatal period.
Keywords: Maternal health services; Newborn health; Ethiopia; Community-

Debra P Bonollo, Jane G Zapka, Anne M Stoddard, Yunsheng Ma, Lori Pbert,
Judith K Ockene, Treating nicotine dependence during pregnancy and
postpartum: understanding clinician knowledge and performance, Patient
Education and Counseling, Volume 48, Issue 3, December 2002, Pages 265-274,
ISSN 0738-3991, 10.1016/S0738-3991(02)00023-X.
Abstract: This study investigated the relationship of clinicians knowledge
of treatments for nicotine dependence during pregnancy and postpartum and
explored what provider characteristics are associated with knowledge
levels. Survey data from community health center (CHC)-based prenatal,
pediatric (PED), and WIC program (Special Supplemental Nutrition Program
for Women, Infants, and Children) providers participating in a randomized
clinical study were used. Providers reported low awareness of the health
risks of smoking to the developing fetus/child of pregnant and postpartum
women and of the effectiveness of nicotine replacement therapy (NRT) for
doubling quit rates. Obstetric (OB) and WIC providers were more aware than
PED providers that provider-delivered interventions are effective.
Confidence in using counseling steps was significantly associated with
general and NRT-related knowledge. NRT-related knowledge, but not general
knowledge, was associated with higher performance of intervention steps.
Educational programs targeting OB, WIC, and PED providers knowledge about
effective smoking cessation counseling strategies and their confidence in
being effective with patients are needed.
Keywords: Smoking; Pregnant women; Health center clinicians; WIC; Nicotine
replacement therapy
Laurence E. Shields, Kathy Smalarz, Lester Reffigee, Sandra Mugg, Theodore
J. Burdumy, Marilyn Propst, Comprehensive maternal hemorrhage protocols
improve patient safety and reduce utilization of blood products, American
Journal of Obstetrics and Gynecology, Volume 205, Issue 4, October 2011,
Pages 368.e1-368.e8, ISSN 0002-9378, 10.1016/j.ajog.2011.06.084.
Abstract: Objective
The purpose of this study was to assess the effectiveness of instituting a
comprehensive protocol for the treatment of maternal hemorrhage.
Study Design
The protocol was separated into 4 stages, designated 0-3, based on the
degree of blood loss and the patient response to interventions. Key
components included admission risk assessment, measurement of blood loss,
early but limited use of uterotonic agents, early presence of obstetrical
and anesthesia staff, and transfusion with fixed ratios of blood products.
Data were collected retrospectively and prospectively relative to the start
of the protocol.
We noted a significant shift toward resolution of maternal bleeding at an
earlier stage (P < .01), use of fewer blood products (P < .01), and a
64% reduction in the rate of disseminated intravascular coagulation. In
addition, there were significant improvements in staff and physician
perceptions of patient safety (P < .01).
Comprehensive maternal hemorrhage treatment protocols improve patient
safety and reduce utilization of blood products.
Keywords: comprehensive; maternal hemorrhage; patient safety; protocol

Tami Rowen, Ndola Prata, Paige Passano, Evaluation of a traditional birth

attendant training programme in Bangladesh, Midwifery, Volume 27, Issue 2,
April 2011, Pages 229-236, ISSN 0266-6138, 10.1016/j.midw.2009.06.003.
Abstract: Background and context
the 1997 Safe Motherhood Initiative effectively eliminated support for
training traditional birth attendants (TBAs) in safe childbirth. Despite
this, TBAs are still active in many countries such as Bangladesh, where 88%
of deliveries occur at home. Renewed interest in community-based approaches
and the urgent need to improve birth care has necessitated a re-examination
of how provider training should be conducted and evaluated.
to demonstrate how a simple evaluation tool can provide a quantitative
measure of knowledge acquisition and intended behaviour following a TBA
training program.
background data were collected from 45 TBAs attending two separate training
sessions conducted by Bangladeshi non-governmental organization (NGO)
Gonoshasthaya Kendra (GK). A semi-structured survey was conducted before
and after each training session to assess the TBAs knowledge and reported
practices related to home-based management of childbirth.
two training sessions conducted in Vatshala and Sreepur in rural
45 active TBAs were recruited for this training evaluation.
there were significant improvements following the training sessions
regarding how TBAs reported they would: (a) measure blood loss, (b) handle
an apneic newborn, (c) refer women with convulsions and (d) refer women who
are bleeding heavily. A greater degree of improvement, and higher scores
overall, were observed among TBAs with no prior training and with less
birth experience.
Key conclusions and recommendations for practice
as the Safe Motherhood community strives to improve safe childbirth care,
the quality of care in pregnancy and childbirth for women who rely on less-
skilled providers should not be ignored. These communities need assistance
from governments and NGOs to help improve the knowledge and skill levels of
the providers upon which they depend. Gonoshasthaya Kendra's extensive
efforts to train and involve TBAs, with the aim of improving the quality of
care provided to Bangladeshi women, is a good example of how to effectively
integrate TBAs into safe motherhood efforts in resource-poor settings. The
evaluation methodology described in this paper demonstrates how trainees
prior experiences and beliefs may affect knowledge acquisition, and
highlights the need for more attention to course content and pedagogic
Keywords: Traditional birth attendant; Training; Home births; Skilled birth
attendant; Bangladesh safe motherhood; Global maternal health

Keng-Yen Huang, Margaret O'Brien Caughy, Janice L. Genevro, Therese L.

Miller, Maternal knowledge of child development and quality of parenting
among White, African-American and Hispanic mothers, Journal of Applied
Developmental Psychology, Volume 26, Issue 2, MarchApril 2005, Pages 149-
170, ISSN 0193-3973, 10.1016/j.appdev.2004.12.001.
Abstract: This study examined the relationship between early maternal
knowledge of child development and later quality of parenting behaviors.
Differences by race/ethnic group were also examined. Motherinfant dyads
(N=378) participated in the study. Mothers completed the Knowledge of
Infant Development Inventory (KIDI) when the infant was 24 months, and
mothertoddler dyads were videotaped in their homes at 1618 months. The
Home Observation for Measurement of the Environment Inventory (HOME),
Parent/Caregiver Involvement Scale (P/CIS), and Nursing Child Assessment by
Satellite Training (NCAST) were used to measure quality of mothertoddler
interaction. A series of hierarchical multiple regression analyses was
conducted controlling for confounding demographic variables. Results
revealed no significant main effect of maternal correct estimation of child
development on quality of parenting, but there was a significant main
effect of maternal underestimation of child development on quality of
parenting during a teaching task. There was also a significant interaction
of maternal knowledge and race in relation to quality of parenting
behavior. Implications for generalizability and interventions are
Keywords: Parenting; Maternal teaching behavior; Maternal knowledge of
development; Race and ethnic differences; Maternal cognition

Renaud Jardri, Michel Maron, Jrme Pelta, Pierre Thomas, Xavier

Codaccioni, Michel Goudemand, Pierre Delion, Impact of midwives training
on postnatal depression screening in the first week post delivery: a
quality improvement report, Midwifery, Volume 26, Issue 6, December 2010,
Pages 622-629, ISSN 0266-6138, 10.1016/j.midw.2008.12.006.
Abstract: Background
postnatal depression (PND) is a major public health problem. The objective
of this study was to improve early PND screening by midwives in a maternity
unit. Professional screening techniques were evaluated and compared with
reference screening techniques [Edinburgh Postnatal Depression Scale
(EPDS), Mini International Neuropsychiatric Interview (MINI-DSM-IV)].
the evaluation took place before and after the midwife training in order to
determine the effectiveness of specific clinical recommendations for two
successive 10-week inclusion periods (from November 2004 to September
2005). A short training course and posters were used to convey the
recommendations, agreed by obstetricians, paediatricians and psychiatrists.
a total of 463 postpartum women were included in the two phases of the
study. Quantitative and qualitative PND screening by midwives improved
significantly following training (Z=2.07, p=0.04; Z=2.62, p=0.008,
respectively). Early detection of major depressive episodes increased by
37.7% (95% confidence interval 25.749.7) following training. A combination
of midwives perception of poor emotional well-being and the EPDS led to a
significant improvement in early detection of PND (Q=8.00, p=0.04).
targeted recommendations given to the midwives led to an improvement in the
early detection of PND. Suitable programmes need to be offered to reduce
the number of cases of PND. Perinatal psychiatrists should be seen to be
meticulous and available for such prevention action.
Keywords: Postnatal depression; Early screening; Primary prevention;
Midwives; Quality improvement; EPDS; MINI

Joanne Borg-Stein, Sheila A. Dugan, Musculoskeletal Disorders of Pregnancy,

Delivery and Postpartum, Physical Medicine and Rehabilitation Clinics of
North America, Volume 18, Issue 3, August 2007, Pages 459-476, ISSN 1047-
9651, 10.1016/j.pmr.2007.05.005.
Abstract: Gender-specific care of musculoskeletal impairments is
increasingly important in women's health. This is most relevant and of
paramount importance as it relates to identification and management of
musculoskeletal and peripheral neurologic disorders of pregnancy, delivery,
and postpartum. The specific anatomic and physiologic changes of pregnancy
predispose to a specific set of diagnoses. Virtually all women experience
some degree of musculoskeletal discomfort during pregnancy. This article
provides an overview of the more common pregnancy-related musculoskeletal
conditions and includes a discussion of epidemiology, risk factors,
diagnosis, prognosis, and management.

Fei-Wan Ngai, Sally Wai-Chi Chan, Wan-Yim Ip, The effects of a childbirth
psychoeducation program on learned resourcefulness, maternal role
competence and perinatal depression: A quasi-experiment, International
Journal of Nursing Studies, Volume 46, Issue 10, October 2009, Pages 1298-
1306, ISSN 0020-7489, 10.1016/j.ijnurstu.2009.03.007.
Abstract: Background
Learned resourcefulness plays a significant role in facilitating maternal
coping during the transition to motherhood. Given the growing evidence of
perinatal depression and the frequent feeling of incompetence in the
maternal role, the implementation of an effective intervention to promote
maternal role competence and emotional well-being is essential.
To determine the impact of a childbirth psychoeducation program based on
the concept of learned resourcefulness on maternal role competence and
depressive symptoms in Chinese childbearing women.
A pretestposttest, control group quasi-experimental design with repeated
measures was used.
The study was conducted in two regional public hospitals in Hong Kong that
provide routine childbirth education programs with similar content and
structure. One hospital was being randomly selected as the experimental
A convenience sample of 184 Chinese pregnant women attending the childbirth
education was recruited between October 2005 and April 2007. Inclusion
criteria were primiparous with singleton and uneventful pregnancy, at
gestation between 12 and 35 weeks, and did not have a past or familial
psychiatric illness.
The intervention was a childbirth psychoeducation program that was
incorporated into the routine childbirth education in the experimental
hospital. The experimental group (n = 92) received the childbirth
psychoeducation program and the routine childbirth education. The
comparison group (n = 92) received the routine childbirth
education alone in the comparison hospital. Outcomes were measured by the
Self-Control Schedule, Parenting Sense of Competence ScaleEfficacy
subscale and Edinburgh Postnatal Depression Scale at baseline, immediately
post-intervention, at 6 weeks and 6 months postpartum. Analysis was by
intention to treat.
Women receiving the childbirth psychoeducation program had significant
improvement in learned resourcefulness at 6 weeks postpartum
(p = 0.004) and an overall reduction in depressive symptoms
(p = 0.01) from baseline to 6 months postpartum compared with
those who only received the routine childbirth education after adjusting
for baseline group differences on age and social support. No significant
group difference was found on maternal role competence.
The childbirth psychoeducation program appears to be a very promising
intervention for promoting learned resourcefulness and minimizing the risk
of perinatal depression in first-time Chinese childbearing women. Future
empirical work is required to determine the effectiveness of extending the
childbirth psychoeducation program into the early postpartum for the
promotion of maternal role competence in Chinese childbearing women.
Keywords: Childbirth psychoeducation program; Learned resourcefulness;
Maternal role competence; Perinatal depression

Andrea Gonzalez, Jennifer M. Jenkins, Meir Steiner, Alison S. Fleming,

Maternal Early Life Experiences and Parenting: The Mediating Role of
Cortisol and Executive Function, Journal of the American Academy of Child
& Adolescent Psychiatry, Volume 51, Issue 7, July 2012, Pages 673-682,
ISSN 0890-8567, 10.1016/j.jaac.2012.04.003.
Abstract: Objective
Research suggests that early life adversity may affect subsequent
parenting. Animal studies investigating mechanisms of transmission have
focused on biological factors; whereas research in humans has emphasized
cognitive and psychosocial factors. We hypothesized that neuropsychological
and physiological factors would act as mediators between maternal
retrospective reports of early life experiences (ELE) and current
We recruited a community sample of 89 mothers and their infants (26 months
of age). Maternal ELE consisted of self-reports of consistency of care and
childhood maltreatment. Diurnal salivary cortisol samples were collected as
the measure of hypothalamic-pituitary-adrenal (HPA) function. Executive
function measures included attentional set-shifting and spatial working
memory. Maternal sensitivity was assessed through videotapes of mothers
interacting with their infants.
A series of path analyses indicated that maternal ELE was indirectly
related to maternal sensitivity via two pathways: one through HPA function,
and the other through HPA function and spatial working memory. There was no
direct path between maternal ELE and parenting.
These findings provide support for the notion that mediators linking early
life experiences to parenting in humans may be similar to physiological
mechanisms found in animal models. As maternal care is associated with
numerous infant outcomes, our findings may have broad relevance to
understanding the risk associated with parenting and adverse outcomes in
infants. A greater understanding of mechanism is important to informing
interventions targeted at disrupting maladaptive trajectories of parenting.
Keywords: early life experiences; parenting; diurnal cortisol; executive

William Coleman, Family-focused pediatrics: A primary care family systems

approach to psychosocial problems, Current Problems in Pediatric and
Adolescent Health Care, Volume 32, Issue 8, September 2002, Pages 260-305,
ISSN 1538-5442, 10.1067/mps.2002.125468.
Abstract: Summary
Every child comes with a familythe single greatest, most enduring
influence on a child. Forces within the familytheir socioeconomic status,
parental medical and mental health, parenting practices, nature of the
spousal/partner relationship, behavior, cultural beliefs, and communication
stylepowerfully affect children's physical and mental health, self-image,
behavior, educational attainment, and overall well-being. It follows
logically that the family is the domain of the pediatrician and other
primary providers.

Pediatricians are trained with the biomedical model, but they increasingly
encounter problems for which they should consider incorporating a
biopsychosocial-family systems-model: (1) psychosocial problems that prove
resistant to traditional child-centered, or symptom-centered interventions,
(2) problems that are affected by and/or impact the family context, and (3)
families who actively seek help for behavioral and interactive-emotional

This article has described (1) the family systems model and techniques
(with an illustrative case study of a common pediatric problem); (2) the
rationale for adopting (and adapting) this model to better address
psychosocial problems that are increasing in America; (3) the unique
qualifications and position of primary care pediatricians in the health
care system to address these problems; (4) the impact of family
relationships and other family-social factors on children's behavior,
development, and emotions; and finally, (5) a variety of clinical
strategies and interviewing techniques for pediatricians (and other primary
care providers) who want to enhance their skills in working with children
and adolescents within the context of their families. This article
concludes with recommendations (from the AAP Task Force on the Family) for
future pediatric training, education, and policymaking.

The family is the pediatrician's greatest resource, and the family is the
best expert on their children. Using an admixture of the family's strengths
and values and the pediatrician's knowledge, skills, and guidance,
pediatricians and families can coconstruct solutions to ensure the best
outcome for children and their families.98,204

Vivienne Jung, Robert Short, Nicole Letourneau, Debra Andrews,

Interventions with depressed mothers and their infants: Modifying
interactive behaviours, Journal of Affective Disorders, Volume 98, Issue 3,
March 2007, Pages 199-205, ISSN 0165-0327, 10.1016/j.jad.2006.07.014.
Abstract: Background
Postpartum depression (PPD) has a prevalence ranging from 3% to 30% and is
associated with serious infant growth and developmental problems.
Interventions directed at improving maternal mood have been unsuccessful in
producing changes in observed face-to-face interactions between mother and
infant. The Keys to Caregiving (KTC) is an intervention program that helps
parents to understand and respond to infant behaviours, with a goal of
increasing positive affective expressions in infants. In this pilot study,
KTC was used with mothers suffering from mild to moderate PPD and their
PPD was confirmed by scores on the Edinburgh Postnatal Depression Scale and
the Beck Depression Inventory. Eleven dyads completed the study. KTC was
carried out in 5 weekly group sessions, beginning at infant age of
3 months. Dyads were videotaped prior to and after KTC, using the Face-to-
Face Still-Face paradigm, which assesses infants' responses during normal
play and the effects of the Still-Face perturbation. The tapes were scored
for infant facial emotion expressions.
After intervention, infants displayed a marked increase in Interest and Joy
when interacting face-to-face with their mothers, even though mothers'
depression ratings did not change.
This pilot study is limited by lack of control dyads, however, it provides
the foundation necessary for a full trial.
This study suggests that intervention that focuses on what mothers do with
their infants instead of how they feel can be effective in increasing
infants' positive responsiveness and improving infant outcomes. Such
interventions can be an essential component of treatment when mothers
present with postpartum depression.
Keywords: Postpartum depression; Motherinfant intervention; Still-Face
perturbation; Infant facial emotion

P.S. Chandra, V.N.G.P. Raghunandan, V.A.S. Krishna, Women's Mental Health,

In: Editor-in-Chief: Kris Heggenhougen, Editor(s)-in-Chief, International
Encyclopedia of Public Health, Academic Press, Oxford, 2008, Pages 608-617,
ISBN 9780123739605, 10.1016/B978-012373960-5.00044-7.
Abstract: Women's mental health is determined by a complex interplay of
several biological, social, and cultural factors. Women are more prone to
several mental health problems because of their lower status in society and
the impact of stressors that are often gandered, including poverty,
violence, and poor physical health. Depression, somatization, posttraumatic
stress disorders, and eating disorders are much more common in women than
in men. Conditions such as schizophrenia, anxiety disorders, and substance
use disorders, though not more common in women, have specific clinical and
long-term implications among women. Sexual trauma and intimate partner
violence are other important determinants of mental health problems in
women. Pregnancy and the postpartum period may also be associated with
mental health problems due to a combination of hormonal, biological, and
psychosocial vulnerability. Postpartum depression has been identified as a
significant cause of morbidity the world over. Reproductive and sexual
health and disease also have associations with help-seeking for both
physical and unexplained somatic symptoms. The article discusses each of
these issues and also reflects on interventions and health policies that
would have a positive impact in improving mental health of women the world
Keywords: Interventions; Mental health; Postpartum depression; Violence;

Sue Kruske, Lesley Barclay, Effect of shifting policies on traditional

birth attendant training, Journal of Midwifery & Women's Health, Volume
49, Issue 4, JulyAugust 2004, Pages 306-311, ISSN 1526-9523,
Abstract: Traditional birth attendant (TBA) training commenced in many
places in the non-Western world in the 1970s, supported by the World Health
Organization and other funding bodies. By 1997, senior policy makers
decided to refocus priorities on the provision of skilled attendants to
assist birthing women. The definition of skilled attendants excluded TBAs
and resulted in the subsequent withdrawal of funding for TBA training
globally. A review of the health and sociological literature and
international policy documents that address TBA training revealed how
international policy and professional orientation are reflected in
education programs designed for the TBA. Policy makers risk ignoring the
important cultural and social roles TBAs fulfill in their local communities
and fail to recognize the barriers to the provision of skilled care. The
provision of skilled attendants for all birthing women cannot occur in
isolation from TBAs who in themselves are also highly skilled. This article
argues a legitimacy of alternative worldviews and acknowledges the
contribution TBAs make to childbearing women across the world.
Keywords: traditional birth attendants; skilled attendants; maternal
mortality; midwives


Comorbidity: Predicting Early Parenting, Attachment Security, and Toddler
Social-Emotional Problems and Competencies, Journal of the American Academy
of Child & Adolescent Psychiatry, Volume 40, Issue 1, January 2001,
Pages 18-26, ISSN 0890-8567, 10.1097/00004583-200101000-00012.
Abstract: ABSTRACTObjective
To examine relations between maternal depression (in pure and comorbid
forms) and motherinfant interactions, infant attachment, and toddler
social-emotional problems and competencies. A second objective was to
explore sex differences.
Sixty-nine motherinfant dyads were followed from pregnancy to 30 months
postpartum. Depression was measured at multiple times with self-report and
interview assessments. Play was assessed at 4 months and attachment status
at 14 months postpartum. At 30 months, mothers completed the Child Behavior
Checklist and Infant-Toddler Social and Emotional Assessment.
Lifetime maternal depression predicted less optimal motherinfant
interactions and insecure infant attachment. However, this depression
effect was accounted for by mothers with comorbid diagnoses, who had less
optimal interactions, and infants with higher rates of insecurity than
either mothers with depression only or mothers with no psychopathology.
Prenatal and postpartum depressive symptoms were associated with problem
behaviors and lower competencies for boys. In contrast, quality of early
interactions predicted problem behaviors in girls.
It is important to examine the context of maternal depression with respect
to additional psychopathology and environmental risks. Maternal depression
in the presence of other psychopathology confers risk to the motherchild
dyad. Consistent with previous work, risk pathways appear to differ for
boys and girls. Early identification and prevention efforts are warranted.
Keywords: maternal depression; infancy; attachment; problem behaviors;

Goldy C. George, Tracey J. Milani, Henry Hanss-Nuss, Jeanne H. Freeland-

Graves, Compliance with Dietary Guidelines and Relationship to Psychosocial
Factors in Low-Income Women in Late Postpartum, Journal of the American
Dietetic Association, Volume 105, Issue 6, June 2005, Pages 916-926, ISSN
0002-8223, 10.1016/j.jada.2005.03.009.
Abstract: Objectives
The goals were to evaluate compliance with the Dietary Guidelines among
low-income women during late postpartum and to examine the relationship
between psychosocial variables and dietary compliance.
Participants were 146 triethnic, low-income women who were recruited 0 to 1
days after childbirth and who visited a clinic site at 1 year postpartum.
At 1 year postpartum, multiple psychosocial characteristics were measured,
and food choices and nutrient intakes were assessed via a validated food
frequency questionnaire. Dietary guidelines index scores and measures of
adherence to dietary recommendations were computed.
Statistical analyses performed
Descriptive statistics, analysis of variance with post-hoc Scheffe tests,
2 with follow-up tests of independent proportions, and Pearson correlation
coefficients were utilized.
For dietary compliance, 60% had adequate intakes of meat, but less than 30%
met recommendations for grains, vegetables, fruits, dairy foods, total fat,
and added sugar. Healthful weights (body mass index <25) were observed
in 37% of women. Those in the highest tertile of dietary compliance had a
more positive body image than those in the lowest tertile, and less neglect
of self-care, weight-related distress, stress, depressive symptoms, and
perceived barriers to weight loss (P<.05). Dietary compliance and
psychosocial scale scores did not vary by ethnicity.
Adherence to dietary guidelines was limited in the low-income, postpartum
women. Psychosocial variables, such as neglect of self-care, weight-related
distress, negative body image, stress, and depressive symptoms were
associated with less healthful diets and lifestyle in late postpartum.
Programs that target diet-related behavior change in low-income women might
be improved by inclusion of psychosocial assessment and counseling

Ruben Barakat, Mireia Pelaez, Rocio Montejo, Maria Luaces, Maria

Zakynthinaki, Exercise during pregnancy improves maternal health
perception: a randomized controlled trial, American Journal of Obstetrics
and Gynecology, Volume 204, Issue 5, May 2011, Pages 402.e1-402.e7, ISSN
0002-9378, 10.1016/j.ajog.2011.01.043.
Abstract: Objective
We have studied the effect of moderate physical activity that is performed
by healthy women during their entire pregnancy on their perception of
health status.
Study Design
Eighty sedentary women were assigned randomly to either an exercise group
(n = 40) or a control group (n = 40). Maternal perception of health status
and several pregnancy outcomes were recorded.
Significant differences (P = .03) were found between study groups in the
percentage of women who perceived their health status as very good; the
values that corresponded to the exercise group (n = 18; 54.5%) were better
than those of the control group (n = 9; 27.3%). In addition, the women of
the exercise group gained less weight (11,885 3146 g) than those of the
control group (13,903 2113; P = .03).
A moderate physical activity program that is performed over the first,
second, and third trimester of pregnancy improves the maternal perception
of health status.
Keywords: exercise; pregnancy; maternal health; weight gain
Nikolaos Vrachnis, Stamatina Iliodromiti, Evi Samoli, Zoe Iliodromiti,
Spyridon Dendrinos, Georgios Creatsas, Maternal mortality in Greece, 1996
2006, International Journal of Gynecology & Obstetrics, Volume 115,
Issue 1, October 2011, Pages 16-19, ISSN 0020-7292,
Abstract: Objective
To present retrospective data for maternal deaths in Greece from 1996 to
Demographic information and information on the causes of death was provided
by the Hellenic Statistical Authority. Maternal deaths were assessed by
cause of death, maternal age, and place of residence. The maternal
mortality ratio (MMR) was estimated and expressed as the number of deaths
per 100 000 live births.
From 1996 to 2006, 29 deaths were attributed to pregnancy and childbirth,
yielding a total MMR of 2.63. The leading cause of direct deaths was
hemorrhage and that of indirect deaths was cardiac disease. There was a
borderline significant decline in the MMR during the study period. The MMR
was significantly higher at the extremes of the reproductive age range.
Maternal mortality in Greece is low; however, no formal data have been
published since 1996. Knowledge of the causes of maternal death can lead to
the prevention of maternal deaths and safer motherhood.
Keywords: Cardiac disease; Embolism; Greece; Maternal death; Postpartum

J. Campion, K. Bhui, D. Bhugra, European Psychiatric Association (EPA)

guidance on prevention of mental disorders, European Psychiatry, Volume 27,
Issue 2, February 2012, Pages 68-80, ISSN 0924-9338,
Abstract: There is considerable evidence that various psychiatric
conditions can be prevented through the implementation of effective
evidence-based interventions. Since a large proportion of lifetime mental
illness starts before adulthood, such interventions are particularly
important during childhood and adolescence. Prevention is important for the
sustainable reduction of the burden of mental disorder since once it has
arisen, treatment can only reduce a relatively small proportion of such
burden. The challenge for clinicians is to incorporate such interventions
into non-clinical and clinical practice as well as engaging with a range of
other service providers including public health. Similar strategies can be
employed in both the European and global contexts. Promotion of mental
well-being can prevent mental disorder but is also important in the
recovery from mental disorder. This guidance should be read in conjunction
with the EPA Guidance on Mental Health Promotion. This guidance draws on
preparatory work for the development of England policy on prevention of
mental disorder which used a wide range of sources.
Keywords: Prevention; Health promotion; Mental health; Mental illness

Michelle Dynes, Aminur Rahman, Diana Beck, Allisyn Moran, Anisur Rahman,
Jesmin Pervin, Mohammad Yunus, Md. Harunor Rashid, Tamanna Gazi, Kamal
Kanti Biswas, Sandra Buffington, Joan M. Patterson, Lynn Sibley, Home-based
life saving skills in Matlab, Bangladesh: a process evaluation of a
community-based maternal child health programme, Midwifery, Volume 27,
Issue 1, February 2011, Pages 15-22, ISSN 0266-6138,
Abstract: Objective
to conduct and describe results from a process evaluation of home-based
life saving skills (HBLSS) one year post-implementation.
a non-experimental, descriptive design was utilised employing both
qualitative and quantitative techniques for data collection including: (1)
key informant interviews, (2) group discussions, (3) performance testing,
and (4) review of programme data.
rural Matlab, Bangladesh in the sub-district of Chandpur.
41 community health research workers (CHRW), five pregnant women, 14
support persons and four programme co-ordinators.
HBLSS is a family-centred approach to improving recognition of and referral
for potentially life-threatening maternal and newborn complications. In
June 2007, four HBLSS meetings were implemented in Matlab by 41 CHRW with
all pregnant women in the study area.
(1) knowledge retention among CHRW, (2) programme coverage, and (3)
strengths and challenges in HBLSS implementation.
results revealed rapid integration of the programme into the Matlab
community with nearly 4500 HBLSS contacts with 2409 pregnant women between
15 June 2007 and 31 March 2008. Over 51% of pregnant women attended all
four HBLSS meetings. Knowledge testing of CHRW showed strong retention with
an increase in mean scores between immediate post-training and one-year
post-training (from 78.7% to 92.7% and from 77.8% to 97.7% for two
different HBLSS modules). Strengths of the HBLSS programme include high
satisfaction among pregnant women, dedication of CHRW to the community, and
strong organisation and supervision by programme staff. Challenges include
lack of involvement of men, loss of two master trainers, and limited access
to comprehensive emergency obstetric care at some referral sites.
Key conclusions
the HBLSS programme was successfully implemented as a result of the high
level of support and supervision by the maternal, newborn and child health
staff at ICDDR,B. This evaluation highlights the value of community health
workers in the fight against maternal and newborn mortality. Findings
emphasise the strength of the HBLSS training approach in transferring
knowledge from trainer to HBLSS guide.
Keywords: Pregnancy; Midwifery; Maternal; Newborn survival; HBLSS;
Community-based evaluation; Home-based life saving skills; Training of

, Position of the American Dietetic Association: Promoting and Supporting

Breastfeeding, Journal of the American Dietetic Association, Volume 109,
Issue 11, November 2009, Pages 1926-1942, ISSN 0002-8223,
Abstract: It is the position of the American Dietetic Association that
exclusive breastfeeding provides optimal nutrition and health protection
for the first 6 months of life and breastfeeding with complementary foods
from 6 months until at least 12 months of age is the ideal feeding pattern
for infants. Breastfeeding is an important public health strategy for
improving infant and child morbidity and mortality, improving maternal
morbidity, and helping to control health care costs. Breastfeeding is
associated with a reduced risk of otitis media, gastroenteritis,
respiratory illness, sudden infant death syndrome, necrotizing
enterocolitis, obesity, and hypertension. Breastfeeding is also associated
with improved maternal outcomes, including a reduced risk of breast and
ovarian cancer, type 2 diabetes, and postpartum depression. These
reductions in acute and chronic illness help to decrease health care-
related expenses and productive time lost from work. Overall breastfeeding
rates are increasing, yet disparities persist based on socioeconomic
status, maternal age, country of origin, and geographic location. Factors
such as hospital practices, knowledge, beliefs, and attitudes of mothers
and their families, and access to breastfeeding support can influence
initiation, duration, and exclusivity of breastfeeding. As experts in food
and nutrition throughout the life cycle, it is the responsibility of
registered dietitians and dietetic technicians, registered, to promote and
support breastfeeding for its short-term and long-term health benefits for
both mothers and infants.

Andr Lalonde, Prevention and treatment of postpartum hemorrhage in low-

resource settings, International Journal of Gynecology & Obstetrics,
Volume 117, Issue 2, May 2012, Pages 108-118, ISSN 0020-7292,

Joan L. Bottorff, John Oliffe, Cecilia Kalaw, Joanne Carey, Lawrence Mroz,
Men's constructions of smoking in the context of women's tobacco reduction
during pregnancy and postpartum, Social Science & Medicine, Volume 62,
Issue 12, June 2006, Pages 3096-3108, ISSN 0277-9536,
Abstract: Men's smoking is largely under-examined despite research that has
consistently linked partner smoking to pregnant women's smoking and smoking
relapse in the postpartum. An on-going qualitative study involving 31
couples in Canada exploring the influence of couple interactions on women's
tobacco reduction provided the opportunity to examine men's smoking in the
context of women's tobacco reduction or cessation during pregnancy and
postpartum. Individual open-ended interviews with 20 men who smoked were
conducted at 06 weeks following the birth of their infants and again at
1624 weeks postpartum. Constant comparative methods were used along with
social constructivist perspectives of fatherhood and gender to guide data
analysis and enhance theoretical sensitivity. Four themes emerged in men's
accounts of their tobacco use: (1) expressing masculinity through smoking,
(2) reconciling smoking as a family man, (3) losing the freedom to smoke,
and (4) resisting a smoke-less life. Men's reliance on and commitment to
dominant ideals of masculinity seemed to preclude them from viewing their
partner's tobacco reduction or cessation for pregnancy as an opportunity
for cessation. Expectant and new fathers who smoke, however, may be
optimally targeted for cessation interventions because it is a time when
men experience discomfort with their smoking and when discontinuities in
everyday life associated with the transition to fatherhood and presence of
a new baby provide opportunities for establishing new routines.
Implications for gender-sensitive smoking cessation interventions are
Keywords: Fathers; Masculinity; Smoking; Pregnancy; Infants; Tobacco
reduction; Canada

Lucia DAmbruoso, Peter Byass, Siti Nurul Qomariyah, Moctar Oudraogo, A

lost cause? Extending verbal autopsy to investigate biomedical and socio-
cultural causes of maternal death in Burkina Faso and Indonesia, Social
Science & Medicine, Volume 71, Issue 10, November 2010, Pages 1728-
1738, ISSN 0277-9536, 10.1016/j.socscimed.2010.05.023.
Abstract: Maternal mortality in developing countries is characterised by
disadvantage and exclusion. Women who die whilst pregnant are typically
poor and live in low-income and rural settings where access to quality care
is constrained and where deaths, within and outside hospitals, often go
unrecorded and unexamined. Verbal autopsy (VA) is an established method of
determining cause(s) of death for people who die outside health facilities
or without proper registration. This study extended VA to investigate
socio-cultural factors relevant to outcomes. Interviews were conducted with
relatives of 104 women who died during pregnancy, childbirth or postpartum
in two rural districts in Indonesia and for 70 women in a rural district in
Burkina Faso. Information was collected on medical signs and symptoms of
the women prior to death and an extended section collected accounts of care
pathways and opinions on preventability and cause of death. Illustrative
quantitative and qualitative analyses were performed and the implications
for health surveillance and planning were considered. The cause of death
profiles were similar in both settings with infectious diseases,
haemorrhage and malaria accounting for half the deaths. In both settings,
delays in seeking, reaching and receiving care were reported by more than
two-thirds of respondents. Relatives also provided information on their
experiences of the emergencies revealing culturally-derived systems of
explanation, causation and behaviour. Comparison of the qualitative and
quantitative results suggested that the quantified delays may have been
underestimated. The analysis suggests that broader empirical frameworks can
inform more complete health planning by situating medical conditions within
the socio-economic and cultural landscapes in which healthcare is situated
and sought. Utilising local knowledge, extended VA has potential to inform
the relative prioritisation of interventions that improve technical aspects
of life-saving services with those that address the conditions that
underlie health, for those whom services typically fail to reach.
Keywords: Maternal mortality; Verbal autopsy; Health planning; Burkina
Faso; Indonesia; Interdisciplinarity

Lynn Sibley, Theresa Ann Sipe, Marge Koblinsky, Does traditional birth
attendant training improve referral of women with obstetric complications:
a review of the evidence, Social Science & Medicine, Volume 59, Issue
8, October 2004, Pages 1757-1768, ISSN 0277-9536,
Abstract: This narrative and meta-analytic review of the effectiveness of
traditional birth attendant (TBA) training to improve access to skilled
birth attendance for obstetric emergencies produced mixed results. Among 16
studies that fit the inclusion criteria, there is a medium, positive, non-
significant association between training and TBA knowledge of risk factors
and conditions requiring referral; and small, positive, significant
associations between TBA referral behavior and maternal service use. These
results cannot be causally attributed to TBA training because of the
overall quality of studies; moreover, in several studies TBA training was a
component of integrated intervention packages.

The effort and expense of more rigorous research focusing on TBA training
to improve access to emergency obstetric care are difficult to justify. The
referral process is complex; the real effects of TBA training on TBA and
maternal behavior are likely to be small; and while the proportion of TBA-
attended births worldwide varies, it is, on average, quite low. The
behavioral determinants and logistical barriers to care seeking for
emergency obstetric care are generally well known. We suggest a more
promising research agenda would reposition the questions surrounding
referral into a broader ecological perspective.
Keywords: Traditional birth attendant training; Obstetric complications;
Emergency obstetric care; Safe motherhood; Referral system; Meta-analysis

F. Richard, C. Oudraogo, V. De Brouwere, Quality cesarean delivery in

Ouagadougou, Burkina Faso: A comprehensive approach, International Journal
of Gynecology & Obstetrics, Volume 103, Issue 3, December 2008, Pages
283-290, ISSN 0020-7292, 10.1016/j.ijgo.2008.08.008.
Abstract: Objective
To assess the effects of a comprehensive intervention (staff training,
equipment, internal clinical audits, cost sharing system, patients
providers meetings) in improving cesarean delivery access and quality in an
urban district of Burkina Faso.
We conducted a before-after study in the health district sector 30 in
Ouagadougou between 2003 and 2006. We measured cesarean delivery quality
(accessibility, diagnosis, procedure, postoperative follow-up) and maternal
and neonatal health in 1371 sections.
The number of cesarean deliveries performed increased each year, from 42 in
2003 to 630 in 2006. This increase happened without increase in maternal
and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006).
The cesarean delivery rate for women of the district increased from 1.9% to
3.3% of expected births between 2003 and 2005.
To improve access to quality cesarean delivery, we have shown that it was
necessary to have a systemic approach combining technical, operational,
sociocultural, and political factors.
Keywords: Cesarean delivery;; Quality of care;; Standards;; Obstetrics;;
Burkina Faso

L. Birch, N. Jones, P.M. Doyle, P. Green, A. McLaughlin, C. Champney, D.

Williams, K. Gibbon, K. Taylor, Obstetric skills drills: Evaluation of
teaching methods, Nurse Education Today, Volume 27, Issue 8, November 2007,
Pages 915-922, ISSN 0260-6917, 10.1016/j.nedt.2007.01.006.
Abstract: SummaryObjective
To determine the most effective method of delivering training to staff on
the management of an obstetric emergency.
The research was conducted in a District General Hospital in the UK,
delivering approximately 3500 women per year. Thirty-six staff, comprising
of junior and senior medical and midwifery staff were included as research
subjects. Each of the staff members were put into one of six multi-
professional teams. Effectively, this gave six teams, each comprising of
six members.
Three teaching methods were employed. Lecture based teaching (LBT),
simulation based teaching (SBT) or a combination of these two (LAS). Each
team of staff were randomly allocated to undertake a full day of training
in the management of Post Partum Haemorrhage utilising one of these three
teaching methods. Team knowledge and performance were assessed pre-
training, post training and at three months later. In addition to this
assessment of knowledge and performance, qualitative semi-structured
interviews were carried out with 50% of the original cohort one year after
the training, to explore anxiety, confidence, communication, knowledge
retention, enjoyment and transferable skills.
All teams improved in their performance and knowledge. The teams taught
using simulation only (SBT) were the only group to demonstrate sustained
improvement in clinical management of the case, confidence, communication
skills and knowledge. However, the study did not have enough power to reach
statistical significance. The SBT group reported transferable skills and
less anxiety in subsequent emergencies. SBT and LAS reported improved
multidisciplinary communication. Although tiring, the SBT was enjoyed the
Obstetrics is a high risk speciality, in which emergencies are to some
extent, inevitable. Training staff to manage these emergencies is a
fundamental principal of risk management. Traditional risk management
strategies based on incident reporting and event analysis are reactive and
not always effective. Simulation based training is an appropriate proactive
approach to reducing errors and risk in obstetrics, improving teamwork and
communication, whilst giving the student a multiplicity of transferable
skills to improve their performance.
Keywords: Postpartum haemorrhage; Skills drills; Emergency training;
Teaching methods; Teamwork; Simulation based training

Pulani Tlebere, Debra Jackson, Marian Loveday, Lyness Matizirofa,

Nomafrench Mbombo, Tanya Doherty, Alyssa Wigton, Latasha Treger, Mickey
Chopra, Community-Based Situation Analysis of Maternal and Neonatal Care in
South Africa to Explore Factors that Impact Utilization of Maternal Health
Services, Journal of Midwifery & Women's Health, Volume 52, Issue 4,
JulyAugust 2007, Pages 342-350, ISSN 1526-9523,
Abstract: This community situational analysis determined factors impacting
the utilization of maternal health services in South Africa. Quantitative
and qualitative research methods were used, including semistructured
household interviews, case studies of women with no antenatal care and/or
home birth, and verbal/social autopsies of maternal and infant deaths,
conducted in three diverse sites across the country. Data analysis used
quantitative statistics for the semistructured interviews and a qualitative
thematic content approach for the case studies and verbal/social autopsies.
Each component was analyzed separately and then triangulated. The following
themes emerged: 1) transport and distance to care were the biggest
problems, particularly in rural areas; 2) providers communication with
families was very poor; 3) health-seeking behavior was better than
anticipated; 4) treatment by health providers and quality of care showed
mixed results; 5) HIV/AIDS is a major issue; however, basic maternity and
neonatal service quality cannot be overlooked; and 6) families and
communities are an untapped resource for improving maternal and neonatal
health. Implications for maternal and infant health care in developing
countries are discussed, with a particular focus on barriers to utilization
and involvement of communities and families in maternity care.
Keywords: HIV/AIDS; infant mortality; maternity care; maternal mortality;
neonatal follow-up; postpartum care; situation analysis; utilization of
health services; verbal autopsy

Kimberly D. Gregory, Clark T. Johnson, Timothy R.B. Johnson, Stephen S.

Entman, The content of prenatal care: Update 2005, Women's Health Issues,
Volume 16, Issue 4, JulyAugust 2006, Pages 198-215, ISSN 1049-3867,
Abstract: Introduction
The Content of Prenatal Care report of the US Preventative Health Service
(USPHS) Expert Panel established an important benchmark when published in
1989, but has not been significantly updated since that time.
The literature since 1989 is reviewed to assess which recommendations have
been validated and/or implemented. Additionally, new findings that support
the recommendations put forth or expand the scope of prenatal care outlined
in the 1989 report are examined and discussed.
The USPHS recommendation of a reduced prenatal visit schedule has support,
and new content for the preconception visit has been identified, although
this preconception visit has not been validated or widely implemented.
We identified new opportunities and initiatives for the content of prenatal
care, particularly improvement in the electronic medical record, attention
to multidisciplinary approaches to patient education and improved patient
literacy, and an extended maternal life span approach, including
postgestation visits.

Pamela Andreatta, Domatilla Debpuur, Abraham Danquah, Joseph Perosky, Using

cell phones to collect postpartum hemorrhage outcome data in rural Ghana,
International Journal of Gynecology & Obstetrics, Volume 113, Issue 2,
May 2011, Pages 148-151, ISSN 0020-7292, 10.1016/j.ijgo.2010.11.020.
Abstract: Objective
To evaluate the use of cell phones by professional and traditional birth
attendants in rural Africa for reporting postpartum hemorrhage (PPH) data.
Ten birth attendants from the remote Sene District of Ghana participated in
the study. Subjects were trained to send Short Message Service text
messages from cell phones using a simple numeric protocol to report data
regarding PPH: maternal age; PPH; use of bimanual uterine compression;
maternal and neonatal mortality; and prenatal care. Participants sent texts
to a pre-programmed number to report data for all births they attended over
a 90-day period.
In total, 425 births and 13 (3.1%) cases of PPH were reported during the
90-day period after training. All attendants followed the reporting
protocol correctly, although with uncertain data integrity.
The results indicate that it is possible to train professional and
traditional birth attendants to use cell phones to report health-related
outcome data via a specified protocol. Reporting from rural-based providers
may present a more accurate picture of what occurs in remote communities
because it happens in real time. These findings could be exportable to
other program evaluation or population-monitoring applications (healthcare
and other) where rural outcome tracking is necessary.
Keywords: Cell phones; Field research; Health services networks;
Information and communication technologies; M-health; Rural health

Nicola A Conners, Patti Bokony, Leanne Whiteside-Mansell, Robert H Bradley,

Jeffrey Liu, Addressing the treatment needs of children affected by
maternal addiction: challenges and solutions, Evaluation and Program
Planning, Volume 27, Issue 2, May 2004, Pages 241-247, ISSN 0149-7189,
Abstract: This paper examines treatment needs of the children of women
served in the Center for Substance Abuse Treatment's Residential Women and
Children and Pregnant and Postpartum Women (RWC/PPW) program. It integrates
statistical information from CSAT's cross-site evaluation of the program
and clinical insights obtained from one RWC treatment site, the Arkansas
CARES project. The cross-site data provide broad-based information about
the extent to which clients' children experience various risk factors,
while the project data provide concrete information about major
administrative and clinical challenges to the provision of needed child
services in a parent-focused residential treatment setting. Data from both
perspectives suggest that many children admitted into residential treatment
with their mothers need an array of long-term supportive services,
requiring a new focus and a commitment of resources from substance abuse
treatment providers.
Keywords: Residential treatment; Children; Substance abuse; Comprehensive
care; Risk factors

Kim Yiong Wee, Helen Skouteris, Ciaran Pier, Ben Richardson, Jeannette
Milgrom, Correlates of ante- and postnatal depression in fathers: A
systematic review, Journal of Affective Disorders, Volume 130, Issue 3, May
2011, Pages 358-377, ISSN 0165-0327, 10.1016/j.jad.2010.06.019.
Abstract: Background
Contemporary research findings suggest that depression during the ante- and
postnatal periods is a significant problem not only for women but also for
many men. This paper provides a conceptual and methodological review of the
literature on cross-sectional and prospective correlates of depressive
symptoms in men during both pregnancy and the postpartum period.
The search, via several electronic databases, was limited to English papers
published between January 1996 and August 2009, and identified 30 relevant
The most common correlate of paternal depressive symptoms pre- and post
birth was having a partner with elevated depressive symptoms or depression;
poor relationship satisfaction was also frequently associated with elevated
depressive symptoms or depression in men.
There were significant methodological limitations of existing studies,
including small sample sizes; the use of cross-sectional designs; varied
measures of depression; focus on depression in the postpartum only; and in
the few longitudinal gestational studies, the inclusion of only one
assessment point. The limitations of the current systematic review include
the inclusion of only papers written in English and potential publication
bias, where studies with null findings are less likely to be published.
The scientific study of predictors of men's depressive symptoms pre and
post birth remains in its infancy. Given the implications of clinical
depression in men both during the gestational and postpartum periods,
further systematic investigation of direct and indirect predictors of
elevated depressive symptoms in men during this time is warranted.
Keywords: Father; Men; Antenatal depression; Postnatal depression;
Pregnancy; Postpartum

Carol Henshaw, Psychological and social approaches to treatment,

Psychiatry, Volume 8, Issue 1, January 2009, Pages 28-32, ISSN 1476-1793,
Abstract: Psychological and social interventions can be used singly or as
adjuncts to drug treatment in a variety of settings. Health visitor
counselling is effective; its acceptability depends on the quality of the
relationship with the health visitor. Individual psychotherapies such as
cognitive behavioural therapy and interpersonal psychotherapy are effective
and, like some other interventions, can be given in a group setting. They
can be adapted to treat women with other disorders, for instance anxiety
and obsessivecompulsive disorder, and pregnant women. Interventions may be
delivered in the home or in a day-hospital setting. Mental health services
should relate to maternity care and primary care professionals, and to the
voluntary sector (which provides and meets the needs of both mothers and
fathers), and refer women with severe disorders to specialist perinatal
mental health services. Services should ensure that they meet the needs of
any minority communities in their area, including migrants, asylum seekers,
and refugees.
Keywords: counselling; health visitors; postnatal or postpartum depression;
psychological interventions; psychotherapy; social interventions

Lisa D. Lieberman, Overview of substance abuse prevention and treatment

approaches in urban, multicultural settings: the center for substance abuse
prevention programs for pregnant and postpartum women and their infants,
Women's Health Issues, Volume 8, Issue 4, JulyAugust 1998, Pages 208-217,
ISSN 1049-3867, 10.1016/S1049-3867(98)00010-3.
Samiye Mete, Kerziban Yenal, Hlya Okumu, An Investigation into
Breastfeeding Characteristics of Mothers Attending Childbirth Education
Classes, Asian Nursing Research, Volume 4, Issue 4, December 2010, Pages
216-226, ISSN 1976-1317, 10.1016/S1976-1317(11)60006-6.
Abstract: Purpose
This paper is a report of a study of the effects of breastfeeding education
on the breastfeeding success and breastfeeding characteristics of mothers
in a Turkish context.
The research was designed as quasi-experimental. The sample consisted of 93
mothers who participated in (n = 46) and did not participate in childbirth
education classes (n= 47). The date was collected between 2005 and 2007.
The childbirth education class comprised 16 hours in total. Two hours of
this class involved breastfeeding education. The course was carried out
with the principles of adult education principles. Data on mothers'
breastfeeding were collected in the sixth week postpartum.
The majority of the mothers (63.4%) were university graduates. No
difference was found between breastfeeding frequency in the control and
experimental groups and starting supplemental food. It was found that 80.4%
of the women in the experimental group breastfed in line with the
techniques. This rate was found to be 48.9% in the control group. It was
documented that the first breastfeeding times were earlier in the
experimental group, their babies slept longer after being fed, their
perceived spouse support was higher, and had even higher perceived
breastfeeding success.
On the basis of the study results it could be argued that attending
childbirth preparation class with the husband has a positive effect over
breastfeeding. Childbirth education classes will greatly contribute to the
health of the society by affecting breastfeeding positively.
Keywords: breastfeeding; childbirth; education; nursing; Turkey

Kristen F. Bean, Differential ratings of and maternal impact on anxiety and

depression among African American children in special education, Children
and Youth Services Review, Available online 2 June 2012, ISSN 0190-7409,
Abstract: African American children are overrepresented in special
education based on diagnoses of internalizing behaviors, such as anxiety
and depression. Differential ratings of depression and anxiety between
self-report and children's mothers and teachers have caused skepticism
around the accuracy of teachers' ratings of signs and symptoms of anxiety
and depression among African American children. If African American
children are truly suffering from disproportionate rates of anxiety and
depression, prevention and intervention efforts should be targeted to
improve their mental health. According to the ecological systems theory and
the social cognitive theory, children's mental health development is
impacted by their environments and efficacy beliefs. This study aimed to
see if teachers, mothers, and African American children in special
education rate internalizing behaviors of children differently and to
understand what factors impact these behaviors among African American
children in special education. A secondary data analysis of a sample of 126
African American children in special education found that children's self-
report of internalizing behaviors was significantly higher than mothers'
and teachers' ratings of African American children's internalizing
behaviors. Higher reports of mothers' mastery were associated with fewer
internalizing behaviors of African American children in special education.
In addition, African American girls were more likely to experience anxiety
and depression than boys. There was not a statistically significant
relationship between children's environment, receipt of the NurseFamily
Partnership intervention, and their internalizing behaviors.
Keywords: African American children; Internalizing behavior; Anxiety;
Depression; Special education; Disability

Rebecca Reay, Stephen Matthey, David Ellwood, Maureen Scott, Long-term

outcomes of participants in a perinatal depression early detection program,
Journal of Affective Disorders, Volume 129, Issues 13, March 2011, Pages
94-103, ISSN 0165-0327, 10.1016/j.jad.2010.07.035.
Abstract: Background
Long-term follow-up studies are required to better understand the extent of
the effectiveness of early detection programs for perinatal depression. We
followed up participants in such a program to investigate the long-term
depression, treatment and relationship outcomes of mothers originally
identified as probably depressed (screened positive).
At 2 years postpartum all participants who had screened positive
(N = 159) and a random sample of participants who had screened
negative were invited to participate in a mailed survey. Measures
included: current mood; coping; access to treatment; quality of partner
relationship; and motherinfant bonding.
Mothers originally detected as probably depressed (n = 98) fared
significantly worse than screened negative mothers (n = 101)
both in terms of their higher mean depression scores (EPDS:
Ms = 11.0 vs. 6.4) and greater proportions categorised as
probably depressed at 2 years postpartum (40% vs. 11% respectively,
p < .001, phi = .33). Elevated depression symptoms
at 2 years postpartum were associated with poorer partner
relationships and motherinfant bonding. Moreover, there appears to be a
double dose effect for women who screen positive on two occasions. Thirty-
seven percent of depressed mothers did not take up treatment, frequently
citing a preference for using their own resources.
Limitations include the use of self-report measures to assess depression
symptoms and motherinfant bonding. Treatment data was collected
Despite being offered treatment options, a substantial proportion of women
who screened positive had poor long-term mental health and relationship
outcomes. This paper discusses some of the implications for perinatal early
detection and treatment programs.
Keywords: Perinatal; Screening; Postnatal depression; Postpartum; Maternal
bonding; Partner

Jan Brunson, Confronting maternal mortality, controlling birth in Nepal:

The gendered politics of receiving biomedical care at birth, Social Science
& Medicine, Volume 71, Issue 10, November 2010, Pages 1719-1727, ISSN
0277-9536, 10.1016/j.socscimed.2010.06.013.
Abstract: One way of reducing maternal mortality in developing countries is
to ensure that women have a referral system at the local level that
includes access to emergency obstetric care. Using a 13-month ethnographic
study from 2003 to 2005 of womens social positions and maternal health in
a semi-urban community of Hindu-caste women in the Kathmandu Valley, this
paper identifies impediments to receiving obstetric care in a context where
the infrastructure and services are in place. As birth in Nepal
predominantly takes place at home, this paper identifies the following
areas for potential improvement in order to avoid the loss of womens lives
during childbirth: the frequency of giving birth unaided, minimal planning
for birth or obstetric complications, and delayed responses at the
household level to obstetric emergencies. Focusing particularly on the last
item, this study concludes that women do not have the power to demand
biomedical services or emergency care, and men still viewed birth as the
domain of women and remained mostly uninvolved in the process. As the
cultural construction of birth shifts from a natural phenomenon that did
not require human regulation toward one that is located within the domain
of biomedical expertise and control, local acceptance of a biomedical model
does not necessarily lead to the utilization of services if neither women
nor men are in a culturally-defined position to act.
Keywords: Nepal; Gender; Maternal health care; Childbirth loss; Birth;
Obstetric emergencies; Medicalization; Women

Farideh Bastani, Alireza Hidarnia, Anoshirvan Kazemnejad, Maryam Vafaei,

Maryam Kashanian, A Randomized Controlled Trial of the Effects of Applied
Relaxation Training on Reducing Anxiety and Perceived Stress in Pregnant
Women, Journal of Midwifery & Women's Health, Volume 50, Issue 4, July
August 2005, Pages e36-e40, ISSN 1526-9523, 10.1016/j.jmwh.2004.11.008.
Abstract: The purpose of this study was to investigate the effect of
applied relaxation training on reducing anxiety and perceived stress among
pregnant women. A randomized controlled trial with a prospective pretest-
posttest experimental design was used. One hundred ten primigravid women
(mean age = 23.8 years) in their second trimester (mean of gestational age
= 17.8 weeks) were randomly assigned into experimental and control groups.
The experimental group received routine prenatal care with applied
relaxation training, and the control group received only routine prenatal
care. State/trait anxiety was measured with the Spielberger State-Trait
Anxiety Inventory, and perceived stress was measured with the Cohen
Perceived Stress Scale. There were significant reductions in state/trait
anxiety and perceived stress for the experimental group compared with the
control group after the intervention. The findings suggest beneficial
effects of relaxation on reducing anxiety and perceived stress in pregnant
women. Teaching relaxation techniques could serve as a resource for
improving maternal psychological health.
Keywords: anxiety; stress; pregnancy; relaxation

Anna L. Papero, Is early, high-quality daycare an asset for the children of

low-income, depressed mothers?, Developmental Review, Volume 25, Issue 2,
June 2005, Pages 181-211, ISSN 0273-2297, 10.1016/j.dr.2004.10.001.
Abstract: This paper reviews the relations found in the literature among
poverty, maternal depression, early intervention, and child developmental
outcome and a theoretical model is suggested. Motherchild transactional
processes have been found to be impaired under conditions of poverty and
maternal depression, leading to non-optimal outcomes in children. The first
2 years of life are particularly sensitive to deficits in parenting,
suggesting that effective intervention might appropriately target this age
group. High-quality daycare may offer an effective pathway for intervention
with depressed mothers and their children due to the compensatory
caregiving children receive and the opportunity for early identification of
maternal mental health needs. However, most current daycare intervention
programs are designed to begin between 3 or 4 years of age. Further
research that addresses the relative efficacy of interventions dependent on
age of entry is needed to determine whether early daycare is an asset to
families with a depressed caregiver.

J.E. Taylor, Life-saving skills training for midwives: report on the

Ghanaian experience, International Journal of Gynecology & Obstetrics,
Volume 38, Supplement, 1992, Pages S41-S43, ISSN 0020-7292, 10.1016/0020-
Abstract: The shortage of rural-based physicians in Ghana has led to a
decision to provide short term courses to rural midwives on the treatment
of those obstetric conditions that are the main causes of maternal
mortality. A description of this ongoing training is provided.
Keywords: Midwifery training; Maternal mortality

Cynthia J. Berg, From Identification and Review to ActionMaternal

Mortality Review in the United States, Seminars in Perinatology, Volume 36,
Issue 1, February 2012, Pages 7-13, ISSN 0146-0005,
Abstract: The maternal mortality review process is an ongoing quality
improvement cycle with 5 steps: identification of maternal deaths,
collection of medical and other data on the events surrounding the death,
review and synthesis of the data to identify potentially alterable factors,
the development and implementation of interventions to decrease the risk of
future deaths, and evaluation of the results. The most important step is
utilization of the data to identify and implement evidence-based actions;
without this step, the rest of the work will not have an impact. The review
committee ideally is based in the health department of a state (or large
city) as a core public health function. This provides stability for the
process as well as facilitates implementation of the review committees'
recommendations. The review committee should be multidisciplinary, with its
members being official representatives of their organizations or
departments, again to improve buy-in of the stakeholders.
Keywords: maternal mortality; audit; surveillance

Jerker Liljestrand, Mean Reatanak Sambath, Socio-economic improvements and

health system strengthening of maternity care are contributing to maternal
mortality reduction in Cambodia, Reproductive Health Matters, Volume 20,
Issue 39, June 2012, Pages 62-72, ISSN 0968-8080, 10.1016/S0968-
Abstract: Maternal mortality has been falling significantly in Cambodia
since 2005 though it had been stagnant for at least 15 years before that.
This paper analyzes the evolution of some major societal and health system
factors based on recent national and international reports. The maternal
mortality ratio fell from 472 per 100,000 live births in 20002005 to 206
in 20062010. Background factors have included peace and stability,
economic growth and poverty reduction, improved primary education,
especially for girls, improved roads, improved access to information on
health and health services via TV, radio and cellphones, and increased
ability to communicate with and within the health system. Specific health
system improvements include a rapid increase in facility-based births and
skilled birth attendance, notably investment in midwifery training and
numbers of midwives providing antenatal care and deliveries within an
expanding primary health care network, a monetary incentive for facility-
based midwives for every live birth conducted, and an expanding system of
health equity funds, making health care free of cost for poor people.
Several major challenges remain, including post-partum care, family
planning, prevention and treatment of breast and cervical cancer, and
addressing sexual violence against women, which need the same priority
attention as maternity care.
Keywords: maternal mortality; maternity care; midwifery; human resources;
health system strengthening; economic and social development;
communications; Cambodia
Brenda Dobson, Maureen A Murtaugh, Position of the American Dietetic
Association: Breaking the Barriers to Breastfeeding, Journal of the
American Dietetic Association, Volume 101, Issue 10, October 2001, Pages
1213-1220, ISSN 0002-8223, 10.1016/S0002-8223(01)00298-X.
Abstract: It is the position of the American Dietetic Association (ADA)
that broad-based efforts are needed to break the barriers to breastfeeding
initiation and duration. Exclusive breastfeeding for 6 months and
breastfeeding with complementary foods for at least 12 months is the ideal
feeding pattern for infants. Increases in initiation and duration are
needed to realize the health, nutritional, immunological, psychological,
economical, and environmental benefits of breastfeeding. Breastfeeding
initiation rates have increased, but cultural barriers to breastfeeding,
especially against breastfeeding for 6 months and longer, still exist. Gaps
in rates of breastfeeding based on age, race, and socioeco-nomic status
remain. Children benefit from the biologically unique properties of human
milk including protection from illness with resulting economic benefits.
Mother's benefits include reduced rates of premenopausal breast and ovarian
cancers. Appropriate lactation management is a critical component of
successful breastfeeding for healthy women. Lactation support and
management is even more important in women and children with special needs
caused by physical or developmental disability, disease, or limited
resources. Dietetics professionals have a responsibility to support
breastfeeding through appropriate education and training, advocacy, and
legislative action; through collaboration with other professional groups;
and through research to eliminate the barriers to breastfeeding.

Rima Azar, Daniel Paquette, Mark Zoccolillo, Franziska Baltzer, Richard E.

Tremblay, The Association of Major Depression, Conduct Disorder, and
Maternal Overcontrol with a Failure to Show a Cortisol Buffered Response in
4-Month-Old Infants of Teenage Mothers, Biological Psychiatry, Volume 62,
Issue 6, 15 September 2007, Pages 573-579, ISSN 0006-3223,
Abstract: Background
Adolescent pregnancy can be associated with major depression (MD) and
conduct disorder (CD). Some infants of adolescent mothers are prenatally
exposed to these factors, which may result in heightened risk for
perturbations of their stress systems. Between 2 and 4 months, a normal
shift occurs in the adrenocortical system in which we observe a marked
decrease in infant cortisol response when facing mild stressors. This study
aimed to explore whether MD (lifetime, during pregnancy, postpartum), CD,
and maternal overcontrol are associated with increased cortisol reactivity
in 4-month-old infants of teenage mothers.
Using arm restraint as a stressor, morning salivary cortisol was taken
prestressor and poststressor in 212 infants during a laboratory visit.
Major depression and CD were measured with the computerized National
Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS),
postpartum depressive mood was measured with the Edinburgh Postnatal
Depression Scale, and overcontrol was observed with the CARE-Index.
Independent of the predictors, there was a dampened cortisol response.
Infants of mothers with lifetime MD and of average to highly
overcontrolling mothers showed increased cortisol reactivity. Conduct
disorder and cortisol levels were not associated.
Future studies should detect whether the absence of a dampened cortisol
response in infants whose mothers have lifetime MD or display
overcontrolling parenting is stable over time.
Keywords: Conduct disorder; infant cortisol; major depression; maternal

Donna Karl, Maternal responsiveness of socially high-risk mothers to the

elicitation cues of their 7-month-old infants, Journal of Pediatric
Nursing, Volume 10, Issue 4, August 1995, Pages 254-263, ISSN 0882-5963,
Abstract: This descriptive study of 19 socially high-risk mother-infant
dyads in naturalistic interaction focused on maternal response to infant
elicitation cues. Maternal response behavior was coded on a continuum from
underresponsive to adequate to overresponsive. Maternal affect was rated
separately using selected items from an existing scale. As a whole, the
maternal sample was emotionally depressed and largely underresponsive to
infant cues. When placed by maternal response into adequate,
overresponsive, and underresponsive subgroups, adequate mothers more often
responded appropriately to infant cues, were never physically unavailable
to their infants, showed no anxiety, and were more positively responsive to
their infants' smiles and cries. Adequate mothers scored higher in all
affective areas. Maternal depression was associated with both overresponse
and underresponse. Angry maternal mood was significantly related to
underresponse. Considerable maternal strength lies in this high-risk sample
and could be the basis for therapeutic intervention to normalize parenting.

Yoko Yamamoto, Susan D. Holloway, Sawako Suzuki, Maternal involvement in

preschool children's education in Japan: Relation to parenting beliefs and
socioeconomic status, Early Childhood Research Quarterly, Volume 21, Issue
3, 3rd Quarter 2006, Pages 332-346, ISSN 0885-2006,
Abstract: Studies conducted in the US consistently demonstrate that
parenting self-efficacy and construction of the parent role are critical
elements associated with parents involvement in their children's
elementary school education. Less is known about the dynamics of parent
involvement during the preschool period, or in nations outside the US. This
study examined the relation of maternal beliefs and family SES to three
dimensions of parent involvement in Japan: preschool selection strategies,
engagement in reading at home, and involvement in activities at the
preschool. Interview and questionnaire data were obtained from 108 Japanese
mothers, all of whom had a child in the last year of preschool. Consistent
with theory and findings in the US, parenting self-efficacy and family role
construction were associated with Japanese mothers strategies for
selecting preschools and frequency of engaging in home reading. Findings
regarding family SES demonstrated a culturally specific pattern; mothers of
higher SES background were more likely to access formal sources of
information and to engage in daily home reading but less likely to
participate at the school site.
Keywords: Parent involvement; Parenting self-efficacy; Maternal role;
Preschool; Japan; Early literacy; Socioeconomic status

Jeanne-Marie Guise, Anticipating and responding to obstetric emergencies,

Best Practice & Research Clinical Obstetrics & Gynaecology, Volume
21, Issue 4, August 2007, Pages 625-638, ISSN 1521-6934,
Abstract: During the last 10 years, international attention has focused on
the importance of medical errors and patient safety. When obstetric
emergencies occur, effective and efficient care is essential for good
outcome and safety. This chapter presents a framework for obstetric safety,
reviews the impact of obstetric emergencies on global health, and discusses
possible interventions to improve the anticipation of and responses to
obstetric emergencies.
Keywords: patient safety; obstetric emergencies; obstetric delivery;
pregnancy; simulation; human factors; medical errors

Stephen N. Wall, Anne C.C. Lee, Waldemar Carlo, Robert Goldenberg, Susan
Niermeyer, Gary L. Darmstadt, William Keenan, Zulfiqar A. Bhutta, Jeffrey
Perlman, Joy E. Lawn, Reducing Intrapartum-Related Neonatal Deaths in Low-
and Middle-Income CountriesWhat Works?, Seminars in Perinatology, Volume
34, Issue 6, December 2010, Pages 395-407, ISSN 0146-0005,
Abstract: Each year, 814,000 neonatal deaths and 1.02 million stillbirths
result from intrapartum-related causes, such as intrauterine hypoxia.
Almost all of these deaths are in low- and middle-income countries, where
women frequently lack access to quality perinatal care and may delay care-
seeking. Approximately 60 million annual births occur outside of health
facilities, and most of these childbirths are without a skilled birth
attendant. Conditions that increase the risk of intrauterine hypoxiasuch
as pre-eclampsia/eclampsia, obstructed labor, and low birth weightare
often more prevalent in low resource settings. Intrapartum-related neonatal
deaths can be averted by a range of interventions that prevent intrapartum
complications (eg, prevention and management of pre-eclampsia), detect and
manage intrapartum problems (eg, monitoring progress of labor with access
to emergency obstetrical care), and identify and assist the nonbreathing
newborn (eg, stimulation and bag-mask ventilation). Simple, affordable, and
effective approaches are available for low-resource settings, including
community-based strategies to increase skilled birth attendance, partograph
use by frontline health workers linked to emergency obstetrical care
services, task shifting to increase access to Cesarean delivery, and
simplified neonatal resuscitation training (Helping Babies BreatheSM).
Coverage of effective interventions is low, however, and many opportunities
are missed to provide quality care within existing health systems. In sub-
Saharan Africa, recent health services assessments found only 15% of
hospitals equipped to provide basic neonatal resuscitation. In the short
term, intrapartum-related neonatal deaths can be substantially reduced by
improving the quality of services for all childbirths that occur in health
facilities, identifying and addressing the missed opportunities to provide
effective interventions to those who seek facility-based care. For example,
providing neonatal resuscitation for 90% of deliveries currently taking
place in health facilities would save more than 93,000 newborn lives each
year. Longer-term strategies must address the gaps in coverage of
institutional delivery, skilled birth attendance, and quality by
strengthening health systems, increasing demand for care, and improving
community-based services. Both short- and long-term strategies to reduce
intrapartum-related mortality should focus on reducing inequities in
coverage and quality of obstetrical and perinatal care.
Keywords: neonatal mortality; intrapartum; birth asphyxia; developing
countries; stillbirths; emergency obstetrical care; neonatal resuscitation

Thalia Dragonas, George N Christodoulou, PRENATAL CARE, Clinical Psychology

Review, Volume 18, Issue 2, March 1998, Pages 127-142, ISSN 0272-7358,
Abstract: This paper describes the psychological and psychosocial aspects
of prenatal care, which are believed to be of particular importance for
medical/psychological practice. The emotional changes that normally take
place during pregnancy are surveyed and evidence is provided linking these
changes with potential adverse effect on pregnancy and labour. The salience
of anxiety and life stresses in pregnancy research is highlighted as well
as their intricate inverse relationship with social support. Antenatal
classes are offered as an example of social support provision. The
different kinds of such classes and evaluation of their effectiveness are
briefly presented, as well as a number of controlled trials of enhanced
support during pregnancy. Finally, the effect provision of prenatal care
has on women as well as their role in their own care are raised. The need
is stressed for further sophisticated longitudinal and multivariate
research exploring further the causative links between quality of prenatal
care, pregnancy outcome, and subsequent child development.

Barbara E. Kwast, Reduction of maternal and perinatal mortality in rural

and peri-urban settings: what works?, European Journal of Obstetrics &
Gynecology and Reproductive Biology, Volume 69, Issue 1, October 1996,
Pages 47-53, ISSN 0301-2115, 10.1016/0301-2115(95)02535-9.
Abstract: The purpose of this article is two-fold: (i) to lay out
conceptual frameworks for programming in the fields of maternal and
neonatal health for the reduction of maternal and peri/neonatal mortality;
(ii) to describe selected MotherCare demonstration projects in the first 5
years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria.
In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's
groups in remote rural villages in the Andean mountains. Through a
participatory research process, the autodiagnosis, actions identified by
women's groups included among others: provision of family planning through
a local non-governmental organization (NGO), training of community birth
attendants, income generating projects. In Quetzaltenango, Guatemala,
access was improved through training of traditional birth attendants (TBAs)
in timely recognition and referral of pregnancy/delivery/neonatal
complications, while quality of care in health facilities was improved
through modifying health professionals' attitude towards TBAs and clients,
and implementation of management protocols. In Indonesia, the University of
Padjadjaran addressed issues of referral and emergency obstetric care in
the West-Java subdistrict of Tanjunsari. Birthing homes with radios were
established in ten of the 27 villages in the district, where trained
nurse/midwives provided maternity care on a regular basis. In Nigeria
professional midwives were trained in interpersonal communication and
lifesaving obstetric skills, while referral hospitals were refurbished and
equipped. While reduction in maternal mortality after such a short
implementation period is difficult to demonstrate, all projects showed
improvements in referral and in reduction in perinatal mortality.
Keywords: Maternal mortality; Perinatal mortality; Safe Motherhood
programmes; Traditional birth attendants (TBAs)

Janet Molzan Turan, Hacer Nalbant, Ayen Bulut, Yusuf Sahip, Including
expectant fathers in antenatal education programmes in Istanbul, Turkey,
Reproductive Health Matters, Volume 9, Issue 18, November 2001, Pages 114-
125, ISSN 0968-8080, 10.1016/S0968-8080(01)90098-9.
Abstract: In this article we present the results of three studies
investigating methods for including men in antenatal education in Istanbul,
Turkey. Participants were first-time expectant parents living in low and
middle-income areas. After a formative study on the roles of various family
members in health during the period surrounding a first birth, an
antenatal-clinic-based education programme for women and for couples was
carried out as a randomised, controlled study. Based on the results,
separate community-based antenatal education programmes for expectant
mothers and expectant fathers were tested. There was demand among many
pregnant women and some of their husbands for including expectant fathers
in antenatal education. In the short term, these programmes seemed to have
positive effects on women and men's reproductive health knowledge,
attitudes and behaviours. In the clinic-based programme the positive
effects of including men were mainly in the area of post-partum family
planning, while in the community-based programme positive effects among men
were also seen in the areas of infant health, infant feeding and spousal
communication and support. Free an tenatal education should be made
available to all expectant mothers and when possible, men should be
included, either together with their wives or in a culture such as that of
Turkey, in separate groups.
Keywords: maternal and child health; antenatal education; male involvement;
community-based programmes; Turkey

Gabriela Gonzlez-Mariscal, Pascal Poindron, 3 - Parental Care in Mammals:

Immediate Internal and Sensory Factors of Control, In: Donald W. Pfaff,
Arthur P. Arnold, Susan E. Fahrbach, Anne M. Etgen and Robert T. Rubin,
Editor(s), Hormones, Brain and Behavior, Academic Press, San Diego, 2002,
Pages 215-298, ISBN 9780125321044, 10.1016/B978-012532104-4/50005-6.
Abstract: The strategies by which animals succeed in reproducing and
spreading their genes vary greatly across species. Whereas those using the
r strategy (or opportunistic breeders) tend to produce many small
offspring in a short time, K breeders (also called stable species)
produce fewer but larger offspring at longer intervals. There are numerous
internal and environmental factors that influence the type of reproductive
strategy that a species will develop. Overall, mammals tend to be K
breeders: They generally show a relatively long gestation period and give
birth to few neonates of reasonable wieght compared to the adult (May and
Rubenstein, 1984). Nonetheless, within this range, striking differences
exist: Some species produce in a single reproductive cycle more young than
others do in a lifetime (e.g., rodents versus most large herbivores and
primates). In other words, some mammalian species tend to show r
reproductive strategies. The degree of maturity of the offspring also
varies greatly, from a rather underdeveloped larva (marsupials) to a fully
developed young, able to follow its dam within less than an hour after
birth (ungulates). Given this extraordinary variation in the
characteristics of the neonate, it is not surprising that selective
pressure by ultimate factors (i.e., those ensuring the successful
transmission of the parent's genes) has resulted in a remarkable
diversification in the patterns of parental care in mammals (Section II).

Rebecca S Black, Peter Brocklehurst, A systematic review of training in

acute obstetric emergencies, BJOG: An International Journal of Obstetrics
and Gynaecology, Volume 110, Issue 9, September 2003, Pages 837-841, ISSN
1470-0328, 10.1016/S1470-0328(03)02488-1.
Abstract: Objective
To describe models used for the training of labour ward personnel in acute
obstetric emergencies and to describe how these models have been evaluated
and compared.
A systematic review of the following databases: Medline, the Cumulative
Index of Nursing and Allied Health Literature, Embase, PsycLit, Allied and
Alternative Medicine, Education Resources Information Center and the
Cochrane Library using a structured search strategy.
Labour ward.
Population or Sample
Labour ward personnel.
Inclusion criteria
All papers that described or evaluated any form of drill or training in
acute obstetric emergencies involving any personnel in a labour ward
environment were included. Descriptions of training in developing countries
were excluded.
Papers were classified as editorials or commentaries, papers describing a
training programme or papers evaluating a training method. A data
collection form was used to extract relevant information by two
investigators independently.
Main outcome measure
Description of training models.
Of 44 relevant papers, 22 were classed as editorials or commentaries. Six
descriptions of training programmes were found and four papers involved an
evaluation of such programmes. All evaluations involved the use of
questionnaires to course participants. No studies comparing one form of
training with another were found.
With regard to training in acute obstetric emergencies, few training
programmes have been described, and even fewer have been evaluated.
Training methods need to be developed, described and evaluated; further
well-conducted research for this important intervention is urgently

Barbara E. Kwast, Quality of care in reproductive health programmes:

Monitoring and evaluation of quality improvement, Midwifery, Volume 14,
Issue 4, December 1998, Pages 199-206, ISSN 0266-6138, 10.1016/S0266-
Abstract: As 200 million women become pregnant every year, at least 30
million will develop life-threatening complications requiring emergency
treatment at any level of society where they live. But it is a basic human
right that pregnancy be made safe for all women as complications are mostly
unpredictable. This requires reproductive health programmes which are
responsive to women's and their families' needs and expectations on the one
hand and enhancement of community participation, high quality obstetric
services, and both provider collaboration and satisfaction on the other.

Monitoring and evaluation of these facets need to be an integral part of

any safe motherhood programme, not only to assess progress, but also to use
this information for subsequent planning and implementation cycles of
national programmes. Lessons learned from ten years' implementation of Safe
Motherhood programmes indicate that process and outcome indicators are more
feasible for short-term evaluation purposes than impact indicators, such as
maternal mortality reduction. The former are described in this paper with
relevant country examples.

This is the third, and last, article in a series on quality of care in

reproductive health programmes. The first (Kwast 1998a) contains an
overview of concepts, assessments, barriers and improvements of quality of
care. The second (Kwast 1998b) addresses education issues for quality

JosM. Belizn, Fernando Barros, Ana Langer, Ubaldo Farnot, Cesar Victora,
Jos Villar, Impact of health education during pregnancy on behavior and
utilization of health resources, American Journal of Obstetrics and
Gynecology, Volume 173, Issue 3, Part 1, September 1995, Pages 894-899,
ISSN 0002-9378, 10.1016/0002-9378(95)90362-3.
Abstract: OBJECTIVE: Our purpose was to assess whether an intervention in
the education of the mother and the support person involves a change in
health-related behavior and use of health facilities.

STUDY DESIGN: A randomized, controlled trial was conducted in four cities

of Latin America on pregnant women at risk. Half of them (n = 1115)
received a home intervention of four to six visits dealing with
psychosocial support and education about health-related habits, alarm
signs, hospital facilities, antismoking and antialcohol programs, and a
reinforcement of adequate health services utilization for the pregnant
woman and a support person. The control group (n = 1120) received routine
prenatal care.

RESULTS: The distribution of risk factors and demographic, obstetric, and

psychologic characteristics at baseline was similar in both groups. Women
in the intervention group showed a statistically significant better
knowledge of seven of the nine alarm signs considered and of two of the
three labor-onset signs required. No differences between groups were
observed in improvement on diet, cigarette and alcohol consumption,
maternal physicial strain, lactation at 40 days postpartum, and utilization
of health facilities.

CONCLUSIONS: An intervention of psychosocial support and health education

during pregnancy failed to show any benefit on perinatal outcome, health-
related behavior, or utilization of health facilities.
Keywords: Health education; health knowledge; health-related behavior

Upul Senarath, Dulitha N. Fernando, Graham Vimpani, Ishani Rodrigo, Factors

associated with maternal knowledge of newborn care among hospital-delivered
mothers in Sri Lanka, Transactions of the Royal Society of Tropical
Medicine and Hygiene, Volume 101, Issue 8, August 2007, Pages 823-830, ISSN
0035-9203, 10.1016/j.trstmh.2007.03.003.
Abstract: Summary
The aim of this study was to assess mothers knowledge on newborn care as
well as factors associated with poor knowledge. A cross-sectional study
sampled 446 mothernewborn pairs from five hospitals in the Puttalam
district of Sri Lanka by stratified random sampling. Maternal knowledge on
newborn care was assessed using a questionnaire with 50 statements via exit
interview. A knowledge score was created by allocating 1 point for each
correct response, which was dichotomised as satisfactory or poor by the
median score. Only 21.7% correctly answered that surgical spirit (70%
isopropyl alcohol) should not be applied on the umbilical stump. More than
90% of mothers knew about breastfeeding on demand, the advantages of
colostrum and the duration of exclusive breastfeeding. Except for a few
conditions, mothers demonstrated a satisfactory knowledge in recognising
danger signs of the newborn. According to multivariate analysis, primiparae
(odds ratio (OR) = 2.31; 95% CI 1.533.50), unemployed women
(OR = 3.31; 95% CI 1.895.80) and those with delayed antenatal
booking visits (OR = 2.02; 95% CI 1.262.23) were more likely to
have poor knowledge. In conclusion, mothers had a satisfactory level of
knowledge about breastfeeding and recognition of danger signs, but
knowledge about care of the umbilical cord was poor. Maternal education
programmes should place more emphasis on first-time mothers, unemployed
women and those with delayed booking visits.
Keywords: Newborn infant; Newborn care; Health education; Maternal welfare;
Maternal knowledge; Sri Lanka

Sindhu K. Srinivas, Scott A. Lorch, The laborist model of obstetric care:

we need more evidence, American Journal of Obstetrics and Gynecology,
Volume 207, Issue 1, July 2012, Pages 30-35, ISSN 0002-9378,
Abstract: Literature suggesting improved patient outcomes and patient
satisfaction with the hospitalist model of inpatient medical care coupled
with the desire to improve provider satisfaction led to the introduction of
the laborist in obstetrics. This represents a significant change in the way
obstetrics has been experienced and practiced from both a patient and
provider perspective. The laborist was designed as a plausible model of
obstetric care delivery where hospitals employ physicians to provide
continuous coverage of labor and delivery units without other competing
clinical duties. Anecdotal use of the laborist model in the provision of
obstetric care is growing rapidly, despite the lack of research regarding
its impact on maternal outcomes, neonatal outcomes, patient and provider
satisfaction, and graduate medical education. We provide an overview of
both the positive and negative attributes of this model of obstetric care
delivery, discuss the current state of research addressing these
attributes, and propose a research strategy to improve understanding of the
impact of this model of care delivery.
Keywords: care delivery; laborist; obstetrics; pregnancy

Fangbiao Tao, Kun Huang, Xiang Long, Rachel Tolhurst, Joanna Raven, Low
postnatal care rates in two rural counties in Anhui Province, China:
Perceptions of key stakeholders, Midwifery, Volume 27, Issue 5, October
2011, Pages 707-715, ISSN 0266-6138, 10.1016/j.midw.2009.10.001.
Abstract: Objective
to explore the perceptions of stakeholders on postnatal care and to
describe the rate of postnatal home visits in two rural counties in Anhui
Province, China.
this was a mixed methods study which uses mainly qualitative methods
including focus group discussions, in- depth interviews and key informant
interviews. A household survey of postpartum women was used to calculate
the rates of postnatal home visits.
two rural counties in Anhui Province, China.
qualitative study participants: officials responsible for maternal health
care at county level, health providers at township and village level and
maternal health-care users. Household survey participants: 2326 women who
gave birth in the two counties from January 2005 to December 2006.
the survey of postpartum women revealed that only 4.2% and 4.5% of women
received one or more postnatal visits at home in County A and County B.
Qualitative interviews revealed a range of perceived reasons for this low
rate of provision and utilisation of postnatal care, including: inadequate
funding for maternal health care; limited human resources; lack of
transport in township hospitals; and limited value placed on postnatal care
by women and providers. In addition, where services were provided, a number
of factors were likely to restrict health providers from delivering high-
quality postnatal health service, such as: weak skills and knowledge of
staff; inadequate in-service training; lack of equipment in township
hospitals; and poor supervision and monitoring.
Key conclusions
the rate of postnatal visits was extremely low in two counties in rural
China. Understaffing and inadequate funding are the main factors that
affect provision of postnatal health care.
Implications for practice
more emphasis should be attached to political support and funding for
postnatal care. Research into feasible ways to provide quality postnatal
care needs to be conducted.
Keywords: Postnatal care; Quality of care; Health seeking behaviour;

Simon Cooper, Robyn Cant, Jo Porter, Fiona Bogossian, Lisa McKenna,

Susannah Brady, Stephanie Fox-Young, Simulation based learning in midwifery
education: A systematic review, Women and Birth, Volume 25, Issue 2, June
2012, Pages 64-78, ISSN 1871-5192, 10.1016/j.wombi.2011.03.004.
Abstract: Aim
To critically examine the evidence for simulation based learning in
midwifery education.
Simulated Learning Programs (SLPs) using low to high fidelity techniques
are common in obstetric professionals education and focus on the
development of team work, labour and obstetric emergencies.
Review methods
A systematic review incorporating critical appraisal approaches, setting
clear objectives and a defined search and analysis strategy. Evidence from
obstetrics, neonatology, technical and non-technical skills (teamwork) was
included where it informed the development of midwifery curricula. Studies
in English from 2000 to 2010 were included searching CINAHL Plus, OVID
Medline, Cochrane, SCOPUS and ProQuest and Google Scholar.
Twenty-four papers were identified that met the inclusion criteria. All
were quantitative reports; outcomes and levels of evidence varied with two
notable papers indicating that simulation had an impact on clinical
practice. Benefits of SLP over didactic formats were apparent, as were the
development of non-technical skills confidence and competence. The study
outcomes were limited by the range of evidence and context of the reports
which focussed on obstetric emergency training using a number of simulation
There is evidence that simulated learning of midwifery skills is
beneficial. Simulation learning has an educational and clinical impact and
advantages over didactic approaches. Where clinical practice is infrequent
i.e. obstetric emergencies, simulation is an essential component of
curricula. Simulation enhances practice and therefore may reduce the time
taken to achieve competence; however there is no evidence from the
literature that simulation should replace clinical practice.
Keywords: Midwifery; Simulation; Education; Obstetrics; Review

Carine Ronsmans, Wendy J Graham, on behalf of The Lancet Maternal Survival

Series steering group, Maternal mortality: who, when, where, and why, The
Lancet, Volume 368, Issue 9542, 30 September6 October 2006, Pages 1189-
1200, ISSN 0140-6736, 10.1016/S0140-6736(06)69380-X.
Abstract: Summary
The risk of a woman dying as a result of pregnancy or childbirth during her
lifetime is about one in six in the poorest parts of the world compared
with about one in 30000 in Northern Europe. Such a discrepancy poses a
huge challenge to meeting the fifth Millennium Development Goal to reduce
maternal mortality by 75% between 1990 and 2015. Some developed and
transitional countries have managed to reduce their maternal mortality
during the past 25 years. Few of these, however, began with the very high
rates that are now estimated for the poorest countriesin which further
progress is jeopardised by weak health systems, continuing high fertility,
and poor availability of data. Maternal deaths are clustered around labour,
delivery, and the immediate postpartum period, with obstetric haemorrhage
being the main medical cause of death. Local variation can be important,
with unsafe abortion carrying huge risk in some populations, and HIV/AIDS
becoming a leading cause of death where HIV-related mortaliy rates are
high. Inequalities in the risk of maternal death exist everywhere.
Targeting of interventions to the most vulnerablerural populations and
poor peopleis essential if substantial progress is to be achieved by 2015.

Katherine C. Teela, Luke C. Mullany, Catherine I. Lee, Eh Poh, Palae Paw,

Nicole Masenior, Cynthia Maung, Chris Beyrer, Thomas J. Lee, Community-
based delivery of maternal care in conflict-affected areas of eastern
Burma: Perspectives from lay maternal health workers, Social Science &
Medicine, Volume 68, Issue 7, April 2009, Pages 1332-1340, ISSN 0277-9536,
Abstract: In settings where active conflict, resource scarcity, and
logistical constraints prevail, provision of maternal health services
within health centers and hospitals is unfeasible and alternative
community-based strategies are needed. In eastern Burma, such conditions
necessitated implementation of the Mobile Obstetric Maternal Health
Worker (MOM) project, which has employed a community-based approach to
increase access to essential maternal health services including emergency
obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM
service delivery model and, because they are accessible to both the
communities inside Burma and to outside project managers, they serve as key
informants for the project. Their insights can facilitate program and
policy efforts to overcome critical delays and insufficient management of
maternal complications linked to maternal mortality. Focus group
discussions (n = 9), in-depth interviews (n = 18), and
detailed case studies (n = 14) were collected from MHWs during
centralized project management meetings in February and October of 2007.
Five case studies are presented to characterize and interpret the realities
of reproductive health work in a conflict-affected setting. Findings
highlight the process of building supportive networks and staff ownership
of the MOM project, accessing and gaining community trust and participation
to achieve timely delivery of care, and overcoming challenges to manage and
appropriately deliver essential health services. They suggest that some
emergency obstetric care services that are conventionally delivered only
within healthcare settings might be feasible in community or home-based
settings when alternatives are not available. This paper provides an
opportunity to hear directly from community-based workers in a conflict
setting, perspectives seldom documented in the scientific literature. A
rights-based approach to service delivery and its suitability in settings
where human rights violations are widespread is highlighted.
Keywords: Burma; Reproductive health; Emergency obstetrical care; Community
health; Internally displaced populations; Health workers; Conflict setting;

Dwenda K. Gjerdingen, Elizabeth Ann Shaw, Sharon S.-L. Wong, CHAPTER 21 -

Postpartum Psychosocial Concerns, In: Stephen D. Ratcliffe, MD, MSPH,
Elizabeth G. Baxley, MD, Matthew K. Cline, MD, and Ellen L. Sakornbut, MD,
Editor(s), Family Medicine Obstetrics (Third Edition), Mosby, Philadelphia,
2008, Pages 645-663, ISBN 9780323043069, 10.1016/B978-032304306-9.50026-4.

Stacy Leigh Pigg, Acronyms and effacement: Traditional medical

practitioners (TMP) in international health development, Social Science
& Medicine, Volume 41, Issue 1, July 1995, Pages 47-68, ISSN 0277-9536,
Abstract: International development draws on a globalized vision of
traditional medicine when constructing country-specific programs that use
local practitioners to further health objectives. This paper looks at the
tension between this mobile notion of the traditional and the local
social ground. Categories such as traditional birth attendant (TBA) and
traditional medical practitioner (TMP) emerge from a process of translation
that links local realities to development in specific ways. Examination of
training programs for two kinds of indigenous practitioners in Nepal
birth attendants and shamansshows that various Nepalese specialists are
constructed as TBAs and TMPs in a discursive process that emphasizes some
differences while eliding others. The acronyms TBA and TMP encapsulate
numerous acts of translation through which diverse local practices are
subsumed into an overarching development framework. The many layers of this
process include: how traditional healers are understood in international
health policy; how, in national planning, these conceptions are made to fit
with existing Nepalese healers; and how research on local ideas and
practices becomes authoritative knowledge about traditions, which then,
in turn, form a basis for the planning and implementation of training

The conceptual categories evident in development discourse on traditional

healers take concrete, practical form in the design and implementation of
training programs. At the same time development attempts to create programs
tailored to local conditions, it generates frameworks that efface or
exclude much of what local people think, believe and do. Although training
programs for TBAs and TMPs have been advocated as a way to bridge the gap
between the realities of local peoples lives and development institutions'
visions, it is important to realize that, at another level, development
discourse produces the very problems it aims to solve.

The case study of training programs for TMPs and TBAs in Nepal shows how
the universalizing principles inherent in development discourse
systematically dismantle and decontextualize different socio-cultural
realities in the course of taking them into account. Development
institutions are thus positioned as authoritative mediators of all local
worlds. Translation is a social act that, through the management of the
circulation of discourses, reinforces the particular global-local power
relations of international development. Relations of power, as well as
states of health, are at stake in health development encounters. This paper
questions whether health development can achieve its humanitarian goals
within the existing conceptual framework.
Keywords: traditional medical practitioners; health development policy;
development discourse; Nepal

G. Justus Hofmeyr, Rachel A. Haws, Staffan Bergstrm, Anne CC Lee, Pius

Okong, Gary L. Darmstadt, Luke C. Mullany, Eh Kalu Shwe Oo, Joy E. Lawn,
Obstetric care in low-resource settings: What, who, and how to overcome
challenges to scale up?, International Journal of Gynecology &
Obstetrics, Volume 107, Supplement, October 2009, Pages S21-S45, ISSN 0020-
7292, 10.1016/j.ijgo.2009.07.017.
Abstract: Background
Each year, approximately 2 million babies die because of complications
of childbirth, primarily in settings where effective care at birth,
particularly prompt cesarean delivery, is unavailable.
We reviewed the content, impact, risk-benefit, and feasibility of
interventions for obstetric complications with high population attributable
risk of intrapartum-related hypoxic injury, as well as human resource,
skill development, and technological innovations to improve obstetric care
quality and availability.
Despite ecological associations of obstetric care with improved perinatal
outcomes, there is limited evidence that intrapartum interventions reduce
intrapartum-related neonatal mortality or morbidity. No interventions had
high-quality evidence of impact on intrapartum-related outcomes in low-
resource settings. While data from high-resource settings support planned
cesarean for breech presentation and post-term induction, these
interventions may be unavailable or less safe in low-resource settings and
require risk-benefit assessment. Promising interventions include use of the
partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for
shoulder dystocia, improved management of intra-amniotic infections, and
continuous labor support. Obstetric drills, checklists, and innovative low-
cost devices could improve care quality. Task-shifting to alternative
cadres may increase coverage of care.
While intrapartum care aims to avert intrapartum-related hypoxic injury,
rigorous evidence is lacking, especially in the settings where most deaths
occur. Effective care at birth could save hundreds of thousands of lives a
year, with investment in health infrastructure, personnel, and research
both for innovation and to improve implementation.
Keywords: Birth asphyxia/asphyxia neonatorum; Childbirth care; Emergency
obstetric care; Intrapartum care; Intrapartum-related mortality; Low-income
countries; Neonatal mortality; Perinatal mortality

Angelo Fernando Robledo-Colonia, Natalia Sandoval-Restrepo, Yannier Ferley

Mosquera-Valderrama, Celia Escobar-Hurtado, Robinson Ramrez-Vlez, Aerobic
exercise training during pregnancy reduces depressive symptoms in
nulliparous women: a randomised trial, Journal of Physiotherapy, Volume 58,
Issue 1, 2012, Pages 9-15, ISSN 1836-9553, 10.1016/S1836-9553(12)70067-X.
Abstract: Question
Does supervised aerobic exercise during pregnancy reduce depressive
symptoms in nulliparous women?
Randomised trial with concealed allocation, blinded assessors, and
intention-to-treat analysis.
80 nulliparous, pregnant women attending for prenatal care at one of three
tertiary hospitals in Cali, Colombia.
The experimental group completed a 3-month supervised exercise program,
commencing at 16 to 20 weeks of gestation. Each session included walking
(10 min), aerobic exercise (30 min), stretching (10 min), and relaxation
(10 min). The control group continued usual activities and performed no
specific exercise.
Outcome measures
:The primary outcome was symptoms of depression assessed by the Center for
Epidemiological Studies Depression Scale (CES-D) at baseline and
immediately after the 3-month intervention.
74 women completed the study. After the 3-month intervention, the
experimental group reduced their depressive symptoms on the CES-D
questionnaire by 4 points (95% CI 1 to 7) more than the control group.
A supervised 3-month program of primarily aerobic exercise during pregnancy
reduces depressive symptoms.
Trial registration
Keywords: Aerobic exercise; Pregnant women; Depression; Randomised trial;

Mohammad Tajul Islam, Yasmin Ali Haque, Rachel Waxman, Abdul Bayes Bhuiyan,
Implementation of Emergency Obstetric Care Training in Bangladesh: Lessons
Learned, Reproductive Health Matters, Volume 14, Issue 27, May 2006, Pages
61-72, ISSN 0968-8080, 10.1016/S0968-8080(06)27229-X.
Abstract: The Women's Right to Life and Health project aimed to reduce
maternal morbidity and mortality in Bangladesh through provision of
comprehensive emergency obstetric care (EmOC) in the country's district and
sub-district hospitals. Human resources development was one of the
project's major activities. This paper describes the project in 20002004
and lessons learned. Project documents, the training database, reports and
training protocols were reviewed. Medical officers, nurses, facility
managers and laboratory technicians received training in the country's
eight medical college hospitals, using nationally accepted curricula. A 17-
week competency-based training course for teams of medical officers and
nurses was introduced in 2003. At baseline in 1999, only three sub-district
hospitals were providing comprehensive EmOC and 33 basic EmOC, mostly due
to lack of trained staff and necessary equipment. In 2004, 105 of the 120
sub-district hospitals had become functional for EmOC, 70 with
comprehensive EmOC and 35 with basic EmOC, while 53 of 59 of the district
hospitals were providing comprehensive EmOC compared to 35 in 1999. The
scaling up of competency-based training, innovative incentives to retain
trained staff, evidence-based protocols to standardise practice and improve
quality of care and the continuing involvement of key stakeholders,
especially trainers, will all be needed to reach training targets in
Keywords: training of service providers; human resources; emergency
obstetric care; Bangladesh

Carl M. Corter, Alison S. Fleming, Maternal Responsiveness in Humans:

Emotional, Cognitive, and Biological Factors, In: Peter J.B. Slater, Jay S.
Rosenblatt and Colin Beer, Editor(s), Advances in the Study of Behavior,
Academic Press, 1990, Volume 19, Pages 83-136, ISSN 0065-3454, ISBN
9780120045198, 10.1016/S0065-3454(08)60201-6.

Lesley M. Barclay, Beverly Lloyd, The misery of motherhood: alternative

approaches to maternal distress, Midwifery, Volume 12, Issue 3, September
1996, Pages 136-139, ISSN 0266-6138, 10.1016/S0266-6138(96)90057-1.
Abstract: This paper was developed from a presentation delivered to the
Marce Society Pacific Rim Conference, Childbearing and mental health: risks
and remedies (Barclay & Lloyd 1995). Midwives involved in education and
clinical care are challenged to carefully consider the implications of
accepting a psychiatric approach to new motherhood. While acknowledging the
importance of understanding and treating clinical depression, the authors
question the appropriateness of extending the psychiatric model to the
psychological and social changes inherent in parenting. We focus our
discussion on new motherhood and illustrate our argument with quotations
from our own research.

Christopher S. Ennen, Andrew J. Satin, Training and assessment in

obstetrics: the role of simulation, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 24, Issue 6, December 2010, Pages 747-
758, ISSN 1521-6934, 10.1016/j.bpobgyn.2010.03.003.
Abstract: Simulation is becoming an integral part of the training and
assessment of obstetricians. Given the variety of manual skills that must
be learned, awake patients and high-risk environment, obstetrics is
uniquely suited for simulation. Simulation provides opportunities to
rehearse and learn from mistakes without risks to patients. The use of
simulation can help overcome some limitations of the current medical
education and practice environment, including work-hour limitations and
concerns for patient safety. Both low- and high-fidelity simulation models
can be used to accomplish educational goals. Basic and advanced skills as
well as the management of obstetric emergencies are amenable to simulation.
For a simulation programme to be successful, one must identify the learner
and the skills that are to be learned. In the future, simulation will be
more available and realistic and will be used not only for education, but
also for ongoing assessment of providers.
Keywords: simulation; skills; assessment; training; obstetrics; curriculum
Lynn Sibley, Sandra Tebben Buffington, Degafech Haileyesus, The American
College of Nurse-Midwives home-based lifesaving skills program: a review
of the Ethiopia field test, Journal of Midwifery & Women's Health,
Volume 49, Issue 4, JulyAugust 2004, Pages 320-328, ISSN 1526-9523,
Abstract: The Home-Based Lifesaving Skills program (HBLSS) is a family- and
community-focused, competency-based program that aims to reduce maternal
and newborn mortality by increasing access to basic lifesaving measures
within the home and community and by decreasing delays in reaching referral
facilities where obstetric complications, such as postpartum hemorrhage and
newborn asphyxia, can be managed. HBLSS was field tested in rural southern
Ethiopia where over 90% of births take place at home with unskilled
attendants. The program review assessed 1) the performance of HBLSS-trained
guides; 2) management of postpartum hemorrhage and newborn infection by
women, family, and birth attendants; 3) exposure of women and families to
HBLSS training; and 4) community support. There was improved performance in
management of postpartum hemorrhage, a leading cause of maternal death.
Findings for management of newborn infection were less compelling. None of
the communities had established reliable emergency transportation. Exposure
to HBLSS training in the community was estimated at 38%, and there was
strong community support. Organizations incorporating HBLSS into proposals
focusing on maternal and newborn health during birth and the immediate
postpartum period are encouraged to conduct research necessary to establish
the evidence base for this promising new approach.
Keywords: Ethiopia; safe motherhood; lifesaving skills; maternal mortality;
newborn mortality; community mobilization

Leon Chaitow, Hal Brown, Nick Buratovich, Brian Isbell, Lisa Maeckel, Dean
E. Neary Jr, David Russ, Roger Newman Turner, Chapter 10 - Naturopathic
Physical Medicine Approaches to General Health Enhancement and Specific
Conditions, In: Leon Chaitow, ND DO, Editor(s), Naturopathic Physical
Medicine, Churchill Livingstone, Edinburgh, 2008, Pages 417-513, ISBN
9780443103902, 10.1016/B978-044310390-2.50015-8.

Marge Koblinsky, Zo Matthews, Julia Hussein, Dileep Mavalankar, Malay K

Mridha, Iqbal Anwar, Endang Achadi, Sam Adjei, P Padmanabhan, Wim van
Lerberghe, on behalf of The Lancet Maternal Survival Series steering group,
Going to scale with professional skilled care, The Lancet, Volume 368,
Issue 9544, 1420 October 2006, Pages 1377-1386, ISSN 0140-6736,
Abstract: Summary
Because most women prefer professionally provided maternity care when they
have access to it, and since the needed clinical interventions are well
known, we discuss in their paper what is needed to move forward from
apparent global stagnation in provision and use of maternal health care
where maternal mortality is high. The main obstacles to the expansion of
care are the dire scarcity of skilled providers and health-system
infrastructure, substandard quality of care, and women's reluctance to use
maternity care where there are high costs and poorly attuned services. To
increase the supply of professional skilled birthing care, strategic
decisions must be made in three areas: training, deployment, and retention
of health workers. Based on results from simulations, teams of midwives and
midwife assistants working in facilities could increase coverage of
maternity care by up to 40% by 2015. Teams of providers are the efficient
option, creating the possibility of scaling up as much as 10 times more
quickly than would be the case with deployment of solo health workers in
home deliveries with dedicated or multipurpose workers.
Melissa Page, Mari S. Wilhelm, Wendy C. Gamble, Noel A. Card, A comparison
of maternal sensitivity and verbal stimulation as unique predictors of
infant socialemotional and cognitive development, Infant Behavior and
Development, Volume 33, Issue 1, February 2010, Pages 101-110, ISSN 0163-
6383, 10.1016/j.infbeh.2009.12.001.
Abstract: Although maternal sensitivity has been shown to influence social
emotional development, the role of verbal stimulation on infant
developmental outcomes has received less exploration. Recent research has
focused on intentional behaviors within the context of a motherinfant
interaction as a critical influence and as distinct from sensitivity. In
this investigation 6377 motherinfant dyads participated in a teaching task
as part of the sample from the Early Childhood Longitudinal Study Birth
Cohort (ECLS-B). Analyses focused in deciphering the role of maternal
sensitivity and verbal stimulation as contributors to the infant's social
emotional (SE) and cognitive (Cog) development. We further hypothesized
that inclusion of infant age as a moderator of maternal behaviors would
illuminate any differences between younger and older infants. Results: For
the infant's SE development, our hypothesis that maternal sensitivity
would be a stronger predictor than verbal stimulation was not supported;
nor did we find support for our hypothesis that the association would be
moderated by age. For Cog development, only verbal stimulation had a direct
positive effect on the infant's cognitive ability; our findings for
moderation showed that mothers spoke more to older infants than younger
infants. Conclusion: Identification of specific maternal behaviors
associated with infant outcomes informs the child development field, and
also provides strategies for early intervention to assist mothers with
developing or maintaining a consistent relationship that includes
sensitivity and verbal stimulation.
Keywords: Maternal sensitivity; Verbal stimulation; Socialemotional;

Simon Cooper, Bree Bulle, Mary Anne Biro, Jan Jones, Maureen Miles, Carole
Gilmour, Penny Buykx, Rosemarie Boland, Leigh Kinsman, Julie Scholes, Ruth
Endacott, Managing women with acute physiological deterioration: Student
midwives performance in a simulated setting, Women and Birth, Available
online 22 September 2011, ISSN 1871-5192, 10.1016/j.wombi.2011.08.009.
Abstract: Objective
Midwives ability to manage maternal deterioration and failure to rescue
are of concern with questions over knowledge, clinical skills and the
implications for maternal morbidity and, mortality rates. In a simulated
setting our objective was to assess student midwives ability to assess,
and manage maternal deterioration using measures of knowledge, situation
awareness and skill, performance.
An exploratory quantitative analysis of student performance based upon
performance, ratings derived from knowledge tests and observational
ratings. During 2010 thirty-five student, midwives attended a simulation
laboratory completing a knowledge questionnaire and two video, recorded
simulated scenarios. Patient actresses wearing a birthing suit simulated
deteriorating, women with post-partum and ante-partum haemorrhage (PPH and
APH). Situation awareness was, measured at the end of each scenario.
Applicable descriptive and inferential statistical tests were, applied to
the data.
The mean total knowledge score was 75% (range 4691%) with low skill
performance, means for both scenarios 54% (range 3970%). There was no
difference in performance between the scenarios, however performance of key
observations decreased as the women deteriorated; with significant
reductions in key vital signs such as blood pressure and blood loss
measurements. Situation, awareness scores were also low (54%) with
awareness decreasing significantly (t(32) = 2.247,
p = 0.032), in the second and more difficult APH scenario.
Whilst knowledge levels were generally good, skills were generally poor and
decreased as the women deteriorated. Such failures to apply knowledge in
emergency stressful situations may be resolved by repetitive high stakes
and high fidelity simulation.
Keywords: Education; Midwifery; Simulation; Patient deterioration; Decision
making; Situation awareness

Young-Mi Kim, Partamin Zainullah, Jaime Mungia, Hannah Tappis, Linda

Bartlett, Nabila Zaka, Availability and quality of emergency obstetric and
neonatal care services in Afghanistan, International Journal of Gynecology
& Obstetrics, Volume 116, Issue 3, March 2012, Pages 192-196, ISSN
0020-7292, 10.1016/j.ijgo.2011.10.017.
Abstract: Objective
To assess the availability and utilization of emergency obstetric and
neonatal care (EmONC) facilities in Afghanistan, as defined by UN
In a cross-sectional study of 78 first-line referral facilities located in
secure areas of Afghanistan, EmONC service delivery was evaluated by using
Averting Maternal Deaths and Disabilities (AMDD) Program assessment tools.
Forty-two percent of peripheral facilities did not perform all 9 signal
functions required of comprehensive EmONC facilities. The study facilities
delivered 17% of all neonates expected in their target populations and
treated 20% of women expected to experience direct complications. The
population-based rate of cesarean delivery was 1%. Most maternal deaths
(96%) were due to direct causes. The direct and indirect obstetric case
fatality rates were 0.8% and 0.2%, respectively.
Notable progress has been made in Afghanistan over the past 8 years in
improving the quality, coverage, and utilization of EmONC services, but
gaps remain. Re-examination of the criteria for selecting and positioning
EmONC facilities is recommended, as is the provision of high-quality,
essential maternal and neonatal health services at all levels of the
healthcare system, linked by appropriate communication and functional
referral systems.
Keywords: Afghanistan; Delivery (obstetric/standards); Emergency obstetric
and neonatal care; Health services availability; Maternal health; Neonatal

Catherine Stevens-Simon, Donna Nelligan, Strategies for identifying and

treating adolescents at risk for maltreating their children, Aggression and
Violent Behavior, Volume 3, Issue 2, Summer 1998, Pages 197-217, ISSN 1359-
1789, 10.1016/S1359-1789(97)00015-3.
Abstract: Using data published in English since 1970, the analyses
presented in this article examine the identification and treatment of the
antecedents of child maltreatment by adolescent parents. Reviewed studies
indicate that (a) the sensitivity and specificity of predictors of child
abuse is poor, (b) children of adolescents are at increased risk for
maltreatment, (c) controlling for background sociodemographic factors
decreases but does not eliminate this risk, (d) home visitation programs
help at-risk adolescent parents improve their parenting skills.
Maltreatment of children by their adolescent parents is a preventable
problem. Short-term programs that address behavioral manifestations of the
social ills and developmental conflicts that antedate child maltreatment
without touching the underlying causes are unlikely to be successful.

Young-Mee Ahn, Nam-Hee Kim, Parental Perception of Neonates, Parental

Stress and Education for NICU Parents, Asian Nursing Research, Volume 1,
Issue 3, December 2007, Pages 199-210, ISSN 1976-1317, 10.1016/S1976-
Abstract: Purpose
The purpose of this study was to conduct a comparative analysis between the
perception of parents with premature infants in the NICU and parents with
full-term newborns, and in the process to evaluate the effects of NICU
educational support on parents with regard to their perception of neonate
and parental stress.
A mixed quantitative design was employed to compare parental perception of
neonates using the Neonatal Perception Index (NPI) between the parents of
26 full-term infants (full-term group) and the parents of 22 premature
infants in the NICU (NICU group), and also to evaluate the effect of NICU
educational support on NPI and parental stress using the Parental Stress
Scale (PSS) between the mothers and fathers in the NICU group.
NICU mothers showed the lowest NPI score among full-term and NICU parents.
However, no difference in direction of NPI scores was observed between
parents in either the full-term or NICU group. NICU education improved NPI
and decreased PSS in fathers but not in mothers.
Environmental modifications of the nursery setting, particularly its remote
location to the NICU, could improve mothers' perception of full-term
neonates. NICU mothers, as the principal care- givers, may suffer from
culturally-grounded, psychoemotional disturbances after giving birth to a
sick infant, which may not be applicable to fathers. The quality of family-
centered care in the NICU environment, parental role alteration, and the
condition of infants need to be improved to decrease parental stress in the
NICU. Fathers may have significant potential in caring for mothers and sick
infants during the transition to parenthood. Education for NICU parents
should be done for both mothers and fathers in the acute postpartum period.
Keywords: education; intensive care units; neonatal; parenting; premature
infant; stress

Sadatoshi Matsuoka, Hirotsugu Aiga, Lon Chan Rasmey, Tung Rathavy, Akiko
Okitsu, Perceived barriers to utilization of maternal health services in
rural Cambodia, Health Policy, Volume 95, Issues 23, May 2010, Pages 255-
263, ISSN 0168-8510, 10.1016/j.healthpol.2009.12.011.
Abstract: Objective
The aim of this study was to identify the underlying causes of Cambodian
women's non-use of maternal health services provided by skilled birth
A qualitative study of 66 reproductive-age women was conducted in Kampong
Cham Province, Cambodia. Data were collected through 30 semi-structured
interviews and 6 focus groups.
We identified 5 barriers to the utilization of maternal health services:
(i) financial barriers; (ii) physical barriers; (iii) cognitive barriers;
(iv) organizational barriers; and (v) psychological and socio-cultural
The Cambodian Ministry of Health and its development partners should take
these barriers into account when promoting the use of maternal health
services. These barriers should be addressed proactively. A successful
approach to increasing use of maternal health services should involve
changes to both service programs and public education.
Keywords: Cambodia; Maternal health services; Health seeking behaviour;
Barriers to health services; Qualitative study

Leon Speroff, Daniel R. Mishell Jr., The postpartum visit: it's time for a
change in order to optimally initiate contraception, Contraception, Volume
78, Issue 2, August 2008, Pages 90-98, ISSN 0010-7824,

Nicole L. Letourneau, Miriam J. Stewart, Alison K. Barnfather, Adolescent

mothers: Support needs, resources, and support-education interventions,
Journal of Adolescent Health, Volume 35, Issue 6, December 2004, Pages 509-
525, ISSN 1054-139X, 10.1016/j.jadohealth.2004.01.007.
Abstract: Adolescent mothers are prone to live in poor conditions, lack
adequate financial resources, suffer high stress, encounter family
instability, and have limited educational opportunities. These factors
contribute to inadequate parent-child interactions and diminished infant
development. Social support can promote successful adaptation for
adolescent mothers and their children. This review article describes the
support needs and challenges faced by adolescent parents and their
children, the support resources available to and accessed by adolescent
parents, and existing support-education intervention studies, to provide
directions for future research. Relevant research published between January
1982 and February 2003 was obtained from online database indices and
retrieved article bibliographies. Frequently encountered problems included
small sample sizes and attrition, lack of suitable comparison groups, and
measurement inconsistencies. When planning support-education interventions,
content, duration, intensity, mode, level, intervention agents, and targets
should be considered. Future research can address these challenges.
Keywords: Adolescent parents; Support needs; Support resources; Support-
education interventions

Sina Haeri, Gary A. Dildy III, Maternal Mortality From Hemorrhage, Seminars
in Perinatology, Volume 36, Issue 1, February 2012, Pages 48-55, ISSN 0146-
0005, 10.1053/j.semperi.2011.09.010.
Abstract: Hemorrhage remains as one of the top 3 obstetrics related causes
of maternal mortality, with most deaths occurring within 24-48 hours of
delivery. Although hemorrhage related maternal mortality has declined
globally, it continues to be a vexing problem. More specifically, the
developing world continue to shoulder a disproportionate share of
hemorrhage related deaths (99%) compared with industrialized nations (1%).
Given the often preventable nature of death from hemorrhage, the
cornerstone of effective mortality reduction involves risk factor
identification, quick diagnosis, and timely management. In this monograph
we will review the epidemiology, etiology, and preventative measures
related to maternal mortality from hemorrhage.
Keywords: hemorrhage; pregnancy; maternal; mortality; morbidity

S. Bhattacharya, J. Tucker, Maternal Health Services, In: Editor-in-

Chief: Kris Heggenhougen, Editor(s)-in-Chief, International Encyclopedia
of Public Health, Academic Press, Oxford, 2008, Pages 210-221, ISBN
9780123739605, 10.1016/B978-012373960-5.00522-0.
Abstract: This article describes the objectives, scope, and organization of
maternity services during the antenatal, intranatal, and postnatal periods
in developing and developed countries. It also discusses the epidemiology
and sociodemographic determinants of maternal mortality and morbidity and
reviews some relevant issues such as utilization and financing of maternity
services. Finally, it discusses some of the challenges of providing
comprehensive maternity services and the implications for health policy.
Keywords: Antenatal; Health services; Intrapartum; Maternal mortality;
Maternity; Perinatal mortality; Postnatal

Julie M. Turner-Cobb, Psychological and neuroendocrine correlates of

disease progression, In: A. Clow and F. Hucklebridge, Editor(s),
International Review of Neurobiology, Academic Press, 2002, Volume 52,
Pages 353-381, ISSN 0074-7742, ISBN 9780123668530, 10.1016/S0074-

Heather O'Mahen, Gina Fedock, Erin Henshaw, Joseph A. Himle, Jane Forman,
Heather A. Flynn, Modifying CBT for Perinatal Depression: What Do Women
Want?: A Qualitative Study, Cognitive and Behavioral Practice, Volume 19,
Issue 2, May 2012, Pages 359-371, ISSN 1077-7229,
Abstract: The evidence for the efficacy of CBT for depression during the
perinatal period is mixed. This was a qualitative study that aimed to
understand the perinatal-specific needs of depressed women in an effort to
inform treatment modifications that may increase the relevance and
acceptability of CBT during this period. Stratified purposeful sampling
resulted in 23 participants selected by pregnancy, socioeconomic, and
depression status. Participants completed semistructured interviews
exploring their experiences of pregnancy and the postpartum period and its
relationship to mood, and perspectives on ideal treatment content. Thematic
analysis revealed a number of perinatal-specific themes that were relevant
to CBT in three key domains: self, motherhood, and interpersonal. Mothers
particularly struggled with: internalization of motherhood myths, self-
sacrifice, and managing social support during this period. Shifts in
women's themes across the perinatal period, and between racial and
socioeconomic groups are discussed as are implications for modification of
CBT to improve relevance for perinatal depression.
Keywords: pregnancy; postpartum; antenatal; cognitive behavioral therapy;

Michael Baker, Kevin Milligan, Maternal employment, breastfeeding, and

health: Evidence from maternity leave mandates, Journal of Health
Economics, Volume 27, Issue 4, July 2008, Pages 871-887, ISSN 0167-6296,
Abstract: Public health agencies around the world have renewed efforts to
increase the incidence and duration of breastfeeding. Maternity leave
mandates present an economic policy that could help achieve these goals. We
study their efficacy, focusing on a significant increase in maternity leave
mandates in Canada. We find very large increases in mothers time away from
work post-birth and in the attainment of critical breastfeeding duration
thresholds. We also look for impacts of the reform on self-reported
indicators of maternal and child health captured in our data. For most
indicators we find no effect.
Keywords: Maternity leave; Maternal employment; Breastfeeding; Child health

Yuri Sasaki, Moazzam Ali, Kazuhiro Kakimoto, Ou Saroeun, Koum Kanal, Chushi
Kuroiwa, Predictors of Exclusive Breast-Feeding in Early Infancy: A Survey
Report from Phnom Penh, Cambodia, Journal of Pediatric Nursing, Volume 25,
Issue 6, December 2010, Pages 463-469, ISSN 0882-5963,
Abstract: Background
Exclusive breast-feeding (EBF) is recommended in the first 6 months of an
infant's life. This study aims to investigate the present status of infant
feeding practices and identify factors that affect EBF practices during the
first 6 months following infant birth in Phnom Penh, Cambodia.
A cross-sectional survey with a semistructured questionnaire was given to
312 mothers with children aged 6 to 24 months who visited the immunization
clinic in the National Maternal and Child Health Centre in Phnom Penh,
Cambodia, from December 2005 to February 2006.
Eighty-three percent of mothers fed breast milk exclusively in the first
month, whereas only 51.3% continued EBF in the first 6 months. Within 30
minutes after delivery, 39% of mothers began breast-feeding. Results from
logistic regression analysis indicate that the lack of a maternal antenatal
EBF plan (odds ratio [OR] = 10.01, 95% confidence interval [CI] = 3.68
27.24, p < .001), working mothers (OR = 4.71, 95% CI = 2.778.01, p <
.001), and lack of paternal attendance at breast-feeding classes (OR =
1.93, 95% CI = 1.133.28, p < .05) have independently positive
associations with cessation of EBF during the first 6 months of infant
The findings have helped to identify some important factors affecting EBF
practices in the study area in Cambodia. The findings revealed that it is
important to educate pregnant mothers, probably through exposure to trained
midwives and media, so they may recognize the significance of EBF and will
develop intention and plan to feed their babies, keeping in mind the
benefits it may yield. Paternal involvement in breast-feeding classes may
increase their awareness and consequently complement EBF practices.
Finally, development of conducive working environments and policies for
working mothers should be carefully explored because it could have positive
influence in better care and promotion of EBF.
Keywords: Antenatal feeding plan; Breast-feeding education; Exclusive
breast-feeding (EBF); Paternal involvement; Working mothers; Cambodia

Chelsea M. Weaver, Daniel S. Shaw, Thomas J. Dishion, Melvin N. Wilson,

Parenting self-efficacy and problem behavior in children at high risk for
early conduct problems: The mediating role of maternal depression, Infant
Behavior and Development, Volume 31, Issue 4, December 2008, Pages 594-605,
ISSN 0163-6383, 10.1016/j.infbeh.2008.07.006.
Abstract: Parenting self-efficacy (PSE) has been positively linked to
children's adjustment and negatively associated with maternal depression.
However, most PSE research has been cross-sectional, limited to
predominantly white, middle-class samples, and has not examined potential
mechanisms underlying associations of PSE with children's behavior. The
present study investigates: (1) how PSE changes over time, (2) the
relationship between age 2 PSE and children's behavior problems 2 years
later, and (3) the potential mediating role of maternal depression in
relation to the association between PSE and child problem behavior.
Participants are 652 ethnically and geographically diverse mothers and
their children, at high risk for conduct problems. PSE increased between
ages 2 and 4 and higher initial levels predicted lower caregiver-reported
age 4 conduct problems after controlling for problem behavior at age 2. The
relationship between PSE and later conduct problems was mediated, however,
by maternal depression. These findings suggest maternal depression as a
potential disruptor of caregiver confidence in early childhood, which has
implications for the design and focus of parenting interventions.
Keywords: Parenting self-efficacy; Child problem behavior; Early childhood;
Maternal depression
Neriman Sogukpinar, Birsen K. Saydam, zlem D. Bozkurt, Hafize Ozturk,
Aytl Pelik, Past and present midwifery education in Turkey, Midwifery,
Volume 23, Issue 4, December 2007, Pages 433-442, ISSN 0266-6138,
Abstract: Among criteria relating to the level of development in a country
are health indicators such as total fertility, maternal mortality, infant
mortality, and rates of life expectancy at birth. These have a close
relationship with the quality of health-care services, especially those
provided by midwives. An improvement in midwifery services can be achieved
to a great extent by standardised and high-quality midwifery education.
Until recently, midwifery education has not been standardised in Turkey.
Although improvements have been made, more needs to be accomplished. In
this paper, we report the development of midwifery education in Turkey from
a historical perspective, dealing with past and present applications, and
make recommendations to overcome existing problems.
Keywords: Midwifery; Midwifery education; Turkey; History of Midwifery

Masumi Imura, Hanako Misao, Hiroshi Ushijima, The Psychological Effects of

Aromatherapy-Massage in Healthy Postpartum Mothers, Journal of Midwifery
& Women's Health, Volume 51, Issue 2, MarchApril 2006, Pages e21-e27,
ISSN 1526-9523, 10.1016/j.jmwh.2005.08.009.
Abstract: This study examined the effect of aromatherapy-massage in healthy
postpartum mothers. A quasi-experimental between-groups design was used.
Mothers who received aromatherapy-massage were compared with a control
group who received standard postpartum care. Thirty-six healthy, first-time
mothers with vaginal delivery of a full-term, healthy infant participated
in this study. Sixteen mothers received a 30-minute aromatherapy-massage on
the second postpartum day; 20 mothers were in the control group. All
mothers completed the following four standardized questionnaires before and
after the intervention: 1) Maternity Blues Scale; 2) State-Trait Anxiety
Inventory; 3) Profile of Mood States (POMS); and 4) Feeling toward Baby
Scale. In the aromatherapy-massage group, posttreatment scores
significantly decreased for the Maternity Blues Scale, the State-Anxiety
Inventory, and all but one of the Profile of Mood States subscales.
Posttreatment scores in the intervention group significantly increased in
Profile of Mood States-Vigor subscale and the Approach Feeling toward Baby
subscale. Scores in the intervention group significantly decreased in
Conflict Index of Avoidance/Approach Feeling toward Baby subscale. Our
results suggest that aromatherapy-massage might be an effective
intervention for postpartum mothers to improve physical and mental status
and to facilitate mother-infant interaction.
Keywords: puerperium; mothers; aromatherapy; massage; anxiety; depression;
mother-child relations; clinical trial

Michael H. Antoni, Neil Schneiderman, Frank Penedo, Chapter 32 - Behavioral

Interventions: Immunologic Mediators and Disease Outcomes, In: Robert Ader,
Editor(s), Psychoneuroimmunology (Fourth Edition), Academic Press,
Burlington, 2007, Pages 675-703, ISBN 9780120885763, 10.1016/B978-
Abstract: Behavioral interventions are the mainstay of the biobehavioral
arsenal used to prevent the development of disease, and to foster
adaptation to the stress of diagnosis and treatment for major conditions
including cancers, cardiovascular disease, and immunologic disorders such
as Acquired Immune Defi ciency Syndrome (AIDS). There is growing interest
in the question of whether the effects of these interventions in diagnosed
patients may extend beyond improving adjustment and quality of life (QOL)
to the possibility of improving health outcomes including decreased risk of
recurrence and slowed disease progression. In the interest of exploring the
mechanisms underlying these effects, there has accumulated a small but
important empirical base demonstrating that behavioral interventions may
also modulate immune system functioning by modifying stress responses and
negative mood states. The major behavioral interventions directed toward
disease management are those designed to reduce anxiety, depressed affect,
hostility, and stress/distress; modify cognitive appraisals about stress
and disease; teach new behavioral and interpersonal coping skills; and
provide social support.

Emily Hannum, Claudia Buchmann, Global Educational Expansion and Socio-

Economic Development: An Assessment of Findings from the Social Sciences,
World Development, Volume 33, Issue 3, March 2005, Pages 333-354, ISSN
0305-750X, 10.1016/j.worlddev.2004.10.001.
Abstract: Summary
Among development agencies, conventional wisdom holds that educational
expansion improves economic welfare and health, reduces inequalities, and
encourages democratic political systems. We investigate the empirical
foundations for these expectations in recent social science research.
Consistent evidence indicates that health and demographic benefits result
from educational expansion, and suggests that education enhances, but does
not ensure, individuals economic security. However, the impact of
educational expansion on growth remains debated, and decades of
sociological studies offer evidence that educational expansion does not
necessarily narrow social inequalities. Finally, considerable controversy
surrounds the implications of educational expansion for democratization.
Reasonable forecasts of the consequences of further educational expansions
need to consider the diverse social contexts in which these expansions will
Keywords: health; growth; poverty; inequality; demographic change;

Julie Jomeen, The importance of assessing psychological status during

pregnancy, childbirth and the postnatal period as a multidimensional
construct: A literature review, Clinical Effectiveness in Nursing, Volume
8, Issues 34, SeptemberDecember 2004, Pages 143-155, ISSN 1361-9004,
Abstract: Summary
This paper presents a comprehensive review of the literature surrounding
womens psychological health in pregnancy, childbirth and the postnatal
periods. The content will provide clinically useful information to midwives
and health care professionals involved in caring for women during the
antenatal, intranatal and postnatal periods. The impact of psychological
health status in pregnancy on clinical outcomes such as preterm labour,
pre-eclampsia, epidural use, caesarean section, instrumental deliveries and
increased rates of admission to neonatal intensive care, alongside the
cognitive and social development of the infant and child are well
documented. Less research to date has considered the impact of
psychological well-being on the mother throughout pregnancy, the
peripartum, postpartum and beyond. Psychological status for these women has
traditionally been characterised by anxiety and depression, largely
ignoring the complex psychological interrelations that characterise
pregnancy. Psychological status in pregnancy cannot be defined within a
unidimensional framework but must include a comprehensive assessment of all
the dimensions that attribute to mood and emotional status for women during
pregnancy, childbirth and the postnatal period. This paper intends to
address the constructs of anxiety and depression, worry, control, quality
of life, sleep and self-esteem. Screening for, and identification of,
maternal psychological distress from a multidimensional perspective enables
healthcare professionals to recognise and acknowledge normal and abnormal
adjustment and offer interventions, strategies and support to facilitate a
womans transition to motherhood.
Keywords: Pregnancy; Psychological status; Maternity care

Jasmeet Soar, Gavin D. Perkins, Gamal Abbas, Annette Alfonzo, Alessandro

Barelli, Joost J.L.M. Bierens, Hermann Brugger, Charles D. Deakin, Joel
Dunning, Marios Georgiou, Anthony J. Handley, David J. Lockey, Peter Paal,
Claudio Sandroni, Karl-Christian Thies, David A. Zideman, Jerry P. Nolan,
European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.
Cardiac arrest in special circumstances: Electrolyte abnormalities,
poisoning, drowning, accidental hypothermia, hyperthermia, asthma,
anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution,
Resuscitation, Volume 81, Issue 10, October 2010, Pages 1400-1433, ISSN
0300-9572, 10.1016/j.resuscitation.2010.08.015.

Grgoire Lagger, Zoltan Pataky, Alain Golay, Efficacy of therapeutic

patient education in chronic diseases and obesity, Patient Education and
Counseling, Volume 79, Issue 3, June 2010, Pages 283-286, ISSN 0738-3991,
Abstract: Objective
To evaluate the clinical, methodological and reporting aspects of
systematic reviews and meta-analyses in order to determine the efficacy of
therapeutic patient education (TPE).
A thorough search of the medical and nursing literature recorded in MedLine
database from 1999 to August 2009 was conducted using the keywords: patient
education, efficacy, diabetes, asthma, COPD, hypertension, cardiology,
obesity, rheumatology, and oncology.
Thirty five relevant meta-analyses were identified and initially selected
for critical analyses (598 studies concerning approximately 61,000
patients). The detailed description of the educative intervention was
present in 4% of articles whereas in 23% the interventions were briefly
described. In the majority of studies, the educative interventions were
only named (49%) or totally absent (24%).

The majority of studies reported improvement of patient outcomes due to the

TPE (64%), 30% of studies reported no effect of TPE and 6% of the analysed
reviews and meta-analyses reported worsening of measured outcomes.
Patient education could improve patient outcomes. The high benefit from TPE
was shown by articles with detailed description of educational intervention
as well as by those who report multidimensional and multidisciplinary
educational intervention.
Practice implications
The impact of therapeutic patient education on health outcomes is 5080%.
Keywords: Patient education; Efficacy; Systematic review; Meta-analysis

Barbara E Kwast, Joan Bentley, Introducing confident midwives: Midwifery

education action for safe motherhood, Midwifery, Volume 7, Issue 1, March
1991, Pages 8-19, ISSN 0266-6138, 10.1016/S0266-6138(05)80129-9.
Abstract: The present crisis in midwifery and the seriousness of maternal
mortality and morbidity demands a rethink about the background and training
requirements of each level of midwifery worker. This paper describes the
background of the present shortage and mal-distribution of midwives. The
reduction of maternal mortality by 50% at the turn of this century requires
the development of a maternal health care team in which the midwife
functions as the linchpin. In order to equip the midwife for the leadership
functions in this team, the present educational system needs to be
fundamentally improved. The rationale for the acquisition of
epidemiological, managerial specialised technical and teaching skills by
midwives is discussed. Implications for futher education are high-lighted.
Collaborative actions taken by the WHO, ICM, UNICEF and other governmental
and non-governmental agencies to address the issue of midwifery are

This paper was given at the 1990 ICM, WHO, UNICEF Pre-Congress Workshop on
Midwifery Education Action for Safe Motherhood in Kobe, Japan.

Sydney L. Hans, Victor J. Bernstein, Candice Percansky, Adolescent

parenting programs: Assessing parent-infant interaction, Evaluation and
Program Planning, Volume 14, Issues 12, 1991, Pages 87-95, ISSN 0149-7189,
Abstract: With the increasing awareness that the offspring of adolescent
parents are at high risk for developmental problems, programs serving
adolescent parents are introducing services designed to improve the quality
of interaction between adolescent mothers and their infants. Since most
program planners and evaluation researchers have had little training or
experience in the highly specialized field of parent-infant interaction,
this paper will provide orientation to some academic and applied issues in
this area. First we will give evidence documenting the key role that the
parent-infant relationship plays as a foundation for the child's later
developmentand in particular the evidence suggesting that adolescent
parent-infant relationships place the child at risk. Second, by drawing
upon experiences with the Ounce of Prevention Fund adolescent parenting
programs, we will describe some of the challenges in selecting a parent-
infant interaction assessment instrument for use in community-based

Ann Olsson, Eva Robertson, Katarina Falk, Eva Nissen, Assessing women's
sexual life after childbirth: the role of the postnatal check, Midwifery,
Volume 27, Issue 2, April 2011, Pages 195-202, ISSN 0266-6138,
Abstract: Objective
to describe midwives reflections on counselling women at the postnatal
check with special focus on sexual life after childbirth.
qualitative descriptive study with focus group discussions as the method of
data collection.
antenatal clinics in Stockholm greater catchments area.
during 2006 and 2007, a voluntary sample of midwives from 10 different
antenatal clinics were invited.
content analysis was undertaken through identification of codes, categories
and themes.
Two themes emerged: balancing between personal perceptions of the woman's
needs and the health system restrictions and strategies for counselling
about sexual life after childbirth. The midwives tried to create a picture
for themselves of the woman coming for the postnatal check and her needs
before the consulation. This picture guided the midwives, but lack of time
and knowledge restricted them when counselling on sexual life after
childbirth. Two different strategies in counselling were identified, one
task-oriented and one subject-oriented. Demands and time restrictions led
midwives to distance themselves from their clients. A task-oriented
approach was more visible in midwives encounters with foreign-born women,
where linguistic difficulties, cultural diversity and narrow time frames
restricted the midwives effectiveness and/or sensitivity as caregivers. In
contrast, the subject-oriented strategy meant getting in tune, i.e.
listening to the woman when she expressed her feelings and emotions,
encouraging the woman to be an active participant in decisions involving
her care. This strategy is used for women who arouse midwives empathy and
when there is some form of recognition and understanding.
The picture created of the woman and her needs guided the midwives, but
lack of knowledge and time limitations restricted counselling on sexual
life after childbirth. Two counselling strategies were identified, one
task-oriented and one subject-oriented. Balancing these two counselling
strategies improves both the ethical aspects and the quality of the
Keywords: Postnatal visit; Sexual life; Midwifery care; Focus group

S. Miller, M. Cordero, A.L. Coleman, J. Figueroa, S. Brito-Anderson, R.

Dabagh, V. Calderon, F. Cceres, A.J. Fernandez, M. Nunez, Quality of care
in institutionalized deliveries: the paradox of the Dominican Republic,
International Journal of Gynecology & Obstetrics, Volume 82, Issue 1,
July 2003, Pages 89-103, ISSN 0020-7292, 10.1016/S0020-7292(03)00148-6.
Abstract: Objectives: To better understand the paradox in the Dominican
Republic of a relatively high maternal mortality ratio despite nearly
universal institutionalized deliveries with trained attendants, a rapid
assessment using an adaptation of the strategic assessment method was
conducted. Methods: A multi-disciplinary team reviewed national statistics
and hospital records, inventoried facilities, and observed peripartum
clientprovider interactions at 14 facilities. Results: The major referral
hospitals, where more than 40% of births in the country occur, were
overcrowded and understaffed, with inexperienced residents overseeing care
provided by medical students, interns and nurses. Uncomplicated labor and
deliveries were overmedicalized, while complicated ones were not managed
appropriately; emergencies were not dealt with in a timely fashion. In the
peripheral hospitals physicians were seldom present and clients were either
turned away or delivered by unprepared nursing staff. Providers in the
busiest facilities suffered from compassion fatigue, and were demoralized
and overworked. In all facilities, quality of care was lacking and the
delivery and birthing process was dehumanized. Conclusions: Access and
availability of institutional delivery alone is not enough to decrease MMR,
it is also the quality of emergency obstetric care that saves lives.
Keywords: Maternal mortality; Emergency obstetric care; Quality of care

Susanne Steinberg, Laurence Kruckman, Stephanie Steinberg, Reinventing

fatherhood in Japan and Canada, Social Science & Medicine, Volume 50,
Issue 9, May 2000, Pages 1257-1272, ISSN 0277-9536, 10.1016/S0277-
Abstract: This article summarizes the findings of a transnational study of
Japanese and Canadian families. Fathers' perceptions are presented for a
critical developmental phase of life: pregnancy, labor, birth, the early
and late postpartum periods. Using qualitative and quantitative research
methods, 33 fathers and 194 mothers were interviewed: Japanese in Tokyo and
Montreal, and English and French Canadians in Montreal. In addition, the
study examines the impact of pregnancy and birth on the relationship of
marriage. The results suggest that the social meaning of fatherhood has
been transformed, legitimizing the presence of the father in the domestic
sphere as a consequence of shifting extended family household structures,
economic conditions and the empowerment of women. Other significant
(p<0.05) patterns were identified. (1) Canadian fathers participate in
labor and delivery to a higher degree than Japanese fathers in Montreal and
Tokyo do (mothers in Tokyo felt more isolated). (2) Canadian men (60%) are
more likely to take time off from work during this phase than the Japanese.
(3) Overall, the majority of fathers, in all four groups, cared for the
child to a higher degree than expected and (4). Birth and early child
rearing appears to have a significant impact on marriage in all four
groups. Public policy issues are addressed and potential responses
Keywords: Fatherhood; Birth; Postpartum; Social support; In-laws

Nathalie Kapp, Kathryn Curtis, Kavita Nanda, Progestogen-only contraceptive

use among breastfeeding women: a systematic review, Contraception, Volume
82, Issue 1, July 2010, Pages 17-37, ISSN 0010-7824,
Abstract: Background
The use of progestogen-only contraceptives by breastfeeding women raises
theoretical concerns regarding possible adverse effects on breastfeeding
success, and infant health or growth. This review was conducted to
determine from the literature whether use of progestogen-only
contraceptives by breastfeeding women leads to adverse effects on
lactation, or infant growth or health when compared to nonuse.
Study Design
We searched the Medline, Popline, Cochrane and LILACS databases for all
articles published from database inception through May 2009. Studies were
included if they investigated the use of progestogen-only methods in
breastfeeding women and reported on clinical outcomes in either women or
their infants. Standard data abstraction templates were used to
systematically assess and summarize. Summary odds ratios were not
calculated, given the heterogeneity of interventions, results and non-
quantifiable outcomes reported.
We identified 43 articles for this review. Overall, five randomized trials
and 38 observational studies demonstrated no adverse effects of various
progestogen-only methods of contraception on multiple measures of
breastfeeding performance through 12 months in women using these methods in
the postpartum period. Many of these studies also demonstrated no adverse
effects of progestogen-only methods on infant growth, health or development
from 6 months to 6 years of age. Additional studies demonstrated no effects
on infant immunoglobulins or sex hormones of exposed male infants. A single
study of a desogestrel pill reported two cases of gynecomastia in exposed
Evidence suggests that progestogen-only methods of contraception do not
adversely affect breastfeeding performance when used during lactation.
Evidence that progestogen-only contraception does not adversely affect
infant growth, health, or development when used by breastfeeding women is
consistent but methodologically limited.
Keywords: Breastfeeding; Lactation; Postpartum contraception; Progestogen-
only contraception

John T. Walkup, Allison Barlow, Britta C. Mullany, William Pan, Novalene

Goklish, Ranelda Hasting, Brandii Cowboy, Pauline Fields, Elena Varipatis
Baker, Kristen Speakman, Golda Ginsburg, Raymond Reid, Randomized
Controlled Trial of a Paraprofessional-Delivered In-Home Intervention for
Young Reservation-Based American Indian Mothers, Journal of the American
Academy of Child & Adolescent Psychiatry, Volume 48, Issue 6, June
2009, Pages 591-601, ISSN 0890-8567, 10.1097/CHI.0b013e3181a0ab86.
Abstract: Objective
To evaluate the efficacy of a paraprofessional-delivered, home-visiting
intervention among young, reservation-based American Indian (AI) mothers on
parenting knowledge, involvement, and maternal and infant outcomes.
From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were
randomized (1:1) to one of two paraprofessional-delivered, home-visiting
interventions: the 25-visit Family Spirit intervention addressing
prenatal and newborn care and maternal life skills (treatment) or a 23-
visit breast-feeding/nutrition education intervention (active control). The
interventions began during pregnancy and continued to 6 months postpartum.
Mothers and children were evaluated at baseline and 2, 6, and 12 months
postpartum. Primary outcomes included changes in mothers' parenting
knowledge and involvement. Secondary outcomes included infants' social and
emotional behavior; the home environment; and mothers' stress, social
support, depression, and substance use.
Participants were mostly teenaged, first-time, unmarried mothers living in
reservation communities. At 6 and 12 months postpartum, treatment mothers
compared with control mothers had greater parenting knowledge gains, 13.5
(p < .0001) and 13.9 (p < .0001) points higher, respectively (100-
point scale). At 12 months postpartum, treatment mothers reported their
infants to have significantly lower scores on the externalizing domain ( =
.17, p < .05) and less separation distress in the internalizing domain
( = .17, p < .05). No between-group differences were found for
maternal involvement, home environment, or mothers' stress, social support,
depression, or substance use.
This study supports the efficacy of the paraprofessional-delivered Family
Spirit home-visiting intervention for young AI mothers on maternal
knowledge and infant behavior outcomes. A longer, larger study is needed to
replicate results and evaluate the durability of child behavior outcomes.
J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):591-601.
Keywords: American Indian; home visiting; parenting; infant development

Charles D. Deakin, Laurie J. Morrison, Peter T. Morley, Clifton W.

Callaway, Richard E. Kerber, Steven L. Kronick, Eric J. Lavonas, Mark S.
Link, Robert W. Neumar, Charles W. Otto, Michael Parr, Michael Shuster,
Kjetil Sunde, Mary Ann Peberdy, Wanchun Tang, Terry L. Vanden Hoek, Bernd
W. Bttiger, Saul Drajer, Swee Han Lim, Jerry P. Nolan, on behalf of the
Advanced Life Support Chapter Collaborators, Part 8: Advanced life support:
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations, Resuscitation,
Volume 81, Issue 1, Supplement, October 2010, Pages e93-e174, ISSN 0300-
9572, 10.1016/j.resuscitation.2010.08.027.

Jeanne Raisler, Jonathan Cohn, Mothers, Midwives, and HIV/AIDS in Sub-

Saharan Africa, Journal of Midwifery & Women's Health, Volume 50, Issue
4, JulyAugust 2005, Pages 275-282, ISSN 1526-9523,
Abstract: This article reviews clinical and program issues in the
prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan
Africa. Topics include prevention of infection, voluntary counseling and
testing, prenatal care, labor and birth, postpartum, family planning,
infant feeding, and the role of traditional birth attendants. Programs
providing short-course antiretroviral therapy to prevent infant infection
are contrasted with comprehensive programs offering antiretroviral therapy
and medical care to mothers, children, and families. Feminization of the
epidemic is related to gender inequalities that facilitate the spread of
HIV and make pregnant women an especially vulnerable group. Nurses and
midwives are the primary health care providers for most of the population
in sub-Saharan Africa. They are the backbone of the new PMTCT programs and
will be the largest group of health workers available to diagnose and treat
opportunistic infections and dispense antiretroviral therapy. But they have
received little training and support to provide AIDS care and treatment and
are rarely consulted when plans are made about workforce issues and
capacity development in the health sector. Clinical training, leadership
skills, salary support, expansion of the nursing workforce, and development
of expanded roles for nurses and midwives in AIDS care are needed to help
them turn the tide of the epidemic.
Keywords: HIV/AIDS; midwifery care; maternal to child transmission

Huynh Nhu Le, Michelle A. Ramos, Ricardo F. Muoz, The relationship between
alexithymia and perinatal depressive symptomatology, Journal of
Psychosomatic Research, Volume 62, Issue 2, February 2007, Pages 215-222,
ISSN 0022-3999, 10.1016/j.jpsychores.2006.09.012.
Abstract: Objective
The purpose of this study was to examine the relationship between
alexithymia and perinatal depressive symptoms and the stability of the
alexithymia construct in a sample of low-income, predominantly Latina women
during pregnancy and the early postpartum period.
Seventy-seven pregnant women completed self-report questionnaires and were
classified as high risk or low risk for developing a major depressive
episode based on a history of depression and/or current high depressive
symptom scores. Measures included the Toronto Alexithymia Scale, the Center
for Epidemiological Studies Depression Scale, and the Maternal Mood
Screener, and were completed during pregnancy and at postpartum month 2.
Alexithymia was positively associated with depressive symptoms during
pregnancy and early postpartum. Women at high risk for depression had
significantly higher alexithymia levels than low-risk women during
pregnancy but not during postpartum. Alexithymia and depressive symptoms
were independently and strongly correlated across the ante- and postpartum
periods. Hierarchical regression analyses indicate that alexithymia scores
at postpartum were predicted by alexithymia scores during pregnancy, above
and beyond the variance explained by the depressive symptom scores during
pregnancy and postpartum.
Alexithymia is positively correlated with depressive symptoms during the
perinatal period and is a stable phenomenon.
Keywords: Alexithymia; Depression; Pregnancy; Postpartum

Mary Philip Sebastian, M.E. Khan, Sohini Roychowdhury, Promoting healthy

spacing between pregnancies in India: Need for differential education
campaigns, Patient Education and Counseling, Volume 81, Issue 3, December
2010, Pages 395-401, ISSN 0738-3991, 10.1016/j.pec.2010.10.019.
Abstract: Objective Birth spacing intervals are relatively short in India.
Healthy spacing of 35 years between births is an effective way to prevent
maternal and child mortality and morbidities. Socio-cultural and structural
barriers, including limited awareness, socio-cultural norms, and
misconceptions need to be addressed for behavior change. Hence the
objective was to understand these barriers and accordingly develop separate
messages for young women, her husband and her mother-in-law.

Methods Data were collected from young women, husbands and mothers-in-law
using qualitative methods. Altogether 16 Focus Group Discussions and 30 in-
depth interviews were conducted. Beliefs related to need of spacing,
disadvantages of closely spaced pregnancies and messages considered
suitable for different stakeholders were investigated. Messages were
identified for women, husband and mother-in-law; communication aids
prepared and community workers trained to appropriately communicate the
messages to stakeholders. Quantitative data were collected to measure the
effect of the intervention.

Results Educational campaign resulted in higher use of contraceptives for

spacing among registered pregnant women from experimental area compared to
control area.

Conclusion Differential audience specific educational campaign is feasible

and effective.

Practice implications For an effective communication in the community,

workers should know how exactly to convey the different health messages to
different target population.
Keywords: Communication; Reproductive health; Birth spacing; Education
campaign; Qualitative research

Sereen Thaddeus, Deborah Maine, Too far to walk: Maternal mortality in

context, Social Science & Medicine, Volume 38, Issue 8, April 1994,
Pages 1091-1110, ISSN 0277-9536, 10.1016/0277-9536(94)90226-7.
Abstract: The Prevention of Maternal Mortality Program is a collaborative
effort of Columbia University's Center for Population and Family Health and
multidisciplinary teams of researchers from Ghana, Nigeria and Sierra
Leone. Program goals include dissemination of information to those
concerned with preventing maternal deaths. This review, which presents
findings from a broad body of research, is part of that activity.

While there are numerous factors that contribute to maternal mortality, we

focus on those that affect the interval between the onset of obstetric
complication and its outcome. If prompt, adequate treatment is provided,
the outcome will usually be satisfactory; therefore, the outcome is most
adversely affected by delayed treatment. We examine research on the factors
that: (1) delay the decision to seek care; (2) delay arrival at a health
facility; and (3) delay the provision of adequate care.

The literature clearly indicates that while distance and cost are major
obstacles in the decision to seek care, the relationships are not simple.
There is evidence that people often consider the quality of care more
important than cost. These three factorsdistance, cost and qualityalone
do not give a full understanding of decision-making process. Their salience
as obstacles is ultimately defined by illness-related factors, such as
severity. Differential use of health services is also shaped by such
variables as gender and socioeconomic status.

Patients who make a timely decision to seek care can still experience
delay, because the accessibility of health services is an acute problem in
the developing world. In rural areas, a woman with an obstetric emergency
may find the closet facility equipped only for basic treatments and
education, and she may have no way to reach a regional center where
resources exist.

Finally, arriving at the facility may not lead to the immediate

commencement of treatment. Shortages of qualified staff, essential drugs
and supplies, coupled with administrative delays and clinical
mismanagement, become documentable contributors to maternal deaths.

Findings from the literature review are discussed in light of their

implications for programs. Options for health programs are offered and
examples of efforts to reduce maternal deaths are presented, with an
emphasis on strategies to mobilize and adapt existing resources.
Keywords: maternal mortality; obstetric complication; developing countries;
health services utilization

Patrick Casey, Michael Sharp, Frank Loda, Child-health supervision for

children under 2years of age: A review of its content and effectiveness,
The Journal of Pediatrics, Volume 95, Issue 1, July 1979, Pages 1-9, ISSN
0022-3476, 10.1016/S0022-3476(79)80073-6.

Stephanie S. Daniel, Joseph G. Grzywacz, Esther Leerkes, Jenna Tucker, Wen-

Jui Han, Nonstandard maternal work schedules during infancy: Implications
for children's early behavior problems, Infant Behavior and Development,
Volume 32, Issue 2, April 2009, Pages 195-207, ISSN 0163-6383,
Abstract: This paper examines the associations between maternal nonstandard
work schedules during infancy and children's early behavior problems, and
the extent to which infant temperament may moderate these associations.
Hypothesized associations were tested using data from the National
Institute of Child Health and Human Development (NICHD) Study of Early
Child Care (Phase I). Analyses focused on mothers who returned to work by
the time the child was 6 months of age, and who worked an average of at
least 35 h per week from 6 through 36 months. At 24 and 36 months,
children whose mothers worked a nonstandard schedule had higher
internalizing and externalizing behaviors. Modest, albeit inconsistent,
evidence suggests that temperamentally reactive children may be more
vulnerable to maternal work schedules. Maternal depressive symptoms
partially mediated associations between nonstandard maternal work schedules
and child behavior outcomes.
Keywords: Maternal nonstandard work schedules; Early behavior problems;
Infant temperament; Maternal depressive symptoms

The Transforming Maternity Care Symposium Steering Committee, Peter B.

Angood, Elizabeth Mitchell Armstrong, Diane Ashton, Helen Burstin, Maureen
P. Corry, Suzanne F. Delbanco, Barbara Fildes, Daniel M. Fox, Paul A.
Gluck, Sue Leavitt Gullo, Joanne Howes, R. Rima Jolivet, Douglas W. Laube,
Donna Lynne, Elliott Main, Anne Rossier Markus, Linda Mayberry, Lynn V.
Mitchell, Debra L. Ness, Rachel Nuzum, Jeffrey D. Quinlan, Carol Sakala,
Alina Salganicoff, Blueprint for Action: Steps Toward a High-Quality, High-
Value Maternity Care System, Women's Health Issues, Volume 20, Issue 1,
Supplement, JanuaryFebruary 2010, Pages S18-S49, ISSN 1049-3867,
Abstract: Childbirth Connection hosted a 90th Anniversary national policy
symposium, Transforming Maternity Care: A High Value Proposition, on April
3, 2009, in Washington, DC. Over 100 leaders from across the range of
stakeholder perspectives were actively engaged in the symposium work to
improve the quality and value of U.S. maternity care through broad system
improvement. A multi-disciplinary symposium steering committee guided the
strategy from its inception and contributed to every phase of the project.
The Blueprint for Action: Steps Toward a High Quality, High Value
Maternity Care System, issued by the Transforming Maternity Care Symposium
Steering Committee, answers the fundamental question,

Who needs to do what, to, for, and with whom to improve the quality of
maternity care over the next five years?

Five stakeholder workgroups collaborated to propose actionable strategies

in 11 critical focus areas for moving expeditiously toward the realization
of the long term 2020 Vision for a High Quality, High Value Maternity Care
System, also published in this issue. Following the symposium these
workgroup reports and recommendations were synthesized into the current
blueprint. For each critical focus area, the Blueprint for Action
presents a brief problem statement, a set of system goals for improvement
in that area, and major recommendations with proposed action steps to
achieve them. This process created a clear sightline to action that if
enacted could improve the structure, process, experiences of care, and
outcomes of the maternity care system in ways that when anchored in the
culture can indeed transform maternity care.

Ana Fonseca, Brbara Nazar, Maria Cristina Canavarro, Parental

psychological distress and quality of life after a prenatal or postnatal
diagnosis of congenital anomaly: A controlled comparison study with parents
of healthy infants, Disability and Health Journal, Volume 5, Issue 2, April
2012, Pages 67-74, ISSN 1936-6574, 10.1016/j.dhjo.2011.11.001.
Abstract: Background
Parental early adjustment to a prenatal or postnatal diagnosis of
congenital anomaly has been studied mainly within a pathological and
deterministic perspective, giving us an inadequate view of the impact of
the diagnosis.
Adopting a comprehensive approach on parental adjustment, we aimed to
characterise the impact of the diagnosis on psychological distress and
quality of life, in the early postdiagnosis stage. The effects of gender
and the timing of the diagnosis were also examined.
In this cross-sectional study, 42 couples with healthy infants and 42
couples whose infants were prenatal or postnatally diagnosed with a
congenital anomaly responded to the Brief Symptom Inventory-18 and to the
World Health Organization Quality of LifeBrief instrument.
In the early postdiagnosis stage, parents whose infants were diagnosed with
a congenital anomaly presented higher levels of psychological distress than
did the parents of healthy infants (F2,79 = 6.23, p = .003), although they
displayed similar levels of quality of life (F4,78 = 0.62, p = .647).
Mothers reported more adjustment difficulties than fathers in both groups.
Receiving the diagnosis in the prenatal period was associated with higher
maternal psychological quality of life (Z = 2.00, p = .045).
The occurrence of a diagnosis of congenital anomaly during the transition
to parenthood adds to an accumulation of stress-inducing events and
manifests itself in psychopathological symptoms. Maintaining a positive
evaluation of well-being may be understood as a parental resource to deal
with the diagnosis. The importance of adopting a comprehensive perspective
on parental adjustment is highlighted.
Keywords: Parental adjustment; Postnatal diagnosis of congenital anomaly;
Prenatal diagnosis of congenital anomaly; Psychological distress; Quality
of life

Mary E. Young, Maternal health in China - challenges of the next decade,

Health Policy, Volume 14, Issue 2, MarchApril 1990, Pages 87-125, ISSN
0168-8510, 10.1016/0168-8510(90)90369-O.
Abstract: In China, about 10 000 women die every year in pregnancy and
childbirth. These women are young, aged 24 to 34. Morbidity among all women
is still high. About one-third of married women surveyed in some regions
have cervicitis or vaginitis. Ninety percent of the total population have
hepatitis A by young adulthood. Because increasing proportions of
pregnancies are first pregnancies, the risks of complications, such as
toxemia and difficult labor, are higher.

Even though there are still wide regional differences in the mortality
rate, from 18 maternal deaths per 100000 live births in Shanghai to 108 in
Ningxia Autonomous Region, China's achievements in reducing the maternal
deaths to levels less than those found in other developing countries are
impressive. China's policy 1960 - 1980 concentrated on providing access to
basic care, including a rapid expansion of a network of maternal and child
health services, a large group of community health workers trained to
provide basic care, drugs, family planning services, and attendance to
deliveries, and the full political support of the government to improve
women's literacy and the Institution of laws increased the minimum legal
age for marriage.

However, the level of maternal mortality has not declined much in the past
nine years. Furthermore, the difference in the level of morbidity and
mortality varies with the economic status of the region and access to
health services. A strategy to improve maternal health would include
developing a comprehensive approach to strengthen the epidemiological,
clinical, and managerial expertise of the health system. Interventions
would also have to be tailored to local health priorities. Most maternal
deaths in rural areas occur at home as a result of hemorrhage. In the
cities, almost all deliveries occur in hospitals, and the major cause of
death is toxemia. Resources can be used better If targeted to programs that
match these problems. The maternal and child health centers must avoid
overexpansion of curative services that duplicate the existing network of
hospital services. Early intervention to decrease the risks of maternal
deaths, such as correcting anemia, providing tetanus toxoid immunization,
and managing excessive weight gain or hypertension, require patient
cooperation and compliance. Thus, health education is necessary to Increase
patients' awareness of the progression of normal pregnancy and the early
signs of risk factors.

Maternal deaths are preventable. So is most of the morbidity related to

pregnancy. To further reduce the maternal mortality rate and reduce
morbidity, China needs to provide basic maternal health care in the poorest
regions, and needs to experiment with innovative planning and management
methods, such as the risk approach, to match Interventions with priority
health problems.
Keywords: Maternal health; Maternal health care; Population policy; One-
child family policy; Rural health care service; Alternative health service
management; China

May Loo, Chapter 10 - Common Pediatric ConditionsEast and West, Pediatric

Acupuncture, Churchill Livingstone, Saint Louis, 2002, Pages 164-317, ISBN
9780443070327, 10.1016/B978-0-443-07032-7.50014-7.

Helen Scholefield, Safety in obstetric critical care, Best Practice &

Research Clinical Obstetrics & Gynaecology, Volume 22, Issue 5, October
2008, Pages 965-982, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.06.009.
Abstract: High-profile inquiries in several countries have helped to raise
public awareness of safety issues and driven policy change. In obstetric
critical care, various publications have highlighted organizational
factors, communication, absence of guidelines, failure to follow local
protocols, poor documentation and delay in identifying the deteriorating
woman as issues. Patient safety in obstetric critical care is paramount
because of its complexity and the vulnerability of the critically ill
patient to error. The principles of risk management and its various
components can be used to make improvements. A framework to achieve this is
as follows: building a safety culture; leading and supporting staff;
integrating risk management activity; promoting reporting; involving and
communicating with patients and the public; learning and sharing safety
lessons; and implementing solutions to prevent harm.
Keywords: patient safety; risk management; human error; risk assessment;
in-service training; guidelines; medical audit; communication

Elisabeth Kurth, Holly Powell Kennedy, Elisabeth Spichiger, Irene Hsli,

Elisabeth Zemp Stutz, Crying babies, tired mothers: What do we know? A
systematic review, Midwifery, Volume 27, Issue 2, April 2011, Pages 187-
194, ISSN 0266-6138, 10.1016/j.midw.2009.05.012.
Abstract: Objective
to synthesise the evidence on the interconnectedness of infant crying and
maternal tiredness in the postpartum period, both from quantitative as well
as from qualitative studies.
a systematic review was conducted including studies in English, French and
German published from 1980 to 2007. Studies were included in the systematic
review if they had extractable data on infant crying as well as maternal
tiredness in the period of 03 months post partum. Of 100 retrieved
publications, 10 met these criteria.
evidence from this review indicated that the amount of infant crying during
the first three months postpartum is associated with the experience of
tiredness and fatigue in new mothers. Significant associations were found
in five of six quantitative studies. The four identified qualitative
studies describe how infant crying disrupts new mothers circadian rhythms,
reducing opportunities to rest and exacerbating tiredness. Incremental
exhaustion diminished parents ability to concentrate, raising the fear of
harming their children, triggering depressive symptoms and burdening
parentchild interaction.
Key conclusions and implications for practice
if healthcare professionals are to address the prominent concerns of
parents caring for a neonate, it is essential to review current care
practices and tailor them to maternal and infant needs. A care strategy
alleviating the burden of infant crying and maternal fatigue has the
potential to strengthen family health from the earliest stage.
Keywords: Postpartum period; Infant crying; Colic; Postpartum fatigue

M. Carlough, M. McCall, Skilled birth attendance: What does it mean and how
can it be measured? A clinical skills assessment of maternal and child
health workers in Nepal, International Journal of Gynecology &
Obstetrics, Volume 89, Issue 2, May 2005, Pages 200-208, ISSN 0020-7292,
Abstract: The presence of a skilled birth attendant at delivery is
important in averting maternal and neonatal mortality and morbidity. It has
now shown that even trained traditional birth attendants (TBAs) cannot, in
most cases, save women's lives effectively because they are unable to treat
complications, and are often unable to refer. Qualified midwives and
doctors are often not available in the rural areas and community settings
where most women in developing countries deliver. Defining the minimum
competency level necessary to meet the definition of skilled birth
attendant is important, particularly in countries such as Nepal with
limited availability of facility-based emergency obstetric care. Maternal
and child health workers are local women aged 1835 who completed a 15-week
course in maternal and child health. As the role of MCHWs has expanded to
meet the country's needs for skilled attendance, a 6-week refresher
course in midwifery skills is offered. The results of this clinical skills
assessment of 104 randomly selected MCHWs from 15 districts across Nepal
supports the premise that MCHWs with appropriate training have an
acceptable level of knowledge and skill, demonstrated in a practice
situation, to meet the definition of community level skilled birth
attendants. Yet, competency alone will not necessarily improve the
situation. To affect maternal mortality in Nepal, MCHWs must be widely
available, they must be allowed to do what they are trained to do, and they
must have logistical and policy support.
Keywords: Skilled birth attendants; Emergency obstetrics; Safe motherhood;
Clinical assessment

Karen McCurdy, The influence of support and stress on maternal attitudes,

Child Abuse & Neglect, Volume 29, Issue 3, March 2005, Pages 251-268,
ISSN 0145-2134, 10.1016/j.chiabu.2004.12.007.
Abstract: Objectives:
This study examines an expanded version of Belsky's (1984) multi-
dimensional process model of parenting to determine whether changes in
stress and support influence maternal attitudes during the first year of a
child's life.
Data were collected from mothers of newborns eligible for Hawaii's Healthy
Start program who had been randomly assigned to home visitation
(n = 108) or control (n = 104) status. Multiple
regression analyses were used to test hypotheses regarding the influence of
change in contextual sources of support and stress on parenting attitudes
as measured by the Child Abuse Potential Inventory (CAPI) Abuse Scale. A
post hoc analysis of variance was conducted to explore interactions among
the predictor variables and home visitation.
Stress in the form of change in public assistance status led to more
punitive parenting attitudes while increased support from the partner and
from close associates emerged as significant predictors of less punitive
parental attitudes. The exploratory analyses suggest that home visitation
may moderate the impacts of stress and support on maternal attitudes.
In line with Belsky's (1984) process model of parenting, increased stress
adversely impacted maternal attitudes regarding physical punishment while
increased support exerted favorable effects. The results also support
further elaboration of Belsky's model including the expansion of marital
support to include unmarried partners and the need to consider the impact
of formal support sources on parenting.
Keywords: Child Abuse Potential Inventory; Home visitation; Maternal social
support; Public assistance; Parenting

Kiki V. Roe, Vocal interchange with mother and stranger as a function of

infant age, sex, and parental education, Early Childhood Research
Quarterly, Volume 5, Issue 1, March 1990, Pages 135-145, ISSN 0885-2006,
Abstract: This study explored whether sex and socio-educational differences
could be detected in young infants' pattern of vocal interaction with
mother and stranger. Sixteen male and 16 female normal infants from either
highly educated or lower educated parents were tested at ages 2 and 3
months at their home. Mother and a female experimenter-stranger each tried
to engage the infant in conversation for 3 min. All vocalizations were
recorded and decoded later. Infants at both ages vocalized more to mother
than stranger. Infants from the higher education group and female infants
(particularly in the higher education group) vocalized significantly more
to mother than to stranger at both ages than both male and female infants
in the lower education group. The results suggest that young infants'
pattern of vocal interaction with mother and stranger, which appears to be
influenced by early environmental factors, may be a meaningful behavior to
discern early group differences in linguistic skills.

Joan Forns, Jordi Julvez, Raquel Garca-Esteban, Mnica Guxens, Muriel

Ferrer, James Grellier, Martine Vrijheid, Jordi Sunyer, Maternal
intelligence-mental health and child neuropsychological development at age
14 months, Gaceta Sanitaria, Available online 28 January 2012, ISSN 0213-
9111, 10.1016/j.gaceta.2011.10.011.
Abstract: Objective
To examine the relationship between maternal intelligence-mental health and
neuropsychological development at age 14 months in a normal population,
taking into account maternal occupational social class and education.
We prospectively studied a population-based birth cohort, which forms part
of the INMA (Environment and Childhood) Project. Cognitive and psychomotor
development was assessed at 14 months using Bayley Scales of Infant
Development. Maternal intelligence and mental health were assessed by the
Cattell and Cattell test and the General Health Questionnaire-12
We observed a crude association between maternal intelligence and cognitive
development in children at 14 months but this association disappeared when
maternal education was included. The associations were stratified by
maternal education and occupational social class. Within the manual
maternal occupational social class, there was a significant difference in
cognitive development between children whose mothers scored in the highest
tertile of maternal IQ and those whose mothers scored in the lowest
tertile. In contrast, no differences were observed among children whose
mothers were in the non-manual occupational social class.
The association between maternal intelligence and child cognitive
development differed by occupational social class. While this association
was not confounded by education or other variables in manual occupational
social classes, maternal education explained this association among
advantaged occupational social classes.
Keywords: Child development; Intelligence; Mental health; Neuropsychology;
Desarrollo infantil; Inteligencia; Salud mental; Neuropsicologa

, CHAPTER 20 - Postpartum Biomedical Concerns: Breastfeeding, In: Stephen

D. Ratcliffe, MD, MSPH, Elizabeth G. Baxley, MD, Matthew K. Cline, MD, and
Ellen L. Sakornbut, MD, Editor(s), Family Medicine Obstetrics (Third
Edition), Mosby, Philadelphia, 2008, Pages 618-643, ISBN 9780323043069,

Christine Norton, Fecal Incontinence and Biofeedback Therapy,

Gastroenterology Clinics of North America, Volume 37, Issue 3, September
2008, Pages 587-604, ISSN 0889-8553, 10.1016/j.gtc.2008.06.008.
Abstract: Biofeedback as delivered in most clinical settings in Western
medicine has been consistently reported to improve symptoms of fecal
incontinence. Closer scrutiny of the elements of the intervention and
controlled studies, however, have consistently failed to find any benefit
of the biofeedback element of this complex package of care; nor has any
superiority been found for one modality over another. There is a need for
further well-designed and adequately powered randomized controlled trials.
Meanwhile, there can be little doubt that conservative interventions
improve many patients with fecal incontinence to the point where most
report satisfaction with treatment and do not wish to consider more
invasive options, such as surgery.
Keywords: Fecal incontinence; Biofeedback; Pelvic floor muscle training;
Conservative management

Maureen O. Marcenko, Michael Spence, Linda Samost, Outcomes of a home

visitation trial for pregnant and postpartum women at-risk for child
placement, Children and Youth Services Review, Volume 18, Issue 3, 1996,
Pages 243-259, ISSN 0190-7409, 10.1016/0190-7409(96)00003-5.
Abstract: This study is a randomized clinical trial designed to test the
psychosocial efficacy of a pre- and postpartum home visitation model for
women at-risk for out-of-home placement of their newborns. Two hundred
twenty-five pregnant women with high risk pregnancies for psychosocial
reasons were recruited into the study and randomly assigned to an
experimental (n = 125) or control condition (n = 100) when they presented
for prenatal care at a large urban clinic. After an average of 16 months of
exposure to the intervention, women in the experimental group reported
significantly greater access to services and there was a trend for the
experimental group to show a decrease in psychological distress. At 10
months, there was a trend for experimental group women to experience an
increase in social support, but this was not sustained at 16 months.
Although the difference was not statistically significant, a higher
percentage of women in the experimental group had children in out-of-home
living arrangements. There was also a trend among those with children in
placement, for children of experimental group women to be placed in
extended family care rather than foster care more frequently than controls.
The implications of the findings for interventions with at-risk families
are discussed.

Barbara L Philipp, Anne Merewood, The Baby-Friendly way: the best

breastfeeding start, Pediatric Clinics of North America, Volume 51, Issue
3, June 2004, Pages 761-783, ISSN 0031-3955, 10.1016/j.pcl.2004.01.007.

Rajesh Kumar Rai, Prashant Kumar Singh, Lucky Singh, Utilization of

Maternal Health Care Services among Married Adolescent Women: Insights from
the Nigeria Demographic and Health Survey, 2008, Women's Health Issues,
Volume 22, Issue 4, JulyAugust 2012, Pages e407-e414, ISSN 1049-3867,
Abstract: Background
An ongoing social catastrophe of very poor performance in maternal health
coupled with an unacceptably high number of maternal deaths is evident in
Nigeria, especially among adolescent women. This study examines the factors
associated with selected maternity servicesmarried adolescent women who
have had at least four antenatal care (ANC) visits, those who have
undergone safe delivery care, and those who received postnatal care within
42 days of delivery.
Data from Nigeria Demographic and Health Survey, 2008, were used. An
eligible sample of 2,434 married adolescent (aged 1519 years) women was
included in the analysis. Pearson chi-square test and binary logistic
regression were performed to fulfill the study objective.
It was found that about 35% of adolescent women had at least four ANC
visits, a little over 25% had undergone safe delivery care, and nearly 32%
received postnatal care within 42 days of delivery. Women's education,
husband's education, wealth quintile, and region of residence were
documented as the most important factors associated with maternal
healthcare service utilization. The ANC visit was found to be vital in the
utilization of safe delivery and postnatal care.
Findings indicate that programs to improve maternal healthcare have not
succeeded in overcoming the socioeconomic obstacles in the way of
adolescents' utilizing maternity services. In the long run, the content and
service delivery strategy of maternity programs must be designed in keeping
with the socioeconomic context with special attention to adolescent women
who are uneducated, poor, and residing in rural areas.

Lorraine B. Sanders, Assessing and Managing Women With Depression: A

Midwifery Perspective, Journal of Midwifery & Women's Health, Volume
51, Issue 3, MayJune 2006, Pages 185-192, ISSN 1526-9523,
Abstract: Women are at disproportionate risk for depression. Depression
often goes untreated because of lack of recognition by providers. The
Institute of Medicine maintains that primary care providers are essential
in the management of mental health disorders. The assessment and management
of depression in women are sensitive topics and may require advanced
training and skills.
Keywords: depression; midwifery; screening; postpartum depression

Susanna Rose Cohen, Leslie Cragin, Bob Wong, Dilys M. Walker, Self-Efficacy
Change With Low-Tech, High-Fidelity Obstetric Simulation Training for
Midwives and Nurses in Mexico, Clinical Simulation in Nursing, Volume 8,
Issue 1, January 2012, Pages e15-e24, ISSN 1876-1399,
Abstract: Background
This prospective descriptive study examined the relationship between low-
tech, high-fidelity simulationbased training and pre- and posttraining
changes in participant self-efficacy (SE).
A 3-week training was followed by a 2-day session 4 months later in
Cuernavaca, Mexico. Midwives and obstetrical nurses either participated in
or observed 41 scenarios during a clinical update in emergency obstetric
SE increased significantly. It decreased at 4 months posttraining but
remained higher than pretraining levels.
The training positively affected participants' perceived readiness for the
technical, behavioral, and cognitive dimensions of obstetric emergencies.
After simulation training, participants faced the critical, high-pressure,
and often abusive real world in clinical sites, which may explain the
drop in SE scoresr.
Keywords: patient simulation; self-efficacy; high-fidelity; nursing
education; teaching methods; Mexico; midwifery education

Fiona Bogossian, Lisa McKenna, Monica Higgins, Christine Benefer, Susannah

Brady, Stephanie Fox-Young, Simon Cooper, Simulation based learning in
Australian midwifery curricula: Results of a national electronic survey,
Women and Birth, Volume 25, Issue 2, June 2012, Pages 86-97, ISSN 1871-
5192, 10.1016/j.wombi.2011.02.001.
Abstract: SummaryObjective
The primary aim of this paper is to describe the extent, nature and types
of simulation used as a learning method in contemporary Australian
midwifery curricula.
An electronic survey was developed using Graduate e-Cohort Pro and
administered to key midwifery academics who had responsibility for 38
curricula leading to initial midwifery registration in Australia.
Engagement of midwifery academics in the survey was high with a response
rate of 82%. There is a range of midwifery programs by type and level of
award across Australia that vary in duration, enrolments, and by component
theoretical and clinical hours. The proportion of simulation hours in
curricula varied across programs accounting for up to 17% of clinical
program hours. However simulation was used extensively to teach all
identified generic technical skills (n = 16) midwifery technical
skills (n = 51) and generic non-technical skills
(n = 6). Most commonly used simulation types were scenarios,
peer-to-peer learning, partial task trainers and standardised patients.
Simulation types were suited to the learning tasks.
Simulation is used extensively in midwifery education in Australia. Further
research is required to understand the curriculum development imperatives
of simulation and there is a need to adequately resource and support staff
in the use of simulation to provide high quality simulation learning
experiences for students.
Keywords: Midwifery; Simulation; Clinical education; Curricula; Electronic
survey; Technical skills; Non-technical skills

M.C. Lu, J.S. Lu, Prenatal Care, In: Editors-in-Chief: Marshall M. Haith
and Janette B. Benson, Editor(s)-in-Chief, Encyclopedia of Infant and Early
Childhood Development, Academic Press, San Diego, 2008, Pages 591-604, ISBN
9780123708779, 10.1016/B978-012370877-9.00127-4.
Abstract: Prenatal care is healthcare provided to a woman during pregnancy.
It consists of a series of clinical visits and ancillary services designed
to promote the health and well-being of the mother, fetus, and family. Its
major components include early and continuing risk assessment, health
promotion, and medical and psychosocial interventions and follow-up. Risk
assessment includes comprehensive evaluation of the womans or couples
reproductive history, medical risks, medication use, family history and
genetic risks, psychosocial factors, nutritional and behavioral risks, and
laboratory testing. Health promotion includes alleviating unpleasant
symptoms during pregnancy, providing lifestyle advice, promoting healthy
nutrition, reducing environmental exposures, promoting family planning and
breastfeeding. Medical and psychosocial interventions address identified
medical and psychosocial risks. Ideally, prenatal care should begin before
pregnancy (preconception care) and continue after (postpartum care) and
between pregnancies (internatal care), as part of a longitudinally and
contextually integrated strategy to promote optimal development of womens
reproductive health not only during pregnancy, but over the life course.
Keywords: Family planning; Genetic screening; Health promotion; Internatal
care; Life course; Nutrition; Postpartum care; Preconception care;
Pregnancy; Prenatal care; Prenatal laboratory tests; Psychosocial support;
Reproductive life plan; Risk assessment; Stress resilience; Teratogens

Vanessa E. Murphy, Peter G. Gibson, Asthma in Pregnancy, Clinics in Chest

Medicine, Volume 32, Issue 1, March 2011, Pages 93-110, ISSN 0272-5231,
Keywords: Asthma; Pregnancy; Exacerbation; Inhaled corticosteroid

Gijs Walraven, Sikolia Wanyonyi, William Stones, Management of post-partum

hemorrhage in low-income countries, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 22, Issue 6, December 2008, Pages
1013-1023, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.08.002.
Abstract: The provision of safe and effective delivery care for all women
in poor countries remains elusive, resulting in a continuing burden of
mortality in general and mortality from post-partum haemorrhage in
particular. Deployment of a functional health system and effective linkage
of the health system to communities are the necessary prerequisites for the
provision of the life-saving technical interventions that will make a
difference in individual cases. Sadly, two factors militate against
progress: the mantra that we know what works (resulting in some serious
gaps in evidence for best practice in resource-poor settings) and a lack of
large-scale investment in maternity services to counteract the degradation
of infrastructure and depletion of human resources evident in many
Keywords: barriers to access to care; developing countries; health systems;
post-partum haemorrhage

Susan Panzarine, Elisa Slater, Phyllis Sharps, Coping, social support, and
depressive symptoms in adolescent mothers, Journal of Adolescent Health,
Volume 17, Issue 2, August 1995, Pages 113-119, ISSN 1054-139X,
Abstract: Purpose:
The purpose of this study was to determine how the degree of depressive
symptomatology among adolescent mothers differentiated maternal outcomes,
social support, and coping at 6 months postpartum.
Fifty primiparous adolescents, predominantly black and of low income,
participated in the study. During a home visit at 6 months postpartum, a
research assistant, blind to the study's hypotheses, administered
questionnaires related to depressive symptoms, coping with motherhood,
social support, maternal confidence, and maternal gratification. Feeding
and teaching interactions between mother and child were observed.
Fifty-six percent of the subjects had no depressive symptoms (group 1), 20%
reported mild symptoms (group 2), and 24% reported moderate to severe
symptoms (group 3). Adolescents with mild or moderate depressive symptoms
had more negative feeding interactions with their infants, reported less
maternal confidence and gratification, and used more emotion-focused coping
than their nondepressed counterparts. While the groups did not differ in
the frequency with which they received social support, adolescents with
mild or moderate depressive symptoms were less satisfied with this support.
No differences were found among groups with regard to the size of their
conflicted networks.
This study extends the research findings related to depressive symptoms
among adult mothers to a sample of adolescent mothers. Although the study
design is crosssectional and therefore causal sequences cannot be
determined, the results identify factors that may place certain adolescents
at risk for problems in parenting. The authors suggest screening adolescent
mothers during the first postpartum year for symptoms of depression.
Keywords: Adolescent mothers; Depression; Coping; Social support

Lydia Furman, Richard J. Schanler, Chapter 65 - Breastfeeding, Avery's

Diseases of the Newborn (Ninth Edition), W.B. Saunders, Philadelpia, 2012,
Pages 937-951, ISBN 9781437701340, 10.1016/B978-1-4377-0134-0.10065-4.

Olga de Haan, From patient to client, Patient Education and Counseling,

Volume 81, Issue 3, December 2010, Pages 442-447, ISSN 0738-3991,
Abstract: Objective
To gain insight in the knowledge, attitude and practices of users and
providers of reproductive health services in rural areas of Kyrgyzstan and
Tajikistan before and after interventions.
KAP (Knowledge, Attitude, Practices) studies under 500 respondents.
Training that addressed the determinants of behavioural change contributed
to the motivation under health care providers to improve performances. The
simultaneously implemented education program for users of health services
enhanced the preparedness for birth of pregnant women and their family
members. Both interventions had positive effects on health outcomes.
Behavioural change, from hierarchic and directive into client-centred and
supportive, can be realized in Central Asia by enhancing the decision-
making capacities of providers. A client-centred attitude of health care
providers is the key condition for sustainable improvement of service
delivery. Improving clientprovider communication is a cost-effective way
to enhance the quality of care in low resource settings, such as in Central
Practice implications
The providers can be best trained in a practical setting, when trainees are
enabled to practice with real patients, under guidance of a highly skilled
professional. Psychological components such as addressing emotions and
exploring the values and beliefs of providers should be incorporated in
separate training modules.
Keywords: Health psychology; Informed choices

C MacArthur, HR Winter, DE Bick, H Knowles, R Lilford, C Henderson, RJ

Lancashire, DA Braunholtz, H Gee, Effects of redesigned community postnatal
care on womens' health 4 months after birth: a cluster randomised
controlled trial, The Lancet, Volume 359, Issue 9304, 2 February 2002,
Pages 378-385, ISSN 0140-6736, 10.1016/S0140-6736(02)07596-7.
Abstract: SummaryBackground
Much postpartum physical and psychological morbidity is not addressed by
present care, which tends to focus on routine examinations. We undertook a
cluster randomised controlled trial to assess community postnatal care that
has been redesigned to identify and manage individual needs.
We randomly allocated 36 general practice clusters from the West Midlands
health region of the UK to intervention (n=17) or control (19) care.
Midwives from the practices recruited women and provided care. 1087 (53%)
of 2064 women were in practices randomly assigned to the intervention
group, with 977 (47%) women in practices assigned to the control group.
Care was led by midwives, with no routine contact with general
practitioners, and was extended to 3 months. Midwives used symptom
checklists and the Edinburgh postnatal depression scale (EPDS) to identify
health needs and guidelines for the management of these needs. Primary
outcomes at 4 months were obtained by postal questionnaire and included the
women's short form 36 physical (PCS) and mental (MCS) component summary
scores and the EPDS. Secondary outcomes were women's views about care.
Multilevel analysis accounted for possible cluster effects.
801 (77%) of 1087 women in the intervention group and 702 (76%) of 977
controls responded at 4 months. Women's mental health measures were
significantly better in the intervention group (MCS, 303 [95% CI 153
452]; EPDS 192 [255 to 129]; EPDS 13+ odds ratio 057 [043076])
than in controls, but the physical health score did not differ.
Redesign of care so that it is midwife-led, flexible, and tailored to
needs, could help to improve women's mental health and reduce probable
depression at 4 months' postpartum.

, References, Sex Differences, Academic Press, San Diego, 2000, Pages 379-
462, ISBN 9780124874602, 10.1016/B978-012487460-2/50013-1.


KESSLER, JOAN JENSEN, DAVID M PAIGE, Counseling and Motivational Videotapes
Increase Duration of Breast-Feeding in African-American WIC Participants
Who Initiate Breast-Feeding, Journal of the American Dietetic Association,
Volume 98, Issue 2, February 1998, Pages 143-148, ISSN 0002-8223,
Abstract: Objective To evaluate the relative effects introducing
motivational videotapes and/or peer counseling in Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) clinics serving
African-American women have on breast-feeding duration.

Design Experimental intervention study. Pregnant women were enrolled at or

before 24 weeks gestation and were followed up until postpartum week 16.
Women were interviewed at enrollment, 7 to 10 days, 8 weeks, and 16 weeks

Subjects/setting One hundred fifteen African-American WIC participants who

initiated breast-feeding and who had been enrolled in 1 of 4 clinics.

Intervention Two-by-two factorial design, in which 4 clinics were randomly

assigned to receive either no intervention, a motivational video package
intervention, a peer-counseling intervention, or both interventions.

Main outcome measures Breast-feeding duration in weeks and relative risk

ratios for breast-feeding cessation before 16 weeks postpartum.

Statistical analysis performed Contingency table analysis, including 2

tests and log-rank tests; multivariate analysis using Cox proportional
hazards regression analysis.

Results A higher proportion of women were breast-feeding at 8 and 16 weeks

postpartum in the intervention clinics than in the control clinic. The
proportion of women reporting breast-feeding declined at 8 and 16 weeks
postpartum, but the rate of decline was slower in the 3 intervention
clinics than in the control clinic. Being younger than 19 years of age or
older than 25 years of age, having a male infant, and returning to work or
school all negatively affected breast-feeding duration, whereas previous
breast-feeding experience positively influenced breast-feeding duration.

Applications/conclusions WIC-based peer counselor support and motivational

videos can positively affect the duration of breast-feeding among African-
American women. WIC nutritionists and other health professionals in contact
with this population should expand their efforts toward promoting increased
duration of breast-feeding. J Am Diet Assoc. 1998;98:143-148.

Paul Ramchandani, Lamprini Psychogiou, Paternal psychiatric disorders and

children's psychosocial development, The Lancet, Volume 374, Issue 9690,
2228 August 2009, Pages 646-653, ISSN 0140-6736, 10.1016/S0140-
Abstract: Summary
Psychiatric disorders of parents are associated with an increased risk of
psychological and developmental difficulties in their children. Most
research has focused on mothers, neglecting psychiatric disorders affecting
fathers. We review findings on paternal psychiatric disorders and their
effect on children's psychosocial development. Most psychiatric disorders
that affect fathers are associated with an increased risk of behavioural
and emotional difficulties in their children, similar in magnitude to that
due to maternal psychiatric disorders. Some findings indicate that boys are
at greater risk than girls, and that paternal disorders, compared with
maternal disorders, might be associated with an increased risk of
behavioural rather than emotional problems. Improved paternal mental health
is likely to improve children's wellbeing and life course.

Kathleen Fahy, Carolyn Hastie, Andrew Bisits, Christine Marsh, Lurena

Smith, Anne Saxton, Holistic physiological care compared with active
management of the third stage of labour for women at low risk of postpartum
haemorrhage: A cohort study, Women and Birth, Volume 23, Issue 4, December
2010, Pages 146-152, ISSN 1871-5192, 10.1016/j.wombi.2010.02.003.
Abstract: SummaryQuestion
Is holistic psychophysiological care in the third stage of labour safe
for women at low risk of postpartum haemorrhage?.
Although there have been four randomised trials and a Cochrane Review on
the safety and effectiveness of care during the third stage labour, no
previous study has focussed only on women at low risk of postpartum
haemorrhage and no previous study has tested a form of physiological third
stage care that is provided by skilled midwives in an appropriate setting.
Retrospective cohort study involving a maternity unit at a tertiary
referral hospital and a freestanding, midwifery-led birthing unit.
All low risk women who gave birth at either unit in the period July 2005
August 2008.
Active management of the third stage of labour compared with holistic
psychophysiological third stage care.
At the tertiary unit, 344 of 3075 low risk women (11.2%) experienced
postpartum haemorrhages (PPH). At the midwifery-led unit, PPH occurred for
10 of 361 women (2.8%), OR = 4.4, 95% CI [2.3, 8.4]. Treatment
received analysis showed that active management (n = 3016) was
associated with 347 postpartum haemorrhages (11.5%) compared with receiving
holistic psychophysiological care (n = 420) which was associated
with 7 (1.7%) PPH OR = 7.7, 95% CI [3.6, 16.3].
This study suggests that holistic psychophysiological care in the third
stage labour is safe for women at low risk of postpartum haemorrhage.
Active management was associated with a seven to eight fold increase in
postpartum haemorrhage rates for this group of women. Further prospective
observational evaluation would be helpful in testing this association.
Keywords: Labour, third stage; Physiological third stage care; Midwifery
models; Birth centre care; Labour

John Kattwinkel, Lynn J Cook, George Nowacek, Carey Bailey, Warren M

Crosby, Hallam Hurt, Jerry Short, Regionalized perinatal education,
Seminars in Neonatology, Volume 9, Issue 2, April 2004, Pages 155-165, ISSN
1084-2756, 10.1016/j.siny.2003.08.005.
Abstract: Despite changes in the organization and financing of healthcare
delivery, and dramatic increases in the number and distribution of
perinatal facilities and professionals over the past three decades, there
remains a continuing need for effective and efficient regionalized
perinatal outreach education programmes. Both the organizers and the
participants should be multidisciplinary and include both inpatient and
outpatient providers. Content should be restricted to issues relevant to
participants' practice, and include topics ranging from preconception to
postpartum and early infant care. There are various effective formats, but
consideration should be given to reaching as many providers as possible
simultaneously within a given facility, minimizing expense and economizing
on participants' time. Evaluation strategies range from assessment of
immediate outcomes, which generally examine programme process, to ultimate
outcomes, which measure changes in patient care and patient health.
Keywords: Education; Continuing education; Education evaluation;
Neonatology; Obstetrics; Outreach education; Perinatal education;
Perinatology; Regionalization; Perinatal care; Neonatal care; Organization

Nancy F Krebs, Maureen A Murtaugh, Position of The American Dietetic

Association: Promotion of Breast-Feeding, Journal of the American Dietetic
Association, Volume 97, Issue 6, June 1997, Pages 662-666, ISSN 0002-8223,

Phillip N. Rauk, Educational intervention, revised instrument sterilization

methods, and comprehensive preoperative skin preparation protocol reduce
cesarean section surgical site infections, American Journal of Infection
Control, Volume 38, Issue 4, May 2010, Pages 319-323, ISSN 0196-6553,
Abstract: Background
In 2005, of the approximately 4 million births in the United States, 30%
were by cesarean section (C-section) delivery, which translates to roughly
over 1 million C-sections in 2005 alone. C-section is associated with
higher morbidity than vaginal delivery. Women who undergo C-section are 5
times more likely to develop a postpartum infection after delivery than
women who undergo vaginal delivery.
Estimates of surgical site infection (SSI) after C-section range from 1.50
to 2.64. A quality improvement initiative was implemented at the University
of Minnesota Medical School to reduce rates of SSI using changes based on
recommended care initiatives.
The multidisciplinary team developed a comprehensive staff education and
training program, added a preoperative skin preparation protocol using
chlorhexidine gluconate (CHG) no-rinse cloths, added CHG with alcohol for
interoperative skin preparation, and modified instrument sterilization
Data analysis revealed a statistically significant reduction in the overall
SSI rate from 7.5% (33/441) in January-July 2006 to 1.2% (5/436) in
January-July 2007 (2 test statistic, 21.2; P < .001; relative reduction
of 84%).
Interventions, including staff education, use of CHG no-rinse cloths for
preoperative skin prep, CHG with alcohol for intraoperative skin prep, and
appropriate instrument sterilization management led to reductions in SSI
rates in patients undergoing C-section at our institution. Rates of
endometritis were also noted to be lower after implementation of the
Keywords: Surgical site infections; obstetrical surgical site infections;
C-section surgical site infections; chlorhexidine gluconate skin
Sue Barton, Chapter 7 - The postnatal period, In: Jill Mantle, BA FCSP
DIPTP, Jeanette Haslam, MPHIL GRADDIPPHYS MCSP SRP, and Sue Barton, MSC
DIPED MCSP DIPTP DIPRG&RT DIPTHRF SRP, Editor(s), Physiotherapy in
Obstetrics and Gynaecology (Second Edition), Butterworth-Heinemann, Oxford,
2004, Pages 205-247, ISBN 9780750622653, 10.1016/B978-0-7506-2265-3.50015-

Jean-Pierre Unger, Patrick Van Dessel, Kasturi Sen, Pierre De Paepe,

International health policy and stagnating maternal mortality: is there a
causal link?, Reproductive Health Matters, Volume 17, Issue 33, May 2009,
Pages 91-104, ISSN 0968-8080, 10.1016/S0968-8080(09)33460-6.
Abstract: This paper examines why progress towards Millennium Development
Goal 5 on maternal health appears to have stagnated in much of the global
south. We contend that besides the widely recognised existence of weak
health systems, including weak services, low staffing levels, managerial
weaknesses, and lack of infrastructure and information, this stagnation
relates to the inability of most countries to meet two essential
conditions: to develop access to publicly funded, comprehensive health
care, and to provide the not-for-profit sector with needed political,
technical and financial support. This paper offers a critical perspective
on the past 15 years of international health policies as a possible
cofactor of high maternal mortality, because of their emphasis on disease
control in public health services at the expense of access to comprehensive
health care, and failures of contracting out and publicprivate
partnerships in health care. Health care delivery cannot be an issue both
of trade and of right. Without policies to make health systems in the
global south more publicly-oriented and accountable, the current standards
of maternal and child health care are likely to remain poor, and maternal
deaths will continue to affect women and their families at an intolerably
high level.
Keywords: health policy and programmes; health systems; privatisation;
neoliberal economics; maternal mortality and morbidity

Susan P Walker, Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff, Gail A
Wasserman, Ernesto Pollitt, Julie A Carter, the International Child
Development Steering Group, Child development: risk factors for adverse
outcomes in developing countries, The Lancet, Volume 369, Issue 9556, 1319
January 2007, Pages 145-157, ISSN 0140-6736, 10.1016/S0140-6736(07)60076-2.
Abstract: Summary
Poverty and associated health, nutrition, and social factors prevent at
least 200 million children in developing countries from attaining their
developmental potential. We review the evidence linking compromised
development with modifiable biological and psychosocial risks encountered
by children from birth to 5 years of age. We identify four key risk factors
where the need for intervention is urgent: stunting, inadequate cognitive
stimulation, iodine deficiency, and iron deficiency anaemia. The evidence
is also sufficient to warrant interventions for malaria, intrauterine
growth restriction, maternal depression, exposure to violence, and exposure
to heavy metals. We discuss the research needed to clarify the effect of
other potential risk factors on child development. The prevalence of the
risk factors and their effect on development and human potential are
substantial. Furthermore, risks often occur together or cumulatively, with
concomitant increased adverse effects on the development of the world's
poorest children.

Bernard Guyer, Sai Ma, Holly Grason, Kevin D. Frick, Deborah F. Perry,
Alyssa Sharkey, Jennifer McIntosh, Early Childhood Health Promotion and Its
Life Course Health Consequences, Academic Pediatrics, Volume 9, Issue 3,
MayJune 2009, Pages 142-149.e71, ISSN 1876-2859,
Abstract: Objective
To explore whether health promotion efforts targeted at preschool-age
children can improve health across the life span and improve future
economic returns to society.
We selected 4 health topics to reviewtobacco exposure, unintentional
injury, obesity, and mental healthbecause they are clinically and
epidemiologically significant, and represent the complex nature of health
problems in this early period of life. The peer-reviewed literature was
searched to assess the level of evidence for short- and long-term health
impacts of health promotion and disease prevention interventions for
children from before birth to age 5. This review sought to document the
monetary burden of poor child health, the cost implications of preventing
and treating child health problems, and the net benefit of the
The evidence is compelling that these 4 topicstobacco exposure,
unintentional injury, obesity, and mental healthconstitute a significant
burden on the health of children and are the early antecedents of
significant health problems across the life span. The evidence for the cost
consequences of these problems is strong, although more uneven than the
epidemiological data. The available evidence for the effectiveness of
interventions in this age group was strongest in the case of preventing
tobacco exposure and injuries, was limited to smaller-scale clinical
interventions in the case of mental health, and was least available for
efforts to prevent obesity among preschoolers.
Currently available research justifies the implementation of health
interventions in the prenatal to preschool periodespecially to reduce
tobacco exposure and prevent injuries. There is an urgent need for
carefully targeted, rigorous research to examine the longitudinal causal
relationships and provide stronger economic data to help policy makers make
the case that the entire society will benefit from wise investment in
improving the health of preschool-age children and their families.
Keywords: child health; early intervention; investing in children; life
course; mental health; obesity; tobacco exposure; unintentional injury

Beatrice K.M. Hung, Lydia Ling, S.G. Ong, Sources of influence on infant
feeding practices in Hong Kong, Social Science & Medicine, Volume 20,
Issue 11, 1985, Pages 1143-1150, ISSN 0277-9536, 10.1016/0277-
Abstract: The breastfeeding rate in Hong Kong is low compared to the rates
in Western countries. To understand the relative importance of different
sources of influence on infant feeding practices, 714 Chinese mothers with
infants aged 4 weeks to 6 months were studied. It was found that the
bottlefeeding mothers were influenced more by the medical professionals who
did not support breastfeeding. This influence was further reinforced by the
mass media and particularly television advertisements on infant formulae.
The successful breastfeeding mothers, on the other hand, were influenced
more by their social networks through which they were told of the dangers
of bottlefeeding. The failed breastfeeding mothers differed from the other
groups in the lack of support they experienced from friends and relatives.
Although they received professional encouragement to breastfeed, they were
more sheltered from the influence of mass media and social networks. From
these findings, it is suggested that different sources of influence are
related to different feeding practices. However, to be able to continue
with the practice that one has chosen, the availability of social support
is essential. Implications of these findings are discussed and several
recommendations to promote breastfeeding are made.

Bibhuti K. Sar, Becky F. Antle, Linda K. Bledsoe, Anita P. Barbee, Michiel

A. Van Zyl, The importance of expanding home visitation services to include
strengthening family relationships for the benefit of children, Children
and Youth Services Review, Volume 32, Issue 2, February 2010, Pages 198-
205, ISSN 0190-7409, 10.1016/j.childyouth.2009.08.016.
Abstract: Although home visiting programs effectively address risks of
maltreatment related to the mother and infant through providing services
such as medical care, education/vocational support, and training on
positive infant parenting practices, little programmatic attention has been
paid to couple relationships, father involvement, and parenting
interactions in the context of new parenthood. These relationships within
the family system, if not nurtured, can heighten the risks for
maltreatment. Therefore, the research on the impact of these relationships
for children's wellbeing are reviewed, examples of evidence-based programs
to strengthen these relationships are provided, and changes to existing
home visiting policies and programs to include strengthening family
relationships for the benefit of children are recommended.
Keywords: Home visitation services; Economically disadvantaged families;
Evidence-based practices (EBP); Relationship strengthening programs

Barthlmy Kuate Defo, Effects of socioeconomic disadvantage and women's

status on women's health in Cameroon, Social Science & Medicine, Volume
44, Issue 7, April 1997, Pages 1023-1042, ISSN 0277-9536, 10.1016/S0277-
Abstract: Research on the effects of socioeconomic disadvantage and women's
status on women's health is important for policy makers in developing
countries, where limited resources make it crucial to use existing maternal
and child health care resources to the best advantage. Using a community-
based data set collected prospectively in Cameroon, this study attempts to
understand the extent to which socioeconomic factors and women's status
have influences on women's health. The most important finding is that the
burden of illness rests disproportionately on the economically
disadvantaged women and on those with low social status. The long-term
effects of social disadvantage are apparent in the excesses of morbidity
among women who are not employed at the time of their children's birth,
women living in poor neighborhoods, and those living in households without
modern amenities. The maternal morbidity patterns during the postpartum
period indicate that the women's reports of their recovery and health
status from childbirth extend far beyond the first few weeks that previous
studies have focused on. From a theoretical perspective, this study has
demonstrated the importance of the intermediate framework for the study
of women's health: the operations of effects of a number of background
characteristics are mediated by more proximate determinants of women's
health. These results remain robust even after controlling for other
measured factors and after correcting for unmeasured heterogeneity and
sample selection; this helps to dismiss the potential influence of some
artifacts. While this study suggests that there are opportunities within
the existing health care system for meeting many of the health care needs
of the socially disadvantaged, further biobehavioral and psychosocial
research is needed to determine how women's status and social disadvantage
influence the demand for health care services, in order to ensure equitable
as well as a more effective delivery of health care services and to break
the vicious circle of disadvantage.
Keywords: women's health; women's status; socioeconomic status; prospective
study; Cameroon
Shirley Russ, Nicole Garro, Neal Halfon, Meeting children's basic health
needs: From patchwork to tapestry, Children and Youth Services Review,
Volume 32, Issue 9, September 2010, Pages 1149-1164, ISSN 0190-7409,
Abstract: Few would deny that if a system were to be designed de novo to
meet children's basic health needs, it would be radically different from
the confusing and fragmented patchwork of programs in place today. While
Medicaid and the Children's Health Insurance Program (CHIP), have improved
access to care, increased use of health care services, and reduced unmet
health needs for low-income children, the impact of these programs on the
quality of health care, and on children's health outcomes is less certain.
At the same time, the prevalence of childhood chronic illness is
increasing, there is an epidemic of obesity, and sizeable increases in
reported developmental and behavioral problems and mental health issues.
Our existing system of care appears ill-equipped to respond to this
changing epidemiology. Unmet needs for care in childhood represent time-
bombs, likely to result in an explosion of chronic illness in mid-life. We
propose a new approach to child health policy, based on the life course
health development model in which health in childhood is regarded as a
foundation for lifelong well-being. A new tapestry of comprehensive
children's services, integrated across sectors, which fully address
children's health needs and promote positive health, could set children on
optimal health trajectories for life. This system could be a major
component of the transformative change the nation is seeking to reduce
health care costs and improve quality of life across the lifespan.
Keywords: Child health; Child welfare; Health insurance; Child policy;
Child health outcomes

Kristina M. Deligiannidis, Marlene P. Freeman, Complementary and

Alternative Medicine for the Treatment of Depressive Disorders in Women,
Psychiatric Clinics of North America, Volume 33, Issue 2, June 2010, Pages
441-463, ISSN 0193-953X, 10.1016/j.psc.2010.01.002.
Keywords: Complementary/alternative treatment; <span style='font-style:
italic'>S</span>-Adenosylmethionine; Omega-3 fatty acids; St John's wort;
Acupuncture; Depression; Women

Luc R.C.W. van Lonkhuijzen, Jos van Roosmalen, Gerda Zeeman, Implementing
safe motherhood: Free resources for training in maternal and neonatal care,
International Journal of Gynecology &amp; Obstetrics, Volume 109, Issue 3,
June 2010, Page 189, ISSN 0020-7292, 10.1016/j.ijgo.2010.01.017.
Keywords: Millennium Development Goals; Obstetric emergency; Online
training resources; Safe motherhood

Robert Halpern, Parent support and education programs, Children and Youth
Services Review, Volume 12, Issue 4, 1990, Pages 285-308, ISSN 0190-7409,
Abstract: Parent support and education programs are receiving renewed
attention as a vehicle for strengthening parenting and addressing other
support needs in low-income families. In this paper the author reviews the
theoretical rationale, situational context and empirical basis for these

Jonathan B. Kotch, Dorothy C. Browne, Christopher L. Ringwalt, Paul W.

Stewart, Ellen Ruina, Kathleen Holt, Betsy Lowman, Jin-Whan Jung, Risk of
child abuse or neglect in a cohort of low-income children, Child Abuse
&amp; Neglect, Volume 19, Issue 9, September 1995, Pages 1115-1130, ISSN
0145-2134, 10.1016/0145-2134(95)00072-G.
Abstract: The purposes of this research were to identify risk factors for
reported child abuse or neglect and to examine the roles of stress and
social support in the etiology of child maltreatment. Mothers of newborn
infants with biomedical and sociodemographic risk factors were recruited
from community and regional hospitals and local health departments in 42
counties of North and South Carolina selected for geographic distribution
and for large numbers of such newborns. For every four such mothers, the
next mother to deliver an otherwise normal newborn was sought. Mothers were
interviewed shortly after giving birth, and state Central Registries of
Child Abuse and Neglect were reviewed when each infant was 1 year of age.
Eight hundred forty-two of 1,111 recruited mothers were successfully
interviewed in their homes between March 1986 and June 1987. Seven hundred
forty-nine North Carolina births who resided in the state more than 6
months were eligible for inclusion in the analysis. Logistic regression
with backward elimination procedures was used in the analysis. Maternal
education (p &lt; .01), number of other dependent children in the home (p
&lt; .01), receipt of Medicaid (p &lt; .01), maternal depression (p &lt; .
05), and whether the maternal subject lived with her own mother at age 14
years (p &lt; .05) were the best predictors of a maltreatment report.
Further examination revealed an interaction effect between stressful life
events, as measured by life event scores, and social well-being (p &lt; .
01). For children born at risk for social and/or medical problems, extreme
low income (participation in public income support programs), low maternal
education, maternal depression, the presence of any other young children in
the home, and a mother's separation at age 14 years from her own mother
significantly predict child maltreatment reports in the first year of life.
In addition, stressful life events, even if perceived positively, may
increase or decrease the risk of maltreatment reports, depending upon the
presence of social support.
Keywords: Child abuse; Child neglect; Poverty; Psychological stress; Social

Douglas Vanderbilt, Mary Margaret Gleason, Mental Health Concerns of the

Premature Infant Through the Lifespan, Child and Adolescent Psychiatric
Clinics of North America, Volume 19, Issue 2, April 2010, Pages 211-228,
ISSN 1056-4993, 10.1016/j.chc.2010.02.003.
Keywords: Preterm birth; Parent child interactions; Mental health;

Douglas Vanderbilt, Mary Margaret Gleason, Mental Health Concerns of the

Premature Infant Through the Lifespan, Pediatric Clinics of North America,
Volume 58, Issue 4, August 2011, Pages 815-832, ISSN 0031-3955,
Keywords: Preterm birth; Parent child interactions; Mental health;

A. Stoebner-Delbarre, F. Letourmy, Conduite tenir pour aider les femmes

enceintes arrter de fumer : rles des professionnels de sant, Journal
de Gyncologie Obsttrique et Biologie de la Reproduction, Volume 34,
Supplement 1, April 2005, Pages 326-335, ISSN 0368-2315, 10.1016/S0368-
Abstract: Rsum
Lexposition au tabagisme actif et passif pendant la grossesse est la cause
vitable la plus importante des complications gynco-obsttricales et
pdiatriques en France. Les bnfices cliniques et conomiques de larrt
du tabac sont bien documents. Lobjectif de ce travail est deffectuer une
revue des connaissances actuelles en matire daide larrt du tabac pour
les femmes enceintes. Cet article dcrit en dtail les actions efficaces
raliser en cabinet libral ou lhpital pour aider les femmes enceintes
arrter de fumer et les accompagner dans leur dmarche : mesure du
monoxyde de carbone expir, aide larrt selon la mthode des 5 A,
distribution de brochure daide larrt du tabac, prvention des
rechutes, formation des professionnels, participation et soutien des
actions collectives et aux mesures nationales.
Active and passive exposure to tobacco smoke during pregnancy is the most
serious and preventable cause of adverse maternal, fetal, and infant
outcomes in France. The clinical and economic benefits of cessation have
been documented. The objective of this article is to review the evidence
base addressing smoking cessation in pregnant women. The article describes
how best to assist the pregnant smoker in clinical practice or hospital to
quit during pregnancy. The following low intensity interventions designed
to be integrated into routine prenatal care are detailed: expired air CO
measures, practice of the evidence-based 5 A's smoking cessation
intervention for pregnant women, use of pregnant woman's self-help guide to
quit smoking, relapse prevention, health professionals training,
participation to community program.
Keywords: Grossesse; Tabac; Mdecins; Aide larrt; Professionnels de
sant; Pregnancy; Tobacco; Smoking cessation; Health professionals;

Robert Li Kitts, Stuart J. Goldman, Education and Depression, Child and

Adolescent Psychiatric Clinics of North America, Volume 21, Issue 2, April
2012, Pages 421-446, ISSN 1056-4993, 10.1016/j.chc.2012.01.007.
Keywords: Depression; Education; Children; Adolescents

V.D Tsu, B Shane, New and underutilized technologies to reduce maternal

mortality: call to action from a Bellagio workshop, International Journal
of Gynecology &amp; Obstetrics, Volume 85, Supplement 1, June 2004, Pages
S83-S93, ISSN 0020-7292, 10.1016/j.ijgo.2004.02.011.
Abstract: Little progress has been made in preventing the more than
500&#xa0;000 maternal deaths that occur each year. Many new and
underutilized technologies can be used to reduce these deaths. In July
2003, maternal health experts from around the world gathered in Bellagio,
Italy, to develop a set of priority actions for reducing maternal mortality
using proven and promising technologies. To reduce maternal mortality,
immediate efforts are needed to accelerate the appropriate use of
technologies and to reduce their inequitable distribution. Organizations
are called on to commit the necessary human and financial resources to
evaluate and document the effectiveness of promising technologies and to
scale up and put proven technologies into widespread use to save women's
Keywords: Maternal morbidity and mortality; Technologies; Developing

Marie-Paule Austin, Jana Colton, Susan Priest, Nicole Reilly, Dusan Hadzi-
Pavlovic, The Antenatal Risk Questionnaire (ANRQ): Acceptability and use
for psychosocial risk assessment in the maternity setting, Women and Birth,
Available online 20 July 2011, ISSN 1871-5192, 10.1016/j.wombi.2011.06.002.
Abstract: SummaryObjectives
To assess the value of the Antenatal Risk Questionnaire (ANRQ) as a
predictor of postnatal depression, to evaluate its acceptability to
pregnant women and midwives, and to consider its use as part of a model for
integrated psychosocial risk assessment in the antenatal setting.
This paper further analysed published data from the Pregnancy Risk
Questionnaire in a sample of 1196 women. We extracted 12 items from the
original 23 item Pregnancy Risk Questionnaire to assess how the shorter
ANRQ would perform, and undertook the analysis in the subset who were
administered the Composite International Diagnostic Interview (CIDI) at 2
or 4 months postpartum to assess for major depression (N&#xa0;=&#xa0;276).
We also sampled a subset of pregnant participants (N&#xa0;=&#xa0;378) and
midwives (N&#xa0;=&#xa0;44) to assess the tool's acceptability to these
groups respectively.
ROC curve analysis for the ANRQ yielded an acceptable area under the curve
of 0.69. The most clinically useful cut off on the ANRQ was a score of 23
or more, yielding a sensitivity of 0.62 and specificity of 0.64 with
positive predictive value of 0.3. The odds that a woman scoring 23 or more
on the ANRQ is also a case was 6.3 times greater than for a woman scoring
less than 23. Acceptability of the ANRQ was high among both women and
The ANRQ is a highly acceptable self-report psychosocial assessment tool
which aids in the prediction of women who go on to develop postnatal
depression. In combination with a symptom based screening measure (e.g.,
the Edinburgh Postnatal Depression Scale) and routine questions relating to
drug and alcohol use and domestic violence, the ANRQ becomes most useful as
a key element of a screening intervention aimed at the early
identification of mental health risk and morbidity across the perinatal
period. Evaluation of this model in terms of clinical outcomes remains to
be undertaken.
Keywords: Pregnancy; Postnatal; Depression; Screening; Psychosocial

Kees De Meer, Roland Bergman, John S. Kusner, Socio-cultural determinants

of child mortality in Southern Peru: Including some methodological
considerations, Social Science &amp; Medicine, Volume 36, Issue 3, February
1993, Pages 317-331, ISSN 0277-9536, 10.1016/0277-9536(93)90016-W.
Abstract: Among Amerindian children living at high altitude in the Andes in
southern Peru, high child mortality rates have been reported in the
literature, especially in the perinatal and neonatal period. We compared
mortality rates in children calculated from retrospective survey data in 86
rural families from 2 Aymara and 3 Quechua peasant communities living at
the same level of altitude (3825m) in southern Peru. Relations between land
tenure, socio-cultural factors and child mortality were studied, and
methodological considerations in this field of interest are discussed.

Checks on consistency of empirical data showed evidence for underreporting

of neonatal female deaths with birth order 3 and more. Perinatal (124 vs 34
per 1000 births) and infant mortality (223 vs 111 per 1000 live births) was
significantly higher in Aymara compared with Quechua children, but no
difference was found after the first year of life. A short pregnancy
interval was associated with an elevated perinatal and infant mortality
rate, and a similar albeit insignificant association was found with
increased maternal age. Amount of land owned and birth order were not
related with child mortality. Although levels of maternal education are
generally low in both cultures, a consistent decline in infant and child
mortality was found with the amount of years mothers had attended school.
However, the results suggest a U-shaped relationship between the amount of
years of parental education and perinatal mortality in offspring. Late
fetal and early neonatal mortality were particularly high in one Aymara
community where mothers were found to have more years of education.
Infanticide, a known phenomenon in the highlands of the Andes, is discussed
in relation with the findings of the study. Although maternal and child
health services are utilized by the majority of families in 4 of 5 study
communities, 43 of 51 mothers under the age of 45 years reported that they
delivered their last baby in the absence of traditional midwives or
official medical supervision.
Keywords: perinatal mortality; child mortality; neonatal mortality;
altitude; land tenure; Aymara Indians; Quechua Indians; Peru

William D. Fraser, Michael S. Kramer, 15 - Labor and Delivery, In: Marlene

B. Goldman and Maureen C. Hatch, Editor(s), Women and Health, Academic
Press, San Diego, 2000, Pages 182-195, ISBN 9780122881459, 10.1016/B978-
Abstract: No other physiological event, with the possible exception of her
own birth, has as great a potential to benefit or to harm a woman's life as
labor and delivery. Consequently, health care planners, educators, and
providers hold the responsibility to ensure that the risk of mishap during
this period is minimized. They must regularly assess relevant indicators of
maternal and perinatal health to identify problems. Using this information,
they must develop and implement training, policies, and programs to ensure
effective approaches to prevention and to care. These programs must be
based on the best available scientific evidence.

Patricia C. Devine, Obstetric Hemorrhage, Seminars in Perinatology, Volume

33, Issue 2, April 2009, Pages 76-81, ISSN 0146-0005,
Abstract: Despite advances is medical and surgical therapy, obstetric
hemorrhage remains a significant medical problem for both the developing
and developed world. Depending on the definition that is used, postpartum
hemorrhage complicates up to 18% of all deliveries. It is the single most
important cause of maternal mortality worldwide, accounting for 25% to 30%
of all maternal deaths, and it is the most common maternal morbidity in the
developed world. Most cases of hemorrhage are related to uterine atony and
abnormal placentation; however, many patients have no identifiable risk
factors. Implementation of the active management of labor has resulted in a
significant reduction in the incidence postpartum hemorrhage. However, a
large number of cases still involve suboptimal care, with delays in
diagnosis and treatment identified as common deficiencies.
Keywords: hemorrhage; risk factors; morbidity; quality

A.K. Mbonye, J.B. Asimwe, J. Kabarangira, G. Nanda, V. Orinda, Emergency

obstetric care as the priority intervention to reduce maternal mortality in
Uganda, International Journal of Gynecology &amp; Obstetrics, Volume 96,
Issue 3, March 2007, Pages 220-225, ISSN 0020-7292,
Abstract: Purpose
We conducted a survey to determine availability of emergency obstetric care
(EmOC) to provide baseline data for monitoring provision of obstetric care
services in Uganda.
The survey, covering 54 districts and 553 health facilities, assessed
availability of EmOC signal functions. Following this, performance
improvement process was implemented in 20 district hospitals to scale-up
EmOC services.
A maternal mortality ratio (MMR) of 671/100,000 live births was recorded.
Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and
malaria accounted for 65.5% of the indirect causes. Among the obstetric
complications, abortion accounted for 38.9% of direct and malaria 87.4% of
indirect causes. Removal of retained products (OR 3.3,
P&#xa0;&lt;&#xa0;0.002), assisted vaginal delivery (OR 3.3,
P&#xa0;&lt;&#xa0;0.001) and blood transfusion (OR 13.7,
P&#xa0;&lt;&#xa0;0.001) were the missing signal functions contributing to
maternal deaths. Most health facilities expected to offer basic EmOC, 349
(97.2%) were not offering them. Using the performance improvement process,
availability of EmOC in the 20 hospitals improved significantly.
An integrated programming approach aiming at increasing access to EmOC,
malaria treatment and prevention services could reduce maternal mortality
in Uganda.
Keywords: Emergency obstetric care; Performance improvement process; Uganda

Deborah Maine, Therese McGinn, 31 - Maternal Mortality and Morbidity, In:

Marlene B. Goldman and Maureen C. Hatch, Editor(s), Women and Health,
Academic Press, San Diego, 2000, Pages 395-403, ISBN 9780122881459,

Jeanne Pfeiffer, Melissa D. Avery, Mary Benbenek, Robbie Prepas, Lisa

Summers, Cecilia M. Wachdorf, Carol O'Boyle, Maternal and Newborn Care
During Disasters: Thinking Outside the Hospital Paradigm, Nursing Clinics
of North America, Volume 43, Issue 3, September 2008, Pages 449-467, ISSN
0029-6465, 10.1016/j.cnur.2008.04.008.
Abstract: Emergencies that challenge the infrastructure of the current
health care system require a shift in the standard of usual practice.
Pregnant women and their newborns are intimately linked special populations
that require continued care despite the community circumstances. Pre-event
planning with community partners can generate a safer alternative for
providing care during a public health emergency. Lessons learned from
international and United States public health emergencies have resulted in
a better understanding of the essentials of care and the development of
resources to guide planning for these populations.

Jocelyn DeJong, Chaza Akik, Faysal El Kak, Hibah Osman, Fadi El-Jardali,
The safety and quality of childbirth in the context of health systems:
mapping maternal health provision in Lebanon, Midwifery, Volume 26, Issue
5, October 2010, Pages 549-557, ISSN 0266-6138, 10.1016/j.midw.2010.06.012.
Abstract: Objective
to provide basic information on the distribution (public/private and
geographically) and the nature of maternity health provision in Lebanon,
including relevant health outcome data at the hospital level in order to
compare key features of provision with maternal/neonatal health outcomes.
a self-completion questionnaire was sent to private hospitals by the
Syndicate of Private Hospitals in collaboration with the study team and to
all public hospitals in Lebanon with a functioning maternity ward by the
study team in cooperation with the Ministry of Public Health.
childbirth in an institutional setting by a trained attendant is almost
universal in Lebanon and the predominant model of care is obstetrician-led
rather than midwife-led. Yet due to a 15-year-old civil war and a highly
privatised health sector, Lebanon lacks systematic or publically available
data on the organisation, distribution and quality of maternal health
services. An accreditation system for private hospitals was recently
initiated to regulate the quality of hospital care in Lebanon.
in total, 58 (out of 125 eligible) hospitals responded to the survey (46%
total response rate). Only hospital-level aggregate data were collected.
the survey addressed the volume of services, mode of payment for
deliveries, number of health providers, number of labour and childbirth
units, availability of neonatal intensive care units, fetal monitors and
infusion rate regulation pumps for oxytocin, as well as health outcome data
related to childbirth care and stillbirths for the year 2008.
the study provides the first data on maternal health provision from a
survey of all eligible hospitals in Lebanon. More than three-quarters of
deliveries occur in private hospitals, but the Ministry of Public Health is
the single most important source of payment for childbirth. The reported
hospital caesarean section rate is high at 40.8%. Essential equipment for
safe maternal and newborn health care is widely available in Lebanon, but
over half of the hospitals that responded lack a neonatal intensive care
unit. The ratio of reported numbers of midwives to deliveries is three
times that of obstetricians to deliveries.
Key conclusions and implications for practice
there is a need for greater interaction between maternal/neonatal health,
health system specialists and policy makers on how the health system can
support both the adoption of evidence-based interventions and, ultimately,
better maternal and perinatal health outcomes.
Keywords: Maternal health; Safety; Health system

Linda J. Harrison, Leanne Clarke, Judy A. Ungerer, Children's drawings

provide a new perspective on teacherchild relationship quality and school
adjustment, Early Childhood Research Quarterly, Volume 22, Issue 1, 1st
Quarter 2007, Pages 55-71, ISSN 0885-2006, 10.1016/j.ecresq.2006.10.003.
Abstract: A growing literature points to the importance of children's
relationships with their teachers as a factor influencing attitudinal,
cognitive, and behavioral aspects of school adjustment. However, such data
may be confounded when the same teacher rates school adjustment as well as
relationship quality. The present study sought to address this problem by
investigating direct (self-reported feelings about the teacher) and
indirect (representations through drawings) procedures to assess children's
perspectives on the relationship. Self-report questions were adapted from
measures of school liking and maternal acceptance. Drawings applied Fury's
system for describing relational negativity in childfamily drawings.
Results, based on a sample of 125 six-year-olds, showed significant
associations between children's reports/drawings and teacher-rated
relationship quality and school adjustment. Negativity in childteacher
drawings was a particularly salient correlate, suggesting that children's
representations of relationships can provide a useful independent means of
identifying relationship or adjustment difficulties at school.
Keywords: Teacherchild relationship; School adjustment; Children's

EEVA T. ARONEN, SIRPA A. KURKELA, Long-Term Effects of an Early Home-Based

Intervention, Journal of the American Academy of Child &amp; Adolescent
Psychiatry, Volume 35, Issue 12, December 1996, Pages 1665-1672, ISSN 0890-
8567, 10.1097/00004583-199612000-00019.
Abstract: ABSTRACTObjective
To evaluate the long-term effects of an early home-based intervention on
the quantity and quality of psychiatric symptoms in adolescents.
The material consisted of 160 families with a baby born in 1975-1976.
First, the families were classified with a weighted risk index into low-
and high-risk families. Eighty families attended a 5-year-long family
counseling program (10 times/year). The other half of the families served
as a control group for the effects of counseling. The mental state of the
adolescents was assessed at age 14 to 15 years by the Child Behavior
Checklist and the Youth Self-Report.
The adolescents in the counseling families scored significantly fewer total
symptoms on both the parent and the youth reports. The counseling reduced
more effectively internalizing than externalizing symptoms. The counseling
predicted better mental health in adolescence in both low- and high-risk
Home-based early intervention can have positive long-term effects on the
mental state of adolescents. These results can be used when programs for
primary prevention in families with small children are planned.
Keywords: primary prevention; home-based intervention; follow-up

Paulo A. Graziano, Daniel M. Bagner, Stephen J. Sheinkopf, Betty R. Vohr,

Barry M. Lester, Evidence-based intervention for young children born
premature: Preliminary evidence for associated changes in physiological
regulation, Infant Behavior and Development, Volume 35, Issue 3, June 2012,
Pages 417-428, ISSN 0163-6383, 10.1016/j.infbeh.2012.04.001.
Abstract: The current study examined whether changes in maternal behaviors
following an evidence-based treatmentParentChild Interaction Therapy
(PCIT)was associated with improvements in cardiac vagal regulation in
young children born premature. Participants included 28 young children
(mean age&#xa0;=&#xa0;37.79 months) that were born premature and presented
with elevated externalizing behavior problems. To assess cardiac vagal
regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA
change (withdrawal or suppression) to a clean-up task were derived pre and
post-treatment. Results indicated that an increase in behaviors mothers are
taught to use during treatment (i.e., do skillspraise, reflection, and
behavioral descriptions) was associated with an improvement in children's
post-treatment RSA suppression levels. The current study illustrates the
important role of caregiver behavior in promoting physiological regulation
in children born premature.
Keywords: Cardiac vagal regulation; RSA suppression; Emotion regulation;
Prematurity; Child; Parent training

Jennifer Prah Ruger, Milton C. Weinstein, S. Katherine Hammond, Margaret H.

Kearney, Karen M. Emmons, Cost-Effectiveness of Motivational Interviewing
for Smoking Cessation and Relapse Prevention among Low-Income Pregnant
Women: A Randomized Controlled Trial, Value in Health, Volume 11, Issue 2,
MarchApril 2008, Pages 191-198, ISSN 1098-3015, 10.1111/j.1524-
Abstract: AbstractObjectives
Low-income women have high rates of smoking during pregnancy, but little is
known about the costs, benefits, and cost-effectiveness of motivational
interviewing (MI), focused on the medical and psychosocial needs of this
population, as an intervention for smoking cessation and relapse
A sample of 302 low-income pregnant women was recruited from multiple
obstetrical sites in the Boston metropolitan area into a randomized
controlled trial of a motivational intervention for smoking cessation and
relapse prevention versus usual care (UC). The findings of this clinical
trial were used to estimate the costs, benefits, and cost-effectiveness of
the intervention from a societal perspective, incorporating published
quality-adjusted life-year (QALY) and life-year (LY) estimates. Outcomes
included smoking cessation and relapse, maternal and infant outcomes,
economic costs, LYs and QALYs saved, and incremental cost-effectiveness
The cost-effectiveness of MI for relapse prevention compared to UC was
estimated to be $851/LY saved and $628/QALY saved. Including savings in
maternal medical costs in sensitivity analyses resulted in cost savings for
MI for relapse prevention compared to UC. For smoking cessation, MI cost
more but did not provide additional benefit compared to UC. In one-way
sensitivity analyses, the incremental cost-effectiveness of MI versus UC
would have been $117,100/LY saved and $86,300/QALY saved if 8% of smokers
had quit. In two-way sensitivity analyses, MI was still relatively cost-
effective for relapse prevention ($17,300/QALY saved) even if it cost as
much as $2000/participant and was less effective. For smoking cessation,
however, a higher level of effectiveness (9/110) and higher cost
($400/participant) resulted in higher incremental cost-effectiveness ratios
Among low-income pregnant women, MI helps prevent relapse at relatively low
cost, and may be cost-saving when net medical cost savings are considered.
For smoking cessation, MI cost more but provided no additional benefit
compared to UC, but might offer benefits at costs comparable to other
clinical preventive interventions if 810% of smokers are induced to quit.
Keywords: cost-effectiveness; low-income; pregnant women; relapse
prevention; smoking cessation

Dawn Flandermeyer, Cynthia Stanton, Deborah Armbruster, Uterotonic use at

home births in low-income countries: A literature review, International
Journal of Gynecology &amp; Obstetrics, Volume 108, Issue 3, March 2010,
Pages 269-275, ISSN 0020-7292, 10.1016/j.ijgo.2009.12.001.
Abstract: Objectives
This literature review compiles data on rates of use, indications, types of
provider, mode of administration, and dose of uterotonics used for home
births in low-income countries, and identifies gaps meriting further
Published and unpublished English language articles from 1995 through 2008
pertaining to home use of uterotonics were identified via electronic
searches of medical and social science databases. In addition,
bibliographies of articles were examined for eligible studies. Data were
abstracted and analyzed by the objectives outlined for this review.
Twenty-three articles met the inclusion/exclusion criteria. Use rates of
uterotonics at home births ranged widely from 1% to 69%, with the large
majority of observations from South Asia. Descriptive studies suggest that
home use of uterotonics before delivery of the baby are predominantly
administered by nonprofessionals to accelerate labor, and are not perceived
as unsafe.
To achieve maximum benefit and minimal harm, programs that increase access
to uterotonics for postpartum hemorrhage prevention must take into account
existing practices among pregnant women. Further research regarding access
to uterotonics and intervention studies for provider behavior change
regarding uterotonic use is warranted.
Keywords: Home birth; Labor augmentation; Misoprostol; Oxytocin; Postpartum
hemorrhage; Uterotonics

Jeanne McDermott, Diana Beck, Sandra Tebben Buffington, Janne Annas,

Gunawan Supratikto, Darwin Prenggono, Dra.M.F.Sri Ekonomi, Endang Achadi,
Two models of in-service training to improve midwifery skills: how well do
they work?, Journal of Midwifery &amp; Women's Health, Volume 46, Issue 4,
JulyAugust 2001, Pages 217-225, ISSN 1526-9523, 10.1016/S1526-
Abstract: This program evaluation compared the knowledge, confidence, and
skills of Indonesian village midwives who attended an intensive in-service
training with midwives who received an internship program and midwives who
attended no program. The five key skills compared were prevention of
infection, use of the partograph, manual removal of placenta, bimanual
uterine compression, and neonatal resuscitation. Midwives from the
intensive in-service that combined competency-based skill training with
peer review and continuing education scored higher on the knowledge test
and demonstration of the five key skills and reported managing
complications better than midwives who attended no training program.
Midwives from the internship program scored intermediate between the
intensively trained and the untrained midwives. Overall, skill scores were
71% for midwives in the intensive program, 62% for the interns, and 51% for
midwives with no in-service training. Village midwives from the intensive
program scored significantly higher in the practical demonstration of
manual removal of placenta, bimanual compression, and neonatal
resuscitation than the interns, but the scores on infection prevention and
use of the partograph were not different between the two groups.
Differences in the volume of training opportunities between the two
programs could be responsible for the different outcomes.

Oona Campbell, M. Koblinsky, P. Taylor, Off to a rapid start: appraising

maternal mortality and services, International Journal of Gynecology &amp;
Obstetrics, Volume 48, Supplement, June 1995, Pages S33-S52, ISSN 0020-
7292, 10.1016/0020-7292(95)02319-8.
Abstract: Enthusiasm for doing something about Safe Motherhood has been
expressed in many developing countries, but priorities for action cannot be
identified without adequately assessing a country's maternal mortality
situation. It is also important, however, to avoid embarking on time-
consuming research measuring indicators which are not essential to
developing programs. After presenting an overview of ideal Safe Motherhood
program components, the paper lists a series of questions which serve as an
assessment tool for collecting useful information and for identifying data
sources on maternal mortality and health. The framework for these questions
centers around the following steps: (1) gaining an overview of health
policy relevant to maternal mortality and morbidities; (2) assessing the
magnitude and causes of maternal mortality and morbidity, and the
characteristics of groups at particular risk; and (3) assessing the
available inputs in terms of services (access, quality, providers, what is
provided at various tiers, etc.) and in terms of the culture and existing
resources and groups.
Keywords: Maternal mortality; Maternal morbidity; Safe motherhood

Kathryn M. Andolsek, Gaylen M. Kelton, RISK ASSESSMENT, Primary Care:

Clinics in Office Practice, Volume 27, Issue 1, 1 March 2000, Pages 71-103,
ISSN 0095-4543, 10.1016/S0095-4543(05)70149-4.

Oona MR Campbell, Wendy J Graham, on behalf of The Lancet Maternal Survival

Series steering group, Strategies for reducing maternal mortality: getting
on with what works, The Lancet, Volume 368, Issue 9543, 713 October 2006,
Pages 1284-1299, ISSN 0140-6736, 10.1016/S0140-6736(06)69381-1.
Abstract: Summary
The concept of knowing what works in terms of reducing maternal mortality
is complicated by a huge diversity of country contexts and of determinants
of maternal health. Here we aim to show that, despite this complexity, only
a few strategic choices need to be made to reduce maternal mortality. We
begin by presenting the logic that informs our strategic choices. This
logic suggests that implementation of an effective intrapartum-care
strategy is an overwhelming priority. We also discuss the alternative
configurations of such a strategy and, using the best available evidence,
prioritise one strategy based on delivery in primary-level institutions
(health centres), backed up by access to referral-level facilities. We then
go on to discuss strategies that complement intrapartum care. We conclude
by discussing the inexplicable hesitation in decision-making after nearly
20 years of safe motherhood programming: if the fifth Millennium
Development Goal is to be achieved, then what needs to be prioritised is
obvious. Further delays in getting on with what works begs questions about
the commitment of decision-makers to this goal.

Bruce Rabin, Chapter 33 - Stress: A System of the Whole, In: Robert Ader,
Editor(s), Psychoneuroimmunology (Fourth Edition), Academic Press,
Burlington, 2007, Pages 709-722, ISBN 9780120885763, 10.1016/B978-
Abstract: Psychoneuroimmunologists direct their attention to understanding
the mechanisms of stressor-induced alterations of immune system function
and subsequent health alterations. However, stressor-induced health
alterations involve many components of health and affect many tissues of
the body that are independent of immune system alterations. Although the
theme of this book is directed to the immune system, this chapter will
consider stress as a system that alters the function of other systems that
are not part of the immune system, an area of particular interest to the
chapter author.

J. Chamberlain, R. McDonagh, A. Lalonde, S. Arulkumaran, The role of

professional associations in reducing maternal mortality worldwide,
International Journal of Gynecology &amp; Obstetrics, Volume 83, Issue 1,
October 2003, Pages 94-102, ISSN 0020-7292, 10.1016/S0020-7292(03)00185-1.
Abstract: The death of hundreds of thousands of women due to pregnancy-
related complications casts a shadow over the modern obstetrical world.
This paper examines the potential roles and responsibilities of
professional obstetrical and midwifery associations in addressing this
tolerated tragedy of maternal deaths. We examine the successes and
challenges of obstetrical and midwifery associations and encourage the
growth and development of active associations to address maternal mortality
within their own borders. Professional associations can play a vital role
in the reduction of maternal mortality worldwide. Their roles include
lobbying for women's health and rights, setting standards of practice,
raising awareness and team building. Associations from developed countries
can influence and strengthen their colleagues within developing countries;
for example, the FIGO Save the Mothers initiative. Professional
associations should be encouraged to play an active role in reducing
maternal mortality within their own country and abroad.
Keywords: Maternal mortality; Professional associations; Human rights

Penny E Clarke, Harriet Gross, Women's behaviour, beliefs and information

sources about physical exercise in pregnancy, Midwifery, Volume 20, Issue
2, June 2004, Pages 133-141, ISSN 0266-6138, 10.1016/j.midw.2003.11.003.
Abstract: Objective:
to examine the potential effect of low-risk pregnancy on women's
recreational activity patterns and to explore pregnant women's beliefs and
information sources regarding physical exercise participation.
preliminary, prospective survey
participants homes in the East Midlands, UK.
fifty-seven nulliparous, pregnant women.
levels of maternal physical activity participation were assessed by semi-
structured interview at 16, 25, 34 and 38 weeks gestation. The modified
Baecke questionnaire provided a measure of women's habitual sport and
leisure activities in the 12 months prior to pregnancy. A 10-item scale
assessed maternal beliefs regarding the importance of physical activity in
pregnancy. The fetal health locus of control scale measured the extent to
which women believed their own behaviour, the behaviour of others and/or
chance would influence fetal health. Open-ended questions assessed women's
information sources.
fourteen of the 36 (39%) women who reported participating in some form of
weekly exercise before pregnancy did not report pursuing any similar
activities during pregnancy. Rest and relaxation were perceived as being
significantly more important during pregnancy than was regular exercise or
the maintenance of an active lifestyle. Fifty-five respondents (96%)
indicated that they had received advice about physical activity at least
once during pregnancy. At 16 weeks gestation, women obtained most of their
information from books and magazines. Between 25 and 38 weeks gestation,
most advice came from family and friends. Participants who reported
receiving this advice were significantly older, more educated and of a
higher activity level pre-pregnancy.
Key conclusions:
levels of maternal exercise may decline during pregnancy both as a result
of the physical changes of pregnancy and from a combination of social and
psychological factors. Present health education may be failing to correct
inaccurate perceptions of the risks associated with physical exercise in
Implications for practice:
improving the quantity and quality of information related to physical
exercise has the potential to correct inaccurate perceptions and confer
several benefits on maternal and fetal health. Effective intervention
strategies should focus not only on the pregnant woman but also extend to
her family, friends and exercise provider.

Sahar Hassan-Bitar, Sheila Narrainen, Shedding light on the challenges

faced by Palestinian maternal health-care providers, Midwifery, Volume 27,
Issue 2, April 2011, Pages 154-159, ISSN 0266-6138,
Abstract: Objective
to explore the challenges and barriers faced by Palestinian maternal
health-care providers (HCPs) to the provision of quality maternal health-
care services through a case study of a Palestinian public referral
hospital in the Occupied Palestinian Territory.
Design and method
descriptive qualitative study. The data are from a broader study, conducted
in 2005 at the same hospital as part of a baseline assessment of maternal
health services.
31 maternal HCPs; nine midwives and 14 nurses and eight doctors.
the quality of care provided for women and infants at this Palestinian
public hospital is substandard. The maternal HCPs work within a difficult
and resource-constrained environment.
Issues include
high workload, poor compensation, humiliation in the workplace, suboptimal
supervision and the absence of professional support and guidance. Midwives
are perceived to be at the bottom of the health professional hierarchy.
there is a need for managers and policy makers to enable maternal HCPs to
provide better quality care for women and infants during childbirth,
through facilitating the roles of midwives and nurses and creating a more
positive and resourceful environment.
Implications for practice
Palestinian midwives need to increase their knowledge and use evidence-
based practices during childbirth. They need to unite and create their own
circle of professional support in the form of a Palestinian midwifery
professional body.
Keywords: Midwife; Maternal human resources; Working conditions; Occupied
Palestinian territory

Anna LaRocco-Cockburn, Jennifer Melville, Michelle Bell, Wayne Katon,

Depression screening attitudes and practices among obstetrician
gynecologists, Obstetrics &amp; Gynecology, Volume 101, Issue 5, Part 1,
May 2003, Pages 892-898, ISSN 0029-7844, 10.1016/S0029-7844(03)00171-6.
Abstract: Objective
To assess obstetriciangynecologists attitudes and practices related to
depression screening.
A total of 282 obstetriciangynecologists completed a 36-question mail
survey that assessed attitudes regarding depression screening, training to
treat depression, psychosocial concern, professional influence, and ease of
Depression screening (employed regardless of signs or symptoms) was
reported by 44% of physicians. Positive attitudes toward depression
screening, high psychosocial concern, high ease of screening, and adequate
training to treat depression were significant independent predictors of
depression screening practices.
The majority of obstetriciangynecologists are concerned about depression,
believe depression screening is effective, and perform some degree of
depression screening with their patients. However, they perceive depression
screening as difficult to carry out in everyday practice, and some question
whether screening improves outcomes.

Harriet L MacMillan, C Nadine Wathen, Jane Barlow, David M Fergusson, John

M Leventhal, Heather N Taussig, Interventions to prevent child maltreatment
and associated impairment, The Lancet, Volume 373, Issue 9659, 1723
January 2009, Pages 250-266, ISSN 0140-6736, 10.1016/S0140-6736(08)61708-0.
Abstract: Summary
Although a broad range of programmes for prevention of child maltreatment
exist, the effectiveness of most of the programmes is unknown. Two specific
home-visiting programmesthe NurseFamily Partnership (best evidence) and
Early Starthave been shown to prevent child maltreatment and associated
outcomes such as injuries. One population-level parenting programme has
shown benefits, but requires further assessment and replication. Additional
in-hospital and clinic strategies show promise in preventing physical abuse
and neglect. However, whether school-based educational programmes prevent
child sexual abuse is unknown, and there are currently no known approaches
to prevent emotional abuse or exposure to intimate-partner violence. A
specific parent-training programme has shown benefits in preventing
recurrence of physical abuse; no intervention has yet been shown to be
effective in preventing recurrence of neglect. A few interventions for
neglected children and motherchild therapy for families with intimate-
partner violence show promise in improving behavioural outcomes. Cognitive-
behavioural therapy for sexually abused children with symptoms of post-
traumatic stress shows the best evidence for reduction in mental-health
conditions. For maltreated children, foster care placement can lead to
benefits compared with young people who remain at home or those who reunify
from foster care; enhanced foster care shows benefits for children. Future
research should ensure that interventions are assessed in controlled
trials, using actual outcomes of maltreatment and associated health

Mira M. Grice, Patricia M. McGovern, Bruce H. Alexander, Laurie Ukestad,

Wendy Hellerstedt, Balancing Work and Family After Childbirth: A
Longitudinal Analysis, Women's Health Issues, Volume 21, Issue 1, January
February 2011, Pages 19-27, ISSN 1049-3867, 10.1016/j.whi.2010.08.003.
Abstract: Background
In the United States, women with young children have dramatically increased
their participation in the workforce, resulting in greater potential
conflict between work and family roles. However, few studies have examined
postpartum workfamily conflict. This study examined associations between
workfamily conflict and womens health after childbirth.
Employed women, 18 years of age and older, were recruited while
hospitalized for childbirth and followed for 18 months (n = 541; 66%
response rate). Health outcomes were measured using the Short Form 12,
version 2. Longitudinal fixed-effects models estimated the associations
between workfamily conflict (modeled as job and home spillover) and
Women who reported high levels of job spillover to home had mental health
scores slightly, but significantly, worse than women who reported low
levels of spillover ( = 1.26; SE = 0.47). Women with medium and high
levels of home spillover to job also reported worse mental health ( =
0.81, SE = 0.30; and = 1.52, SE = 0.78) relative to those with low
spillover. Women who reported medium (versus low) levels of home spillover
reported slightly improved physical health ( = 0.64, SE = 0.30). There was
no significant association between job spillover and physical health.
This study focused exclusively on employed postpartum women. Results
illustrate that job and home spillover are associated with maternal mental
and physical health. Findings also revealed that flexible work arrangements
were associated with poorer postpartum mental health scores, which may
reflect unintended consequences, such as increasing the amount of work
brought home.

Nirbhay N. Singh, Subhashni D. Singh, Chapter 2 - Developmental

Considerations in Treatment, In: Helen Orvaschel, Jan Faust and Michel
Hersen, Editor(s), Handbook of Conceptualization and Treatment of Child
Psychopathology, Pergamon, Oxford, 2001, Pages 9-38, ISBN 9780080433622,
Abstract: A developmental perspective provides a framework for
understanding the nature and course of specific childhood disorders, an
essential basis for case conceptualization and long-term treatment.
Knowledge of the developmental course of childhood disorders provides
information about how symptoms of specific disorders vary across the life
span, and how children's individual differences affect not only their
developmental pathways but also their psychopathological pathways.
Hadiza Galadanci, Wolfgang Knzel, Oladapo Shittu, Robert Zinser, Manfred
Gruhl, Stefanie Adams, Obstetric quality assurance to reduce maternal and
fetal mortality in Kano and Kaduna State hospitals in Nigeria,
International Journal of Gynecology &amp; Obstetrics, Volume 114, Issue 1,
July 2011, Pages 23-28, ISSN 0020-7292, 10.1016/j.ijgo.2011.02.005.
Abstract: Objective
To achieve Millennium Development Goals 4 and 5 in Nigeria, a quality
assurance project in obstetrics in 10 hospitals in northern Nigeria was
established to improve maternal and fetal outcome.
The project commenced in January 2008 with assessment and improvement of
the structure of the 10 hospitals. Continuous maternal and fetal data
collection and analysis were conducted from 2008 to 2009 by means of a
maternity record book and structured monthly summary form. The quality of
hospital infrastructure and equipment was also assessed.
The mean maternal mortality ratio (MMR) was reduced from 1790 per
100&#xa0;000 births in the first half of 2008 to 940 per 100&#xa0;000
births in the second half of 2009. The average fetal mortality ratio (FMR)
decreased slightly from 84.9 to 83.5 per 1000 births. There was an
inversely proportional relationship between the total number of deliveries
in a hospital and MMR and FMR. There was a close correlation between the
MMR and the equipment status and hygiene conditions of the hospitals.
Continuous monitoring of quality assurance in maternity units raised the
awareness of the quality of obstetric performance and improved the quality
of care provided, thereby improving MMR.
Keywords: Maternal mortality ratio; Millennium Development Goal 5;
Obstetrics; Quality Assurance

Elaine Germano, Judith Bernstein, Home birth and short-stay delivery:

Lessons in health care financing for providers of health care for women,
Journal of Nurse-Midwifery, Volume 42, Issue 6, NovemberDecember 1997,
Pages 489-498, ISSN 0091-2182, 10.1016/S0091-2182(97)00080-3.
Abstract: The current restructuring of the U.S. health care delivery system
is driven primarily by economic forces. Although primary care providers may
understand the roles of technology and advocacy in fostering fundamental
change, they may not be familiar with the issues related to financing of
health care and, thus, may not fully appreciate the extent to which
economic factors influence the character of their professional lives and
the services they provide. Analysis of the loss of the home birth option in
the 1950s provides a method for understanding and influencing the factors
driving health care restructuring today. In examining short-stay delivery
in the 1990s, this article also addresses ways in which managed health care
systems may improve or restrict women's access to a variety of primary care

Afshan B. Hameed, Mark S. Sklansky, Pregnancy: Maternal and Fetal Heart

Disease, Current Problems in Cardiology, Volume 32, Issue 8, August 2007,
Pages 419-494, ISSN 0146-2806, 10.1016/j.cpcardiol.2007.04.004.
Abstract: Cardiac disorders complicate less than 1% of all pregnancies.
Physiologic changes in pregnancy may mimic heart disease. In order to
differentiate these adaptations from pathologic conditions, an in-depth
knowledge of cardiovascular physiology is mandatory. A comprehensive
history, physical examination, electrocardiogram, chest radiograph, and
echocardiogram are sufficient in most cases to confirm the diagnosis. Care
of women with cardiac disease begins with preconception counseling. Severe
lesions should be taken care of prior to contemplating pregnancy.
Management principles for pregnant women are similar to those for the non-
pregnant state. A team approach comprised of a maternal fetal medicine
specialist, cardiologist, neonatologist, and anesthesiologist is essential
to assure optimal outcome for both the mother and the fetus.

Although fetal heart disease complicates only a small percentage of

pregnancies, congenital heart disease causes more neonatal morbidity and
mortality than any other congenital malformation. Unfortunately, screening
approaches for fetal heart disease continue to miss a large percentage of
cases. This weakness in fetal screening has important clinical
implications, because the prenatal detection and diagnosis of congenital
heart disease may improve the outcome for many of these fetal patients. In
fact, simply the detection of major heart disease prenatally can improve
neonatal outcome by avoiding discharge to home of neonates with ductal-
dependent congenital heart disease. Fortunately, recent advances in
screening techniques, an increased ability to change the prenatal natural
history of many forms of fetal heart disease, and an increasing recognition
of the importance of a multidisciplinary, team approach to the management
of pregnancies complicated with fetal heart disease, together promise to
improve the outcome of the fetus with congenital heart disease.

Judith E.B. van der Waerden, Cees Hoefnagels, Clemens M.H. Hosman,
Psychosocial preventive interventions to reduce depressive symptoms in low-
SES women at risk: A meta-analysis, Journal of Affective Disorders, Volume
128, Issues 12, January 2011, Pages 10-23, ISSN 0165-0327,
Abstract: Background
Women who have low socioeconomic status (SES) or live in disadvantaged
circumstances are a vulnerable group at risk for depression. Little is
known about the efficacy of preventive interventions to reduce depressive
symptoms in low-SES women. The aim of this study is to provide an overview
of controlled outcome studies and to investigate the overall efficacy and
moderators of interventions targeted at reducing depressive symptoms in
this population.
A systematic review and meta-analysis were conducted for 14 studies
(N&#xa0;=&#xa0;1396). The effect size of the studies was computed for
outcomes assessing changes in depressive symptom levels using the
standardized mean difference effect size. Study, target population, and
intervention descriptors expected to influence effect size were analyzed
using univariate subgroup and metaregression techniques with mixed-effects
statistical models.
The estimated overall effect size of 0.31 was significant; study sample
characteristics, intervention characteristics and the research design of
the studies did not moderate intervention effects.
Limitations to this study are the relatively limited number of well
controlled studies that could be included in the analyses.
A number of promising programs have been developed specifically for low-SES
women, a population at high risk for developing major depression. On
average these programs were found to reduce the level of depressive
symptoms, with more than half of the studies showing medium to large effect
sizes. This indicates that considerable mental health benefits can be
gained among disadvantaged women.
Keywords: Meta-analysis; Low SES; Women; Depressive symptoms; Prevention

April Ann Benasich, Jeanne Brooks-Gunn, Beatriz Chu Clewell, How do mothers
benefit from early intervention programs?, Journal of Applied Developmental
Psychology, Volume 13, Issue 3, JulySeptember 1992, Pages 311-362, ISSN
0193-3973, 10.1016/0193-3973(92)90035-G.
Abstract: Extant reviews of early childhood intervention programs for the
disadvantaged focus on the benefits that accrue to the children. Programs
also may influence the parents (typically the mother), as most programs
provide services to the mother as well as the child. In this article, the
efficacy of a particular set of programs is reviewed. Early interventions
that are educationally oriented, that are at least six months in duration,
that begin prior to age 3, and that serve disadvantaged families were
reviewed. Of the 27 programs, 11 offered regular, substantive, center-based
programming (mode = 40 hr/week; M = 25.7 hr/week), and 16 offered home
visits and/or center-based programs on a less frequent basis. Maternal
benefits are reviewed for maternal employment and education, fertility,
mother-infant interaction, home environment, maternal mental health and
self-esteem, and maternal attitudes and knowledge about childrearing. The
programs had the most impact on maternal employment and education, on
subsequent fertility, and on mother-infant interaction. Implications of
these findings for programs for poor families are considered.

Kathie Records, A Critical Review of Maternal Abuse and Infant Outcomes:

Implications for Newborn Nurses, Newborn and Infant Nursing Reviews, Volume
7, Issue 1, March 2007, Pages 7-13, ISSN 1527-3369,
Abstract: Abuse of women is endemic in the United States, with most
violence occurring during childhood or the childbearing years. This article
presents a summary of the physical and psychological adaptations that occur
in women subsequent to abuse experience and the key physiologic changes
that affect pregnancy for these women. Outlining these physiologic changes
provides the basis for understanding and discussing the available evidence
of newborn outcomes when the mother has been abused. The maternal-newborn
relationship is explored in the context of abuse experiences. Long-term
alterations in childhood growth and development are noted. Recommendations
for nursing interventions to improve newborn outcomes when the mother has
been abused are provided. Areas needing additional research include
comparative descriptive designs exploring early maternal newborn
relationships for abused as compared with nonabused mother-infant dyads and
testing of interventions to decrease the stress response.
Keywords: Abuse; Domestic violence; Maternal; Infant; Newborn; Health;
Maternal-infant relationship

, References, Introduction to Forensic Psychology (Second Edition),

Academic Press, Burlington, 2005, Pages 495-550, ISBN 9780120643516,

Violet Q. Habwe, Posttransplantation Quality of Life: More Than Graft

Function, American Journal of Kidney Diseases, Volume 47, Issue 4,
Supplement 2, April 2006, Pages S98-S110, ISSN 0272-6386,
Abstract: Whereas newer immunosuppressive therapies have increased patient
and graft survival, long-term treatment with these drugs has been linked to
medical and physical complications that may impact on posttransplantation
quality of life. Immunosuppression-related physical side effects that can
alter appearanceincluding hirsutism, gingival hyperplasia, weight gain,
cushingoid facies, hand tremors, alopecia, and skin disordersare among the
most bothersome to patients and may have serious psychosocial implications.
In addition, physical side effects may influence patient adherence to their
prescribed treatment regimens and result in more serious complications,
such as acute rejection, graft loss, rehospitalization, and even mortality.
Therefore, strategies for minimizing side effects of immunosuppressive
therapy and improving medication adherence are integral to better long-term
transplant recipient management.
Keywords: Adherence; kidney transplantation; physical side effects; quality
of life; corticosteroids; cyclosporine; tacrolimus

Marcia A. Ellison, Selen Hotamisligil, Hang Lee, Janet W. Rich-Edwards,

Samuel C. Pang, Janet E. Hall, Psychosocial risks associated with multiple
births resulting from assisted reproduction, Fertility and Sterility,
Volume 83, Issue 5, May 2005, Pages 1422-1428, ISSN 0015-0282,
Abstract: Objective
To determine if increased psychosocial risks are associated with each
increase in birth multiplicity (i.e., singleton, twin, triplet) resulting
from assisted reproduction.
Stratified random sample (n = 249).
An academic teaching hospital and private practice infertility center.
Mothers raising 1- to 4-year-old children (n = 128 singletons, n = 111
twins, and n = 10 triplets) conceived through assisted reproduction.
Self-administered, mailed survey.
Main Outcome Measure(s)
Scales measuring material needs, quality of life, social stigma,
depression, stress, and marital satisfaction.
Using multivariate logistic regression models, for each additional multiple
birth child, the odds of having difficulty meeting basic material needs
more than tripled and the odds of lower quality of life and increased
social stigma more than doubled. Each increase in multiplicity was also
associated with increased risks of maternal depression.
To increase patients' informed decision-making, assisted reproduction
providers might consider incorporating a discussion of these risks with all
patients before they begin fertility treatment, and holding the discussion
again if the treatment results in a multiple gestation. These data may also
help providers to identify appropriate counseling, depression screening,
and supports for patients with multiple births.
Keywords: Multiple births; fertility treatment outcomes; depression;
quality of life; iatrogenic; twins; triplets

Sam Rowlands, Social predictors of repeat adolescent pregnancy and focussed

strategies, Best Practice &amp; Research Clinical Obstetrics &amp;
Gynaecology, Volume 24, Issue 5, October 2010, Pages 605-616, ISSN 1521-
6934, 10.1016/j.bpobgyn.2010.02.016.
Abstract: This article begins with an overview of teenage pregnancy within
a social context. Data are then presented on conceptions and repeat
conceptions in teenagers. Social predictors of repeat teenage pregnancy are
grouped according to social ecological theory. A brief summary of
prevention of teenage pregnancy in general is followed by a detailed
analysis of studies of interventions designed to prevent repeat pregnancy
that reached specific quality criteria. The results of some systematic
reviews show no significant overall effect on repeat pregnancy, whereas
others show an overall significant reduction. Youth development programmes
are shown in some cases to lower pregnancy rates but in other cases to have
no effect or even to increase them. Features of secondary prevention
programmes more likely to be successful are highlighted.
Keywords: repeat; adolescent; teenage; pregnancy; predictor; strategy;
prevention; intervention

Wendy Simonds, Watching the clock: keeping time during pregnancy, birth,
and postpartum experiences, Social Science &amp; Medicine, Volume 55, Issue
4, August 2002, Pages 559-570, ISSN 0277-9536, 10.1016/S0277-9536(01)00196-
Abstract: In this paper, I analyze how different didactic discourses
surrounding pregnancy, birth, and postpartum care portray time in
procreative events. I investigate advice regarding procreative experiences
offered to women by a variety of experts, and offered by experts to each
other, examining literature which demonstrates the wide range of didactic
approaches to procreative events that are accessible in US culture, from
masculinist medical orthodoxythe dominant perspectiveto the
naturalist/feminist midwifery model, with self-help literature reflecting
the influence of both ends of this spectrum as well as of consumer-oriented
health activism. I explore how the conceptualization of time in the medical
discourse contributes to the overpowering or disempowering of procreating
women, and how the self-help and midwifery approaches respond to the
medical modelranging on a continuum from reification to refutation.
Obstetrics works on women's bodies to make them stay on time and on course;
this quest becomes more obsessively time-focused over time. In contrast,
the midwifery discourse centers on women active in time, rather than
against it. Self-help book authors line up somewhere in the middle, mostly
taking medical management of procreative time for granted and occasionally
try to show women ways in which we can buy time or bide our time against
Keywords: Procreative discourses; Childbirth; Midwifery; Obstetrics;
Pregnancy; Procreation

Jeannette Milgrom, Charlene Schembri, Jennifer Ericksen, Jessica Ross, Alan

W. Gemmill, Towards parenthood: An antenatal intervention to reduce
depression, anxiety and parenting difficulties, Journal of Affective
Disorders, Volume 130, Issue 3, May 2011, Pages 385-394, ISSN 0165-0327,
Abstract: Background
There have been few antenatal interventions aimed at preparing women for
the transition to parenthood and previous attempts to intervene antenatally
to prevent postnatal depression and anxiety have had limited impact.
We evaluated the effectiveness of an antenatal intervention which targeted
risk factors for poor postnatal adjustment, with the dual aim of reducing
both postnatal symptoms of depression/anxiety and parenting difficulties (a
nine-unit self-guided workbook with weekly telephone support). Based on an
initial feasibility study (n&#xa0;=&#xa0;200) which confirmed a low level
of help-seeking among distressed women during pregnancy, an additional
community networking component was developed aimed at increasing social
support and access to health professionals to facilitate treatment of
current antenatal depression/anxiety, if present. In the evaluation of a
second version of the intervention, pregnant women (n&#xa0;=&#xa0;143) were
randomly allocated to receive either the intervention or routine care.
Following the antenatal intervention there were significantly fewer cases
scoring above threshold for mild-to-severe depression/anxiety symptoms
postnatally compared to routine care, along with a trend towards reduced
parenting stress. The community networking component appeared helpful and
women with higher baseline depression scores showed higher levels of help-
seeking in both intervention and routine care groups.
It was not possible to evaluate the efficacy of individual program
components separately.
The findings provide support for the effectiveness of the Towards
Parenthood intervention both as a preparation for parenthood program and in
reducing symptoms of postnatal depression/anxiety.
Keywords: Postnatal depression; Antenatal depression; Anxiety; Early
intervention; Parenting preparation; Randomised controlled trial

S. Darius Tandon, Fallon Cluxton-Keller, Julie Leis, Huynh-Nhu Le, Deborah

F. Perry, A comparison of three screening tools to identify perinatal
depression among low-income African American women, Journal of Affective
Disorders, Volume 136, Issues 12, January 2012, Pages 155-162, ISSN 0165-
0327, 10.1016/j.jad.2011.07.014.
Abstract: Background
The purpose of the current study was to determine the sensitivity,
specificity, and positive predictive value of three depression screening
tools among a low-income African American population of pregnant and
recently delivered women enrolled in home visitation programs in a low-
income urban community.
Ninety-five women enrolled in home visitation programs32 who were pregnant
and 63 with a child &lt;&#xa0;6&#xa0;months comprise the study sample. Each
woman completed a structured clinical interview and three depression
screening toolsthe Edinburgh Postnatal Depression Scale (EPDS), Center for
Epidemiologic Studies Depression Scale (CES-D), and Beck Depression
Inventory II (BDI-II).
Over a quarter of women (28.4%) were experiencing major depression. Each
screening tool was highly accurate in detecting major depression and major
or minor depression among prenatal and postpartum women, with areas under
the curve (AUCs) &gt;&#xa0;0.90. Sensitivities of all screening tools were
improved when using cutoffs lower than those considered standard by
instrument developers.
Participants were recruited from home visitation programs in an urban
context which may limit generalizability to other populations of low-income
African American women. Given that no women during pregnancy met criteria
for minor depression, it was not possible to determine optimal prenatal
cutoff scores.
Three depression screening toolsthe EPDS, CES-D, and BDI-IIappear to be
reliable and brief assessments of major and minor depression among low-
income African American perinatal women. Providers using these tools should
consider using lower cutoff scores to most effectively identify women in
need of depression treatment.
Keywords: Postpartum depression; Screening; African American; Home visiting

Thomas F. Baskett, Epidemiology of obstetric critical care, Best Practice

&amp; Research Clinical Obstetrics &amp; Gynaecology, Volume 22, Issue 5,
October 2008, Pages 763-774, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.06.002.
Abstract: In the last 20 years, in developed countries, maternal mortality
rates have fallen such that analysis of cases of severe maternal morbidity
is necessary to provide sufficient numbers to give a clinically relevant
assessment of the standard of maternal care. Different approaches to the
audit of severe maternal morbidity exist, and include need for intensive
care, organ system dysfunction and clinically defined morbidities. In both
developed and developing countries, the dominant causes of severe morbidity
are obstetric haemorrhage and hypertensive disorders. In some low-resource
regions, obstructed labour and sepsis remain significant causes of severe
maternal morbidity. The death to severe morbidity ratio may reflect the
standard of maternal care. Audits of severe maternal morbidity should be
complementary to maternal mortality reviews.
Keywords: maternal mortality; severe maternal morbidity; obstetric
intensive care; postpartum haemorrhage; eclampsia

Ming Wai Wan, Kathryn M. Abel, Jonathan Green, The transmission of risk to
children from mothers with schizophrenia: A developmental psychopathology
model, Clinical Psychology Review, Volume 28, Issue 4, April 2008, Pages
613-637, ISSN 0272-7358, 10.1016/j.cpr.2007.09.001.
Abstract: Research in children of mothers with schizophrenia (HRsz
children) has focused on identifying the early antecedents of adult illness
to understand its intergenerational (primarily genetic) transmission. From
a developmental psychopathology perspective, the vulnerability of HRsz
children may result from multiple environmental factors interacting with
ongoing developmental processes. The objectives were: (1) to understand the
extent to which having a mother with schizophrenia impacts on developmental
and clinical trajectories; (2) to review whether research supports a
proposed model for the non-genetic transmission of risk in HRsz offspring;
(3) to discuss the implications of the model for early intervention. HRsz
children show vulnerability in a range of areas throughout childhood, but
the findings are not unanimous in any single domain, and poor developmental
functioning in any given domain does not necessarily predict morbidity.
Broad support for a developmental psychopathology model is provided by
studies suggesting a generalised vulnerability and studies on the impact of
psychosocial factors. However, little empirical research has elucidated
specific proximal social environmental influences through development. Gaps
in the literature are identified where studies in depressed mothers and
other groups are potentially informative, and which suggest that
conventional psychological therapies may not be sufficient to enhance
offspring outcomes. Future research could inform our understanding of
developmental psychopathology and the development of preventative
Keywords: Maternal schizophrenia; High risk; Developmental outcome; Gene
environment interaction

Noreen Goldman, Dana A. Glei, Evaluation of midwifery care: results from a

survey in rural Guatemala, Social Science &amp; Medicine, Volume 56, Issue
4, February 2003, Pages 685-700, ISSN 0277-9536, 10.1016/S0277-
Abstract: In an effort to reduce infant and maternal morbidity and
mortality in developing countries, the World Health Organization has
promoted the training of traditional birth attendants (midwives) and their
incorporation into the formal health care system. In this paper, we examine
several aspects of the integration of traditional and biomedical maternity
care that are likely to reflect the quality of care received by Guatemalan
women. Specifically, we examine the extent to which women combine
traditional and biomedical pregnancy care, the frequency with which
midwives refer women to biomedical providers, the content and quality of
care offered by midwives, and the effects of midwife training programs on
referral practices and quality of care. The analysis is based on data from
the 1995 Guatemalan Survey of Family Health. The results offer a mixed
assessment of the efficacy of midwife training programs. For example,
although trained midwives are much more likely than other midwives to refer
their clients to biomedical providers, most pregnant women do not see a
biomedical provider, and the quality of midwife care, as defined and
measured in this study, is similar between trained and untrained midwives.
Keywords: Pregnancy; Prenatal care; Birth; Midwifery; Traditional birth
attendant; Guatemala

T.G. Rana, B.D. Chataut, G. Shakya, G. Nanda, A. Pratt, S. Sakai,

Strengthening emergency obstetric care in Nepal: The Women's Right to Life
and Health Project (WRLHP), International Journal of Gynecology &amp;
Obstetrics, Volume 98, Issue 3, September 2007, Pages 271-277, ISSN 0020-
7292, 10.1016/j.ijgo.2007.05.017.
Abstract: Introduction
The Women's Right to Life and Health Project contributes to Nepal's
National Safe Motherhood Program and maternal mortality reduction efforts
by working to improve the availability, quality and utilization of
emergency obstetric care services in public health facilities.
The project upgraded 8 existing public health facilities through
infrastructure, equipment, training, data collection, policy advocacy, and
community information activities. The total cost of the project was
approximately US$1.6 million.
In 5 years, 3 comprehensive and 4 basic emergency obstetric care (EmOC)
facilities were established in an area where adequate EmOC services were
previously lacking. From 2000 to 2004, met need for EmOC improved from 1.9
to 16.9%; the proportion of births in EmOC project facilities increased
from 3.8 to 8.3%; and the case fatality rate declined from 2.7 to 0.3%.
While the use of maternity services is still low in Nepal, improving
availability and quality of EmOC together with community empowerment can
increase utilization by women with complications, even in low-resource
settings. Partnerships with government and donors were key to the project's
success. Similar efforts should be replicated throughout Nepal to expand
the availability of essential life-saving services for pregnant women.
Keywords: Nepal; Emergency obstetric care; Maternal mortality; Utilization

J McCarthy, The conceptual framework of the PMM Network, International

Journal of Gynecology &amp; Obstetrics, Volume 59, Supplement 2, 1 November
1997, Pages S15-S21, ISSN 0020-7292, 10.1016/S0020-7292(97)00143-4.
Abstract: Understanding the determinants of maternal mortality is a complex
task, in part because maternal deaths are influenced by many different
categories of events or conditions. Biology, economics, culture, demography
and the distribution and effectiveness of health services all contribute.
Conceptual frameworks have made important contributions to our
understanding of the determinants of other, equally complex events, such as
fertility and child survival. Also referred to as `proximate determinants
frameworks', such models are useful because they identify the specific
mechanisms through which social, economic and cultural factors lead to the
event of interest. Our model identifies the precise sequence of events that
lead to maternal death (pregnancy, complication and death) and specifies
categories of intermediate factors and distant factors that directly affect
one or more of these events. When the world literature on maternal
mortality was analyzed in light of the causal pathways laid out in the
conceptual framework, it became clear that some pathways are more amenable
to intervention and change than others. Implications for strategies,
programs and monitoring and evaluation are discussed.&#xa0; 1997
International Journal of Gynecology and Obstetrics
Keywords: Maternal mortality; International; Obstetric complications;
Determinants; Model; Education
Tzu-ting Huang, Chieh-Ying Yeh, Yc-Chen Tsai, A diet and physical activity
intervention for preventing weight retention among Taiwanese childbearing
women: a randomised controlled trial, Midwifery, Volume 27, Issue 2, April
2011, Pages 257-264, ISSN 0266-6138, 10.1016/j.midw.2009.06.009.
Abstract: Objective
to examine the effect of individual counselling on diet and physical
activity from pregnancy to six months post partum, or from birth to six
months post partum, on weight retention among Taiwanese women.
a randomised controlled trial assigned participants to two experimental
groups [from pregnancy to six months post partum (EP) and from birth to six
months post partum (EPP)] and one comparison group.
a 3900-bed medical centre in northern Taiwan with around 3000 births
a sample of 189 women who had regular check-ups during pregnancy and gave
birth at the medical centre.
the comparison group received the routine outpatient department obstetric
educational programme. The EP group attended regularly scheduled clinic
visits with individualised dietary and physical activity education plans
from 16 gestational weeks to six months post partum, and received on
brochure. The EPP group received the same educational intervention as the
EP group from 2448 hours after birth to six months post partum.
body weight, body mass index, health-promoting behaviour and psycho-social
variables (self-efficacy, body image, depression and social support).
average gestational weight gain was 14.02, 15.27 and 16.22&#xa0;kg in the
three EP, EPP and comparison groups respectively, and average weight
retention at six months post partum was 2.34, 4.06 and 5.08&#xa0;kg in the
three groups, respectively.
Key conclusions
a diet and physical activity intervention from pregnancy is effective for
reducing post-pregnancy weight retention.
Implications for practice
the findings of the present study should be taken into consideration when
incorporating significant others and weight-loss maintenance strategies
with interventions for a healthier family lifestyle.
Keywords: Weight retention; Intervention; Pregnancy; Post partum

Richard Hirschman, Edward S. Katkin, Psychophysiological Functioning,

Arousal, Attention, and Learning during the First Year of Life, In: Hayne
W. Reese, Editor(s), Advances in Child Development and Behavior, JAI, 1974,
Volume 9, Pages 115-150, ISSN 0065-2407, ISBN 9780120097098, 10.1016/S0065-

Elizabeth R. Moore, Gene Cranston Anderson, Randomized Controlled Trial of

Very Early MotherInfant Skin-to-Skin Contact and Breastfeeding Status,
Journal of Midwifery &amp; Women's Health, Volume 52, Issue 2, MarchApril
2007, Pages 116-125, ISSN 1526-9523, 10.1016/j.jmwh.2006.12.002.
Abstract: This study was done to evaluate effects of maternalinfant skin-
to-skin contact during the first 2 hours postbirth compared to standard
care (holding the infant swaddled in blankets) on breastfeeding outcomes
through 1 month follow-up. Healthy primiparous motherinfant dyads were
randomly assigned by computerized minimization to skin-to-skin contact (n =
10) or standard care (n = 10). The Infant Breastfeeding Assessment Tool was
used to measure success of first breastfeeding and time to effective
breastfeeding (time of the first of three consecutive scores of 1012).
Intervention dyads experienced a mean of 1.66 hours of skin-to-skin
contact. These infants, compared to swaddled infants, had higher mean
sucking competency during the first breastfeeding (8.7 2.1 vs 6.3 2.6;
P &lt; .02) and achieved effective breastfeeding sooner (935 721 minutes
vs 1737 1001; P &lt; .04). No significant differences were found in
number of breastfeeding problems encountered during follow-up (30.9 5.51
vs 32.7 5.84; P &lt; .25) or in breastfeeding exclusivity (1.50 1.1 vs
2.10 2.2; P &lt; .45). Sucking competency was also related to maternal
nipple protractility (r = .48; P &lt; .03). Very early skin-to-skin contact
enhanced breastfeeding success during the early postpartum period. No
significant differences were found at 1 month.
Keywords: breastfeeding; breastfeeding exclusivity; early postpartum;
newborn suckling; skin-to-skin contact

M.H. Peters, Midwives and the achievement of safer motherhood,

International Journal of Gynecology &amp; Obstetrics, Volume 50, Supplement
2, October 1995, Pages S89-S92, ISSN 0020-7292, 10.1016/0020-7292(95)02493-
Abstract: The root problem of unsafe motherhood in developing countries is
lack of access to a competent care-giver throughout pregnancy, childbirth
and the postpartum period. These resources, trained midwives, with or
without prior nursing training, should be recruited from the communities
they are to serve. Community midwives must be involved in any realistic
strategic plan to provide this needed midwifery care.
Keywords: Safe motherhood; Midwives; Maternity care

Dawn P. Misra, Holly Grason, Achieving safe motherhood: Applying a life

course and multiple determinants perinatal health framework in public
health, Women's Health Issues, Volume 16, Issue 4, JulyAugust 2006, Pages
159-175, ISSN 1049-3867, 10.1016/j.whi.2006.02.006.
Abstract: Safe motherhood has begun to be identified as a priority for the
health of American women. We argue that safe motherhood can be achieved
through application of a life course and multiple determinants framework.
This framework, with its focus on the preconception period, poses a dilemma
in that it links together periods of life and domains of activities that
have traditionally not been linked with maternal health. The interests of
women and children have often been juxtaposed in the making of policy.
Further, the domains of womens health, maternal and child health, and
family planning have often clashed over policy priorities and funds. This
framework shows that the research literature now links them inextricably to
better health outcomes, albeit indirectly; there are no intervention
studies that have demonstrated the empirical efficacy of this approach.
Thus, although this framework creates a strong rationale for the linkages
described, it also demands attention to a set of implementation strategies
that will overcome existing barriers. Through a focus on one maternal
factor, obesity, we discuss how a range of strategies grounded in the
framework can be undertaken to address maternal morbidity and mortality. We
then examine selected strategies at each level of the multiple determinants
life course framework and emphasize how public policies and public and
private sector professional practice can be reexamined to improve outcomes
for women in all time periods and aspects of reproductive potential, which
in turn might enhance outcomes for their offspring, both at birth and
beyond. Our intent is to influence how policy makers, public health
professionals, clinicians, and researchers approach safe motherhood.

Gary L. Darmstadt, Anita K.M. Zaidi, Barbara J. Stoll, CHAPTER 2 - Neonatal

Infections: A Global Perspective, Infectious Diseases of the Fetus and
Newborn (Seventh Edition), W.B. Saunders, Philadelphia, 2011, Pages 24-51,
ISBN 9781416064008, 10.1016/B978-1-4160-6400-8.00002-X.

Gary L. Darmstadt, Anne CC Lee, Simon Cousens, Lynn Sibley, Zulfiqar A.

Bhutta, France Donnay, Dave Osrin, Abhay Bang, Vishwajeet Kumar, Steven N.
Wall, Abdullah Baqui, Joy E. Lawn, 60&#xa0;million non-facility births: Who
can deliver in community settings to reduce intrapartum-related deaths?,
International Journal of Gynecology &amp; Obstetrics, Volume 107,
Supplement, October 2009, Pages S89-S112, ISSN 0020-7292,
Abstract: Background
For the world's 60&#xa0;million non-facility births, addressing who is
currently attending these births and what effect they have on birth
outcomes is a key starting point toward improving care during childbirth.
We present a systematic review of evidence for the effect of community-
based cadrescommunity-based skilled birth attendants (SBAs), trained
traditional birth attendants (TBAs), and community health workers (CHWs)in
improving perinatal and intrapartum-related outcomes.
The evidence for providing skilled birth attendance in the community is low
quality, consisting of primarily before-and-after and quasi-experimental
studies, with a pooled 12% reduction in all cause perinatal mortality (PMR)
and a 22%47% reduction in intrapartum-related neonatal mortality (IPR-
NMR). Low/moderate quality evidence suggests that TBA training may improve
linkages with facilities and improve perinatal outcomes. A randomized
controlled trial (RCT) of TBA training showed a 30% reduction in PMR, and a
meta-analysis demonstrated an 11% reduction in IPR-NMR. There is moderate
evidence that CHWs have a positive impact on perinatal-neonatal outcomes.
Meta-analysis of CHW packages (2 cluster randomized controlled trials, 2
quasi-experimental studies) showed a 28% reduction in PMR and a 36%
reduction in early neonatal mortality rate; one quasi-experimental study
showed a 42% reduction in IPR-NMR.
Skilled childbirth care is recommended for all pregnant women, and
community strategies need to be linked to prompt, high-quality emergency
obstetric care. CHWs may play a promising role in providing pregnancy and
childbirth care, mobilizing communities, and improving perinatal outcomes
in low-income settings. While the role of the TBA is still controversial,
strategies emphasizing partnerships with the health system should be
further considered. Innovative community-based strategies combined with
health systems strengthening may improve childbirth care for the rural
poor, help reduce gross inequities in maternal and newborn survival and
stillbirth rates, and provide an effective transition to higher coverage
for facility births.
Keywords: Birth asphyxia; Community health worker; Community midwife;
Hypoxia; Intrapartum; Neonatal mortality; Stillbirth; Traditional birth

L. Say, R.C. Pattinson, Maternal Mortality and Morbidity, In: Editor-in-

Chief: Kris Heggenhougen, Editor(s)-in-Chief, International Encyclopedia
of Public Health, Academic Press, Oxford, 2008, Pages 222-236, ISBN
9780123739605, 10.1016/B978-012373960-5.00466-4.
Abstract: Pregnancy, childbirth, and the postpartum period may have
negative outcomes ranging from minor conditions to more serious morbidities
and even death. Among all maternal deaths, 99% occur in developing parts of
the world, where maternal morbidities are also more prevalent. The patterns
of complications of pregnancy and childbirth reflect the capacity and
functioning of the health system in a population. Understanding the causes
of maternal deaths, the patterns of morbidities, the characteristics of the
groups affected most, and health system failures is essential to determine
where to concentrate efforts to provide improvements. Such information is
also an indicator of the broader issues of social inclusion, women's status
and rights, and socioeconomic development in the society.
Keywords: Eclampsia; Maternal morbidity; Maternal mortality; Maternal
mortality measurement; Maternal mortality ratio; Near miss; Obstetric
embolism; Obstetric hemorrhage; Obstetric morbidity; Obstructed labor;
Preeclampsia; Sepsis; Severe acute maternal morbidity

Monica S. Paz, Lynne M. Smith, Linda L. LaGasse, Chris Derauf, Penny Grant,
Rizwan Shah, Amelia Arria, Marilyn Huestis, William Haning, Arthur Strauss,
Sheri Della Grotta, Jing Liu, Barry M. Lester, Maternal depression and
neurobehavior in newborns prenatally exposed to methamphetamine,
Neurotoxicology and Teratology, Volume 31, Issue 3, MayJune 2009, Pages
177-182, ISSN 0892-0362, 10.1016/j.ntt.2008.11.004.
Abstract: Background
The effects of maternal depression on neonatal neurodevelopment in MA
exposed neonates have not been well characterized.
To determine the neurobehavioral effects of maternal depressive symptoms on
neonates exposed and not exposed to methamphetamine (MA) using the NICU
Network Neurobehavioral Scale (NNNS).
The purpose of the IDEAL study is to determine the effects of prenatal MA
exposure on child outcome. IDEAL screened 13,808 subjects, 1632 were
eligible and consented and 176 mothers were enrolled. Only biological
mothers with custody of their child at the one-month visit
(n&#xa0;=&#xa0;50 MA; n&#xa0;=&#xa0;86 comparison) had the Addiction
Severity Index (ASI) administered. The NNNS was administered to the neonate
by an examiner blinded to MA exposure within the first five days of life.
General Linear Models tested the effects of maternal depression and
prenatal MA exposure on NNNS outcomes, with and without covariates.
Significance was accepted at p&#xa0;&lt;&#xa0;.05.
After adjusting for covariates, regardless of exposure status, maternal
depressive symptoms were associated with lower handling and arousal scores,
elevated physiological stress scores and an increased incidence of
hypotonicity. When adjusting for covariates, MA exposure was associated
with lower arousal and higher lethargy scores.
Maternal depressive symptoms are associated with neurodevelopmental
patterns of decreased arousal and increased stress. Prenatal MA exposure
combined with maternal depression was not associated with any additional
neonatal neurodevelopmental differences.
Keywords: Prenatal exposure; Neurodevelopment; Drugs; Depression

Bernadette Mazurek Melnyk, Holly E Brown, Dolores C Jones, Richard Kreipe,

Julie Novak, Improving the mental/psychosocial health of US children and
adolescents: Outcomes and implementation strategies from the national KySS
summit, Journal of Pediatric Health Care, Volume 17, Issue 6, Supplement,
November 2003, Pages S1-S24, ISSN 0891-5245, 10.1016/j.pedhc.2003.08.002.

Zahra Ghodsi, Maryam Asltoghiri, Does exercise training during pregnancy

affect gestational age and gestational weight gain?, Procedia - Social and
Behavioral Sciences, Volume 31, 2012, Pages 418-422, ISSN 1877-0428,
Abstract: Some controversies exist over the possibility that exercise
during pregnancy might increase the risk of preterm delivery. At the same
time excessive gestational weight gain is increasing in prevalence and
associated with a number of adverse pregnancy outcomes for both mother and
child. This study aimed to determine the possible relationship between
regular exercise of pregnancy and gestational weight gain and gestational
age at the moment of delivery. This was a case-control survey. By using a
continued method, performed on 250 women with one or two gestation were
assigned to either a training (n&#xa0;=&#xa0;125) or a comparison
(n&#xa0;=&#xa0;125) group. The supervised training was included three days
a week, 3045 min, from 2026th weeks to 3839th weeks of pregnancy.
Pregnancy outcomes include of gestational weight gain and gestational age
was recorded for two groups. Statistical analysis was performed using
Students t-test, man-Whitney, and chi-squared test where appropriate.
According finding of this study, No significant differences were found
(p&#xa0;&gt;&#xa0;0.05) between 2 groups for gestational age and exercise.
The mean gestational age did not differ between the training (39 weeks 1
day) and the comparison group (39 weeks, 4 days 1.23 day). There were
meaningful statistical evidences for exercise training and gestational
weight gain at the time of delivery.

According the findings of the present study, healthy gravid with one or two
gestation can safely engage in moderate, supervised exercise programmed
until the end of gestation as this would not affect gestational age. Also
the program proved effective in reducing gestational weight gain at the
time of delivery. Such programs should be considered as part of routine
pregnancy care for pregnant women especially obese ones.
Keywords: exercise training; pregnancy; gestational age; gestational weight

Jennifer L. Williams, Brian McCarthy, Observations From a Maternal and

Infant Hospital in Kabul, Afghanistan2003, Journal of Midwifery &amp;
Women's Health, Volume 50, Issue 4, JulyAugust 2005, Pages e31-e35, ISSN
1526-9523, 10.1016/j.jmwh.2005.02.009.
Abstract: Afghanistan is believed to have one of the highest infant and
maternal mortality rates in the world. As a result of decades of war and
civil unrest, Afghan women and children suffer from poor access to health
services, harsh living conditions, and insufficient food and micronutrient
security. To address the disproportionately high infant and maternal
mortality rates in Afghanistan, the US Department of Health and Human
Services pledged support to establish a maternal health facility and
training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected
because this hospital admits approximately 36,000 patients and delivers
more than 14,000 babies annually. This article reports the initial
observations at Rabia Balkhi Hospital and describes factors that influenced
womens access, the quality of care, and the evaluation health care
services. This observational investigation examined areas of obstetric,
laboratory and pharmacy, and ancillary services. The investigators
concluded that profound changes were needed in the hospitals health care
delivery system to make the hospital a safe and effective health care
facility for Afghan women and children and an appropriate facility in which
to establish an Afghan provider training program for updating obstetric
skills and knowledge.
Keywords: Afghanistan; maternal mortality; infant mortality; pregnant
women; health services; accessibility

Carol Sakala, Midwifery care and out-of-hospital birth settings: How do

they reduce unnecessary cesarean section births?, Social Science &amp;
Medicine, Volume 37, Issue 10, November 1993, Pages 1233-1250, ISSN 0277-
9536, 10.1016/0277-9536(93)90335-2.
Abstract: In studies using matched or adjusted cohorts, U.S. women
beginning labor with midwives and/or in out-of-hospital settings have
attained cesarean section rates that are considerably lower than similar
women using prevailing forms of carephysicians in hospitals. This cesarean
reduction involved no compromise in mortality and morbidity outcome
measures. Moreover, groups of women at elevated risk for adverse perinatal
outcomes have attained excellent outcomes and cesarean rates well below the
general population rate with these care arrangements.

How do midwives and out-of-hospital birth settings so effectively help

women to avoid unnecessary cesareans? This paper explores this question by
presenting data from interviews with midwives who work in home settings.
The midwives' understanding of and approaches to major medical indications
for cesarean birth contrast strikingly with prevailing medical knowledge
and practice. From the midwives' perspective, many women receive cesareans
due to pseudo-problems, to problems that might easily be prevented, or to
problems that might be addressed through less drastic measures.

Policy reports addressing the problem of unnecessary cesarean births in the

U.S. have failed to highlight the substantial reduction in such births that
may be expected to accompany greatly expanded use of midwives and out-of-
hospital birth settings. The present studytogether with cohort studies
documenting such a reduction, studies showing other benefits of such forms
of care, and the increasing reluctance of physicians to provide obstetrical
servicessuggests that childbearing families would realize many benefits
from greatly expanded use of midwives and out-of-hospital birth settings.
Keywords: midwifery care; out-of-hospital birth; cesarean prevention;
maternity care policy

Ling-ling Gao, Sally Wai-chi Chan, Xiaomao Li, Shaoxian Chen, Yuantao Hao,
Evaluation of an interpersonal-psychotherapy-oriented childbirth education
programme for Chinese first-time childbearing women: A randomised
controlled trial, International Journal of Nursing Studies, Volume 47,
Issue 10, October 2010, Pages 1208-1216, ISSN 0020-7489,
Abstract: Objective
This study investigated the effects of an interpersonal-psychotherapy-
oriented childbirth psychoeducation programme on postnatal depression,
psychological well-being and satisfaction with interpersonal relationships
in Chinese first-time childbearing women.
A randomised, controlled trial was conducted in the maternity clinic of a
regional hospital in China. The intervention was based on the principles of
interpersonal psychotherapy, and consisted of two 90-min antenatal classes
and a telephone follow-up within 2 weeks after delivery. One hundred and
ninety-four first-time pregnant women were randomly assigned to the
intervention group (n&#xa0;=&#xa0;96) or a control group
(n&#xa0;=&#xa0;98). Outcomes of the study included symptoms of postnatal
depression, psychological well-being and satisfaction with interpersonal
relationships, which were measured by the Edinburgh Postnatal Depression
Scale (EPDS), General Health Questionnaire (GHQ) and Satisfaction with
Interpersonal Relationships Scale (SWIRS), respectively.
Women receiving the childbirth psychoeducation programme had significantly
better psychological well-being (t&#xa0;=&#xa0;3.33, p&#xa0;=&#xa0;0.001),
fewer depressive symptoms (t&#xa0;=&#xa0;3.76, p&#xa0;=&#xa0;0.000) and
better interpersonal relationships (t&#xa0;=&#xa0;3.25,
p&#xa0;=&#xa0;0.001) at 6 weeks postpartum as compared with those who
received only routine childbirth education.
An interpersonal-psychotherapy-oriented childbirth psychoeducation
programme could be implemented as routine childbirth education with ongoing
evaluation. Replication of this study with more diverse study groups, such
as mothers with high risks to depression, those with multiple, complicated
or multiparas pregnancies, would provide further information about the
effects of the programme.
Keywords: Evaluation; Interpersonal psychotherapy; Childbirth
psychoeducation; First-time childbearing women

Yookyong Lee, Neil B. Guterman, Young motherfather dyads and maternal

harsh parenting behavior, Child Abuse &amp; Neglect, Volume 34, Issue 11,
November 2010, Pages 874-885, ISSN 0145-2134, 10.1016/j.chiabu.2010.06.001.
Abstract: Objective
This study examined whether the age of parents predicted maternal harsh
parenting behavior, specifically whether younger mothers might be at higher
risk than older mothers, and which paternal characteristics might be
associated with maternal parenting behavior.
This study used data from the Fragile Families and Child Wellbeing (FFCW)
study. In the present study, the authors examined a subsample of families
for which complete data were available on all variables that were used in
the analyses (n&#xa0;=&#xa0;1,597). Based on the parents age at the time
of the child's birth, motherfather age-dyad types were classified, and
selected paternal factors were used to examine their association with
maternal harsh parenting behavior. Psychological aggression, physical
aggression, and self-reports of spanking were used as proxies for maternal
harsh parenting behavior.
Multivariate analyses indicated that adolescent mothers, regardless of how
old their partners were, were at higher risk for harsh parenting behavior
than older adult mothers. Regarding paternal factors, paternal coercion
against mother and the fathers use of spanking were significantly
associated with all three proxies for maternal harsh parenting behavior.
Fathers employment was a risk factor for maternal physical aggression.
This study supported findings from previous studies that younger mothers
may indeed be at greater risk for harsh parenting behavior. It is critical,
therefore, that they acquire appropriate parenting behavior and develop a
healthy relationship with their children. Additional studies, both cross-
sectional and longitudinal, are needed to involve their partners (i.e.,
their child's father) in order to shed light on ways of preventing harsh
parenting behavior and examining the role of fathers in maternal parenting
Practice implications
The present study calls for more attention to sex education and
intervention programs in school and health care settings as important
components of prevention services. Practitioners need to better understand
the concept of harsh parenting behavior in order to work with young parents
and prevent future physical child abuse. Policy makers should support these
efforts and research should be done that engages both mothers and fathers
and seeks to enhance and modify existing programs for youths.
Keywords: Motherfather dyads; Maternal harsh parenting behavior; Fragile
families and child; Wellbeing study

Ambreen Kazi, Zafar Fatmi, Juanita Hatcher, Muhammad Masood Kadir, Unaiza
Niaz, Gail A. Wasserman, Social environment and depression among pregnant
women in urban areas of Pakistan: Importance of social relations, Social
Science &amp; Medicine, Volume 63, Issue 6, September 2006, Pages 1466-
1476, ISSN 0277-9536, 10.1016/j.socscimed.2006.05.019.
Abstract: Aspects of the social environment, including social conditions
(socio-economic status, household situations, chronic illnesses) and social
relations (attitude and behaviors of relations) are major determinants of
depression among women. This study evaluates the relative power of social
relations and social conditions in predicting depression among pregnant
women in Pakistan. In the qualitative phase of the study, social
environmental determinants were identified through literature search, and
experts opinions from psychologists, psychiatrists, gynecologists,
sociologists and researchers. Along with this, 79 in-depth interviews were
conducted with pregnant women drawn from six hospitals (public and private)
and two communities in Karachi, Pakistan. Identified determinants of
depression were grouped into themes of social conditions and social
relations and pregnancy-related concerns. In the study's quantitative
phase, the relative power of the identified themes and categories, based on
their scores for predicting depression (determined by the Center for
Epidemiological StudiesDepression Scale (CES-D scale)), was determined
through multivariate linear regression. Social environmental determinants
of pregnant women were described under the themes and categories of (1)
social relations: involving husband, in-laws and children; (2) social
conditions: involving the economy, illness, life events, household work,
environmental circumstances and social problems; and (3) pregnancy-related
concerns i.e. symptoms of pregnancy, changes during pregnancy, dependency
and concern for unborn baby. Multivariate analysis found that among these
themes, social relations and pregnancy-related concerns were significantly
associated with total CES-D scores. Among the categories besides increasing
age and less education, husband, in-laws, household work and pregnancy
symptoms were significantly associated with total CES-D scores. The study
highlights the importance of social relations compared to social conditions
for determining depression in pregnant women.
Keywords: Pakistan; Social environment; Pregnancy; Social conditions;
Social relations; Urban area

Lynn T. Singer, - Methodological Considerations in Longitudinal Studies of

Infant Risk, In: John Dobbing, Editor(s), Developing Brain Behaviour,
Academic Press, London, 1997, Pages 209-251, ISBN 9780122188701,
Abstract: Visual and cognitive developmental advantages have been reported
for term and preterm infants fed human breast milk or formula fortified
with docosahexaenoic acid (DHA) and arachidonic acid (AA) in comparison to
infants fed formula without these long-chain polyunsaturated fatty acids
(LCPUFAs), but these findings remain unclear, controversial, and
contradictory (112). These studies raise the possibility that
specification of, and delivery of, optimal nutrition in the later states of
fetal development or in early postnatal life, can have significant,
positive, long-term impact on brain development, manifest in enhanced
intellectual competence. Further studies, however, are necessary to
establish rigorously if there are long-term benefits of the addition of
LCPUFAs to infant formulas, substances which occur naturally in human
breast milk.

Monica Oxford, Susan Spieker, Preschool language development among children

of adolescent mothers, Journal of Applied Developmental Psychology, Volume
27, Issue 2, MarchApril 2006, Pages 165-182, ISSN 0193-3973,
Abstract: This longitudinal study examined a comprehensive set of
predictors of preschool language performance in a sample of children of
adolescent mothers. Six domains of risk (low maternal verbal ability,
intergenerational risk, contextual risk, relational risk, home
environmental risk, and child characteristics) for poor preschool language
development, measured throughout early childhood, were examined in a sample
of 154 children born to adolescent mothers. Logistic regression revealed
that having a poor language-learning home environment was associated with
children's low language scores even after accounting for mothers' below-
average verbal ability. More importantly, however, was the exploration of
the dual risk hypothesis that evaluated the effects of combined risk
factors. Being reared by a mother with low verbal ability amplified the
risk of a poor quality home linguistic environment, whereas having a poor
home linguistic environment did not adversely affect the language
development of children with mothers of average verbal ability.
Implications for intervention are discussed with regard to specificity of
intervention efforts within sub-populations of risk identified in this
Keywords: Preschool language; Adolescent mothers; Risk factors; Home
environment; Latent profile analysis

Mickey Chopra, Emmanuelle Daviaud, Robert Pattinson, Sharon Fonn, Joy E

Lawn, Saving the lives of South Africa's mothers, babies, and children: can
the health system deliver?, The Lancet, Volume 374, Issue 9692, 511
September 2009, Pages 835-846, ISSN 0140-6736, 10.1016/S0140-6736(09)61123-
Abstract: Summary
South Africa is one of only 12 countries in which mortality rates for
children have increased since the baseline for the Millennium Development
Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are
important factors. Additionally, suboptimum implementation of high-impact
interventions limits programme effectiveness; between a quarter and half of
maternal, neonatal, and child deaths in national audits have an avoidable
health-system factor contributing to the death. Using the LiST model, we
estimate that 11500 infants' lives could be saved by effective
implementation of basic neonatal care at 95% coverage. Similar coverage of
dual-therapy prevention of mother-to-child transmission with appropriate
feeding choices could save 37200 children's lives in South Africa per year
in 2015 compared with 2008. These interventions would also avert many
maternal deaths and stillbirths. The total cost of such a target package is
US$15 billion per year, 24% of the public-sector health expenditure; the
incremental cost is $220 million per year. Such progress would put South
Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs
are affordable and the key gap is leadership and effective implementation
at every level of the health system, including national and local
accountability for service provision.

Kirti Iyengar, Sharad D Iyengar, Emergency obstetric care and referral:

experience of two midwife-led health centres in rural Rajasthan, India,
Reproductive Health Matters, Volume 17, Issue 33, May 2009, Pages 9-20,
ISSN 0968-8080, 10.1016/S0968-8080(09)33459-X.
Abstract: This paper documents the experience of two health centres in a
primary health service located in interior rural areas of southern
Rajasthan, northern India, where trained nurse-midwives are providing
skilled maternal and newborn care round the clock daily. The nurse-midwives
independently detect and manage complications and decide when to refer
women to the nearest hospital for emergency care, in telephonic
consultation with a doctor if required. From 2000-2008, 2,771 women in
labour and 202 women with maternal emergencies who were not in labour were
attended by nurse-midwives. Of women in labour, 21% had a life-threatening
complication or its antecedent condition and 16% were advised referral, of
which two-thirds complied. Compliance with referral was higher for maternal
conditions than fetal conditions. Among the 202 women who came with
complications antenatally, post-abortion or post-partum, referral was
advised for 70%, of whom 72% complied. The referral system included
counselling, arranging transport, accompanying women, facilitating
admission and supporting inpatient care, and led to higher referral
compliance rates. There was only one maternal death in nine years. We
conclude that trained nurse-midwives can significantly improve access to
skilled maternal and neonatal care in rural areas, and manage maternal
complications with and without the need for referral. Protocols must
acknowledge that some families might not comply with referral advice, and
also that initial care by nurse-midwives can reverse progression of certain
complications and thereby avert the need for referral.
Keywords: delivery care; obstetric complications; emergency obstetric care;
referral; nurse-midwives

Embry M. Howell, Nancy Heiser, Mary Harrington, A Review of Recent Findings

on Substance Abuse Treatment for Pregnant Women, Journal of Substance Abuse
Treatment, Volume 16, Issue 3, April 1999, Pages 195-219, ISSN 0740-5472,
Abstract: Recent years have brought an increased interest in the treatment
needs of pregnant substance abusers. This article reviews the literature on
this subject, providing an overview of what is known about the prevalence
of substance abuse during pregnancy; the factors in womens lives,
especially pregnant women, that lead to substance abuse and that facilitate
and impede treatment success; and the components of successful treatment
programs. The prevalence of prenatal illicit drug use is known to be about
5% of all pregnant women nationwide, with higher rates for selected
subgroups. Local studies have shown much higher rates. Substance abuse is
associated with poverty, with the substance abuse of significant others,
and with family violence. Perinatal substance abusers experience poorer
birth outcomes. The negative consequences for babies do not stop at birth;
home environments may be chaotic and often children are removed from their
mothers care if substance abuse continues after birth. While the
literature on prevalence, correlates, and outcomes of perinatal substance
abuse is plentiful, there continues to be sparse information on successful
treatment approaches. Sample sizes are small and there are few studies with
adequate comparison groups. The small number of outcome studies we review
suggest that, as with the broader treatment literature for other
populations, success (as measured by abstinence) is associated with
retention. Retention is facilitated by the provision of support services,
such as child care, parenting classes, and vocational training. There is no
clear empirical basis for concluding that one type of treatment (for
example, residential treatment) is more effective than another. Published
by Elsevier Science Inc.
Keywords: substance abuse; pregnancy; Medicaid substance abuse treatment

Dinesh Khanna, Erin L. Arnold, James N. Pencharz, Jennifer M. Grossman,

Shana B. Traina, Anand Lal, Catherine H. MacLean, Measuring Process of
Arthritis Care: The Arthritis Foundations Quality Indicator Set for
Rheumatoid Arthritis, Seminars in Arthritis and Rheumatism, Volume 35,
Issue 4, February 2006, Pages 211-237, ISSN 0049-0172,
Abstract: Objective
To describe the scientific evidence that supports each of the explicit
process measures in the Arthritis Foundations Quality Indicator Set for
Rheumatoid Arthritis.
For each of the 27 measures in the Arthritis Foundations Quality Indicator
set, a comprehensive literature review was performed for evidence that
linked the process of care defined in the indicator with relevant clinical
outcomes and to summarize practice guidelines relevant to the indicators.
Over 7500 titles were identified and reviewed. For each of the indicators
the scientific evidence to support or refute the quality indicator was
summarized. We found direct evidence that supported a processoutcome link
for 15 of the indicators, an indirect link for 7 of the indicators, and no
evidence to support or refute a link for 5. The processes of care described
in the indicators for which no supporting/refuting data were found have
been assumed to be so essential to care that clinical trails assessing
their importance have not, and probably never will be, performed. The
process of care described in all but 2 of the indicators is recommended in
1 or more practice guidelines.
There are sufficient scientific evidence and expert consensus to support
the Arthritis Foundations Quality Indicator Set for Rheumatoid Arthritis,
which defines a minimal standard of care that can be used to assess health
care quality for patients with rheumatoid arthritis.
Keywords: rheumatoid arthritis; quality of care; quality measures; process
of care

Peter von Dadelszen, Beth Payne, Jing Li, J Mark Ansermino, Fiona Broughton
Pipkin, Anne-Marie Ct, M Joanne Douglas, Andre Gruslin, Jennifer A
Hutcheon, KS Joseph, Phillipa M Kyle, Tang Lee, Pamela Loughna, Jennifer M
Menzies, Mario Merialdi, Alexandra L Millman, M Peter Moore, Jean-Marie
Moutquin, Annie B Ouellet, Graeme N Smith, James J Walker, Keith R Walley,
Barry N Walters, Mariana Widmer, Shoo K Lee, James A Russell, Laura A
Magee, for the PIERS Study Group, Prediction of adverse maternal outcomes
in pre-eclampsia: development and validation of the fullPIERS model, The
Lancet, Volume 377, Issue 9761, 1521 January 2011, Pages 219-227, ISSN
0140-6736, 10.1016/S0140-6736(10)61351-7.
Abstract: SummaryBackground
Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly
result from eclampsia, uncontrolled hypertension, or systemic inflammation.
We developed and validated the fullPIERS model with the aim of identifying
the risk of fatal or life-threatening complications in women with pre-
eclampsia within 48 h of hospital admission for the disorder.
We developed and internally validated the fullPIERS model in a prospective,
multicentre study in women who were admitted to tertiary obstetric centres
with pre-eclampsia or who developed pre-eclampsia after admission. The
outcome of interest was maternal mortality or other serious complications
of pre-eclampsia. Routinely reported and informative variables were
included in a stepwise backward elimination regression model to predict the
adverse maternal outcome. We assessed performance using the area under the
curve (AUC) of the receiver operating characteristic (ROC). Standard
bootstrapping techniques were used to assess potential overfitting.
261 of 2023 women with pre-eclampsia had adverse outcomes at any time after
hospital admission (106 [5%] within 48 h of admission). Predictors of
adverse maternal outcome included gestational age, chest pain or dyspnoea,
oxygen saturation, platelet count, and creatinine and aspartate
transaminase concentrations. The fullPIERS model predicted adverse maternal
outcomes within 48 h of study eligibility (AUC ROC 088, 95% CI 084092).
There was no significant overfitting. fullPIERS performed well (AUC ROC
&gt;07) up to 7 days after eligibility.
The fullPIERS model identifies women at increased risk of adverse outcomes
up to 7 days before complications arise and can thereby modify direct
patient care (eg, timing of delivery, place of care), improve the design of
clinical trials, and inform biomedical investigations related to pre-
Canadian Institutes of Health Research; UNDP/UNFPA/WHO/World Bank Special
Programme of Research, Development, and Research Training in Human
Reproduction; Preeclampsia Foundation; International Federation of
Obstetricians and Gynecologists; Michael Smith Foundation for Health
Research; and Child and Family Research Institute.

Susan J. Crockett, Laura S. Sims, Environmental influences on children's

eating, Journal of Nutrition Education, Volume 27, Issue 5, September
October 1995, Pages 235-249, ISSN 0022-3182, 10.1016/S0022-3182(12)80792-8.
Abstract: Executive Summary
Dramatic changes in lifestyles and the environment have brought about
significant alterations in children's eating patterns and food choices.
Understanding these changes is pivotal if we are to help today's children
establish healthy eating patterns, which contribute to the prevention and
delay of chronic disease later in life.

This paper describes the most salient environmental factors affecting

children's eating patterns and identifies those that appear most amenable
to influence through public policy initiatives. A myriad of sociocultural
and demographic factors that characterize the U.S. population today have
combined to affect what children eat, where children eat, and with whom
they eat. What was once mainly in the purview of family decision making is
now increasingly in the realm of caregivers and peers, and many eating
encounters occur away from home.

Equally important is the plethora of societal and cultural factors that

influence children's food intake in the home, schools, institutions, child
care settings, health care programs, and the marketplace. American children
are given more and more responsibility for making their own food decisions
and are constantly exposed to advertising messages about food. Federally
sponsored food assistance programs, such as Food Stamps, Child Nutrition
Programs, Head Start, and the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC), make positive contributions to the
kinds and amounts of food made available to many children.

This paper makes a number of policy recommendations that have the potential
to positively influence children's eating patterns and nutritional status.
These include:1.
Provide tools to families so that they can provide healthful food choices
and facilitate the teaching of sound eating practices to children, by means
of (a) promoting partnerships and coordination among government programs,
the private sector, and schools to support the family structure, which is
pivotal for teaching decision making and self-management of health and
nutrition; (b) developing family-school partnerships for teenagers to
combat negative peer influences and help parents and adolescents adopt
positive health and eating behaviors; (c) reform the welfare system to
reward work, bolster parents' academic and job skills, and ensure a decent
standard of living that will enable families to provide adequate food and
foster healthful eating patterns.
Reduce fragmentation and lack of coordination among food assistance, public
health, social service, and education programs that serve the same target
Form partnerships with the media to help children improve their eating
habits by promoting food choices consistent with recommendations made in
Dietary Guidelines for Americans.
An ample supply of healthful foods must be made available to children from
which they can choose, and the information base on which these food choices
are made must be relevant and sound. By working together in partnerships
between public and private sector enterprises, we can make the eating
environment more healthful, thus enabling America's children to enjoy
better health and well-being.

Anne Buist, Promoting positive parenthood: emotional health in pregnancy,

Australian Midwifery, Volume 16, Issue 1, March 2003, Pages 10-14, ISSN
1448-8272, 10.1016/S1031-170X(03)80010-7.
Abstract: Depression is a common problem in the general population and is
projected to be one of the major health issues facing the world in 2020
(WHO). Serious consequences exist for the sufferer, and the family.

Given that women are twice as likely to suffer from depression, and are at
particular risk in the child bearing years, children from infancy may be
affected, with long term ramifications.

Postnatal depression (PND) occurs in 14% of women, and there may be a

similar number affected antenatally. The perinatal period thus is a crucial
time to identify depression, and offers an excellent opportunity to screen
women due to their increased contact with health services.

Carol A. Eades, Christopher Brace, Lawrence Osei, Katherine D. LaGuardia,

Traditional birth attendants and maternal mortality in Ghana, Social
Science &amp; Medicine, Volume 36, Issue 11, June 1993, Pages 1503-1507,
ISSN 0277-9536, 10.1016/0277-9536(93)90392-H.
Abstract: Maternal mortality is high in most African countries,
particularly in rural areas where access to formal health care is limited.
The sociopolitical and economic environment complicates the medical factors
directly responsible for this high rate. Since the 1970s many African
countries have addressed this problem by training traditional birth
attendants (TBAs) in health promotion and in the basics of safe delivery
and referral. The Danfa Rural Health Project in Ghana has trained and
supervised TBAs since 1973. It is located relatively close to the health
services of the capital city of Accra, providing an ideal environment for
the practice of trained TBAs. Thirty-seven trained TBAs currently practice
in the area. Most provide patient education and encourage women to go to
the health center for preventive services. However, many report routinely
performing the high risk deliveries that they have been taught to refer to
higher level care and that when they do refer, their patients may not go.
Reasons for referral refusal frequently cited by TBAs include financial
limitation or lack of transportation and the patients fear of disrespectful
or painful treatment from medical personnel. In the rural environment, the
trained TBA's greatest contribution to lower maternal mortality rates may
lie in the area of health promotion rather than disease intervention.
Keywords: maternal mortality; traditional birth attendant; rural health

Alison James, Ruth Endacott, Elizabeth Stenhouse, Identifying women

requiring maternity high dependency care, Midwifery, Volume 27, Issue 1,
February 2011, Pages 60-66, ISSN 0266-6138, 10.1016/j.midw.2009.09.001.
Abstract: The prompt identification of clinical deterioration and referral
for appropriate care are key issues in the management of women who become
critically ill during pregnancy, labour and the postpartum period. The
Intensive Care Society has developed designated levels of care in relation
to adult patient care, which may not be appropriate for use in midwifery.
Therefore, exploring the midwifery, nursing and medical literature related
to levels of care and detection of clinical deterioration may highlight the
need for these to be modified and adapted for the development of midwifery-
specific levels of care that are appropriate for this cohort.
Keywords: Clinical deterioration; Levels of care; Maternity high dependency

E.J. Waterson, Iain M. Murray-Lyon, Preventing alcohol related birth

damage: A review, Social Science &amp; Medicine, Volume 30, Issue 3, 1990,
Pages 349-364, ISSN 0277-9536, 10.1016/0277-9536(90)90190-4.
Abstract: Since 1974 numerous clinical studies have made it clear that
heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units
daily) can result in a child being born with a specific combination of
physical and mental disabilities known as the Fetal Alcohol Syndrome. More
moderate levels of intake (as little as 10 g of 1 unit daily) are
associated with other fetal problems known as Fetal Alcohol Effects. The
most common of these is growth retardation. Reduction of alcohol
consumption is beneficial to pregnancy outcome. However, despite this great
clinical and research interest within the field there has been
comparatively little attention paid to researching possible preventative
strategies and appropriate policy development.

This paper first describes the size of the problem posed by drinking in
pregnancy in the U.S.A. and the U.K., detailing the contrasting policy
response on either side of the Atlantic. It examines the difficulties of
formulating appropriate advice and then assesses the available research
reports on preventative measures. The strategies described include general
publicity and counselling for pregnant women. In addition, attention has
been paid to the problems of dissemination by emphasising professional

One major shortcoming is that most of these studies appear to have been
carried out with little reference to existing knowledge on health education
and promotion, or educational work in the antenatal or alcohol fields. In
addition, little attention appears to have been paid to the characteristics
of the groups at whom intervention might be targeted or the underlying
social or psychological factors which maintain drinking in these groups.

The second part of this paper, therefore, attempts to suggest appropriate

avenues for developing preventative strategies by presenting a wide-ranging
review with special reference to British experience. Particular attention
is given to the issues of form and content of appropriate messages,
targeting of risk populations, the venue for intervention, and media and
the actual mechanisms involved in implementing the programme.

We conclude that women should be advised to limit their alcohol consumption

to no more than one unit a day when they are either pregnant or planning a
pregnancy. We recommend that pregnant women should be asked about their
alcohol and given appropriate advice during routine antenatal clinic
visits. We suggest that the form of advice should be designed with the
characteristics of the risk population in mind. Information about
appropriate levels of alcohol intake and further professional help for
those in need should be widely available and form an integral part of the
primary health service, as well as the antenatal and family planning
clinics in addition to the more specialist alcohol treatment and prevention
services already available.
Keywords: alcohol; prevention; Fetal Alcohol Syndrome; Fetal Alcohol
A. Paxton, D. Maine, L. Freedman, D. Fry, S. Lobis, The evidence for
emergency obstetric care, International Journal of Gynecology &amp;
Obstetrics, Volume 88, Issue 2, February 2005, Pages 181-193, ISSN 0020-
7292, 10.1016/j.ijgo.2004.11.026.
Abstract: Purpose
We searched for evidence for the effectiveness of emergency obstetric care
(EmOC) interventions in reducing maternal mortality primarily in developing
We reviewed population-based studies with maternal mortality as the outcome
variable and ranked them according to the system for ranking the quality of
evidence and strength of recommendations developed by the US Preventive
Services Task Force. A systematic search of published literature was
conducted for this review, including searches of Medline, PubMed, Cochrane
Database of Systematic Reviews, the Cochrane Pregnancy and Childbirth
Database and the Cochrane Controlled Trials Register.
The strength of the evidence is high in several studies with a design that
places them in the second and third tier in the quality of evidence ranking
system. No studies were found that are experimental in design that would
give them a top ranking, due to the measurement challenges associated with
maternal mortality, although many of the specific individual clinical
interventions that comprise EmOC have been evaluated through experimental
design. There is strong evidence based on studies, using quasi-
experimental, observational and ecological designs, to support the
contention that EmOC must be a critical component of any program to reduce
maternal mortality.
Keywords: Evidence; Maternal mortality; Emergency obstetric care

Monica L. Oxford, Jungeun Olivia Lee, The effect of family processes on

school achievement as moderated by socioeconomic context, Journal of School
Psychology, Volume 49, Issue 5, October 2011, Pages 597-612, ISSN 0022-
4405, 10.1016/j.jsp.2011.06.001.
Abstract: This longitudinal study examined a model of early school
achievement in reading and math, as it varies by socioeconomic context,
using data from the NICHD Study of Early Child Care and Youth Development.
A conceptual model was tested that included features of family stress,
early parenting, and school readiness, through both a single-group analysis
and also a multiple-group analysis. Latent profile analysis was used to
identify subgroups of more advantaged and less advantaged families. Family
stress and parenting were shown to operate differently depending on the
socioeconomic context, whereas child-based school readiness characteristics
were shown to operate similarly across socieodemographic contexts.
Implications for intervention are discussed.
Keywords: Academic achievement; Parenting; Sensitivity; Stress;
Socioeconomic disadvantage; Latent profile analysis

Audrey Prost, Rashmi Lakshminarayana, Nirmala Nair, Prasanta Tripathy,

Andrew Copas, Rajendra Mahapatra, Shibanand Rath, Raj Kumar Gope, Suchitra
Rath, Aparna Bajpai, Vikram Patel, Anthony Costello, Predictors of maternal
psychological distress in rural India: A cross-sectional community-based
study, Journal of Affective Disorders, Volume 138, Issue 3, May 2012, Pages
277-286, ISSN 0165-0327, 10.1016/j.jad.2012.01.029.
Abstract: Background
Maternal common mental disorders are prevalent in low-resource settings and
have far-reaching consequences for maternal and child health. We assessed
the prevalence and predictors of psychological distress as a proxy for
common mental disorders among mothers in rural Jharkhand and Orissa,
eastern India, where over 40% of the population live below the poverty line
and access to reproductive and mental health services is low.
We screened 5801 mothers around 6&#xa0;weeks after delivery using the
Kessler-10 item scale, and identified predictors of distress using multiple
hierarchical logistic regression.
11.5% (95% CI: 10.712.3) of mothers had symptoms of distress (K10 score
&gt;&#xa0;15). High maternal age, low asset ownership, health problems in
the antepartum, delivery or postpartum periods, caesarean section, an
unwanted pregnancy for the mother, small perceived infant size and a
stillbirth or neonatal death were all independently associated with an
increased risk of distress. The loss of an infant or an unwanted pregnancy
increased the risk of distress considerably (AORs: 7.06 95% CI: 5.519.04
and 1.49, 95% CI: 1.121.97, respectively).
We did not collect data on antepartum depression, domestic violence or a
mother's past birth history, and were therefore unable to examine the
importance of these factors as predictors of psychological distress.
Mothers living in underserved areas of India who experience infant loss, an
unwanted pregnancy, health problems in the perinatal and postpartum periods
and socio-economic disadvantage are at increased risk of distress and
require access to reproductive healthcare with integrated mental health
Keywords: Common mental disorder; Maternal depression; India; Rural health

Cynthia T Zembo, Breastfeeding, Obstetrics and Gynecology Clinics of North

America, Volume 29, Issue 1, March 2002, Pages 51-76, ISSN 0889-8545,

W.H. Hui Choi, Gabriel K.H. Hui, Angel C.K. Lee, Maureen M.L. Chui, Student
nurses experiences and challenges in providing health education in Hong
Kong, Nurse Education Today, Volume 30, Issue 4, May 2010, Pages 355-359,
ISSN 0260-6917, 10.1016/j.nedt.2009.09.005.
Abstract: Summary
Despite a call for increased emphasis on health education within the Hong
Kong acute healthcare setting, in reality nurses conduct only minimal
health education and do not model good educational practice for students.
At the baccalaureate level, nursing education programmes aim to provide
students with practical experience of best practice and international
standards of care. This study describes the experiences of nursing students
in providing health education to in-patients at an obstetric unit in Hong
Kong. A qualitative research study using a phenomenological approach was
conducted at a major public hospital. Data were collected using participant
observation, debriefing notes, students reflective journals and semi-
structured interviews. Four themes emerged from the data: (a) effective
knowledge building, (b) being a professional nurse, (c) refining learned
skills, and (d) greater cultural awareness. The student experiences were
further influenced by the patients responses, the expectations of both
patients and nurses concerning the health educators role, and the role of
the clinical teacher. Study findings highlight the experience of the
students in conducting health education, something which has not been
adequately examined previously, and demonstrates the benefits of
independent clinical learning.
Keywords: Health education; Influential factor; Nursing student; Acute

J.C. Bhatia, Levels and determinants of maternal morbidity: results from a

community-based study in southern India, International Journal of
Gynecology &amp; Obstetrics, Volume 50, Supplement 2, October 1995, Pages
S153-S163, ISSN 0020-7292, 10.1016/0020-7292(95)02504-6.
Abstract: This analysis is based on detailed interviews with 3600 rural and
urban women in southern India. They were younger than 35 and had at least
one child less than 5 years of age. Each woman was questioned by a trained
female interviewer and asked about problems she had encountered during the
last pregnancy. Approximately two-fifths (41%) reported at least one morbid
condition associated with that event. About one-fifth (18%) had had at
least one problem during the antenatal period and delivery and another 23%
indicated problems during the postpartum. Surgical interventions were made
in 13.1% of all deliveries. However, if we consider only those taking place
in hospital, more than one-third (34.2%) were delivered surgically. The
relationship between socioeconomic and demographic factors and reported
maternal morbidity has been examined by using multivariate statistical
techniques. The policy implications of the study are discussed.
Keywords: Maternal; Obstetric; Reproductive; Morbidity; Determinant

, Chapter 9 - Pelvic floor dysfunction and evidence-based physical therapy,

In: Kari B, PT, MSc, PhD, Bary Berghmans, PT, MSc, PhD, Siv Mrkved, PT,
MSc, PhD, and Marijke Van Kampen, PT, MSc, PhD, Editor(s), Evidence-Based
Physical Therapy for the Pelvic Floor, Churchill Livingstone, Edinburgh,
2007, Pages 161-315, ISBN 9780443101465, 10.1016/B978-0-443-10146-5.50015-

, Subject Index, Journal of the American Dietetic Association, Volume 105,

Issue 12, December 2005, Pages 1990-2018, ISSN 0002-8223, 10.1016/S0002-

S. Russ, M. Regalado, N. Halfon, Healthcare, In: Editors-in-

Chief: Marshall M. Haith and Janette B. Benson, Editor(s)-in-Chief,
Encyclopedia of Infant and Early Childhood Development, Academic Press, San
Diego, 2008, Pages 73-89, ISBN 9780123708779, 10.1016/B978-012370877-
Abstract: Healthcare in early childhood is no longer focused solely on the
treatment of acute illness and the management of chronic conditions but
also on health promotion and illness prevention. Child health is defined
broadly across physical, cognitive, social, and emotional domains, and is
increasingly understood as occurring not in isolation but in the context of
the childs family and community. Child health providers must integrate
their services with those offered by early care and education and social
services to address family needs effectively and to optimize childrens
health and development. A responsive, high-quality childrens healthcare
system could have major benefits for health not just in childhood, but
throughout the life course.
Keywords: Child development; Health; Healthcare; Healthcare systems;
Medicine; Prenatal; Public health; Screening; Surveillance

Cade Fields-Gardner, Position of the American Dietetic Association:

Nutrition Intervention and Human Immunodeficiency Virus Infection, Journal
of the American Dietetic Association, Volume 110, Issue 7, July 2010, Pages
1105-1119, ISSN 0002-8223, 10.1016/j.jada.2010.05.020.
Abstract: It is the position of the American Dietetic Association that
efforts to optimize nutritional status through individualized medical
nutrition therapy, assurance of food and nutrition security, and nutrition
education are essential to the total system of health care available to
people with human immunodeficiency virus (HIV) infection throughout the
continuum of care. Broad-based efforts to improve health care access and
treatment have stabilized HIV prevalence levels in many parts of the world
and led to longer survival for people living with HIV infection.
Confounding clinical and social issues, such as medication interactions,
comorbidities, wasting, lipodystrophy, food insecurity, aging, and other
related conditions further complicate disease management. With greater
understanding of the mechanisms of HIV disease and its impact on body
function, development of new treatments, and wider ranges of populations
affected, the management of chronic HIV infection continues to become more
complex and demanding. Achievement of food and nutrition security and
management of nutrition-related complications of HIV infection remain
significant challenges for clients with HIV infection and health care
professionals. Registered dietitians and dietetic technicians, registered,
should integrate their efforts into the overall health care strategies to
optimize their clinical and social influence for people living with HIV

Jennifer Prah Ruger, Christina M. Lazar, Economic evaluation of drug abuse

treatment and HIV prevention programs in pregnant women: A systematic
review, Addictive Behaviors, Volume 37, Issue 1, January 2012, Pages 1-10,
ISSN 0306-4603, 10.1016/j.addbeh.2011.07.042.
Abstract: Drug abuse and transmission of HIV during pregnancy are public
health problems that adversely affect pregnant women, their children and
surrounding communities. Programs that address this vulnerable population
have the ability to be cost-effective due to resulting cost savings for
mother, child and society. Economic evaluations of programs that address
these issues are an important tool to better understand the costs of
services and create sustainable healthcare systems. This study critically
examined economic evaluations of drug abuse treatment and HIV prevention
programs in pregnant women. A systematic review was conducted using the
criteria recommended by the Panel on Cost-Effectiveness in Health and
Medicine and the British Medical Journal (BMJ) checklist for economic
evaluations. The search identified 6 economic studies assessing drug abuse
treatment for pregnant women, and 12 economic studies assessing programs
that focus on prevention of mother-to-child transmission (PMTCT) of HIV.
Results show that many programs for drug abuse treatment and PMTCT among
pregnant women are cost-effective or even cost-saving. This study
identified several shortcomings in methodology and lack of standardization
of current economic evaluations. Efforts to address methodological
challenges will help make future studies more comparable and have more
influence on policy makers, clinicians and the public.
Keywords: Systematic review; Economic evaluation; Drug abuse treatment;
Prevention of mother-to-child transmission (PMTCT); HIV prevention;
Pregnant women

Sara K. Head, Kathryn M. Yount, Lynn M. Sibley, Delays in recognition of

and Care-seeking response to prolonged labor in Bangladesh, Social Science
&amp; Medicine, Volume 72, Issue 7, April 2011, Pages 1157-1168, ISSN 0277-
9536, 10.1016/j.socscimed.2011.01.030.
Abstract: Maternal death, in which prolonged labor is the third leading
cause, accounts for 20% of deaths among women in Bangladesh. This study
describes the process of recognition and response to symptoms during
potential prolonged labor among 17 women in three sites in Bangladesh. In
OctoberDecember 2008, integrated illness history interviews were conducted
with women and confirmed and/or supplemented by family and/or birth
attendants present during labor. Interviews elicited participants
recognition of symptoms and care-seeking reactions and recorded responses
in time-by-event matrices. Interviews were conducted in Bangla, recorded,
transcribed, and translated into English. The most frequent and usually
first action was to seek care from untrained attendants at home, then from
professional attendants outside the home. Care-seeking outside the home
occurred a median of 19 h after perceived labor onset. Delays in care-
seeking arose for reasons related to: (1) confusion over the onset of
labor, (2) power processes inhibiting womens disclosure of labor symptoms,
(3) the practice of waiting for delivery, and (4) preferences for home
delivery. Strategies to encourage lay recognition of and response to
prolonged labor should consider womens misinterpretation and non-
disclosure of labor pain, health beliefs surrounding the labor process, and
fears of medical intervention.
Keywords: Bangladesh; Maternal health; Labor complications; Prolonged
labor; Care-seeking; Gender

Kymberlee Montgomery, Catherine Morse, Mary Ellen Smith-Glasgow, Bobbie

Posmontier, Michele Follen, Promoting Quality and Safety in Women's Health
Through the Use of Transdisciplinary Clinical Simulation Educational
Modules: Methodology and a Pilot Trial, Gender Medicine, Volume 9, Issue 1,
Supplement, February 2012, Pages S48-S54, ISSN 1550-8579,
Abstract: This manuscript presents the methodology used to assess the
impact of a clinical simulation module used for training providers
specializing in women's health. The methodology presented here will be used
for a quantitative study in the future.

Yvonne Lafayette Bronner, David Martin Paige, Current concepts in infant

nutrition, Journal of Nurse-Midwifery, Volume 37, Issue 2, Supplement,
MarchApril 1992, Pages S43-S58, ISSN 0091-2182, 10.1016/0091-
Abstract: Nutritional needs vary during the first year of life according to
the infant's individualized pattern of growth and amount of physical
activity. After delivery, the infant must make many physiologic
adjustments, develop immunologic defenses, and take in adequate nutrients
for survival. The type and consistency of foods change as the
gastrointestinal system matures and becomes able to metabolize the
components and excrete the needed metabolites of increasingly complex
foods. The recommended dietary allowance for infancy is based on the amount
of nutrients provided to healthy infants in human milk during the first six
months of life and on the consumption of formula and increasing amounts of
solid food during the second six months. The introduction of solid foods
should parallel the developmental changes that occur within the central
nervous system throughout the first year, these provide a level of
readiness for the infant to manage foods of various textures from full
liquid to soft.

Even though significant technologic advances have led to changes in the way
infants can be fed, human milk is still the optimal choice. Most women can
be encouraged to breast-feed regardless of their own nutritional status or
dietary intake. Contraindications can be managed on an individual basis. If
women do not elect to breast-feed, suitable commercial formulas are
available. The important issue in feeding is that of providing a variety of
appropriately prepared foods offered in a nonjudgmental atmosphere so that
the foundation is laid for the development of good food habits.

Emma Pitchforth, Richard J. Lilford, Yigzaw Kebede, Getahun Asres,

Charlotte Stanford, Jodie Frost, Assessing and understanding quality of
care in a labour ward: A pilot study combining clinical and social science
perspectives in Gondar, Ethiopia, Social Science &amp; Medicine, Volume 71,
Issue 10, November 2010, Pages 1739-1748, ISSN 0277-9536,
Abstract: Ensuring high quality intrapartum care in developing countries is
a crucial component of efforts to reduce maternal and neonatal mortality
and morbidity. Conceptual frameworks for understanding quality of care have
broadened to reflect the complexity of factors affecting quality of health
care provision. Yet, the role of social sciences within the assessment and
understanding of quality of care in this field has focused primarily on
seeking to understand the views and experiences of service users and
providers. In this pilot study we aimed to combine clinical and social
science perspectives and methods to best assess and understand issues
affecting quality of clinical care and to identify priorities for change.
Based in one referral hospital in Ethiopia, data collection took place in
three phases using a combination of structured and unstructured
observations, interviews and a modified nominal group process. This
resulted in a thorough and pragmatic methodology. Our results showed high
levels of knowledge and compliance with most aspects of good clinical
practice, and non-compliance was affected by different, inter-linked,
resource constraints. Considering possible changes in terms of resource
implications, local stakeholders prioritised five areas for change. Some of
these changes would have considerable resources implications whilst others
could be made within existing resources.

The discussion focuses on implications for informing quality improvement

interventions. Improvements will need to address health systems issues,
such as supply of key drugs, as well as changes in professional practice to
promote the rational use of drugs. Furthermore, the study considers the
need to understand broader organizational factors and inter-professional
relationships. The potential for greater integration of social science
perspectives as part of currently increasing monitoring and evaluation
activity around intrapartum care is highlighted.
Keywords: Quality of care; Maternal health; Ethiopia; Mixed methods;
Intrapartum care

Joy E. Lawn, Kate Kerber, Christabel Enweronu-Laryea, Simon Cousens, 3.6

Million Neonatal DeathsWhat Is Progressing and What Is Not?, Seminars in
Perinatology, Volume 34, Issue 6, December 2010, Pages 371-386, ISSN 0146-
0005, 10.1053/j.semperi.2010.09.011.
Abstract: Each year 3.6 million infants are estimated to die in the first 4
weeks of life (neonatal period)but the majority continue to die at home,
uncounted. This article reviews progress for newborn health globally, with
a focus on the countries in which most deaths occurwhat data do we have to
guide accelerated efforts? All regions are advancing, but the level of
decrease in neonatal mortality differs by region, country, and within
countries. Progress also differs by the main causes of neonatal death.
Three major causes of neonatal deaths (infections, complications of preterm
birth, and intrapartum-related neonatal deaths or birth asphyxia) account
for more than 80% of all neonatal deaths globally. The most rapid
reductions have been made in reducing neonatal tetanus, and there has been
apparent progress towards reducing neonatal infections. Limited, if any,
reduction has been made in reducing global deaths from preterm birth and
for intrapartum-related neonatal deaths. High-impact, feasible
interventions to address these 3 causes are summarized in this article,
along with estimates of potential for lives saved. A major gap is reaching
mothers and babies at birth and in the early postnatal period. There are
promising community-based service delivery models that have been tested
mainly in research studies in Asia that are now being adapted and evaluated
at scale and also being tested through a network of African implementation
research trials. To meet Millennium Development Goal 4, more can and must
be done to address neonatal deaths. A critical step is improving the
quantity, quality and use of data to select and implement the most
effective interventions and strengthen existing programs, especially at
district level.
Keywords: Neonatal; perinatal; epidemiology; MDGs; neonatal causes of
death; neonatal infection; intrapartum-related; preterm; low-income

Judy Reid, Rebecca OReilly, Barbara Beale, Donna Gillies, Tanya Connell,
Research priorities of NSW midwives, Women and Birth, Volume 20, Issue 2,
June 2007, Pages 57-63, ISSN 1871-5192, 10.1016/j.wombi.2007.03.001.
Abstract: SummaryPurpose
Research is vital to achieve optimum health outcomes for pregnant women,
children and families. Recently, the benefit of setting research priorities
to effectively utilize limited resources has been identified. Currently
there is a lack of published Australian research data relevant to the
practice of midwifery. Consultation with current practitioners is important
to fulfill the National Health and Medical Research Council (NHMRC) key
priority for a healthy start to life, ensure limited resources are expended
appropriately and promote evidence-based midwifery practice. The aim of
this study was to ascertain the perceived research priorities and the
research experience of midwives in NSW, Australia.
Postal questionnaire sent to the 1000 subscribers of Australian Midwifery,
of whom 90% (900) are midwives, in March 2005 with key open-ended questions
to ascertain midwifery research priorities and research experience of
Respondents were all midwives with 95% indicating they were currently
practising as a midwife. They identified six priority areas: professional
practice; clinical issues; education and support; breastfeeding;
psychosocial factors; rural/indigenous issues.
Principle conclusions
Priorities for research were identified and the need for a link between
research and professional midwifery practice was highlighted. Midwives were
positive about the possibility of becoming more actively involved in
research and/or advocates for evidence based practice. The opportunity
exists to take the broad priority areas from this study and develop
research questions of relevance for the midwifery profession.
Keywords: Midwifery research; Research priorities; Evidence-based practice

Ruth A. Lawrence, Robert M. Lawrence, Chapter 1 - Breastfeeding in Modern

Medicine, Breastfeeding (Seventh Edition), W.B. Saunders, Philadelphia,
2011, Pages 1-39, ISBN 9781437707885, 10.1016/B978-1-4377-0788-5.10001-X.

Maureen M. Black, Sarah E. Oberlander, 51 - Psychological Impact and

Treatment of Neglect of Children, In: Carole Jenny, MD, MBA, Editor,
Editor(s), Child Abuse and Neglect, W.B. Saunders, Philadelphia, 2011,
Pages 490-500, ISBN 9781416063933, 10.1016/B978-1-4160-6393-3.00051-8.

Michele Perry, Prenatal educationHow effective is it?, Australian College

of Midwives Incorporated Journal, Volume 5, Issue 1, March 1992, Pages 15-
20, ISSN 1031-170X, 10.1016/S1031-170X(05)80199-0.
Abstract: Are provision of knowledge and skills the major factors to
influence behaviour changes that will in turn affect psychological and
physiological outcomes in pregnancy and childbirth?

This paper argues that courses for expectant parents must not be considered
or promoted in isolation. Rather, they should be viewed as part of a
complex, interrelated structure of variables that serve to create,
influence, modify, support and reinforce factors considered to be
indicators of favourable birth outcomes. The potential for health promotion
activities is highlighted and problems of marketing, access, and
restrictive obstetric management practises emphasised. Relevant research is
discussed and areas for urgent action and further research are identified.

Carol A. Miller, Thomas B. Newman, Chapter 26 - Routine Newborn Care, In:

H. William Taeusch, M.D., Roberta A. Ballard, M.D., and Christine A.
Gleason, M.D., Editor(s), Avery's Diseases of the Newborn (Eighth Edition),
W.B. Saunders, Philadelphia, 2005, Pages 323-337, ISBN 9780721693477,

D.Kay Taylor, Carole Beauchamp, Hospital-based primary prevention strategy

in child abuse: a multi-level needs addressment, Child Abuse &amp; Neglect,
Volume 12, Issue 3, 1988, Pages 343-354, ISSN 0145-2134, 10.1016/0145-
Abstract: The purpose of this study was to evaluate a primary prevention
effort in child maltreatment, the focus of which was a community-wide
endeavor (i.e., subjects were not prescreened for risk potential). Specific
components of the planned intervention addressed four causal levels of
maltreatment: individual, family, community, and cultural factors. That
addressment was intended to build strengths in those parenting areas which
are predictive of abusive or neglectful outcomes. Target areas included
knowledge of child development, child-rearing attitudes, mother-infant
interaction patterns, and parenting skills. A posttest-only control group
design was employed. The control postpartum mothers received traditional or
routine hospital services; experimental mothers received special in-
hospital and aftercare services by trained student nurse volunteers. These
volunteers functioned in a dual educative/supportive role. Experimental
mothers reported more realistic expectations of behavior, embraced more
democratic child-rearing principles, provided more verbal stimulation to
their infants (reflecting an increased sensitivity), and displayed
increased problem-solving abilities.

Ingrid Helen Ravn, Lars Smith, Nina Aarhus Smeby, Nina Margrethe Kynoe,
Leiv Sandvik, Eli Haugen Bunch, Rolf Lindemann, Effects of early mother
infant intervention on outcomes in mothers and moderately and late preterm
infants at age 1 year: A randomized controlled trial, Infant Behavior and
Development, Volume 35, Issue 1, February 2012, Pages 36-47, ISSN 0163-
6383, 10.1016/j.infbeh.2011.09.006.
Abstract: Objective
There is a dearth of knowledge about the effects of early interaction-based
interventions on parenting and infant communication skills in moderately
and late preterm infants.
Assess in a RCT the effects of the MotherInfant Transaction program (MITP)
on maternal depression and stress, breastfeeding and mothers perception of
infant temperament; and MITP's impact on preterm infant communication
skills at 12 months.
Mothers/preterm infants (3036 weeks) were randomly assigned to MITP
(intervention group) or standard care (control group). Mean gestational age
in the intervention group was 33.3&#xa0;&#xa0;1.5 (n&#xa0;=&#xa0;56) and
in the control group (n&#xa0;=&#xa0;50) 33.0&#xa0;&#xa0;1.6. Outcomes were
assessed by CES-D, Parenting Stress Index; WHO breast-feeding categories,
Infant Behavior Questionnaire and The Pictorial Infant Communication
Intervention mothers reported significantly less postpartum depression one
month after discharge (p&#xa0;=&#xa0;.04) and more breastfeeding at 9
months (p&#xa0;=&#xa0;.02). No significant group differences in favour of
the intervention group were found on total parenting stress at 6
(p&#xa0;=&#xa0;.08) and 12 months (p&#xa0;=&#xa0;.46) or on perceived
infant communication skills at 12 months (p&#xa0;=&#xa0;.86). The
intervention mothers reported significantly less infant smile and laughter
at 6 (p&#xa0;=&#xa0;.02) and 12 (p&#xa0;=&#xa0;.006) months and less motor
activity at 12 months (p&#xa0;=&#xa0;.04).
The results suggest that MITP reduced postpartum depression and extended
the period of breastfeeding, but did not support any positive effects of
the intervention on self-reported maternal stress and perceived infant
Keywords: Infants; Depression; Maternal stress; Breastfeeding; Temperament;
Motherinfant communication

Elizabeth G. Damato, Parenting Multiple Infants, Newborn and Infant Nursing

Reviews, Volume 5, Issue 4, December 2005, Pages 208-214, ISSN 1527-3369,
Abstract: The number of multiple-birth families has increased dramatically
in the last several decades. Raising more than one infant of the same age
presents unique challenges to parents, many of whom have endured a period
of infertility to conceive and take home fragile premature infants who
require vigilant care. Stress, depression, and exhaustion are increased for
these parents; recent evidence links these conditions to infant
developmental outcomes. This paper reviews the parenting experience for
families with multiple infants and presents strategies for assisting their
adjustment to parenting.

Joel G. Breman, Kenneth Bridbord, Linda E. Kupfer, Roger I. Glass, Global

Health: The Fogarty International Center, National Institutes of Health:
Vision and Mission, Programs, and Accomplishments, Infectious Disease
Clinics of North America, Volume 25, Issue 3, September 2011, Pages 511-
536, ISSN 0891-5520, 10.1016/j.idc.2011.06.003.
Keywords: Fogarty International Center; NIH; Research training in poor
countries; Infectious and noninfectious diseases training

James A. Taylor, Jeffrey A. Wright, David Woodrum, Chapter 26 - Routine

Newborn Care, Avery's Diseases of the Newborn (Ninth Edition), W.B.
Saunders, Philadelpia, 2012, Pages 300-315, ISBN 9781437701340,

Holly Powell Kennedy, Trisha Farrell, Regina Paden, Shannon Hill, Rima
Jolivet, Jacqueline Willetts, Sharon Schindler Rising, I Wasn't AloneA
Study of Group Prenatal Care in the Military, Journal of Midwifery &amp;
Women's Health, Volume 54, Issue 3, MayJune 2009, Pages 176-183, ISSN
1526-9523, 10.1016/j.jmwh.2008.11.004.
Abstract: The military has recognized that health and quality of life for
service members are closely tied to the resources for their families,
including how they are cared for during pregnancy and childbirth. However,
there has been little examination of women's experience with different
models of prenatal care (PNC) in military settings. The purpose of this
article is to describe the results of a qualitative study of women's
experiences with the CenteringPregnancy model of group PNC compared to
individual PNC in two military health care settings. This clinical trial
enrolled 322 women who were randomized into group or individual PNC at two
military treatment facilities. Qualitative interviews were completed with
234 women during the postpartum period. Interpretative narrative and
thematic analysis was used to identify three themes: 1) I wasn't alone
the experience with group PNC; 2) I liked it butrecommendations to
improve group PNC; and 3) They really need to listengeneral concerns
across the sample about PNC. Greatest concerns of women in individual PNC
included lack of continuity and time with the provider. Our military
families must be assured that their health care system meets their needs
through personal and family-centered care. Group PNC offers the potential
for continuity of provider while also offering community with other women.
In the process, women gain knowledge and power as a health care consumer.
Keywords: CenteringPregnancy; group health care; military pregnancy;
prenatal care; qualitative research

Wendy J. Graham, Outcomes and effectiveness in reproductive health, Social

Science &amp; Medicine, Volume 47, Issue 12, December 1998, Pages 1925-
1936, ISSN 0277-9536, 10.1016/S0277-9536(98)00334-7.
Abstract: Measuring reproductive health is problematic. Awareness of the
problems needs to be raised both among those collecting and those using
data on reproductive health. This paper discusses two major measurement
questions one related to ascertainment and the other to attribution. The
first question is to what extent the observed levels and patterns of
reproductive health outcomes in women are valid as opposed to artefacts of
the data sources and the data collection methods? The second question is
can lack of evidence of effectiveness for any reproductive health
intervention ever confidently be separated into no effects vs an inability
to measure effects? Determining the effectiveness of health interventions
is notoriously difficult. Reproductive health may not be a case for special
pleading in the competition for scarce resources, but equally it should not
be a case for special standards of proof of the effectiveness of
interventions standards which have not indeed been met by many other, and
yet unquestioned, health care priorities. What works in reproductive
health should in fact be judged from at least four different perspectives:
from that of women and their families, health professionals, the scientific
community, and national and international policy-makers.
Keywords: Reproductive health; Measurement; Effectiveness; Evidence;

Matthew Jowett, Safe motherhood interventions in low-income countries: an

economic justification and evidence of cost effectiveness, Health Policy,
Volume 53, Issue 3, 1 October 2000, Pages 201-228, ISSN 0168-8510,
Abstract: It is estimated that 1600 women die world-wide each day as a
result of problems during pregnancy or childbirth. A large proportion of
these deaths is preventable. This article examines the economic case for
investing in safe motherhood interventions, and reviews key evidence of the
cost effectiveness of safe motherhood interventions. According to one
study, antenatal and maternal services comprise two of the six most cost
effective sets of health interventions in low-income countries. However,
little detailed evidence exists regarding the relative cost effectiveness
of antenatal care, post-abortion care and essential obstetric care. Despite
this there is clear evidence that interventions such as substituting manual
vacuum aspiration for dilatation and curettage can result in significant
savings both for health facilities and patients. The paper estimates first
that 26% of maternal deaths are avoidable through antenatal/community-based
interventions, costing around 30% of the WHO Mother Baby Package; and
secondly that access to quality essential obstetric care can prevent a
further 48% of maternal deaths, consuming 24% of total Mother Baby Package
costs. Further work on the cost effectiveness of safe motherhood
interventions would provide useful information for policy makers concerned
with reducing maternal mortality in the most efficient manner possible.
Keywords: Safe motherhood; Maternal mortality; Cost effectiveness;
Efficiency; Cost

Peter S. Kaplan, Christina M. Danko, Christina J. Kalinka, Anna M. Cejka, A

developmental decline in the learning-promoting effects of infant-directed
speech for infants of mothers with chronically elevated symptoms of
depression, Infant Behavior and Development, Volume 35, Issue 3, June 2012,
Pages 369-379, ISSN 0163-6383, 10.1016/j.infbeh.2012.02.009.
Abstract: Infants of mothers who varied in symptoms of depression were
tested at 4 and 12 months of age for their ability to associate a segment
of an unfamiliar non-depressed mother's infant-directed speech (IDS) with a
face. At 4 months, all infants learned the voice-face association. At 12
months, despite the fact that none of the mothers were still clinically
depressed, infants of mothers with chronically elevated self-reported
depressive symptoms, and infants of mothers with elevated self-reported
depressive symptoms at 4 months but not 12 months, on average did not learn
the association. For infants of mothers diagnosed with depression in
remission, learning at 12 months was negatively correlated with the
postpartum duration of the mother's depressive episode. At neither age did
extent of pitch modulation in the IDS segments correlate with infant
learning. However, learning scores at 12 months correlated significantly
with concurrent maternal reports of infant receptive language development.
The roles of the duration and timing of maternal depressive symptoms are
Keywords: Postpartum depression; Infant-directed speech; Infant associative
learning; Depression duration; Depression timing

George R. Heninger, Chapter 12 - Neuroscience, Molecular Medicine, and New

Approaches to the Treatment of Depression and Anxiety, In: MD, PhD Stephen
Waxman, Editor(s), From Neuroscience To Neurology, Academic Press,
Burlington, 2005, Pages 193-214, ISBN 9780127389035, 10.1016/B978-

Sylvia Murphy Tighe, An exploration of the attitudes of attenders and non-

attenders towards antenatal education, Midwifery, Volume 26, Issue 3, June
2010, Pages 294-303, ISSN 0266-6138, 10.1016/j.midw.2008.06.005.
Abstract: Objective
to explore the attitudes of first-time mothers towards antenatal education
from the perspective of attenders and non-attenders.
a qualitative approach was utilised using focus group interviews to collect
the data.
the study was conducted in one local health office area of the Health
Service ExecutiveSouth East, Ireland.
a purposive sample of first-time mothers was interviewed to explore the
area of antenatal education. These women included both attenders and non-
attenders at antenatal education.
Key conclusions
the findings suggest there are many strengths, weaknesses, opportunities
and barriers to antenatal education. Strengths of antenatal education
included the facilitator of antenatal classes, the information and
preparation received, and the social aspect of meeting other expectant
mothers. Barriers to attendance at antenatal education included working
night shifts, no interest, transport difficulties, inflexible employer, and
partner not attending. A move away from didactic teaching methods and
greater participation and involvement of parents was identified as
Implications for practice
fundamental issues related to the provision and of antenatal education were
identified. A need for promotion and advertising of antenatal education was
identified by the participants. Mothers identified specific needs such as
the provision of postnatal classes and peer mentoring, flexible
availability of classes, and facilitators utilising the principles of adult
learning to guide classes. The mothers alluded to the importance of
father's attendance and inclusion at classes. In view of the poor uptake of
antenatal classes in Ireland, it is imperative that an approach to
antenatal education is parent centred and needs driven.
Keywords: Attitudes; Attenders; Non-attenders; Antenatal education;

Eisquel Herrera, Nadja Reissland, John Shepherd, Maternal touch and

maternal child-directed speech: effects of depressed mood in the postnatal
period, Journal of Affective Disorders, Volume 81, Issue 1, July 2004,
Pages 29-39, ISSN 0165-0327, 10.1016/j.jad.2003.07.001.
Abstract: Background: Postnatal depression affects the emotional state of
mothers and the quality of motherinfant interaction. Method: Touch
behaviour and content of child-directed speech were analysed for 72 mothers
and their infants during pleasurable play. Infants (18) of mothers with
depressed mood and 18 controls were seen when they were 6 months old; and
18 infants of mothers with depressed mood and 18 controls were seen when
they were 10 months old. Results: Depressed mothers in comparison with non-
depressed mothers lifted their infants more, restraining their behaviours.
Infants of depressed mothers in contrast to infants of non-depressed
mothers spent greater periods of time in touching self rather than mother
or toy, compensating for the lack of positive touch from their mothers.
Mothers with depressed mood of 6-month-old infants included fewer affective
and informative features in their speech than their controls. Non-depressed
mothers of younger babies showed a higher use of affective features when
compared with non-depressed mothers of older infants. In contrast,
depressed mothers of 6- and 10-month-old babies showed similar frequencies
of affect-salient speech during interactions in spite of their infants'
changing developmental demands. Limitations: Mothers in this study were
only mildly depressed, as assessed by the Edinburgh Postnatal Depression
Scale (EPDS). Nevertheless, the findings indicate that mothers with
depressive symptoms differ from non-depressed mothers in relation to touch
and content of speech when interacting with their infants. Conclusions:
These results suggest that postnatal depression may influence touch
behaviour as well as the affective and informative content of maternal
speech. The effect is that mothers with depressed mood in comparison with
non-depressed mothers touch their infants more negatively and their speech
is less well adjusted concerning the amount of emotional vs. information-
related content thereby preventing depressed mothers from responding
effectively to their infants' developmental needs.
Keywords: Depressed mood; Touch; Maternal child-directed speech; Infant
emotional response

Gemma K.S. Cass, Joanna F. Crofts, Timothy J. Draycott, The Use of

Simulation to Teach Clinical Skills in Obstetrics, Seminars in
Perinatology, Volume 35, Issue 2, April 2011, Pages 68-73, ISSN 0146-0005,
Abstract: Obstetrical practice demands sensitivity, clinical skill, and
acumen. Obstetrical emergencies are rare occurrences and are most
appropriately dealt with by experienced staff. Simulation provides an
opportunity to gain this experience without patient risk and furthermore
builds confidence and satisfaction amongst learners. There is an abundance
of evidence to show the effectiveness of simulation training. Simulation
has been demonstrated to reduce errors, increase knowledge, skills,
communication and team working, and improve perinatal outcomes. Further
research to measure the effect of training to identify what works, where
and at what cost is needed. We explore the evidence for the use of
simulation-based training across a broad range of obstetrical emergencies,
promote collaboration amongst disciplines and discuss the formal
introduction of simulation training into a curriculum. Reducing preventable
harm in obstetrics is a priority for families and society at large and this
article endeavors to highlight the role that simulation has to play.
Keywords: medical simulation; training; obstetric emergencies; clinical
skills; teamwork

Pamela J. Surkan, Louise M. Ryan, Lina M. Carvalho Vieira, Lisa F. Berkman,

Karen E. Peterson, Maternal social and pyschological conditions and
physical growth in low-income children in Piau, Northeast Brazil, Social
Science &amp; Medicine, Volume 64, Issue 2, January 2007, Pages 375-388,
ISSN 0277-9536, 10.1016/j.socscimed.2006.09.021.
Abstract: Prevalence of child undernutrition remains high in many
developing countries. In settings with scarce resources, modifiable
maternal social conditions may influence feeding and parenting practices,
in turn affecting child growth. This study aims to quantify the association
between maternal social support and depression to children's physical
growth outcomes in Teresina, Piau, northeast Brazil. Interviews were
conducted with a random sample of 595 mothers of children 624 months old
in four low-income sections of Teresina, Piau. We collected data on
sociodemographic factors, mothers social support, mothers depressive
symptomatology, and child's weight and recumbent length. Weight-for-height
z-scores (WHZ), height-for-age z-scores (HAZ) and weight-for-age z-scores
(WAZ) were calculated using the National Center for Chronic Disease
Prevention and Health Promotion Center SAS program based on the 2000
Centers for Disease Control reference growth curves. Multivariable linear
regression was used to model the association between maternal social
support and depression to child growth, adjusting for biological and socio-
demographic variables. Interviewer and neighborhood variation was accounted
for through the inclusion of random effects. In adjusted models, material
support, measured by number of friends or family members available to
mothers when needing food or milk, was related to 0.3 higher average WHZ
and 0.2 higher average WAZ in their children. Maternal positive social
interaction, which reflects engagement in leisure-time activities with
others, was associated with 0.3 higher average WHZ. Mothers affectionate
support was related to 0.2 higher average children's WHZ and WAZ, whereas
social support for resolving a conflict was associated with 0.2 lower
average HAZ. Maternal depression was not associated with child growth. It
is concluded that inadequate growth in children may be sensitive to
maternal social support.
Keywords: Social support; Childhood growth; Depression; Brazil; Nutrition;

Jonathan M. Samet, Eugene M. Lewit, Kenneth E. Warner, Involuntary smoking

and children's health, Current Problems in Pediatrics, Volume 25, Issue 6,
July 1995, Pages 189-204, ISSN 0045-9380, 10.1016/S0045-9380(06)80033-2.

Katharine K. ODell, Lisa C. Labin, Common Problems of Urination in

Nonpregnant Women: Causes, Current Management, and Prevention Strategies,
Journal of Midwifery &amp; Women's Health, Volume 51, Issue 3, MayJune
2006, Pages 159-173, ISSN 1526-9523, 10.1016/j.jmwh.2006.01.003.
Abstract: This article uses a case-based approach to review common problems
of urination in nonpregnant women, including overactive bladder; stress,
urge, and mixed incontinence; and retention and prolapse. Up-to-date
clinical issues related to assessment, diagnosis, treatment, and follow-up
are reviewed, with a discussion of underlying pathophysiology and
prevention strategies. Suggestions are made for relevant curriculum content
at both the basic and advanced levels of advanced practice education.
Keywords: urinary incontinence; prolapse; overactive bladder; stress
incontinence; urge incontinence

Suzanne Yates, CHAPTER 11 - Practical bodywork in the postpartum, Pregnancy

and Childbirth, Churchill Livingstone, Edinburgh, 2010, Pages 313-338, ISBN
9780702030550, 10.1016/B978-0-7020-3055-0.00011-X.

Naheed Bano, Rizwana Chaudhri, Lubna Yasmeen, Faiza Shafi, Lubna Ejaz, A
study of maternal mortality in 8 principal hospitals in Pakistan in 2009,
International Journal of Gynecology &amp; Obstetrics, Volume 114, Issue 3,
September 2011, Pages 255-259, ISSN 0020-7292, 10.1016/j.ijgo.2011.03.018.
Abstract: Objectives
To determine maternal mortality to assess the achievement of Millennium
Development Goal 5 in Pakistan and suggest remedial measures.
Throughout 2009, maternal deaths occurring in obstetrics and gynecology
departments in 8 hospitals in Rawalpindi and Islamabad, Pakistan, were
recorded. A data form was filled in by the duty registrar at the time of
death. Data were analyzed via SPSS.
During the study period, there were 47&#xa0;209 live births and 108
maternal deaths (age 1745&#xa0;years). Among those who died, 30% were
primigravidas, 50% had a parity of 14, and 20% had a parity of 5 or more;
20.4% had not delivered, 40.7% had vaginal delivery, and 36.1% had cesarean
delivery; 67.6% were unbooked and 32.4% were booked (14 under care of a
consultant and 21 under care of a medical officer); 73%, 22%, and 5% died
in the first, second, and third trimesters, respectively; 17.5% died
prenatally, 4.6% during labor, and 78% postpartum; 73% were in a critical
condition and 8% were dead on arrival. Eclampsia, postpartum hemorrhage,
and sepsis caused 23, 13, and 13 deaths, respectively.
Maternal death can be effectively managed by skilled care during pregnancy,
childbirth, and the postnatal period.
Keywords: Maternal Mortality; Maternal Mortality Ratio; Millennium
Development Goal 5

Barbara J. Myers, Motherinfant bonding: The status of this critical-period

hypothesis, Developmental Review, Volume 4, Issue 3, September 1984, Pages
240-274, ISSN 0273-2297, 10.1016/S0273-2297(84)80007-6.
Abstract: Bonding is the process which occurs soon after birth in which a
mother forms an affectionate attachment to her infant. Early research
suggested that separation of mother from the infant in the first postpartum
hours and days damages the formation of that bond with deleterious
consequences for maternal behavior and child development. Much of the more
recent research refutes these findings. The research both favoring and not
favoring the bonding hypothesis is critically reviewed, with the evidence
generally not supporting the notion that early and extended contact is
crucial to the motherinfant bond.
Ellen M. Szwajcer, Gerrit J. Hiddink, Maria A. Koelen, Cees M.J. van
Woerkum, Nutrition awareness and pregnancy: Implications for the life
course perspective, European Journal of Obstetrics &amp; Gynecology and
Reproductive Biology, Volume 135, Issue 1, November 2007, Pages 58-64, ISSN
0301-2115, 10.1016/j.ejogrb.2006.11.012.
Abstract: Objective
To explore the influence of a life event (pregnancy) on nutrition awareness
and the motivations for nutrition behaviour.
Study design
In-depth, face-to-face interviews with five groups of 12 women: women
wishing to conceive a child, women in the first, second, and third
trimesters of their first pregnancy, and women in the first trimester of
their second pregnancy. As is common in qualitative research, participants
were selected on the basis of diversity together with maximum
representativeness within normal populations with respect to socio-
demographic characteristics.
With respect to nutrition awareness, three groups of women can be
distinguished: (1) those who are going all the way; these women try to
live precisely by the book, (2) those who are taking the flexible way;
these women are more aware of their nutrition, but are more flexible in
handling it, and (3) women who continue the same way; these women have a
no-nonsense mentality and do not experience essential shifts in their
nutrition awareness. The extent and fluctuations in nutrition awareness
throughout preconception and pregnancy are based on three types of
motivations, the interest of (1) the child, (2) the mother, and (3) the
social environment.
This study provides indications that preconception and pregnancy could
indeed be a life event leading to increased general nutrition awareness
that might influence women's future nutrition-related behaviours.
Keywords: Nutrition; Awareness; Motivation; Preconception; Pregnancy

John G. Borkowski, Thomas L. Whitman, Anne Wurtz Passion, Elizabeth A.

Rellinger, Kristen Sommer, Deborah Keogh, Keri Weed, Unraveling the New
Morbidity: Adolescent parenting and Developmental Delays, In: Norman W.
Bray, Editor(s), International Review of Research in Mental Retardation,
Academic Press, 1992, Volume 18, Pages 159-196, ISSN 0074-7750, ISBN
9780123662187, 10.1016/S0074-7750(08)60119-6.

Suniya S. Luthar, Katy G. Walsh, Treatment needs of drug-addicted mothers:

Integrated parenting psychotherapy interventions, Journal of Substance
Abuse Treatment, Volume 12, Issue 5, SeptemberOctober 1995, Pages 341-348,
ISSN 0740-5472, 10.1016/0740-5472(95)02010-1.
Abstract: Substance abuse among women is associated with several negative
maternal as well as child outcomes. This article reviews the theoretical
and empirical literature on salient domains of risk and vulnerability among
addicted mothers, with a view toward identifying critical components of
effective intervention programs.
Keywords: addicted mothers; parenting psychotherapy

Lucia DAmbruoso, Endang Achadi, Asri Adisasmita, Yulia Izati, Krystyna

Makowiecka, Julia Hussein, Assessing quality of care provided by Indonesian
village midwives with a confidential enquiry, Midwifery, Volume 25, Issue
5, October 2009, Pages 528-539, ISSN 0266-6138, 10.1016/j.midw.2007.08.008.
Abstract: Objective
to conduct a confidential enquiry to assess the quality of care provided by
Indonesian village midwives and to identify opportunities for improvement.
local health-care practitioners assessed village-based care in obstetric
emergencies in 13 cases of maternal death and near-miss from rural villages
in West Java. The study focused on clinical quality of care, but also
investigated the influence of the health system and social factors. The
reviews were based on transcripts of interviews with health-care providers,
family and community members involved in the cases. Both favourable and
adverse factors were identified in order to recognise positive
contributions, where they occurred. At the end of a series of case reviews,
recommendations for practice were generated and disseminated.
in the cases reviewed, midwives facilitated referral effectively, reducing
delays in reaching health facilities. Midwives emergency diagnostic skills
were accurate but they were less capable in the clinical management of
complications. Coverage was poor; in some locations, midwives were
responsible for up to five villages. Village midwives were also perceived
as unacceptable to women and their families. Families and communities did
not prepare for emergencies with finances or transport, partly due to a
poorly understood health insurance system. The enquiry had learning effects
for those involved.
Key conclusions
village midwives should: receive appropriate support for the management of
obstetric emergencies; engage with communities to promote birth
preparedness; and work in partnership with formal and informal providers in
the community. The enquiry was a diagnostic tool to identify opportunities
for improving care. Practitioners had a unique insight into factors that
contribute to quality care and how feasible interventions might be made.
Keywords: Confidential enquiry; Emergency obstetric care; Quality of care;
Village midwife; Indonesia

Robert A. Dyer, Anthony R. Reed, Michael F. James, Obstetric anaesthesia in

low-resource settings, Best Practice &amp; Research Clinical Obstetrics
&amp; Gynaecology, Volume 24, Issue 3, June 2010, Pages 401-412, ISSN 1521-
6934, 10.1016/j.bpobgyn.2009.11.005.
Abstract: Close co-operation between obstetricians and obstetric
anaesthesia providers is crucial for the safety and comfort of parturients,
particularly in low-resource environments. Maternal and foetal mortality is
unacceptably high, and the practice of obstetric anaesthesia has an
important influence on outcome. Well-conducted national audits have
identified the contributing factors to anaesthesia-related deaths. Spinal
anaesthesia for caesarean section is the method of choice in the absence of
contraindications, but is associated with significant morbidity and
mortality. Minimum requirements for safe practice are adequate skills,
anaesthesia monitors, disposables and drugs and relevant management
protocols for each level of care. The importance of current outreach
initiatives is emphasised, and educational resources and the available
financial sources discussed. The difficulties of efficient procurement of
equipment and drugs are outlined. Guiding principles for the practice of
analgesia for labour, anaesthesia for caesarean section and the management
of obstetric emergencies, where the anaesthetist also has a central role,
are suggested.
Keywords: anaesthesia; obstetrics; low resources

C. Jane Morrell, Review of interventions to prevent or treat postnatal

depression, Clinical Effectiveness in Nursing, Volume 9, Supplement 2,
2006, Pages e135-e161, ISSN 1361-9004, 10.1016/j.cein.2006.11.006.
Abstract: SummaryObjective
The objective of this study was to examine evidence of the effectiveness of
interventions, particularly by midwives, to prevent postnatal depression,
or by Health Visitors to treat postnatal depression.
A literature search from 1966 to July 2005 covered health databases
MEDLINE, CINAHL, EMBASE, and PsycINFO, and Evidence-Based databases in The
Cochrane Library, covering the Cochrane Database of Systematic Reviews and
the Cochrane Controlled Trials Register. Studies that evaluated maternal
mood up to one year after delivery were reviewed.
From the 37 published studies that involved an intervention to prevent
postnatal depression, there was little evidence of effectiveness. Of 20
reviewed trials aiming to treat PND, there were encouraging outcomes, but
many of the studies had methodological or reporting limitations. Of all the
trials reviewed, The PoNDER Trial, a pragmatic cluster randomised trial
(commissioned and funded by the NHS R&amp;D Health Technology Assessment
programme) was the largest, with the longest follow-up (to 18 months). This
trial reported the cost-effectiveness of Health Visitors role in the
detection of PND and offering a psychological intervention.
Among all the trials reviewed here, The PoNDER Trial has provided evidence
of the cost-effectiveness of the HVs role in detecting PND and offering a
psychological intervention.
Keywords: Treatment; Depression; Postnatal women; Review; Health visitor;
Primary care

Robert T. Ammerman, Frank W. Putnam, Mekibib Altaye, Liang Chen, Lauren J.

Holleb, Jack Stevens, Jodie A. Short, Judith B. Van Ginkel, Changes in
depressive symptoms in first time mothers in home visitation, Child Abuse
&amp; Neglect, Volume 33, Issue 3, March 2009, Pages 127-138, ISSN 0145-
2134, 10.1016/j.chiabu.2008.09.005.
Abstract: Objective
The expansion of Home Visitation Programs for at-risk, first-time mothers
and their young children has drawn attention to the potential impact of
depression on program outcomes, yet little research has examined depression
in the context of home visitation. The purpose of this study was to
determine the prevalence of and changes in depressive symptoms in mothers
enrolled in home visitation and identify predictors of change in symptoms
over the first 9 months of service.
Subjects consisted of 806 at-risk, first-time mothers enrolled in a Home
Visitation Program. Self-reported depression was measured at enrollment and
again 9 months later. Established clinical cutoffs were used to identify
clinically elevated levels of depression. Additional measures were taken of
interpersonal trauma history, concurrent intimate partner violence, and
social support.
Results indicated that: (1) 45.3% of mothers had clinically elevated
symptoms of depression at some point during the first 9 months of service,
(2) 25.9% of mothers had elevated symptoms at both time points or at the 9-
month assessment, and (3) 74.1% experienced an interpersonal trauma prior
to enrollment. Lack of improvement or worsening of depressive symptoms from
enrollment to 9 months was best predicted by pre-enrollment interpersonal
trauma history, young maternal age, being African American, and symptoms
severe enough to have led to mental health treatment.
Findings suggest that maternal depressive symptoms are a significant
problem in home visitation. The role of interpersonal trauma in depressive
symptoms, and how to best address these clinical issues in home visitation,
warrants further examination.
Practice implications
Maternal depression is prevalent in Home Visitation Programs, and many
mothers exhibit elevated symptoms at multiple time points over the first
year of service. Interpersonal trauma history is also prevalent, and is
predictive of increased depressive symptoms over time. Home Visitation
Programs should note that mothers with interpersonal trauma history, young
maternal age, and being African American have an increased likelihood of
persistent depressive symptoms, which may in turn pose significant
challenges to providing services.
Keywords: Maternal depression; Home visitation; Child abuse prevention

Barbara J. Stoll, Chapter 2 - Neonatal Infections: A Global Perspective,

Infectious Diseases of the Fetus and Newborn Infant (Sixth Edition), W.B.
Saunders, Philadelphia, 2006, Pages 27-57, ISBN 9780721605371, 10.1016/B0-
Abstract: One of the greatest challenges to global public health is to
eliminate the gaps between rich and poor countries in health care
resources, in access to preventive and curative services, and in health
outcomes. Although infant mortality has declined by more than 50% since
1955,1 neonatal mortality has changed little in some of the worlds poorest
countries. Worldwide, neonatal mortality accounts for a substantial
proportion of deaths of both infants and children younger than 5
years.1,2,3 The World Health Organization (WHO) estimates that more than 4
million neonates die each year and that 98% of these deaths occur in
developing countries.2,3 Causes of neonatal mortality, especially in
developing countries, are difficult to ascertain, partly because many of
these deaths occur at home, unattended by medical personnel, and partly
because critically ill neonates often present with nondiagnostic signs and
symptoms of disease. Infectious diseases, birth asphyxia, and complications
of prematurity are thought to be the major causes of neonatal death

Although access to sophisticated technology is limited in developing

countries, neonatal mortality related to infection could be substantially
reduced by simple, known interventions before and during pregnancy, labor,
and delivery; in the immediate postpartum period; and in the early days of
life.2,3,5,6 The global burden of infectious diseases in the newborn,
direct and indirect causes of neonatal mortality attributed to infection,
specific infections of relevance in developing countries, and strategies to
reduce both the incidence of neonatal infection and morbidity and mortality
in infants who do become infected are reviewed in this chapter.

Diane L. Langkamp, Rebecca G. Girardet, Primary Care for Twins and Higher
Order Multiples, Current Problems in Pediatric and Adolescent Health Care,
Volume 36, Issue 2, February 2006, Pages 47-67, ISSN 1538-5442,

Francois Feillet, Anita MacDonald, Danielle Hartung (Perron), Barbara

Burton, Outcomes beyond phenylalanine: An international perspective,
Molecular Genetics and Metabolism, Volume 99, Supplement, 2010, Pages S79-
S85, ISSN 1096-7192, 10.1016/j.ymgme.2009.09.015.
Abstract: Control of blood phenylalanine (Phe) levels throughout the life
of a person diagnosed with phenylketonuria (PKU) is the biochemical
management strategy necessary to provide the best potential for optimal
outcome. Psychosocial support mechanisms comprise the other aspects of PKU
management that are necessary to overcome the hurdles of living with this
chronic disease and to adhere to the rigors of its management. Additional
psychosocial support may be required, in light of increasing evidence that
control of blood Phe levels in PKU can still lead to subtle but measurable
cognitive function deficits as well as a predisposition to certain
psychiatric symptoms and disorders. An all encompassing PKU management
strategy that goes beyond simply treating blood Phe levels can empower and
enable people born with PKU to achieve similar life goals as those born
without PKU. This review looks at PKU management strategies that go beyond
treating Phe levels, specifically (1) the roles psychologists play in
managing PKU from infancy through adulthood and how they help PKU families
and caregivers deal with the disease and the burden of its management; (2)
understanding the challenges of transitioning into adulthood as an
individual with PKU and addressing unmet needs in this population; (3) how
non-traditional practices can be utilized in PKU. The objective is to
emphasize that management of PKU goes well beyond addressing the
biochemical nature of this disease in order to achieve optimal patient
Keywords: Phenylketonuria; ADHD

Dorothy Scott, Early identification of maternal depression as a strategy in

the prevention of child abuse, Child Abuse &amp; Neglect, Volume 16, Issue
3, 1992, Pages 345-358, ISSN 0145-2134, 10.1016/0145-2134(92)90044-R.
Abstract: Maternal suicide and infanticide are merely the extreme tip of
the iceberg of psychological and social morbidity associated with post-
partum depression. Despite research indicating an association between
maternal depression and disturbed parent-child interaction, maternal
depression has been largely ignored in the literature on child maltreatment
and in child protection practice. Practitioners should be alert to the
potential risks to the child associated with maternal depression. In cases
where child abuse has occurred, they should consider the possibility that
the mother is depressed and that this needs to be treated as a problem in
its own right. In terms of prevention of child maltreatment, early
identification of maternal depression is an important strategy in which
primary health workers have an important role. This study investigates the
feasibility of broadening the traditional infant health focus of the role
of the Australian Maternal and Child Health Nurse or Public Health Nurse to
encompass maternal emotional and social well-being. Using quantitative and
qualitative methods, the conditions under which mothers would find this
acceptable, and the factors that facilitate or constrain such role
redefinition are analyzed.
Keywords: Maternal depression; Post-partum depression; Early intervention;
Prevention; Child abuse

Kelly G. Lambert, The parental brain: Transformations and adaptations,

Physiology &amp; Behavior, Available online 27 March 2012, ISSN 0031-9384,
Abstract: Few evolutionary transformations rival the complex
neurobiological modifications accompanying the mammalian transition to
parenthood. Research conducted primarily in maternal rodents highlights the
engagement of multiple areas of the brain to initiate and maintain interest
in resource-depleting vulnerable pups throughout lactation. Interestingly,
many modifications marking the transition to motherhood result in adaptive
response options that persist well beyond the weaning of pups;
specifically, adaptations such as cognitive flexibility, emotional
regulation and enhanced social attentiveness coincide with the parenthood
transition and have emerged as defining characteristics of the most
adaptive mammalian species. The paternal brain also results in interesting
modifications that, in some biparental species, mimic the effects observed
in females. Taken together, research suggests that the designation of
parent is less of a categorical variable and more of a continuous
variable, with the quality of nurturing responses directed toward offspring
influenced by many factors such as predisposed sensitivity to reproductive
hormones, nature and duration of exposure to offspring, number of
reproductive experiences, adequate resources, and composition of the social
environment. Indeed, the transition from an animal focused on self-
preservation to one that is responsive to the needs of other animals, and
the accompanying increases in reproductive fitness, represent a significant
evolutionary transition, or upgrade of sorts, leading to a more diverse
array of response options to meet the challenging demands of changing
environmental and social terrains.
Keywords: Maternal; Paternal; Parental; Nurturing responses;
Neuroplasticity; Adaptive responses; Mammalian brain

Heidi Falter Olson, Janice D. Nunnelee, Incidence of thrombosis in

pregnancy and postpartum: A retrospective review in a large private
hospital, Journal of Vascular Nursing, Volume 16, Issue 4, December 1998,
Pages 84-86, ISSN 1062-0303, 10.1016/S1062-0303(98)90012-7.
Abstract: This article addresses a 10-year retrospective chart review that
was conducted at St John's Mercy Medical Center in St Louis, Mo, to
investigate the incidence and prevalence of deep vein thrombosis in
pregnancy and during the postpartum period. A total of 65, 912 deliveries
occurred between 1985 and 1995, and 105 (0.2%) patients were diagnosed with
a deep vein thrombosis or superficial vein thrombosis during pregnancy or
during the postpartum period. The study compared specific demographic data
of the patients, and the differences in diagnostic testing, obstetric and
medical history, methods of treatment, and sequela of patients, as well as
the nursing implications.

Kathryn E. Phillips, Georgette Flood, Employer Approaches To Preconception

Care, Women's Health Issues, Volume 18, Issue 6, Supplement, November
December 2008, Pages S36-S40, ISSN 1049-3867, 10.1016/j.whi.2008.07.006.
Abstract: In recent years, the idea of preconception careeducation,
counseling, and interventions delivered to women before they become
pregnanthas gained traction as a critically important health promotion
opportunity for women and their families. Employers, as purchasers of
health care and as providers of wellness services, have an important role
to play in the promotion of preconception care. Large, self-insured
employers can craft their medical benefit plans to include evidence-
informed preventive health benefits such as preconception care. Employers
can also design and implement worksite health promotion programs that
address preconception, pregnancy, and postpartum health. And employers of
all sizes can educate women and their partners on pregnancy health through
tailored communication. This article provides an overview of the business
case for preconception care and concrete steps employers can take to
support and incent preconception care among their beneficiaries. The
article also includes suggestions on ways providers and health
professionals support employers in these efforts.

Tracy L. Jones, Ronald J. Prinz, Potential roles of parental self-efficacy

in parent and child adjustment: A review, Clinical Psychology Review,
Volume 25, Issue 3, May 2005, Pages 341-363, ISSN 0272-7358,
Abstract: This review examines the potential roles of parental self-
efficacy (PSE) in parent and child adjustment and the role of parental
cognitions in understanding behaviors and emotions within families. The
areas in this review include parental competence and psychological
functioning, as well as child behaviors, socio-emotional adjustment, school
achievement, and maltreatment. There is strong evidence linking PSE to
parental competence, and more modest linkage to parental psychological
functioning. Some findings suggest that PSE impacts child adjustment
directly but also indirectly via parenting practices and behaviors.
Although the role of PSE likely varies across parents, children, and
culturalcontextual factors, its influence cannot be overlooked as a
possible predictor of parental competence and child functioning, or perhaps
an indicator of risk. PSE may also be an appropriate target for prevention
and intervention efforts. Limitations in the literature include measurement
problems, variability in conceptualizations and definitions of the
construct, and the lack of research exploring causality. Future research
should focus on clarifying the measurement of PSE, studying potential bias
in self-report of PSE, and utilizing experimental and longitudinal designs
to untangle the issues of causal direction and potential transactional
Keywords: Parental self-efficacy; Parenting; Parental competence; Child

Jane Fisher, Thach Duc Tran, Trang Thu Nguyen, Tuan Tran, Common perinatal
mental disorders and alcohol dependence in men in northern Viet Nam,
Journal of Affective Disorders, Volume 140, Issue 1, September 2012, Pages
97-101, ISSN 0165-0327, 10.1016/j.jad.2012.03.029.
Abstract: Background
To establish the prevalence and correlates of the perinatal common mental
disorders of depression and anxiety (PCMD) and alcohol dependence (AD) in
men in northern Viet Nam.
A cross-sectional study of men whose wives were &gt;&#xa0;28&#xa0;weeks
pregnant or mothers of newborns recruited from randomly-selected rural and
urban communes. Data sources were Structured Clinical Interviews for DSM
IV; CAGE assessment of alcohol use and study-specific questionnaires. Odds
ratios and 95% CIs were calculated by multiple logistic regressions.
Overall, 231/360 eligible men were recruited, of whom 17.7% [95% CI, 12.8
22.7] were diagnosed with a PCMD; 33.8% [95% CI, 27.940.1] with AD (CAGE
score&#xa0;&#xa0;2) and 6.9% [95% CI, 4.311.0] with co-morbid PCMD and
AD. PCMD were associated with experiences of coincidental life adversity,
intimate partner violence, age&#xa0;&gt;&#xa0;30; an unwelcome pregnancy
and primiparity. AD was more common among men with low education, living in
the poorest households and in unskilled work.
Common mental disorders and AD are prevalent, but currently unrecognised
among men in northern Viet Nam whose wives are pregnant or have recently
given birth.
Keywords: Common mental disorders; Alcohol dependence; Men; Developing

Guido G. Urizar Jr., Ricardo F. Muoz, Impact of a prenatal cognitive-

behavioral stress management intervention on salivary cortisol levels in
low-income mothers and their infants, Psychoneuroendocrinology, Volume 36,
Issue 10, November 2011, Pages 1480-1494, ISSN 0306-4530,
Abstract: Summary
Recent findings suggest that elevated stress levels during the pre- and
postpartum period are related to poor maternal and infant health outcomes;
yet, few studies have prospectively examined the efficacy of stress
management interventions on regulating stress levels among mothers and
their infants. The current study examined whether a prenatal cognitive
behavioral stress management (CBSM) intervention would be effective in
regulating salivary cortisol (a biological marker of stress) and self-
reported stress levels among mothers and their infants at six and 18 months
postpartum, relative to two control groups. Our sample was comprised of
predominantly Spanish-speaking, low-income women (80%; mean
age&#xa0;=&#xa0;25&#xa0;&#xa0;5 years) who were screened for depression
during their second trimester of pregnancy (M&#xa0;=&#xa0;16&#xa0;&#xa0;5
weeks of gestation). Women at high risk for depression [i.e., having either
a past history of major depression or current elevated symptoms of
depression (16 on CES-D)] were randomized to either a CBSM group
(n&#xa0;=&#xa0;24) or a usual care (UC) group (n&#xa0;=&#xa0;33), while a
low risk comparison (LRC) group (n&#xa0;=&#xa0;29) was comprised of women
not meeting either depression criteria. ANCOVA analyses demonstrated that:
(1) infants of women in the CBSM and LRC groups had significantly lower
cortisol levels than infants of women in the UC group at six months
postpartum (p&#xa0;&lt;&#xa0;.001); and (2) women in the CBSM group had
lower cortisol levels than women in the UC group at 18 months postpartum
(p&#xa0;&lt;&#xa0;.01). These results suggest that prenatal CBSM
interventions may be efficacious in regulating biological markers of stress
among mothers and their infants, thereby decreasing their risk for
developing health complications over time.
Keywords: Stress; Cortisol; Pregnancy; Mothers; Infants; Stress management

Amy M Windham, Leon Rosenberg, Loretta Fuddy, Elizabeth McFarlane, Calvin

Sia, Anne K Duggan, Risk of mother-reported child abuse in the first 3
years of life, Child Abuse &amp; Neglect, Volume 28, Issue 6, June 2004,
Pages 645-667, ISSN 0145-2134, 10.1016/j.chiabu.2004.01.003.
Abstract: Objective: The purpose of this research was to investigate,
within an at-risk population, parent and child characteristics associated
with a mothers self-reports of severe physical assault and assault on the
self-esteem of the child in the first 3 years of life.

Design: The study population consisted of a community-based sample of

mothers of newborns identified as at-risk for child maltreatment (n=595).
Families were assessed annually from the childs birth through age 3 using
instruments with established psychometric properties. Independent variables
investigated included: family socio-demographics, parity, mothers social
support, maternal depression, maternal problem drug or alcohol use, partner
violence, childs age, childs sex, low birth weight/small for gestational
age (SGA), and mothers perception of childs demand level. Associations
with maltreatment were examined using multivariable methods for
longitudinal data.

Results: Child severe physical assault was significantly associated with

parent characteristics (maternal depression and partner violence); and
child characteristics (SGA). Assault to the childs self-esteem was
significantly associated with maternal depression, maternal illicit drug
use, partner violence and mothers perception of childs demand level.
Controlling for family sociodemographic characteristics did not change the
associations. Likewise, while mothers perception of child demand level had
an independent association with self-esteem assault, the associations
described above persisted while demand level was held constant. In this
high-risk sample, abuse was not associated with mothers age, education,
race, parity, or household income level.

Conclusions: While characteristics such as SGA can serve as markers for

increased abuse risk, they are not amenable to intervention after the child
is born. However, certain other risk factors, such as maternal depression
and domestic violence are malleable and should be targeted for intervention
with the goal of preventing child maltreatment.
Keywords: Child abuse; Psychological abuse; Depression; Family violence;
Emre Yanikkerem, Rahime Tuncer, Kezban Yilmaz, Meryem Aslan, Glten
Karadeniz, Breast-feeding knowledge and practices among mothers in Manisa,
Turkey, Midwifery, Volume 25, Issue 6, December 2009, Pages e19-e32, ISSN
0266-6138, 10.1016/j.midw.2007.10.012.
Abstract: Objective
to determine breast-feeding knowledge and practices among mothers before
and after an educational intervention on breast feeding.
cross-sectional, descriptive study using a face-to-face questionnaire.
Manisa Maternity and Children's Hospital, which has Baby Friendly status.
158 women in the early postpartum period.
Measurements and findings
10.8% of women were not aware that they should offer colostrum to their
babies. Only 43.7% of women commenced breast feeding within the first 30
minutes of giving birth. Prior to receiving the educational intervention,
55.7% of mothers knew how often they should feed their baby, 48.7% knew
that they should breast feed their baby for two years together with
additional food, although 55.1% of women did not know how to hold their
breast during a feed. The mean pre-test score was 9.9 (SD 2.4; range 313),
and the mean post-test score was 12.6 (SD 0.8; range 913). The difference
between the mean pre- and post-test scores was statistically significant
(paired t=15.3, df=157, P&lt;0.001).
Conclusion and implications for practice
given the integral role of breast feeding in improving overall community
health, regular breast-feeding counselling should be offered, particularly
during the pregnancy and early postpartum period.
Keywords: Breast feeding; Breast-feeding education; Baby; Newborn baby;
Baby nutrition

Chamarrita Farkas, Nelson Valds, Maternal stress and perceptions of self-

efficacy in socioeconomically disadvantaged mothers: An explicative model,
Infant Behavior and Development, Volume 33, Issue 4, December 2010, Pages
654-662, ISSN 0163-6383, 10.1016/j.infbeh.2010.09.001.
Abstract: Studies have demonstrated that maternal stress and perceptions of
self-efficacy influence a mother's performance, affecting her ability to
interact with her child and to understand and answer his needs. The purpose
of this study was to evaluate maternal stress and the perception of self-
efficacy in the mothers of infants who are cared for in child-care centers
and belong to the poorest segment of the Chilean population. To this end,
these aspects were studied in 121 low-income, high-social-risk mothers with
children between the ages of 4 and 9 months. The final goal was to generate
an explicative model of self-efficacy and maternal stress that considered
characteristics of the family and the child. The results revealed that
family characteristics especially household size, per capita incomes and
mother age are more relevant for explaining maternal self-efficacy and
stress. The findings and implications for practice are discussed.
Keywords: Early infancy; Contextual liabilities; Maternal self-efficacy;
Maternal stress

Debora Barnes-Josiah, Cynthia Myntti, Antoine Augustin, The three delays

as a framework for examining maternal mortality in Haiti, Social Science
&amp; Medicine, Volume 46, Issue 8, 15 April 1998, Pages 981-993, ISSN
0277-9536, 10.1016/S0277-9536(97)10018-1.
Abstract: Haiti has one of the highest rates of maternal mortality in the
Caribbean. The Three Delays model proposes that pregnancy-related
mortality is overwhelmingly due to delays in: (1) deciding to seek
appropriate medical help for an obstetric emergency; (2) reaching an
appropriate obstetric facility; and (3) receiving adequate care when a
facility is reached. This framework was used to analyze a sample of 12
maternal deaths that occurred in a longitudinal cohort of pregnant Haitian
women. Because of political upheavals in Haiti during the survey, these
deaths are an underestimate of all deaths that occurred in the cohort.
Family and friend interviews were used to obtain details about the medical
and social circumstances surrounding each death. A delayed decision to see
medical care was noted in eight of the 12 cases, whereas delays in
transportation only appeared to be significant in two. Inadequate care at a
medical facility was a factor in seven cases. Multiple delays were relevant
in the deaths of three women. Family and friend interviews suggest that a
lack of confidence in available medical options was a crucial factor in
delayed or never made decisions to seek care. Expanding the coverage of
existing referral networks, improving community recognition of obstetric
emergencies, and improving the ability of existing medical institutions to
deliver quality obstetric care, are all necessary. However, services will
continue to be under-utilized if they are perceived negatively by pregnant
women and their families. The current data thus suggest that improvements
to Haitis maternity care system which focus on reducing the third delay
that is, improving the quality and scope of care available at existing
medical facilitieswill have the greatest impact in reducing needless
maternal deaths.
Keywords: Haiti; maternal mortality; verbal autopsies; maternity care

Judith Fullerton, Richard Severino, Kelly Brogan, Joyce Thompson, The

International Confederation of Midwives study of essential competencies of
midwifery practice, Midwifery, Volume 19, Issue 3, September 2003, Pages
174-190, ISSN 0266-6138, 10.1016/S0266-6138(03)00032-9.
Abstract: Objective: to delineate the knowledge, skills, and behaviours
that would characterise the domain of competencies of the midwife who is
educated according to the international definition of the profession.

Design: Phase I: a qualitative Delphi study; Phase II: a descriptive survey

research process.

Participants: a stratified random sample of member organisations of the

International Confederation of Midwives (ICM) and regulatory
representatives from these same countries.

Findings: a list of basic (essential) and additional competencies for

midwives who have been educated in keeping with the ICM/WHO/FIGO
international definition of the midwife was developed through an interative
Delphi process, and then affirmed, using a survey research method. The
final list includes 214 individual task statements within six domains of
midwifery practice.

Implications for practice: this list of competencies can serve as a basis

for educational curriculum design, as a guideline for regulatory policy
development, as a reference document for individual practitioners in an
assessment of their initial and continued competency and by the ICM and its
member associations as a resource for advocating for the role of midwifery
within health-care systems world-wide.

Linda L. Wright, Chapter 4 - Global Neonatal Health, Avery's Diseases of

the Newborn (Ninth Edition), W.B. Saunders, Philadelpia, 2012, Pages 23-36,
ISBN 9781437701340, 10.1016/B978-1-4377-0134-0.10004-6.
Pisake Lumbiganon, Malinee Laopaiboon, A Metin Glmezoglu, Joo Paulo
Souza, Surasak Taneepanichskul, Pang Ruyan, Deepika Eranjanie Attygalle,
Naveen Shrestha, Rintaro Mori, Nguyen Duc Hinh, Hoang Thi Bang, Tung
Rathavy, Kang Chuyun, Kannitha Cheang, Mario Festin, Venus Udomprasertgul,
Maria Julieta V Germar, Gao Yanqiu, Malabika Roy, Guillermo Carroli,
Katherine Ba-Thike, Ekaterina Filatova, Jos Villar, for the World Health
Organization Global Survey on Maternal and Perinatal Health Research Group,
Method of delivery and pregnancy outcomes in Asia: the WHO global survey on
maternal and perinatal health 200708, The Lancet, Volume 375, Issue 9713,
612 February 2010, Pages 490-499, ISSN 0140-6736, 10.1016/S0140-
Abstract: SummaryBackground
There has been concern about rising rates of caesarean section worldwide.
This Article reports the third phase of the WHO global survey, which aimed
to estimate the rate of different methods of delivery and to examine the
relation between method of delivery and maternal and perinatal outcomes in
selected facilities in Africa and Latin America in 200405, and in Asia in
Nine countries participated in the Asia global survey: Cambodia, China,
India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each
country, the capital city and two other regions or provinces were randomly
selected. We studied all women admitted for delivery during 3 months in
institutions with 6000 or fewer expected deliveries per year and during 2
months in those with more than 6000 deliveries. We gathered data for
institutions to obtain a detailed description of the health facility and
its resources for obstetric care. We obtained data from women's medical
records to summarise obstetric and perinatal events.
We obtained data for 109101 of 112152 deliveries reported in 122 recruited
facilities (97% coverage), and analysed 107950 deliveries. The overall
rate of caesarean section was 273% (n=29428) and of operative vaginal
delivery was 32% (n=3465). Risk of maternal mortality and morbidity index
(at least one of: maternal mortality, admission to intensive care unit
[ICU], blood transfusion, hysterectomy, or internal iliac artery ligation)
was increased for operative vaginal delivery (adjusted odds ratio 21, 95%
CI 1726) and all types of caesarean section (antepartum without
indication 27, 1455; antepartum with indication 106, 93120;
intrapartum without indication 142, 98207; intrapartum with indication
145, 132160). For breech presentation, caesarean section, either
antepartum (02, 0103) or intrapartum (03, 0204), was associated
with improved perinatal outcomes, but also with increased risk of stay in
neonatal ICU (20, 1136; and 21, 1237, respectively).
To improve maternal and perinatal outcomes, caesarean section should be
done only when there is a medical indication.
US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank
Special Programme of Research, Development and Research Training in Human
Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and
Welfare of Japan; Ministry of Public Health, China; and Indian Council of
Medical Research.

, Neuroleptic drugs, In: Editor: J.K. Aronson, Editor(s)-in-Chief,

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse
Drug Reactions and Interactions (Fifteenth Edition), Elsevier, Amsterdam,
2006, Pages 2438-2489, ISBN 9780444510051, 10.1016/B0-44-451005-2/00134-0.
Deborah Bender, Ana Santander, Aurora Balderrama, Alfredo Arce, Rosario
Medina, Transforming the process of service delivery to reduce maternal
mortality in Cochabamba, Bolivia, Reproductive Health Matters, Volume 3,
Issue 6, November 1995, Pages 52-59, ISSN 0968-8080, 10.1016/0968-
Abstract: Maternal mortality is a problem of considerable magnitude yet it
still receives inadequate attention in developing countries. Recently,
increased attention has been given to preventing maternal mortality through
innovative programmes of service delivery, in which success is usually
measured by outcomes such as changes in the ratio of maternal
mortality/morbidity or an increase in use of health services, without
looking at the actual process of service delivery. This paper presents a
model of participative management as a means of changing the process of
maternal health care delivery. It was developed as part of Proyecto MADRE,
a community-based reproductive health project in Cochabamba, Bolivia.

Julia S. Seng, Mickey Sperlich, Lisa Kane Low, Mental Health, Demographic,
and Risk Behavior Profiles of Pregnant Survivors of Childhood and Adult
Abuse, Journal of Midwifery &amp; Women's Health, Volume 53, Issue 6,
NovemberDecember 2008, Pages 511-521, ISSN 1526-9523,
Abstract: Our objective was to address the gap in knowledge about the
extent to which perinatal mental health and risk behaviors are associated
with childhood and adult experiences of abuse that arises because of
barriers to screening and disclosure about past and current abuse. Survey
data from an ongoing study of the effects of posttraumatic stress on
childbearing were used to describe four groups of nulliparous women: those
with no abuse history, adult abuse only, childhood abuse only, and abuse
that occurred during both periods. The rates of abuse history disclosure
were higher in the research context than in the clinical settings. Mental
health morbidity and risk behaviors occurred in a dose-response pattern
with cumulative abuse exposure. Rates of current posttraumatic stress
disorder ranged from 4.1% among those never abused to 11.4% (adult only),
16.0% (childhood only), and 39.2% (both periods). Women abused during both
periods also were more likely to be using tobacco (21.5%) and drugs (16.5%)
during pregnancy. We conclude that mental health and behavioral risk
sequelae affect a significant portion of both childhood and adult abuse
survivors in prenatal care. The integration into the maternity setting of
existing evidence-based interventions for the mental health and behavioral
sequelae of abuse is needed.
Keywords: intimate partner violence; childhood abuse; perinatal mental
health; posttraumatic stress; screening

M.A. Koblinsky, Beyond maternal mortality magnitude, interrelationship

and consequences of women's health, pregnancy-related complications and
nutritional status on pregnancy outcomes, International Journal of
Gynecology &amp; Obstetrics, Volume 48, Supplement, June 1995, Pages S21-
S32, ISSN 0020-7292, 10.1016/0020-7292(95)02322-4.
Abstract: The magnitude of maternal morality in developing countries and
its disparity with similar statistics from the developed world has touched
a responsive chord among policy makers and health services program
officials. What is not well appreciated, however, is that maternal
mortality is only the tip of the iceberg for every one maternal death,
acute obstetrical complications cause suffering in nearly 100 women, 250
women contract a sexually transmitted disease, and 1000 women suffer
stunting and/or anemia. All of these problems impact on the pregnancy
outcome, both for the woman as well as for the newborn. Through a review of
the literature, the magnitude, interrelationships and consequences of these
various problems are described. The woman and the newborn are a dyad, a
unit; what affects the woman typically affects the fetus and is manifest in
the newborn. Safe motherhood programs need to pay attention to both,
realizing that interventions aimed at the woman can benefit the next
Keywords: Maternal mortality; Maternal morbidity; Perinatal mortality;

Rachel G. Lucas-Thompson, Wendy A. Goldberg, Chapter 7 - Family

Relationships and Children's Stress Responses, In: Janette B. Benson,
Editor(s), Advances in Child Development and Behavior, JAI, 2011, Volume
40, Pages 243-299, ISSN 0065-2407, ISBN 9780123864918, 10.1016/B978-0-12-
Abstract: Abstract
In this chapter, the theoretical and empirical associations between family
relationships and children's responses to stressors are reviewed. Family
relationships explored are primarily dyadic, representing the emphasis of
past empirical research; these include parentparent, parentchild, and
sibling relationships. However, in recognition of the more complicated and
interconnected nature of family relationships, also reviewed are
associations between the broader family context and children's stress
responses. Multiple measures of stress responses are considered, including
both physiological and emotional responses to and recovery from stressful
experiences. Overall, the studies reviewed suggest that poor-quality family
environments, including those characterized by low emotional support or
high conflict, are associated with dysregulated stress responses throughout
childhood and adolescence. In contrast, children and adolescents in
families with high emotional support or low conflict seem to be protected
from developing stress regulatory problems. Limitations in this body of
research as well as directions for future research are discussed.
Keywords: Family relationships; Stress physiology; Childhood; Adolescence;
Family environment

Susan G. Devine, Simone L. Harrison, Petra G. Buettner, Building capacity

of maternity staff to discourage the use of sunlight therapy in the post-
partum period and infancy, Women and Birth, Volume 21, Issue 3, September
2008, Pages 107-111, ISSN 1871-5192, 10.1016/j.wombi.2008.05.002.
Abstract: SummaryPurpose
To describe the development, implementation and evaluation of an
educational intervention that addresses risky beliefs held by midwives and
nurses working in maternity areas and new mothers about therapeutic sun
In 20022003, 59 midwives and nurses from a hospital in northern Queensland
participated in an educational intervention to discourage mothers from
exposing themselves and their infants to sunlight for therapeutic reasons.
Intervention staff attended an educational workshop and/or received
educational resources. Resources (posters, pamphlets and bookmarks) were
developed for the staff to use for educating mothers. Process evaluation of
the quality and usefulness of the workshop and resources was conducted
immediately after the workshop and 12 months later.
Intervention staff indicated that the workshop was relevant to their work,
and increased their knowledge and confidence in talking to mothers about
sunlight exposure. Ninety percent of the 59 participants indicated they had
used the workshop information in their interactions with post-partum
mothers. Of the resources, pamphlets and bookmarks were used most often.
Conclusions and implications for practice
The educational intervention was successful in developing the knowledge of
midwives and nurses to provide sound advice to new mothers about
therapeutic sun exposure and in developing resources to support them in
their education. Although workshops and resources are useful in the short
term, they are impractical to sustain. To improve sustainability, content
on this topic needs to be incorporated into midwifery and nursing curricula
across Australia.
Keywords: Sun exposure; Maternity staff; Education; Infancy; Post-partum

Jo Borghi, Tim Ensor, Aparnaa Somanathan, Craig Lissner, Anne Mills, on

behalf of The Lancet Maternal Survival Series steering group, Mobilising
financial resources for maternal health, The Lancet, Volume 368, Issue
9545, 2127 October 2006, Pages 1457-1465, ISSN 0140-6736, 10.1016/S0140-
Abstract: Summary
Coverage of cost-effective maternal health services remains poor due to
insufficient supply and inadequate demand for these services among the
poorest groups. Households pay too great a share of the costs of maternal
health services, or do not seek care because they cannot afford the costs.
Available evidence creates a strong case for removal of user fees and
provision of universal coverage for pregnant women, particularly for
delivery care. To be successful, governments must also replenish the income
lost through the abolition of user fees. Where insurance schemes exist,
maternal health care needs to be included in the benefits package, and
careful design is needed to ensure uptake by the poorest people. Voucher
schemes should be tested in low-income settings, and their costs and
relative cost-effectiveness assessed. Further research is needed on methods
to target financial assistance for transport and time costs. Current
investment in maternal health is insufficient to meet the fifth Millennium
Development Goal (MDG), and much greater resources are needed to scale up
coverage of maternal health services and create demand. Existing global
estimates are too crude to be of use for domestic planning, since resource
requirements will vary; budgets need first to be developed at country-
level. Donors need to increase financial contributions for maternal health
in low-income countries to help fill the resource gap. Resource tracking at
country and donor levels will help hold countries and donors to account for
their commitments to achieving the maternal health MDG.

Carole A. Warnes, Roberta G. Williams, Thomas M. Bashore, John S. Child,

Heidi M. Connolly, Joseph A. Dearani, Pedro del Nido, James W. Fasules,
Thomas P. Graham Jr, Ziyad M. Hijazi, Sharon A. Hunt, Mary Etta King,
Michael J. Landzberg, Pamela D. Miner, Martha J. Radford, Edward P. Walsh,
Gary D. Webb, ACC/AHA 2008 Guidelines for the Management of Adults With
Congenital Heart Disease: A Report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing Committee to Develop Guidelines on the Management of Adults With
Congenital Heart Disease) Developed in Collaboration With the American
Society of Echocardiography, Heart Rhythm Society, International Society
for Adult Congenital Heart Disease, Society for Cardiovascular Angiography
and Interventions, and Society of Thoracic Surgeons, Journal of the
American College of Cardiology, Volume 52, Issue 23, 2 December 2008, Pages
e143-e263, ISSN 0735-1097, 10.1016/j.jacc.2008.10.001.
Keywords: ACC/AHA Practice Guidelines; congenital heart disease; cardiac
defects; congenital heart surgery; unoperated/repaired heart defects;
medical therapy; cardiac catheterization

Deborah Koniak-Griffin, Nancy L.R Anderson, Mary-Lynn Brecht, Inese

Verzemnieks, Janna Lesser, Sue Kim, Public health nursing care for
adolescent mothers: impact on infant health and selected maternal outcomes
at 1 year postbirth, Journal of Adolescent Health, Volume 30, Issue 1,
January 2002, Pages 44-54, ISSN 1054-139X, 10.1016/S1054-139X(01)00330-5.
Abstract: Purpose: To compare effects of an early intervention program
(EIP) of intense home visitation by public health nurses (PHNs) with
effects of traditional public health nursing care (TPHN) on infant health
and selected maternal outcomes of adolescent mothers.

Methods: EIP adolescents (N = 102) received preparation-for-motherhood

classes and individual home visits (from pregnancy through 1 year
postpartum) from PHNs employed in a county health department. Participants
were predominantly Latina (64%) and African-American (11%) and from
impoverished backgrounds. Infant health outcomes were determined based on
medical record data; interviews and standardized questionnaires evaluated
other program effects (e.g., maternal educational achievement and
psychological status). Data were analyzed using Chi-square and repeated
measures ANOVA.

Results: Infants of EIP mothers experienced significantly fewer total days

(n = 74) and actual episodes (n = 14) of hospitalization during the first
year of life than those receiving TPHN (n = 154, n = 24, respectively).
Similarly, positive program effects were found for immunization rates.
There were no group differences in emergency room visits or repeat
pregnancy rates. Alcohol, tobacco, and marijuana use significantly
increased from pregnancy through 1 year postpartum in both groups but
remained markedly lower than rates prior to pregnancy (lifetime rates).

Conclusions: These findings demonstrate the positive effects of a PHN home

visitation program on health outcomes for children of adolescent mothers.
Days of infant hospitalization were substantially reduced and immunization
rates increased during the first year of life for children of EIP mothers.
Greater efforts need to be directed toward preventing repeat pregnancy and
return to substance use following childbirth in at-risk adolescent mothers.
Keywords: Adolescents; Adolescent mothers; Nurse home visitation; Infant

Mary Carolan, Cheryl Steele, Heather Margetts, Knowledge of gestational

diabetes among a multi-ethnic cohort in Australia, Midwifery, Volume 26,
Issue 6, December 2010, Pages 579-588, ISSN 0266-6138,
Abstract: Objective
to explore knowledge about gestational diabetes (GDM) among a multi-ethnic
sample of women who were receiving antenatal care in Melbourne, Australia.
cross-sectional comparative survey.
diabetes clinic located in a public hospital in Melbourne's Western
143 pregnant women with GDM from Vietnamese, Indian, Filipino and Caucasian
200 questionnaires were distributed and 143 were returned (response rate
71.5%). There were statistically significant differences between ethnic
groups in terms of educational level (p=0.001) and fluency in English
(p=0.001). Educational levels, measured in completed years of schooling,
were lowest among Vietnamese [mean 8.5 years, standard deviation (SD) 1.0],
Filipino (mean 8.9 years, SD 1.5) and Caucasian [mean 10.2 years, SD 0.9]
women. Indian women had a higher mean level of education (11.6 years, SD
0.9). Fluency in English was reported by 100% of Caucasian, Indian and
Filipino women, but 53.3% of Vietnamese women required interpreter
services. The women's answers varied with ethnicity and educational status.
Vietnamese and Filipino women displayed the least knowledge about GDM and
food values. Caucasian women also scored poorly on general knowledge about
GDM. Indian women scored highest across all areas of interest.
Key conclusions
Vietnamese women had the poorest English skills and lowest educational
levels, and were identified as the group at greatest risk of
misunderstanding GDM. English language proficiency alone, however, was not
associated with better comprehension of GDM in this study. Higher
educational level was the only factor linked to increased comprehension. It
is, therefore, important that new educational strategies are developed to
address lower health literacy as well as cultural factors when caring for
multi-ethnic populations with GDM. This approach may also serve to address
lower levels of comprehension among Caucasian populations.
Keywords: Gestational diabetes; Multi-ethnic; Knowledge; Antenatal care

Susan R. Fawcus, Maternal mortality and unsafe abortion, Best Practice

&amp; Research Clinical Obstetrics &amp; Gynaecology, Volume 22, Issue 3,
June 2008, Pages 533-548, ISSN 1521-6934, 10.1016/j.bpobgyn.2007.10.006.
Abstract: Unsafe abortions refer to terminations of unintended pregnancies
by persons lacking the necessary skills, or in an environment lacking the
minimum medical standards, or both. Globally, unsafe abortions account for
67,900 maternal deaths annually (13% of total maternal mortality) and
contribute to significant morbidity among women, especially in under-
resourced settings. The determinants of unsafe abortion include restrictive
abortion legislation, lack of female empowerment, poor social support,
inadequate contraceptive services and poor health-service infrastructure.
Deaths from unsafe abortion are preventable by addressing the above
determinants and by the provision of safe, accessible abortion care. This
includes safe medical or surgical methods for termination of pregnancy and
management of incomplete abortion by skilled personnel. The service must
also include provision of emergency medical or surgical care in women with
severe abortion complications. Developing appropriate services at the
primary level of care with a functioning referral system and the inclusion
of post abortion contraceptive care with counseling are essential facets of
abortion care.
Keywords: abortion legislation; contraception; manual vacuum aspiration;
maternal mortality; postabortion care; unintended pregnancy; unsafe

S.A. Otchere, H.T. Binh, Strengthening emergency obstetric care in Thanh

Hoa and Quang Tri provinces in Vietnam, International Journal of Gynecology
&amp; Obstetrics, Volume 99, Issue 2, November 2007, Pages 165-172, ISSN
0020-7292, 10.1016/j.ijgo.2007.07.005.
Abstract: Objective
Save the Children/USA and the Ministry of Health of Vietnam undertook a
project between 2001 and 2004 to improve the availability of, access to,
quality and utilization of emergency obstetric care (EmOC) services at
district and provincial hospitals in two provinces in Vietnam.
The project improved the functional capacity of 3 provincial and 1 district
hospitals providing comprehensive EmOC services, and upgraded 1 district
hospital providing basic EmOC into a comprehensive EmOC facility through
training, infrastructure and quality improvement.
Data presented in this paper focus on only the 2 district hospitals even
though the UN process indicators showed increases in utilization of EmOC in
all 5 hospitals. In the case of Hai Lang, the proportion of births
increased from 13% at baseline to 31% at the end of 2004, and met need
increased significantly from 16% to 87% largely due to increased capacity
of the hospital and staff. Met need in Hoang Hoa hospital more than doubled
(17% at baseline versus 54% in 2004) and the proportion of births increased
slightly from 19% in 2001 to 22% in 2004. Case fatality rates for the two
hospitals remarkably remained at zero. Lessons from this project have been
incorporated into national policy and guidelines.
Improvements in the capacity of existing health facilities to treat
complications in pregnancy and childbirth can be realized in a relatively
short period of time and is an essential element in reducing maternal
Keywords: Vietnam; Emergency obstetric care; Quality of care; Maternal

M. Sharan, D. Strobino, S. Ahmed, Intrapartum oxytocin use for labor

acceleration in rural India, International Journal of Gynecology &amp;
Obstetrics, Volume 90, Issue 3, September 2005, Pages 251-257, ISSN 0020-
7292, 10.1016/j.ijgo.2005.05.008.
Abstract: Objective: To examine factors associated with the use of oxytocin
for acceleration of labor in women delivered at home in rural India.
Method: Quantitative data were collected from 527 women who were delivered
at home and qualitative interviews were carried out with 21 mothers and 9
birth attendants. Results: Oxytocin use was associated with higher
education and socioeconomic status, primigravidity, and delivery by a
traditional birth attendant. Conclusion: Labor acceleration with oxytocin
occurs indiscriminately In India. Oxytocin use should be regulated, and
training for birth attendants should be provided as well as health
education for pregnant women.
Keywords: Oxytocin; Home deliveries; India; Traditional birth attendants

Patrice Johnelle Sparks, Racial/Ethnic Differences in Breastfeeding

Duration among WIC-Eligible Families, Women's Health Issues, Volume 21,
Issue 5, SeptemberOctober 2011, Pages 374-382, ISSN 1049-3867,
Abstract: Purpose
This research documented racial/ethnic differences in breastfeeding
duration among mothers from seven diverse racial/ethnic groups in rural and
urban areas of the United States that initiated breastfeeding among income
and categorically eligible WIC participants.
Using data from the Longitudinal 9-MonthPreschool Restricted-Use data file
of the Early Childhood Longitudinal StudyBirth Cohort, this research first
assessed racial/ethnic differences in breastfeeding initiation and
duration, maternal and child health characteristics, social service usage,
and sociodemographic characteristics. Next, breastfeeding survivorship and
Cox proportional hazards models were estimated to assess potential
racial/ethnic disparities in breastfeeding duration once these control
variables were accounted for in multiple variable models.
Breastfeeding initiation rates and breastfeeding durations of 6 months were
lower among WIC-eligible mothers compared with all mothers. WIC-eligible,
foreign-born Mexican-Origin Hispanic (FBMOH) mothers were most likely to
breastfeed for 6 months. Breastfeeding duration rates dropped quickly after
4 months of duration among WIC-eligible mothers that initiated. Two
crossover patterns in breastfeeding durations were noted among 1) FBMOH and
non-Hispanic Black mothers and 2) Asian and Native American mothers. A
FBMOH breastfeeding duration advantage was noted compared with non-Hispanic
White mothers once all control variables were included in the Cox
proportional hazard models. No other racial/ethnic disparities in
breastfeeding duration were noted.
More attention to educational programs and broad forms of support as part
of WIC are needed to help reach the breastfeeding duration goals of Healthy
People 2010 and continued support of the Loving Support Peer Counseling
Program may serve as an ideal policy for local WIC offices.

Ruchi Puri, Stephen Rulisa, Shahrzad Joharifard, Jeffrey Wilkinson, Patrick

Kyamanywa, Nathan Thielman, Knowledge, attitudes, and practices in safe
motherhood care among obstetric providers in Bugesera, Rwanda,
International Journal of Gynecology &amp; Obstetrics, Volume 116, Issue 2,
February 2012, Pages 124-127, ISSN 0020-7292, 10.1016/j.ijgo.2011.09.025.
Abstract: Objective
To determine the knowledge, attitudes, and practices of obstetric care
providers (OCPs) in Bugesera District, Rwanda, crucial to the delivery of
safe motherhood services.
A quantitative descriptive survey in Kinyarwanda targeting all OCPs in the
district was implemented in November 2010 to determine demographic
characteristics, safe motherhood knowledge, obstetric practices, and
attitudes toward additional training.
The study captured 87% of OCPs, of whom 137 of 168 (82%) were A2 level
nurses. Most expressed a need to improve their knowledge (60.6%) and skills
confidence (72.2%) in safe motherhood. The mean percentage of correct
answers of 50 questions assessing overall knowledge was 46.4%; sections on
normal labor (39.3% correct) and obstetric complications (37.1% correct)
were the weakest. Fundal pressure during vaginal delivery was practiced by
60.8%, and only 15.9% of providers practiced active management of the third
stage of labor for all deliveries. Providers supported additional training,
and 89.3% expressed willingness to participate in a 2-day workshop even if
it were their day off.
The study has identified a need to improve safe motherhood knowledge and
practices of OCPs in the Bugesera District of Rwanda. OCPs support
additional training as an intervention to reduce maternal mortality.
Keywords: Emergency obstetric care; Health provider competency; Knowledge,
attitudes, and practice survey; Maternal mortality; Safe motherhood; Sub-
Saharan Africa

Jane Svensson, Lesley Barclay, Margaret Cooke, Randomised-controlled trial

of two antenatal education programmes, Midwifery, Volume 25, Issue 2, April
2009, Pages 114-125, ISSN 0266-6138, 10.1016/j.midw.2006.12.012.
Abstract: Objective
to determine whether a new antenatal education programme with increased
parenting content could improve parenting outcomes for women compared with
a regular antenatal education programme.
a randomised-controlled trial. Data were collected through self-report
specialist referral maternity hospital in Sydney, Australia.
170 women birthing at the hospital. Ninety-one women attended the new
programme and 79 the regular programme.
a new antenatal education programme (Having a Baby programme) developed
from needs assessment data collected from expectant and new parents. One
important feature of the programme was the recognition that pregnancy,
labour, birth and early parenting were a microcosm of the childbearing
experience, rather than separate topics.
the primary outcome measure was perceived maternal parenting self-efficacy.
Worry about the baby, and perceived parenting knowledge, were secondary
outcome measures. They were measured before the programme and after birth.
Birth outcomes were also recorded.
the postnatal perceived maternal parenting self-efficacy scores of women
who attended the Having a Baby programme were significantly higher than
those who attended the regular programme. Perceived parenting knowledge
scores of women who attended the Having a Baby programme were also
significantly higher than those who attended the regular programme. Worry
scores were lower but they did not reach statistical significant. Birth
outcomes were similar.
Implications for practice
the Having a Baby programme improved maternal self-efficacy and parenting
knowledge. Parenting programmes that continue in the early postnatal period
may be beneficial.
Keywords: Childbirth education; Pregnancy; Randomised control trial;
Programme evaluation

Sherryl H. Goodman, Lauren B. Adamson, Joann Riniti, Steven Cole, Mothers'

Expressed Attitudes: Associations with Maternal Depression and Children's
Self-Esteem and Psychopathology, Journal of the American Academy of Child
&amp; Adolescent Psychiatry, Volume 33, Issue 9, NovemberDecember 1994,
Pages 1265-1274, ISSN 0890-8567, 10.1097/00004583-199411000-00007.
Abstract: ABSTRACTObjective
Mothers' expressed attitudes about their children were examined to discern
whether the associations between maternal depression and children's
psychopathology and self-esteem might be modified by the mother's
expression of critical attitudes.
Motherchild dyads with mothers who had a history of at least one episode
of unipolar major depression during the child's lifetime (N = 20) were
compared to dyads with well parents (N = 19). Children's ages ranged from 8
to 10 years. Mothers' attitudes toward their children were derived from
semistructured interviews. The affect expressed in each maternal statement
was coded as neutral, positive, descriptive negative, or affectively
charged negative.
Affectively charged negative statements were found to be associated with
mothers with a history of depressive episodes. A tendency was noted for the
highest rates of psychopathology to be among children of depressed mothers
who used affective-negative statements. Mothers' use of affectively charged
negatives was found to modify the association between maternal depression
and children's lower global self-worth.
Clinicians attuned to mothers' expression of critical attitudes toward
their children might detect children at risk for lowered self-esteem and
the development of psychopathology.
Keywords: expressed attitudes; maternal depression

Mary C Blehar, Public health context of women's mental health research,

Psychiatric Clinics of North America, Volume 26, Issue 3, September 2003,
Pages 781-799, ISSN 0193-953X, 10.1016/S0193-953X(03)00039-X.
Heather L. Colleran, Cheryl A. Lovelady, Use of MyPyramid Menu Planner for
Moms in a Weight-Loss Intervention during Lactation, Journal of the Academy
of Nutrition and Dietetics, Volume 112, Issue 4, April 2012, Pages 553-558,
ISSN 2212-2672, 10.1016/j.jand.2011.12.004.
Abstract: The Internet offers a valuable resource for promotion of healthy
eating and Web-based communication between the dietetics practitioner and
client. In a 16-week intervention examining the effects of energy
restriction (500 kcal/day) and exercise on body composition in
overweight/obese lactating women, MyPyramid Menu Planner for Moms was used
to support dietary counseling. Random assignment occurred at 4 weeks
postpartum to either an Intervention group (n=14) or Minimal Care group
(n=13) from 2008 through 2010. Three 24-hour dietary recalls were obtained
using the Nutrition Data System at 4 and 20 weeks postpartum. Individual
MyPyramid Menu Planner accounts were created for the Intervention group and
used in face-to-face dietary counseling. Repeated measures analysis of
variance was used to test for differences between groups for change in
dietary intake and weight. Changes in energy, saturated fat, and percent of
energy from added sugars were significantly different between Intervention
group and Minimal Care group (613 [521] kcal vs 171 [435] kcal; P=0.03;
14.9 [14.0] g vs +0.9 [13.4] g; P&lt;0.01; and 3.5% [5.3%] vs +2.2%
[4.8%]; P&lt;0.01, respectively). The Intervention group significantly
increased their whole fruit servings and decreased their total grain and
milk servings compared with the Minimal Care group (P&lt;0.05). The
Intervention group lost significantly more weight (5.8 [3.5] kg) than the
Minimal Care group (1.6 [5.4] kg) (P=0.03). Although participants must
have access to an Internet-based computer and possess basic food knowledge,
these results suggest MyPyramid Menu Planner might prove to be an effective
dietary counseling support tool for improving dietary intake and promoting
weight loss during lactation.
Keywords: MyPyramid; Counseling; Weight loss; Diet; Postpartum

David P Hopkins, Peter A Briss, Connie J Ricard, Corinne G Husten, Vilma G

Carande-Kulis, Jonathan E Fielding, Mary O Alao, Jeffrey W McKenna, Donald
J Sharp, Jeffrey R Harris, Trevor A Woollery, Kate W Harris, The Task Force
on Community Preventive Services, Reviews of evidence regarding
interventions to reduce tobacco use and exposure to environmental tobacco
smoke, American Journal of Preventive Medicine, Volume 20, Issue 2,
Supplement 1, February 2001, Pages 16-66, ISSN 0749-3797, 10.1016/S0749-
Abstract: Overview: This report presents the results of systematic reviews
of effectiveness, applicability, other effects, economic evaluations, and
barriers to use of selected population-based interventions intended to
reduce tobacco use and exposure to environmental tobacco smoke. The related
systematic reviews are linked by a common conceptual approach. These
reviews form the basis of recommendations by the Task Force on Community
Preventive Services (TFCPS) regarding the use of these selected
interventions. The TFCPS recommendations are presented on page 67 of this
Keywords: smoking cessation; tobacco use cessation; tobacco smoke
pollution; community health services; decision-making; evidence-based
medicine; meta-analysis; review literature; practice guidelines; preventive
health services; public health practice

, April 2011 New in Review, Journal of the American Dietetic Association,

Volume 111, Issue 4, April 2011, Pages 627-633, ISSN 0002-8223,
Martha Morrison Dore, Joan M. Doris, Pearl Wright, Identifying substance
abuse in maltreating families: A child welfare challenge, Child Abuse &amp;
Neglect, Volume 19, Issue 5, May 1995, Pages 531-543, ISSN 0145-2134,
Abstract: Studies of the link between parental substance abuse and child
maltreatment suggest that chemical dependence is present in at least half
of the families who come to the attention of child welfare authorities for
child abuse and neglect. Parental substance abuse is thought to be a
primary factor in greatly increased rates of children entering foster care
over the past decade. It is also a clear risk factor for child mental
health problems and poor developmental outcomes in children. At the same
time, however, minimal attention is often given to training child
protective services workers and other child welfare personnel in
identifying and confronting substance abuse in families on their caseloads.
The authors explore standardized methods developed for screening for
substance abuse among various populations and suggest ways of adapting
these screening devices for families reported for child maltreatment. They
identify assessment and treatment considerations in substance abusing
families as well.
Keywords: Child; Abuse; Maltreatment; Drugs; Family

Bishara S. Atiyeh, S. William A. Gunn, Shady N. Hayek, Provision of

essential surgery in remote and rural areas of developed as well as low and
middle income countries, International Journal of Surgery, Volume 8, Issue
8, 2010, Pages 581-585, ISSN 1743-9191, 10.1016/j.ijsu.2010.07.291.
Abstract: Background
Surgery is increasingly becoming an integral part of public health and
health systems development worldwide. Such surgical care should be provided
at the same type and level in both urban and rural settings. However,
provision of essential surgery in remote and rural areas of developed as
well as low and middle income countries remains totally inadequate and
poses great challenges.
Though not intended to be a systematic review, several aspects of primary
health care and its surgical aspects in remote and rural areas were
reviewed. Search tools included Medline, PubMed and Scopius. Health
concerns such as quality health care and limitations, as well as
infrastructures, surgical workforce as well as implications for planning,
teaching and training for surgical care in remote areas were searched.
The dire shortage of surgeons and anesthesiologists in most low and middle
income countries means task shifting and training of non-physician
clinicians (NPCs) is the only option particularly in most developing poor
The best means of bringing surgical care to rural dwellers is yet to be
clearly determined. However, modern surgical techniques integrated with the
strategy as outlined by the World Health Organization can be brought to
rural areas through specially organized camps. Sophisticated surgery can
thus be performed in a high-volume and cost-effective manner, even in
temporary settings. However, provision of essential surgery to rural and
remote areas can only partly be met both in developed and in low and middle
income countries and it will take years to solve the problem of unmet
surgical needs in these areas.
Keywords: Essential surgery; Rural area; Primary health care

Catherine StevensSimon, Donna Nelligan, Lisa Kelly, Adolescents at risk

for mistreating their children: Part II: a home- and clinic-based
prevention program, Child Abuse &amp; Neglect, Volume 25, Issue 6, June
2001, Pages 753-769, ISSN 0145-2134, 10.1016/S0145-2134(01)00237-X.
Abstract: Objective: To determine if adding an intensive home visitation
component to a comprehensive adolescent-oriented maternity program prevents
child abuse and neglect.

Methods: We studied 171 participants in a comprehensive, adolescent-

oriented maternity program who were deemed to be at high risk for child
abuse and neglect. Half were randomly assigned to receive in-home parenting
instruction. Major disruptions of primary care-giving by the adolescent
mother were classified hierarchically as abuse, neglect, and abandonment.

Results: Compliance with home visits varied in relation to the support the
teenage mothers received from their families and the fathers of their
babies (p &lt; .0001). There were no significant treatment group
differences in the pattern of health care utilization, the rate of
postpartum school return, repeat pregnancies, or child abuse and neglect.
The incidence of maltreatment rose in tandem with the predicted risk status
of the mother. Ultimately, 19% of the children were removed from their
mothers custody.

Conclusions: Prediction efforts were effective in identifying at-risk

infants, but this intensive home-and clinic-based intervention did not
alter the incidence of child maltreatment or maternal life course
development. A parenting program that was more inclusive of the support
network might be more popular with teenagers and therefore more effective.
Our findings also emphasize the importance of including counseling
specifically designed to prevent teenagers from abandoning their children.
Keywords: Child abuse; Adolescent pregnancy; Adolescent parenting

Katherine B. Saxton, Neha John-Henderson, Matthew W. Reid, Darlene D.

Francis, The social environment and IL-6 in rats and humans, Brain,
Behavior, and Immunity, Volume 25, Issue 8, November 2011, Pages 1617-1625,
ISSN 0889-1591, 10.1016/j.bbi.2011.05.010.
Abstract: Inflammatory cytokine levels predict a wide range of human
diseases including depression, cardiovascular disease, type 2 diabetes,
autoimmune disease, general morbidity, and mortality. Stress and social
experiences throughout the lifecourse have been associated with
inflammatory processes. We conducted studies in humans and laboratory rats
to examine the effect of early life experience and adult social position in
predicting IL-6 levels. Human participants reported family homeownership
during their childhood and current subjective social status. Interleukin-6
(IL-6) was measured from oral mucosal transudate. Rats were housed in
groups of three, matched for quality of maternal care received. Social
status was assessed via competition for resources, and plasma IL-6 was
assessed in adulthood. In both humans and rats, we identified an
interaction effect; early social experience moderated the effect of adult
social status on IL-6 levels. Rats that experienced low levels of maternal
care and people with low childhood socioeconomic status represented both
the highest and lowest levels of IL-6 in adulthood, depending on their
social status as young adults. The predicted interaction held for non-
Hispanic people, but did not occur among Hispanic individuals. Adversity
early in life may not have a monotonically negative effect on adult health,
but may alter biological sensitivity to later social experiences.
Keywords: Stress; Adversity; Socioeconomic status; Rat; Cytokine;

Ruth A. Lawrence, Robert M. Lawrence, Chapter 8 - Practical Management of

the Mother-Infant Nursing Couple, Breastfeeding (Seventh Edition), W.B.
Saunders, Philadelphia, 2011, Pages 232-282, ISBN 9781437707885,

Sandi Dietrich, Ten steps in establishing a nurse-midwifery service/private

practice for the nurse-widwife who's looking for a job in the system,
Journal of Nurse-Midwifery, Volume 24, Issue 2, MarchApril 1979, Pages 9-
18, ISSN 0091-2182, 10.1016/0091-2182(79)90053-3.
Abstract: Most nurse-midwives find that getting an education is the most
important part of becoming a nurse-midwife. In actuality this represents
only about fifty percent of the effort required. the remaining fifty
percent involving the problems of seeking and securing employment that is
other than temporary in nature. The following is a look at the source of
the many common problems in establishing a nurse-midwifery service and a
discussion of some recommended solutions.

David J. Birnbach, Eduardo Salas, Can Medical Simulation and Team Training
Reduce Errors in Labor and Delivery?, Anesthesiology Clinics, Volume 26,
Issue 1, March 2008, Pages 159-168, ISSN 1932-2275,
Abstract: Patient safety is one of the most pressing challenges in health
care today, and there is no question that medical errors occur and that
patients are worried about them. Currently, there is a belief that the
availability of medical simulations and the knowledge gained from the
science of team training may improve patient outcomes, and there is a
paradigm shift occurring in many universities and training programs. This
article discusses two strategies that, when combined, may reduce medical
error in the labor and delivery suite: team training and medical

Dawn Edge, Falling through the net Black and minority ethnic women and
perinatal mental healthcare: health professionals' views, General Hospital
Psychiatry, Volume 32, Issue 1, JanuaryFebruary 2010, Pages 17-25, ISSN
0163-8343, 10.1016/j.genhosppsych.2009.07.007.
Abstract: Objectives
The objective of this study was to investigate health professionals' views
about perinatal mental healthcare for Black and minority ethnic women.
Qualitative data were collected from a range of healthcare professionals
(n=42) via individual interviews and focus groups. Participants were
recruited from antenatal community clinics, a large teaching hospital,
general practice and a specialist voluntary sector agency in the north of
England, UK.
Participants reported inadequacies in training and lack of confidence both
for identifying the specific needs of Black women and for managing
perinatal depression more generally, particularly in women with
mild/moderate and subthreshold depression. Inadequate perinatal
depression management was associated with failure to screen routinely,
confusion about professional roles and boundaries, and poorly defined care
pathways, which increased women's likelihood of falling through the net,
thus failing to receive appropriate care and treatment.
Suboptimal detection and treatment of perinatal depression among high-
risk women highlight gaps between UK policy and practice. This applies to
women from all ethnic groups. However, evidence suggests that Black women
might be particularly vulnerable to deficiencies in provision. Effective
management of perinatal depression requires a more robust implementation of
existing guidelines, more effective strategies to address the full spectrum
of need, improved professional training and a more coordinated multiagency
Keywords: Perinatal depression; Ethnicity; Healthcare; Minority women

M. Rosato, F. Malamba, B. Kunyenge, T. Phiri, C. Mwansambo, P. Kazembe, A.

Costello, S. Lewycka, Strategies developed and implemented by women's
groups to improve mother and infant health and reduce mortality in rural
Malawi, International Health, Available online 2 June 2012, ISSN 1876-3413,
Abstract: We evaluated the strategies to tackle maternal and infant health
problems developed by women's groups in rural Malawi.

Quantitative data were analyzed on strategies developed by 184 groups at

two of the meetings in the community action cycle (attended by 3365 and
3047 women). Data on strategies implemented was collected through a survey
of the 197 groups active in January 2010. Qualitative data on the
identification and implementation of strategies was collected through 17
focus group discussions and 12 interviews with men and women.

To address the maternal and child health problems identified the five most
common strategies identified were: health education sessions, bicycle
ambulances, training of traditional birth attendants, wetland vegetable
garden (dimba garden) cultivation and distribution of insecticide treated
bednets (ITNs). The five most common strategies actually implemented were:
dimba garden cultivation, health education sessions, ITN distribution,
health programme radio listening clubs and clearing house surroundings. The
rationale behind the strategies and the factors facilitating and hindering
implementation are presented.

The potential impact of the strategies on health is discussed. Women's

groups help communities to take control of their health issues and have the
potential to reduce neonatal, infant and maternal mortality and morbidity
in the longer term.
Keywords: Community mobilization; Women's groups; Maternal mortality; Child
mortality; Community empowerment; Malawi

Erin J. Maher, Lyscha A. Marcynyszyn, Tyler W. Corwin, Rhenda Hodnett,

Dosage matters: The relationship between participation in the Nurturing
Parenting Program for infants, toddlers, and preschoolers and subsequent
child maltreatment, Children and Youth Services Review, Volume 33, Issue 8,
August 2011, Pages 1426-1434, ISSN 0190-7409,
Abstract: This article uses statewide data on caregivers of young children
referred to the Nurturing Parenting Program (NPP) for allegations of abuse
and neglect to examine the relationship between program dosage and
subsequent maltreatment. At six months after participating in the program,
caregivers who attended more sessions were significantly less likely to be
reported for child maltreatment, holding other factors constant. At two
years after participating, caregivers attending more sessions were
significantly less likely to have a substantiated maltreatment incidence,
controlling for other characteristics of families associated with
maltreatment. These findings demonstrate the program is associated with
preventing short-term allegations and longer-term substantiated incidences
of maltreatment for a child welfare population. By demonstrating the
importance of participation in the NPP, we increase the evidence about
effective parent education programs for this population.
Keywords: Parent education; Maltreatment; Child welfare; Program evaluation
Carole A. Warnes, Roberta G. Williams, Thomas M. Bashore, John S. Child,
Heidi M. Connolly, Joseph A. Dearani, Pedro del Nido, James W. Fasules,
Thomas P. Graham Jr, Ziyad M. Hijazi, Sharon A. Hunt, Mary Etta King,
Michael J. Landzberg, Pamela D. Miner, Martha J. Radford, Edward P. Walsh,
Gary D. Webb, ACC/AHA 2008 Guidelines for the Management of Adults With
Congenital Heart Disease: Executive Summary: A Report of the American
College of Cardiology/American Heart Association Task Force on Practice
Guidelines (Writing Committee to Develop Guidelines for the Management of
Adults With Congenital Heart Disease) Developed in Collaboration With the
American Society of Echocardiography, Heart Rhythm Society, International
Society for Adult Congenital Heart Disease, Society for Cardiovascular
Angiography and Interventions, and Society of Thoracic Surgeons, Journal of
the American College of Cardiology, Volume 52, Issue 23, 2 December 2008,
Pages 1890-1947, ISSN 0735-1097, 10.1016/j.jacc.2008.10.002.
Keywords: ACC/AHA Practice Guidelines; congenital heart disease; cardiac
defects; congenital heart surgery; unoperated/repaired heart defects;
medical therapy; cardiac catheterization

Bimal Kanti Paul, Deborah J Rumsey, Utilization of health facilities and

trained birth attendants for childbirth in rural Bangladesh: an empirical
study, Social Science &amp; Medicine, Volume 54, Issue 12, June 2002, Pages
1755-1765, ISSN 0277-9536, 10.1016/S0277-9536(01)00148-4.
Abstract: The majority of births in rural Bangladesh are carried out in
unhygienic conditions by relatives and traditional birth attendants (TBAs).
This results in a high incidence of maternal and infant mortality that
could be reduced if childbirth were to occur in health centers or under the
supervision of trained TBAs (TTBAs). In this paper, we examined factors
associated with utilization of modern health resources for childbirth in 39
villages of Bangladesh. We followed a retrospective survey research design
to collect relevant information from couples who experienced childbirth
during a two-year period from July 1, 1995 to June 1997. The data indicate
that slightly over 11% of the deliveries were performed by trained
personnel with the rest attended by TBAs. Multivariate analysis clearly
shows that delivery complications was the most significant factor
determining the use of modern health care resources for childbirth,
followed by parental education, and pre-natal care. We conclude that quick
response to delivery complications and improved access to hospitals and
TTBAs can reduce the risk of infant and maternal mortality and morbidity in
rural Bangladesh.
Keywords: Childbirth; Traditional birth attendants; Trained traditional
birth attendants; Rural Bangladesh

Shad Deering, Lindsay C. Johnston, Kathryn Colacchio, Multidisciplinary

Teamwork and Communication Training, Seminars in Perinatology, Volume 35,
Issue 2, April 2011, Pages 89-96, ISSN 0146-0005,
Abstract: Every delivery is a multidisciplinary event, involving nursing,
obstetricians, anesthesiologists, and pediatricians. Patients are often in
labor across multiple provider shifts, necessitating numerous handoffs
between teams. Each handoff provides an opportunity for errors. Although a
traditional approach to improving patient outcomes has been to address
individual knowledge and skills, it is now recognized that a significant
number of complications result from team, rather than individual, failures.
In 2004, a Sentinel Alert issued by the Joint Commission revealed that most
cases of perinatal death and injury are caused by problems with an
organization's culture and communication failures. It was recommended that
hospitals implement teamwork training programs in an effort to improve
outcomes. Instituting a multidisciplinary teamwork training program that
uses simulation offers a risk-free environment to practice skills,
including communication, role clarification, and mutual support. This
experience should improve patient safety and outcomes, as well as enhance
employee morale.
Keywords: teamwork; patient safety; labor and delivery; communication;

Susan McClennan Reece, Stress and maternal adaptation in first-time mothers

more than 35 years old, Applied Nursing Research, Volume 8, Issue 2, May
1995, Pages 61-66, ISSN 0897-1897, 10.1016/S0897-1897(95)80490-0.
Abstract: This prospective longitudinal study assessed relationships among
variables of the early transition to parenthood and maternal stress and
adaptation 1 year after delivery in primiparas older than 35 years. Life
change scores at 1 month were associated with greater stress at 1 year.
Positive self-evaluations of parenting early in the transition to
parenthood were associated with greater confidence and support in mothering
at 1 year. Compared with normative data, stress scores of study
participants were found to be high. The importance of addressing early
perceptions of parenting with older first-time mothers was supported.

Farida M. Jeejeebhoy, Carolyn M. Zelop, Rory Windrim, Jose C.A. Carvalho,

Paul Dorian, Laurie J. Morrison, Management of cardiac arrest in pregnancy:
A systematic review, Resuscitation, Volume 82, Issue 7, July 2011, Pages
801-809, ISSN 0300-9572, 10.1016/j.resuscitation.2011.01.028.
Abstract: Objective
To describe the consensus on science pertaining to resuscitation of the
pregnant patient.
Systematic review.
Data sources
EMBASE, Ovid MEDLINE, Evidence Based Reviews, American Heart Association
library and bibliographies of selected articles.
Review methods
The following inclusion criteria were used: pregnancy and cardiac arrest
out of hospital, pregnancy and cardiac arrest in hospital, cardiovascular,
respiratory, fetal survival, and pharmacology as they relate to cardiac
arrest and resuscitation. Non-English papers, case reports and reviews were
excluded. Studies were selected through an independent review of titles,
abstracts and full article. Two reviewers independently graded the
methodological quality of selected articles.
1305 articles were identified and 5 were selected for further review. There
were no randomized trials and overall the quality of the selected studies
was good. Two studies examined chest compressions on a manikin in left
lateral tilt from the horizontal and concluded that although feasible with
increasing degrees of tilt forcefulness of the chest compressions
decreases. The third study observed the transthoracic impedance was not
altered during pregnancy. One case series and one retrospective cohort
study reviewed perimortem cesarean section. Both reports concluded that
perimortem cesarean section is rarely done within the recommended time
frame of 5&#xa0;min after the onset of maternal cardiac arrest.
Usual defibrillation dosages are likely appropriate in pregnancy.
Perimortem cesarean section is an intervention which is rarely done within
5&#xa0;min to optimize maternal salvage from cardiac arrest. Chest
compressions in left lateral tilt are less forceful compared to the supine
Keywords: Cardiac arrest; Maternal resuscitation; Systematic review
Shannon K. de lEtoile, Responses to Infant-Directed Singing in Infants of
Mothers with Depressive Symptoms, The Arts in Psychotherapy, Available
online 19 May 2012, ISSN 0197-4556, 10.1016/j.aip.2012.05.003.
Abstract: This study explored responses to infant-directed (ID) singing in
infants of mothers with and without depressive symptoms under two
conditions: mother sings to infant, and stranger sings to infant. Sixteen,
3 to 9-month-old infants of mothers with depression were matched by age and
gender to sixteen infants of mothers without depression. Infant gaze
responses toward each singer were coded from video and ranged from most
negative to most positive, in the order of roaming, averted, neutral,
intermittent and sustained. Mothers depression status had no effect on
infant gaze response toward ID singing from mother or stranger. During ID
singing from mother, infants displayed high levels of either neutral or
sustained gaze. In response to ID singing from stranger, infants
demonstrated sustained gaze more than any other gaze type. Infants also
showed significantly more roaming and neutral gaze toward mother than
stranger, and used significantly more averted and sustained gaze with
stranger than mother. Findings indicate that infants of depressed mothers
did not display a depressed interaction style with their mother or with a
stranger during ID singing. Additionally, infants in both groups appeared
capable of discriminating their mother from a stranger. ID singing appears
to enhance face-to-face interaction such that infants can experience self-
regulation, even when mothers have depression. Findings support the idea of
combining ID singing and interaction coaching as a therapeutic intervention
for mothers with depression and their infants.
Keywords: Infant-directed singing; Maternal depression; infant gaze; Infant

Matthews Mathai, Working with communities, governments and academic

institutions to make pregnancy safer, Best Practice &amp; Research Clinical
Obstetrics &amp; Gynaecology, Volume 22, Issue 3, June 2008, Pages 465-476,
ISSN 1521-6934, 10.1016/j.bpobgyn.2008.02.002.
Abstract: The major medical causes of maternal death and the effective
interventions to prevent maternal death due to these causes are known. Yet,
every year, an estimated 529,000 women die during and following pregnancy
and childbirth. Most of these deaths occur in developing countries where
other non-medical determinants of maternal health influence the
accessibility to these interventions. Improvements in maternal health can
be achieved through a health systems approach. Care should be provided as a
continuum throughout the life cycle and across health facilities through
the health system. Communities, professional organizations and academic
institutions should work actively with the government to: provide a package
of service, based on population health needs, that is close to home; ensure
availability of essential medicines and commodities; address financial
barriers to receiving care; strengthen the health workforce; and gather and
use information to improve maternal health.
Keywords: academic institutions; community; continuum of care; government;
health systems; making pregnancy safer; maternal mortality

Nancy Donelan-McCall, John Eckenrode, David L. Olds, Home Visiting for the
Prevention of Child Maltreatment: Lessons Learned During the Past 20 Years,
Pediatric Clinics of North America, Volume 56, Issue 2, April 2009, Pages
389-403, ISSN 0031-3955, 10.1016/j.pcl.2009.01.002.
Abstract: For nearly two decades, home visitation has been promoted as a
promising strategy to prevent child maltreatment, but reviews of the
literature on home visiting programs have been mixed. This article examines
how home visitation for the prevention of child maltreatment has evolved
during the past 20 years. It reviews several home visitation programs
focused on preventing child maltreatment and highlights the Nurse-Family
Partnership home visitation program. It discusses how advocacy and public
policy for prevention of child maltreatment have shifted from a general
call to promote universal home visitation programs to a more refined
emphasis on promoting programs that are evidence-based, targeted to those
most at risk for maltreatment, and with infrastructure in place to ensure
implementation with fidelity to the model tested in trials. Finally, it
discusses how primary care providers may advocate to ensure that their
patients have access to evidence-based home visiting programs that meet
their needs.
Keywords: Home visiting; Child maltreatment; Prevention; Nurses; Policy;
Early childhood

Sachie Oshima, Kristi L. Kirschner, Allen Heinemann, Patrick Semik,

Assessing the knowledge of future internists and gynecologists in caring
for a woman with tetraplegia, Archives of Physical Medicine and
Rehabilitation, Volume 79, Issue 10, October 1998, Pages 1270-1276, ISSN
0003-9993, 10.1016/S0003-9993(98)90274-X.
Abstract: Objective: To assess the knowledge base and comfort level of
potential physician gatekeepers when treating women with spinal cord
injuries. Residents with at least 1 year of training in either internal
medicine (IM) or obstetrics and gynecology (Ob/Gyn) from a large academic
urban medical center were surveyed.

Study Design: This study used a written questionnaire that included a case
scenario of a young woman with C6 tetraplegia who presented to her primary
care physician for a routine visit. Information about the patient from her
history and physical and laboratory exams was presented in stages, followed
by open-ended queries to elicit information about the residents' problem-
solving processes and management strategies.

Results: Thirty-eight percent (30 of 79) of the IM residents and 64% (14 of
22) of the Ob/Gyn residents completed the questionnaire. Significant
deficits in knowledge about physical accessibility, spasticity management,
and potential disability-related medical complications in pregnancy were
found. More Ob/Gyn residents were aware of the risk of autonomic
hyperreflexia than IM residents, whereas the IM residents demonstrated
greater awareness of neurogenic bladder and skin problems. Both groups
indicated they were not very comfortable in managing the patient's care.

Conclusions: The results raise concern about the adequacy of the training
of primary care physicians to meet the needs of people with severe

Chaturaka Rodrigo, Senaka Rajapakse, HIV, poverty and women, International

Health, Volume 2, Issue 1, March 2010, Pages 9-16, ISSN 1876-3413,
Abstract: Summary
This review examines the interactions of financial status and HIV and its
implications for women. MEDLINE and Google scholar were searched using the
keywords women, poverty and HIV in any field of the article. The
search was limited to articles published in English over the last 10 years.
The first section of the article tries to establish whether poverty or
wealth is a risk factor for HIV. There is credible evidence for both
arguments. While wealth shows an increased risk for both sexes, poverty
places women at a special disadvantage. The second section explains how the
financial status interacts with other non biological factors to put women
at increased risk. While discrimination based on these factors disadvantage
women, there are some paradoxical observations that do not fit with the
traditional line of explanation (e.g. paradoxical impact of wealth and
education on HIV). The final section assesses the impact of HIV in driving
poverty and the role of women in interventional programmes. The specific
impact of poverty on females in families living with HIV is less explored.
Though microfinance initiatives to empower women are a good idea in theory,
the actual outcome of such a programme is less convincing.
Keywords: HIV; Poverty; Violence; Women; Gender norms; HAART

Shinya Ito, Amy Lee, Drug excretion into breast milkOverview, Advanced
Drug Delivery Reviews, Volume 55, Issue 5, 29 April 2003, Pages 617-627,
ISSN 0169-409X, 10.1016/S0169-409X(03)00034-6.
Abstract: Breastfeeding is the optimal form of infant feeding for the first
months of an infants life, and the majority of healthy women initiate
breastfeeding after the birth of their infant. However, women on medication
may default to formula feeding or not taking their drug therapy for fear of
exposing their infant to the medication through the breast milk. Although
the majority of medications are considered to be compatible with
breastfeeding, cases of significant infant toxicity exist, suggesting a
case by case risk assessment to be made before the mother initiates
breastfeeding or drug therapy. Unfortunately, current clinical risk
assessment is often compromised by the paucity of data, as studies in
breastfeeding women and their infants are ethically difficult to conduct.
Circumventing the ethical constraints, approaches have been proposed to
estimate drug excretion into milk from physicochemical characteristics of
the drug, which diffuses through the mammary gland epithelia. However, as
our understanding on drug transfer mechanisms increases, it has become
abundantly clear that carrier-mediated processes are involved with
excretion of a number of drugs into milk. This article provides an overview
of the benefits of breastfeeding, the effect of medication use during
breastfeeding on maternal decisions and infant health, and factors
determining infant exposure to medication through the breast milk.
Keywords: Adherence; Breastfeeding; Drug effect; Drug therapy; Drug
transfer; Human milk; Milk production; Neonate

Judith E Herwig, Markus Wirtz, Jrgen Bengel, Depression, partnership,

social support, and parenting: interaction of maternal factors with
behavioral problems of the child, Journal of Affective Disorders, Volume
80, Issues 23, June 2004, Pages 199-208, ISSN 0165-0327, 10.1016/S0165-
Abstract: Background: Children of depressed mothers are at elevated risk to
develop behavioral problems. Besides maternal depression, other risk
factors like interpersonal functioning, are discussed. The object of this
study was to investigate the predictive value of the maternal variables
depression, partnership, social support, and parenting for internal and
external behavioral problems of the children. Methods: A total of 100
mothers and their children who participated in a German motherchild
rehabilitation program were interviewed by questionnaire. Structural
equation modeling was conducted in order to determine the predictive value
of the mentioned maternal variables on behavioral problems of the children.
Results: Behavioral problems of the children can be predicted by the
parenting and the partnership of the mothers. Mothers with more parenting
difficulties and with less containment with partnership report more
behavioral problems of their children. Depression and social support do
indirectly predict the childs problems. Limitations: The data is from a
cross-sectional sample. Therefore, path models do not demonstrate
causation. All information is based upon maternal report. Conclusions:
These findings suggest the need for intervention programs which focus on
the parenting and the partnership of the mothers. More research with
independent assessment is needed.
Keywords: Mother; Children; Rehabilitation; Depression; Parenting

Ruth A. Lawrence, Robert M. Lawrence, Chapter 23 - Educating and training

the medical professional, Breastfeeding (Sixth Edition), Mosby,
Philadelphia, 2005, Pages 809-823, ISBN 9780323028233, 10.1016/B978-0-323-

B.E. Kwast, Building a community-based maternity program, International

Journal of Gynecology &amp; Obstetrics, Volume 48, Supplement, June 1995,
Pages S67-S82, ISSN 0020-7292, 10.1016/0020-7292(95)02321-3.
Abstract: The MotherCare Project has as its goal the reduction of maternal
and neonatal mortality and related morbidities, and the promotion of the
health of women and newborns. To achieve these goals, maternal and family
planning programs were strengthened in both rural and urban settings
through three intervention strategies policy reform, affecting behaviors
and improving services. The fundamental premise in each project was to
strengthen the weakest part of the maternity care pyramid, ensuring
linkages among all levels of service from community through to the
referral hospital level. In rural Andean populations of Bolivia, knowledge
of danger signs and women's response to them improved, increasing in use of
prenatal and family planning services through a participatory problem-
solving and community-based strategy. In West Java, Indonesia, bringing
professional midwifery services and facilities closer to women together has
resulted in a positive response to their use. Augmenting this intervention
with a transport and intercommunication system together with improved
hospital practice through perinatal mortality meetings and in-service
training for doctors and midwives has reduced the maternal and perinatal
mortality over a four year period. Hospital practice has improved in Uganda
and in two states of Nigeria, maternal mortality and morbidity have been
reduced in the training facility where seminars for physicians, training of
midwives in life saving midwifery and interpersonal communication skills
have taken place, and equipment and supplies have been improved.
Furthermore, in rural Guatemala, implementation of norms and protocols,
expert supervision and sensitization of hospital staff to the needs of the
community has increased referral by traditional birth attendants (TBAs) to
the hospital and reduced perinatal mortality.
Keywords: Maternal and perinatal mortality; Risk scoring; Maternity
services; Midwifery training; Referral

Maria Marino, Roberta Masella, Pamela Bulzomi, Ilaria Campesi, Walter

Malorni, Flavia Franconi, Nutrition and human health from a sexgender
perspective, Molecular Aspects of Medicine, Volume 32, Issue 1, February
2011, Pages 1-70, ISSN 0098-2997, 10.1016/j.mam.2011.02.001.
Abstract: Nutrition exerts a life-long impact on human health, and the
interaction between nutrition and health has been known for centuries. The
recent literature has suggested that nutrition could differently influence
the health of male and female individuals. Until the last decade of the
20th century, research on women has been neglected, and the results
obtained in men have been directly translated to women in both the medicine
and nutrition fields. Consequently, most modern guidelines are based on
studies predominantly conducted on men. However, there are many sexgender
differences that are the result of multifactorial inputs, including gene
repertoires, sex steroid hormones, and environmental factors (e.g., food
components). The effects of these different inputs in male and female
physiology will be different in different periods of ontogenetic
development as well as during pregnancy and the ovarian cycle in females,
which are also age dependent. As a result, different strategies have
evolved to maintain male and female body homeostasis, which, in turn,
implies that there are important differences in the bioavailability,
metabolism, distribution, and elimination of foods and beverages in males
and females. This article will review some of these differences underlying
the impact of food components on the risk of developing diseases from a
sexgender perspective.
Keywords: Nutrition; Health; Sex; Gender; Food; Beverage

Abdul Wahed Al Serouri, Arwa Al Rabee, Mohammed Bin Afif, Abdullah Al

Rukeimi, Reducing maternal mortality in Yemen: Challenges and lessons
learned from baseline assessment, International Journal of Gynecology &amp;
Obstetrics, Volume 105, Issue 1, April 2009, Pages 86-91, ISSN 0020-7292,
Abstract: Objective
The Yemen is a signatory of the Millennium Development Goals (MDGs) and one
of 10 countries chosen for the UN Millennium Project. However, recent MDG
progress reviews show that it is unlikely that the maternal health goal
will be reached by 2015 and Yemen still has an unacceptably high maternal
mortality of 365 per 100&#xa0;000 live births. Because 82% of deaths happen
intrapartum, the purpose of this needs assessment was to identify and
prioritize constraints in delivery of emergency obstetric care (EmOC).
Four district hospitals and 16 health centers in 8 districts were assessed
for functional capacity in terms of infrastructure; availability of
essential equipment and drugs; EmOC technical competency and training
needs; and Health Management Information System.
We found poor obstetric services in terms of structure (staffing pattern,
equipment, and supplies) and process (knowledge and management skills).
The data argue for strengthening the 4 interlinked health system elements
human resources, and access to, use, and quality of services. The
Government must address each of these elements to meet the Safe Motherhood
Keywords: Emergency obstetric care; Baseline assessment; Maternal
mortality; Millennium Development Goals; World Bank; Yemen

Janine Schooley, Christine Mundt, Pascale Wagner, Judith Fullerton, Mark

ODonnell, Factors influencing health care-seeking behaviours among Mayan
women in Guatemala, Midwifery, Volume 25, Issue 4, August 2009, Pages 411-
421, ISSN 0266-6138, 10.1016/j.midw.2007.07.011.
Abstract: Objective
to identify and better understand factors that influence care-seeking
behaviour for women's health among indigenous Mayan populations in the
highlands of Guatemala.
adaptation of qualitative anthropological methods involving observations,
key informant interviews and focus group discussions (FGDs).
Project Concern International's Casa Materna, Huehuetenango, Guatemala.
Interviews and FGDs were conducted among 21 clients (current or past) of
the Casa Materna and traditional birth attendants; 17 female
advocates/promoters of the Casa Materna and related services; and 12 male
advocates, including spouses, non-government organisation staff and
community health workers.
the following findings emerged from focus group data:
Women's support groups (WSGs) provided an enabling environment in which
women could form friendships, bond, discuss concerns about their
reproductive health, and identify concrete ways of addressing them;
Supportive friends, family members and advocates influenced women's
decisions to seek health care at the Casa Materna; Women's decisions to
seek care were often associated with their sense of self-worth and self-
esteem, and women's self-esteem was enhanced by their participation in the
WSGs; Women's decisions to seek care were influenced by the perception that
women would be able to access culturally appropriate, safe and secure
health care services at the Casa Materna; The learned behaviour of
negotiation with key decision-makers and/or opinion leaders was an
effective tool for convincing such individuals of the value of accessing
facility-based care; The proven track record, high quality of services and
cultural competence offered at the Casa Materna increased the confidence
and level of trust of clients and their family members about the care that
would be received; Couple-based education and health promotion were
effective techniques for achieving behaviour and attitude change among both
men and women.
Key conclusions
the Casa Materna and its community outreach strategy serve an essential
purpose in the provision of maternity care for the isolated and vulnerable
families of the Guatemalan highlands, by bridging traditional and Western
approaches to health care services. The Casa Materna service model plays a
critical role in improving women's self-efficacy and ultimately
strengthening the social fabric that characterises this high risk and
vulnerable population.
Implications for practice
the Casa Materna model provides a foundation upon which to bridge and
strengthen the relationship between community advocates, traditional
community-based health care providers, and the government-funded system of
health care. The findings of this study should be incorporated into future
research to determine the potential for bringing the model to scale.
Keywords: Maternal mortality; Birth centers; Maternity waiting home;
Perinatal care

Christine Wekerle, David A. Wolfe, Prevention of child physical abuse and

neglect: Promising new directions, Clinical Psychology Review, Volume 13,
Issue 6, 1993, Pages 501-540, ISSN 0272-7358, 10.1016/0272-7358(93)90044-M.
Abstract: Intervention studies targeting risk factors to child physical
abuse and neglect are reviewed. Programs that addressed parental competency
enhancement with a wide range of at-risk individuals, including new parents
and teen parents, formed the principal data base. Outcome evaluation
studies using an appropriate research methodology were identified from 1977
to 1990 (N = 34). Maternal global adjustment and child-rearing skills were
principal intervention targets, and significant gains were shown in these
areas across studies. The promotion of child cognitive development and
child behavioral competencies was a secondary target of intervention in
many studies. More modest gains in these child areas were found, especially
for behavioral competeneies. Programs that provided an individualized
approach were most successful, especially with parents considered to be at
greater risk of maltreatment. Base don these findings, specific strategies
to address identified needs of the parent, child, and family situation hold
the most promise for prevention, as opposed to nonspecific support and
assistance; however, evidence of long-term benefits is limited, and
indicators of actual maltreatment (e.g., child abuse reports) are rare and
unreliable. Theoretical constructs for consideration in the development and
evaluation of prevention strategies are discussed, as well as
methodological and applied issues.
Ian Norman, Two years into the job: An overview of published papers and
future directions, International Journal of Nursing Studies, Volume 44,
Issue 1, January 2007, Pages 1-8, ISSN 0020-7489,
Keywords: Review; Publication synthesis

Philip Blumenshine, Susan Egerter, Colleen J. Barclay, Catherine Cubbin,

Paula A. Braveman, Socioeconomic Disparities in Adverse Birth Outcomes: A
Systematic Review, American Journal of Preventive Medicine, Volume 39,
Issue 3, September 2010, Pages 263-272, ISSN 0749-3797,
Abstract: Context
Adverse birth outcomes, such as preterm birth and low birth weight, have
serious health consequences across the life course. Socioeconomic
disparities in birth outcomes have not been the subject of a recent
systematic review. The aim of this study was to systematically review the
literature on the association of socioeconomic disadvantage with adverse
birth outcomes, with specific attention to the strength and consistency of
effects across socioeconomic measures, birth outcomes, and populations.
Evidence acquisition
Relevant articles published from 1999 to 2007 were obtained through
electronic database searches and manual searches of reference lists.
English-language studies from industrialized countries were included if (1)
study objectives included examination of a socioeconomic disparity in a
birth outcome and (2) results were presented on the association between a
socioeconomic predictor and a birth outcome related to birth weight,
gestational age, or intrauterine growth. Two reviewers extracted data and
independently rated study quality; data were analyzed in 20082009.
Evidence synthesis
Ninety-three of 106 studies reported a significant association, overall or
within a population subgroup, between a socioeconomic measure and a birth
outcome. Socioeconomic disadvantage was consistently associated with
increased risk across socioeconomic measures, birth outcomes, and
countries; many studies observed racial/ethnic differences in the effect of
socioeconomic measures.
Socioeconomic differences in birth outcomes remain pervasive, with
substantial variation by racial or ethnic subgroup, and are associated with
disadvantage measured at multiple levels (individual/family, neighborhood)
and time points (childhood, adulthood), and with adverse health behaviors
that are themselves socially patterned. Future reviews should focus on
identifying interventions to successfully reduce socioeconomic disparities
in birth outcomes.

P. Bailey, A. Paxton, S. Lobis, D. Fry, Measuring progress towards the MDG

for maternal health: Including a measure of the health system's capacity to
treat obstetric complications, International Journal of Gynecology &amp;
Obstetrics, Volume 93, Issue 3, June 2006, Pages 292-299, ISSN 0020-7292,
Abstract: Objective
This paper argues for an additional indicator for measuring progress of the
Millennium Development Goal for maternal healththe availability of
emergency obstetric care.
MDG monitoring will be based on two indicators: the maternal mortality
ratio and the proportion of births attended by skilled personnel. Strengths
and weaknesses of a third indicator are discussed
The availability of EmOC measures the capacity of the health system to
respond to direct obstetric complications. Benefits to using this
additional indicator are its usefulness in determining an adequate
distribution of services and showing management at all levels what life-
saving interventions are not being provided, and stimulate thought as to
why. It can reflect programmatic changes over a relatively short period of
time and data requirements are not onerous.
A measure of strength of the health system is important since many
interventions depend on the health system for their implementation.
Keywords: Indicator; MDG; Maternal mortality

Julia A. Snethen, Marion E. Broome, Susan E. Cashin, Effective Weight Loss

for Overweight Children: A Meta-Analysis of Intervention Studies, Journal
of Pediatric Nursing, Volume 21, Issue 1, February 2006, Pages 45-56, ISSN
0882-5963, 10.1016/j.pedn.2005.06.006.
Abstract: Childhood overweight has increased in the United States. Success
of weight-loss programs has been limited (Barlow, S.E., &amp; Dietz, W.H.
(1998). Obesity evaluation and treatment: Expert committee recomendations.
Pediatrics, 102, e29.). The purpose of this investigation was to
systematically examine the effectiveness of weight-loss interventions for
children. For this meta-analysis, seven weight-loss intervention studies
were coded and quality index scores calculated. The interventions had a
significant positive effect on weight-loss average d = 0.95, with a 95%
confidence interval of 0.79 to 1.11. Limited interventional studies with
effective long-term maintenance of weight loss in children are available in
the literature. However, there are effective methods for weight loss in

Siv Mrkved, Chapter 10 - Evidence for pelvic floor physical therapy for
urinary incontinence during pregnancy and after childbirth, In: Kari B,
PT, MSc, PhD, Bary Berghmans, PT, MSc, PhD, Siv Mrkved, PT, MSc, PhD, and
Marijke Van Kampen, PT, MSc, PhD, Editor(s), Evidence-Based Physical
Therapy for the Pelvic Floor, Churchill Livingstone, Edinburgh, 2007, Pages
317-336, ISBN 9780443101465, 10.1016/B978-0-443-10146-5.50016-2.

Peter J. Blizard, Undergraduate medical education in Indonesia and its

relevance for the needs of primary health care services, Health Policy,
Volume 10, Issue 1, August 1988, Pages 77-109, ISSN 0168-8510,
Abstract: As a cumulative result of efforts made over the last 15 years,
Indonesian medical school teachers have developed and are implementing a
common core curriculum of undergraduate medical education in 14
government medical schools. This curric-ulum is based on explicit learning
objectives. The Indonesian Government requires that all new doctors must
work for between 3 and 5 years in a Primary Health Care (PHC) centre
immediately after graduation. Indonesian medical school teachers and
administrators have deliberately tried to shape the core curriculum to the
needs of PHC in their country. This study provides a detailed content
analysis of the core curriculum in an effort to estimate the relevance
of the core curriculum to the func-tions and tasks doctors are expected to
undertake at the PHC level of the Indone-sian health system. It is shown
that the core curriculum is largely relevant both in terms of its
framework and in its details. Some omissions from the curriculum are
noted. It is contended that the development of the core curriculum is but
the cul-mination of the many efforts at educational innovation and change
which have been attempted in Indonesia over the last 15 years; it is
contended that Indonesia's ex-perience shows that it is possible, even in a
well-established system of medical schools, for teachers to plan and
implement programmes of Community-Oriented Medical Education (COME); and,
finally, it is contended that medical teachers in other developing
countries who may wish to reorient their programmes of medical edu-cation
towards the needs of Primary Health Care would benefit from a careful ex-
amination of the approaches to this task which have been adopted by their
col-leagues in Indonesia.
Keywords: Medical education; Curriculum planning; Competency-based
curriculum; Primary health care; Indonesia

Barbara J. Rawlins, Young-Mi Kim, Aleisha M. Rozario, Eva Bazant, Tambudzai

Rashidi, Sheila N. Bandazi, Fannie Kachale, Harshad Sanghvi, Jin Won Noh,
Reproductive health services in Malawi: An evaluation of a quality
improvement intervention, Midwifery, Available online 12 November 2011,
ISSN 0266-6138, 10.1016/j.midw.2011.10.005.
Abstract: Objective
this study was to evaluate the impact of a quality improvement initiative
in Malawi on reproductive health service quality and related outcomes.
(1) post-only quasi-experimental design comparing observed service quality
at intervention and comparison health facilities, and (2) a time-series
analysis of service statistics.
sixteen of Malawi's 23 district hospitals, half of which had implemented
the Performance and Quality Improvement (PQI) intervention for reproductive
health at the time of the study.
a total of 98 reproductive health-care providers (mostly nursemidwives)
and 139 patients seeking family planning (FP), antenatal care (ANC), labour
and delivery (L&amp;D), or postnatal care (PNC) services.
health facility teams implemented a performance and quality improvement
(PQI) intervention over a 3-year period. Following an external
observational assessment of service quality at baseline, facility teams
analysed performance gaps, designed and implemented interventions to
address weaknesses, and conducted quarterly internal assessments to assess
progress. Facilities qualified for national recognition by complying with
at least 80% of reproductive health clinical standards during an external
verification assessment.
key measures include facility readiness to provide quality care, observed
health-care provider adherence to clinical performance standards during
service delivery, and trends in service utilisation.
intervention facilities were more likely than comparison facilities to have
the needed infrastructure, equipment, supplies, and systems in place to
offer reproductive health services. Observed quality of care was
significantly higher at intervention than comparison facilities for PNC and
FP. Compared with other providers, those at intervention facilities scored
significantly higher on client assessment and diagnosis in three service
areas, on clinical management and procedures in two service areas, and on
counselling in one service area. Service statistics suggest that the PQI
intervention increased the number of Caesarean sections, but showed no
impact on other indicators of service utilisation and skilled care.
the PQI intervention showed a positive impact on the quality of
reproductive health services. The effects of the intervention on service
utilisation had likely not yet been fully realized, since none of the
facilities had achieved national recognition before the evaluation. Staff
turnover needs to be reduced to maximise the effectiveness of the
Implications for practice
the PQI intervention evaluated here offers an effective way to improve the
quality of health services in low-resource settings and should continue to
be scaled up in Malawi.
Keywords: Performance improvement; Reproductive health; Maternal and child
health; Impact evaluation

Ruth A. Lawrence, Robert M. Lawrence, Chapter 23 - Educating and Training

the Medical Professional, Breastfeeding (Seventh Edition), W.B. Saunders,
Philadelphia, 2011, Pages 728-738, ISBN 9781437707885, 10.1016/B978-1-4377-

Chao-Hua Chuang, Pei-Jen Chang, Yi-Chun Chen, Wu-Shiun Hsieh, Baai-Shyun

Hurng, Shio-Jean Lin, Pau-Chung Chen, Maternal return to work and
breastfeeding: A population-based cohort study, International Journal of
Nursing Studies, Volume 47, Issue 4, April 2010, Pages 461-474, ISSN 0020-
7489, 10.1016/j.ijnurstu.2009.09.003.
Abstract: Background
In recent decades there has been a marked rise in the participation of
women with infants in the labour market, while there has been a decline in
the prevalence rate of breastfeeding.
To explore the relationship between maternal return to work and
An on-going prospective longitudinal study.
Setting and participants
Multistage stratified systematic sampling was designed to recruit 24,200
pairs, postpartum women and newborns, from the Taiwan national birth
register in 2005. Participating women underwent two home interviews at 6
and 18 months after giving birth, following structured questionnaires. A
total of 21,248 and 20,172 women were interviewed, and the completed
interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively.
All study participants provided informed consent as approved by the Ethics
Review Board of the National Taiwan College of Public Health.
The overall prevalence of initial breastfeeding was 83.7%. Postpartum women
returning to work less than or equal to 1 month had the lowest initiation
of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding
duration less than or equal to 1 month (34.9%) than the overall population
(26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started
breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12
months, respectively. Women with maternal leave of less than or equal to 6
months ceased breastfeeding earlier than those with maternal leave beyond 6
months and those who did not return to work up to 18 months after birth.
After adjustment for potential confounders, odds ratios of initial
breastfeeding seemed no different, except those for postpartum women who
returned to work less than or equal to 1 month and those who did not return
to work. Mothers returning to work within 1 year after giving birth were
significantly earlier in weaning than those without return to work.
In our study, an early maternal return to work, especial within 6 months
after giving birth, was a barrier to the initiation and continuation of
breastfeeding. Thus, a comprehensive strategy is required to encourage the
practice of breastfeeding in working women from pregnancy to the return to
work, and nurses should work to promote breastfeeding in the different
Keywords: Return to work; Maternity leave; Breastfeeding; Population-based
cohort study

A. Paxton, P. Bailey, S. Lobis, The United Nations Process Indicators for

emergency obstetric care: Reflections based on a decade of experience,
International Journal of Gynecology &amp; Obstetrics, Volume 95, Issue 2,
November 2006, Pages 192-208, ISSN 0020-7292, 10.1016/j.ijgo.2006.08.009.
Abstract: Objective
The paper reviews the experience with the EmOC process indicators, and
evaluates whether the indicators serve the purposes for which they were
originally created to gather and interpret relatively accessible data to
design and implement EmOC service programs.
We review experience with each of the 6 process indicators individually,
and monitoring change over time, at the level of the facility and at the
level of a region or country. We identify problems encountered in the field
with data collection and interpretation.
While they have strengths and weaknesses, the process indicators in general
serve the purposes for which they were developed. The data are easily
collected, but some data problems were identified. We recommend several
relatively minor modifications to improve data collection, interpretation
and utility.
The EmOC process indicators have been used successfully in a wide variety
of settings. They describe vital elements of the health system and how well
that system is functioning for women at risk of dying from major obstetric
Keywords: Emergency obstetric care; Process indicators; Program monitoring;
Maternal mortality

Marcia C Inhorn, Global infertility and the globalization of new

reproductive technologies: illustrations from Egypt, Social Science &amp;
Medicine, Volume 56, Issue 9, May 2003, Pages 1837-1851, ISSN 0277-9536,
Abstract: Infertility is a problem of global proportions, affecting on
average 812 percent of couples worldwide. In some societies, however
particularly those in the infertility belt of sub-Saharan Africaas many
as one-third of all couples are unable to conceive. Factors causing high
rates of tubal infertility in parts of the developing world include
sexually transmitted, postpartum, and postabortion infections; however,
male infertility, which is rarely acknowledged, contributes to more than
half of all cases. Unfortunately, the new reproductive technologies (NRTs)
such as in vitro fertilization (IVF), which are prohibitively expensive and
difficult to implement in many parts of the developing world, represent the
only solution to most cases of tubal and male infertility. Not
surprisingly, these technologies are rapidly globalizing to pronatalist
developing societies, where children are highly desired, parenthood is
culturally mandatory, and childlessness socially unacceptable. Using Egypt
as an illustrative case study, this paper examines five of the major forces
fueling the global demand for NRTs; these include demographic and
epidemiological factors, the fertilityinfertility dialectic, problems in
health care seeking, gendered suffering, and adoption restrictions.
Following this overview, a detailed examination of the implications of the
rapid global spread of NRTs to the developing world will be offered. By
focusing on Egypt, where nearly 40 IVF centers are in operation, this
article will demonstrate the considerable constraints on the practice and
utilization of NRTs in a developing country on the receiving end of
global reproductive technology transfer. The article concludes by stressing
the need for primary prevention of infections leading to infertility,
thereby reducing global reliance on NRTs.
Keywords: Infertility; New reproductive technologies; Gender;
Globalization; Global health; Egypt

Beverly Rossman, Breastfeeding Peer Counselors in the United States:

Helping to Build a Culture and Tradition of Breastfeeding, Journal of
Midwifery &amp; Women's Health, Volume 52, Issue 6, NovemberDecember 2007,
Pages 631-637, ISSN 1526-9523, 10.1016/j.jmwh.2007.05.006.
Abstract: Traditionally, women have relied upon the wisdom and experience
of other women to learn about mothering and breastfeeding. In the United
States, however, this once-standard mother-to-mother interaction was almost
nonexistent by the mid20th century. Recent advances in the understanding
of the benefits of breastfeeding for maternal and child health have led
most professional organizations to advocate breastfeeding as the norm of
infant feeding. Promotional breastfeeding efforts over the past 3 decades
include strategies to strengthen support for breastfeeding in the health
care system and in the community. Breastfeeding peer counseling represents
a model of mother-to-mother support which emerged in the 1980s as a
community-based resource to provide mothers with the support and assistance
needed to establish and maintain breastfeeding in the early weeks and
months postpartum. This article describes the role, training, and
effectiveness of breastfeeding peer counselors and discusses ways that
mothers and peer counselors might benefit from the connection and
relationship that develops between the breastfeeding mother and her peer
counselor. An exemplar of a breastfeeding peer counseling program is
Keywords: breastfeeding; mother-to-mother support; peer counseling; peer

Constance Williams, David Munson, John Zupancic, Haresh Kirpalani,

Supporting bereaved parents: practical steps in providing compassionate
perinatal and neonatal end-of-life care A North American perspective,
Seminars in Fetal and Neonatal Medicine, Volume 13, Issue 5, October 2008,
Pages 335-340, ISSN 1744-165X, 10.1016/j.siny.2008.03.005.
Abstract: Summary
Providing compassionate bereavement support challenges care-givers in
perinatal medicine. A practical and consistent approach tailored to
individual families may increase the care-giver's ability to relieve
parental grief. This approach includes: (1) clear and consistent
communication compassionately delivered; (2) shared decision-making; (3)
physical and emotional support; and (4) follow-up medical, psychological
and social care. Challenges to providing comprehensive end-of-life care
include care-giver comfort, consistency of care, cultural and legal
barriers, and lack of adequate training.
Keywords: Perinatal bereavement; End-of-life care; Neonatal intensive care;
Ethics; Parental involvement

Lauren B. Levy, Michael W. O'Hara, Psychotherapeutic interventions for

depressed, low-income women: A review of the literature, Clinical
Psychology Review, Volume 30, Issue 8, December 2010, Pages 934-950, ISSN
0272-7358, 10.1016/j.cpr.2010.06.006.
Abstract: Low-income women have very high rates of depression and also face
a number of unique barriers that can prevent them from seeking, accepting,
engaging in, or benefiting from psychotherapy treatment. Untreated
depression often leads to deleterious psychological consequences for these
women and their children, and may also diminish a woman's ability to
improve her economic circumstances. We reviewed the literature on
psychotherapeutic interventions for depressed, low-income women,
identifying a number of practical, psychological, and cultural barriers
that often prevent them from engaging in psychotherapy. Next, we assessed
the degree to which established intervention programs help women overcome
these barriers. The data suggest that it is quite difficult to engage
depressed, low-income women in psychotherapy, but that a number of standard
psychotherapy approaches do show promise. However, we found that many of
the currently available interventions fail to fully address the barriers
that prevent this population from engaging in treatment. Moreover, the
impact these interventions have on engagement and attrition rates or
clinical improvements is often inadequately reported. We provide
preliminary recommendations for clinicians who work with low-income women
as well as suggestions for bolstering the literature base.
Keywords: Low-income; Psychotherapy; Depression

Douglas Almond, Janet Currie, Chapter 15 - Human Capital Development before

Age Five, In: Orley Ashenfelter and David Card, Editor(s), Handbook of
Labor Economics, Elsevier, 2011, Volume 4, Part B, Pages 1315-1486, ISSN
1573-4463, ISBN 9780444534521, 10.1016/S0169-7218(11)02413-0.
Abstract: This chapter seeks to set out what economists have learned about
the effects of early childhood influences on later life outcomes, and about
ameliorating the effects of negative influences. We begin with a brief
overview of the theory which illustrates that evidence of a causal
relationship between a shock in early childhood and a future outcome says
little about whether the relationship in question is biological or
immutable. We then survey recent work which shows that events before five
years old can have large long term impacts on adult outcomes. Child and
family characteristics measured at school entry do as much to explain
future outcomes as factors that labor economists have more traditionally
focused on, such as years of education. Yet while children can be
permanently damaged at this age, an important message is that the damage
can often be remediated. We provide a brief overview of evidence regarding
the effectiveness of different types of policies to provide remediation. We
conclude with a list of some of the many outstanding questions for future
Keywords: Human capital; Early childhood; Health; Fetal origins

Theresa O. Scholl, 8 - Puberty and Adolescent Pregnancy, In: Marlene B.

Goldman and Maureen C. Hatch, Editor(s), Women and Health, Academic Press,
San Diego, 2000, Pages 85-98, ISBN 9780122881459, 10.1016/B978-012288145-
Abstract: Puberty is a time of life that is characterized by maturation of
the hypothalamic-pituitary-gonadal axis, accelerated physical growth, and
the development of the secondary sexual characteristics. The underlying
mechanism that gives rise to these changes is not known. Physical
modifications, however, are part of the complex alteration that takes
place. The growth spurt modifies the size and shape of almost every bodily
dimensionthe face grows and markedly alters, the heart, lungs, viscera,
and reproductive tract all expand in size, weight, and volume. The skeleton
(long bones, vertebrae), musculature, and, in females, the fat mass also
increase. In the end, a girl will be transformed physically in a woman-
adult in the size, shape, and composition of her body, with mature
secondary sexual characteristics, and she is likely to be sexually active
and capable of reproduction. The ages at which the growth spurt commences,
breasts begin to bud (thelarche), pubic hair first appears (pubarche), and
menarche (first menstrual bleeding) starts vary by nearly a third of the
life span of a prepubertal girl.
Cynthia Farquhar, Lynn Sadler, Vicki Masson, Gillian Bohm, Alastair Haslam,
Beyond the numbers: classifying contributory factors and potentially
avoidable maternal deaths in New Zealand, 20062009, American Journal of
Obstetrics and Gynecology, Volume 205, Issue 4, October 2011, Pages 331.e1-
331.e8, ISSN 0002-9378, 10.1016/j.ajog.2011.07.044.
Abstract: Objective
We sought to describe a new classification system for contributory factors
in, and potential avoidability of, maternal deaths and to determine the
contributory factors and potential avoidability among 4 years of maternal
deaths in New Zealand.
Study Design
A new classification system for reporting contributory factors in all
maternal deaths was developed from previous tools and applied to all
maternal deaths in New Zealand from 2006 through 2009.
There were 49 deaths and the maternal mortality ratio was 19.2/100,000
maternities. Contributory factors were identified in 55% of cases. An
expert panel identified 35% of maternal deaths as potentially avoidable. In
cases where potential avoidability was determined, there were nearly always
2 or 3 domains where contributory factors were identified.
Almost one third of maternal deaths in New Zealand can be considered to be
potentially avoidable. This methodology has the potential to identify areas
for improvement in the quality of maternity care.
Keywords: maternal death; mortality review; potentially avoidable factors;
quality improvement

Aluisio Cotrim Segurado, Vera Paiva, Rights of HIV Positive People to

Sexual and Reproductive Health: Parenthood, Reproductive Health Matters,
Volume 15, Issue 29, Supplement, May 2007, Pages 27-45, ISSN 0968-8080,
Abstract: In many areas of the globe most HIV infection is transmitted
sexually or in association with pregnancy, childbirth and breastfeeding,
raising the need for sexual and reproductive health and HIV/AIDS
initiatives to be mutually reinforcing. Many people with HIV, who are in
good health, will want to have children, and highly active antiretroviral
therapy provides women and men living with AIDS the possibility of
envisaging new life projects such as parenthood, because of a return to
health. However, there are still difficult choices to face concerning
sexuality, parenthood desires and family life. Structural, social and
cultural issues, as well as the lack of programmatic support, hinder the
fulfilment of the right to quality sexual and reproductive health care and
support for having a family. This paper addresses the continuum of care
involved in parenthood for people living with HIV, from pregnancy to infant
and child care, and provides evidence-based examples of policies and
programmes that integrate sexual and reproductive health interventions with
HIV/AIDS care in order to support parenthood. Focusing on parenthood for
people living with and affected by HIV, that is, focusing on the couple
rather than the woman as the unit of care, the individual or the set of
adults who are responsible for raising children, would be an innovative
programmatic advance. Going beyond maternal and child health care to
providing care and support for parents and others who are responsible for
raising children is especially relevant for those living with HIV
Keywords: HIV/AIDS; parenthood; antenatal care; delivery care; post-partum
care; infant care; infant feeding

Stephen Thielke, Steven Vannoy, Jrgen Untzer, Integrating Mental Health

and Primary Care, Primary Care: Clinics in Office Practice, Volume 34,
Issue 3, September 2007, Pages 571-592, ISSN 0095-4543,
Abstract: Mental health and primary care delivery systems have evolved to
operate differently. For example, attention to multiple medical issues,
health maintenance, and structured diagnostic procedures are standard
elements of primary care rarely incorporated into mental health care. A
multidisciplinary treatment approach, group care, and case management are
common features of mental health treatment settings only rarely used in
primary care practices. Advances in treatments for mental health disorders
and increased knowledge of the integral link between mental health and
physical health encourage mental health disorder treatment in primary care
settings, which reach the most patients. Effective integration of mental
health care into primary care requires systematic and pragmatic change that
builds on the strengths of both mental health and primary care.

Clarissa Bonanno, Sreedhar Gaddipati, Mechanisms of Hemostasis at Cesarean

Delivery, Clinics in Perinatology, Volume 35, Issue 3, September 2008,
Pages 531-547, ISSN 0095-5108, 10.1016/j.clp.2008.07.007.
Abstract: Postpartum hemorrhage is an obstetric emergency that represents a
major cause of maternal morbidity and mortality. With the recent rise in
the cesarean delivery rate, prompt recognition and proper management at the
time of cesarean delivery are becoming increasingly important for providers
of obstetrics. Preparedness for hemorrhage can be achieved by recognition
of prior risk factors and implementation of specific hemorrhage protocols.
Medical and surgical therapies are available to treat obstetric hemorrhage
after cesarean delivery.
Keywords: Hemostasis; Hemorrhage; Cesarean delivery; Uterine atony; Medical
therapy; Uterotonic agents; Surgical therapy

M. Bellad, T. D, M. Ganachari, M. Mallapur, O110 Sublingual (SL) powdered

misoprostol (400 mcg) vs IM oxytocin (10 IU) for prevention of postpartum
blood loss a randomized controlled trial, International Journal of
Gynecology &amp; Obstetrics, Volume 107, Supplement 2, October 2009, Pages
S124-S125, ISSN 0020-7292, 10.1016/S0020-7292(09)60482-3.

Shalini Bharat, Vaishali Sharma Mahendra, Meeting the Sexual and

Reproductive Health Needs of People Living with HIV: Challenges for Health
Care Providers, Reproductive Health Matters, Volume 15, Issue 29,
Supplement, May 2007, Pages 93-112, ISSN 0968-8080, 10.1016/S0968-
Abstract: A trained health service workforce is critical to ensuring good
quality service delivery to people with HIV. There is only limited
documented information on the challenges and constraints facing health care
providers in meeting the sexual and reproductive health needs of HIV
positive women and men. This paper reviews information on providers'
attitudes, motivation and level of preparedness in addressing the sexual
and reproductive health needs of people living with HIV in the context of
the human resources crisis and emerging treatment and prevention
strategies. There is a need for significant investment in improving the
health infrastructure and providers' ability to take universal precautions
against infection in health care settings. Additionally, there is need for
comprehensive and appropriate training for health care providers to build
their capacity to meet the requirements and expectations of different sub-
populations of HIV positive people. This includes not only physicians but
also nurses and midwives, who are the primary caregivers for most of the
population in many resource-poor settings. Supportive and knowledgeable
providers are crucial for helping HIV positive people seek and adhere to
treatment, prevent sexually transmitted infections, unintended pregnancies
and vertical transmission of HIV and support positive living free from
stigma and discrimination. Providers, some of whom may themselves be HIV
positive, can make an important difference, especially if they are
supported in their working conditions, are knowledgeable about HIV and
sexual and reproductive health and have the skills to provide good quality
Keywords: health care providers; sexual and reproductive health services;
HIV/AIDS; training of service providers; providerpatient relations

Carol Sakala, Medically unnecessary cesarean section births: Introduction

to a symposium, Social Science &amp; Medicine, Volume 37, Issue 10,
November 1993, Pages 1177-1198, ISSN 0277-9536, 10.1016/0277-9536(93)90331-
Abstract: Between 1965 and 1986, the United States cesarean section rate
increased from 4.5 to 24.1%. Increasingly, childbearing women and their
advocates, along with many others, have recognized that a large proportion
of cesareans confers a broad array of risks without providing any medical
benefit. A growing literature examines the diverse causes of medically
unnecessary cesareans and the diverse effects of surgical birth on women,
infants, and families. Various programs and policies have been proposed or
implemented to reduce cesarean rates.

In recent decades, many other nations have also experienced a sharply

escalating cesarean section rate. It is reasonable to conclude that a
largely uncontrolled international pandemic of medically unnecessary
cesarean births is occurring. The level of political, analytic, and
programmatic activity that has occurred in the U.S. regarding medically
unnecessary surgical births does not seem to be paralleled in other nations
with sharply escalating rates.

This symposium was organized with the objective of presenting the U.S.
experience with various dimensions of the problem of medically unnecessary
cesareans to an international audience. Although preliminary and
inadequate, it is hoped that this experience will encourage policy leaders
and investigators throughout the world to recognize and address the problem
of run-away cesarean section births.

The first section of this introduction summarizes the U.S. experience with
medically unnecessary cesareans from the perpective of trends, causes,
consequences, and solutions. The second section covers the same topics,
presenting selected material from various other nations throughout the
world. In the course of these overviews, I introduce the symposium's seven
contributions, most of which focus on circumstances in the U.S.
Keywords: cesarean section; U.S.; cesarean section international trends;
cesarean section medically unnecessary; cesarean section pandemic

Matthew P Longnecker, Howard J Hoffman, Mark A Klebanoff, John W Brock,

Haibo Zhou, Larry Needham, Tilahun Adera, Xuguang Guo, Kimberly A Gray, In
utero exposure to polychlorinated biphenyls and sensorineural hearing loss
in 8-year-old children, Neurotoxicology and Teratology, Volume 26, Issue 5,
SeptemberOctober 2004, Pages 629-637, ISSN 0892-0362,
Abstract: Early-life exposure to polychlorinated biphenyls (PCBs), a
ubiquitous environmental contaminant, increases the hearing threshold at
selected frequencies in rats. Among humans from the Faroe Islands with
unusually high early-life PCB exposure, exposure was directly associated
with increased hearing thresholds at two frequencies, although the deficits
were present in the left ear but not the right. We examined PCB levels in
maternal pregnancy serum in relation with audiometrically determined
hearing thresholds among offspring when they were of school age. Complete
data were available for 195 children with sensorineural hearing loss (SNHL)
and 615 children selected at random, all of whom were born in 19591966 in
the Collaborative Perinatal Project (CPP) U.S. cohort. The median exposure
among those selected at random, as reflected by the mother's third
trimester serum total PCB concentration, was 2.8 g/l, about twofold higher
than recent background levels in the United States. Based on the average
hearing threshold across the frequencies essential for speech recognition
in the worst ear, the maternal serum PCB level was unrelated to the
adjusted odds of SNHL or to adjusted mean hearing threshold. Overall, an
adverse effect of early-life, background-level PCB exposure on SNHL was not
supported by these data.
Keywords: Polychlorinated biphenyls; Sensorineural hearing loss;
Audiometry; Children

T. Ostler, B. Ackerson, Parental Chronic Mental Illness, In: Editors-in-

Chief: Marshall M. Haith and Janette B. Benson, Editor(s)-in-Chief,
Encyclopedia of Infant and Early Childhood Development, Academic Press, San
Diego, 2008, Pages 479-490, ISBN 9780123708779, 10.1016/B978-012370877-
Abstract: This article provides an overview of the effects of parental
chronic mental illness on parenting and on the development and well-being
of infants and young children. The article describes various types of
chronic mental illness and discusses how illness symptoms can contribute to
parenting risk. A model for understanding how chronic parental mental
illness can effect child development is then presented followed by a
synthesis of findings on the outcomes of young children who are reared by a
parent with a chronic mental illness. Attention is given to maternal mental
illnesses in the peripartum period.
Keywords: Anxiety disorders; Child development; Chronic mental illness;
Infants; Parenting; Postpartum depression; Postpartum psychosis; Young

Ruth A. Lawrence, Robert M. Lawrence, Chapter 13 - Maternal employment,

Breastfeeding (Sixth Edition), Mosby, Philadelphia, 2005, Pages 461-477,
ISBN 9780323028233, 10.1016/B978-0-323-02823-3.50018-8.

Ying Lau, Yuqiong Wang, Lei Yin, Kin Sun Chan, Xiujing Guo, Validation of
the Mainland Chinese version of the Edinburgh Postnatal Depression Scale in
Chengdu mothers, International Journal of Nursing Studies, Volume 47, Issue
9, September 2010, Pages 1139-1151, ISSN 0020-7489,
Abstract: Background
The Mainland Chinese version of the Edinburgh Postnatal Depression Scale
(EPDS) has been validated among antenatal women, subsequent validation
among postnatal women is necessary.
This study investigated the prevalence of postnatal depression and the
psychometric characteristics of the Mainland Chinese version of the EPDS
among postnatal women.
Two studies were used for validating the EPDS with specific aims. Study I
established the psychometric properties of the EPDS by examining the
convergent, discriminant and construct validity, internal consistency and
stability of the scale. Study II established its sensitivity, specificity
and the optimal cut-off score of the EPDS according the DSM-IV-TR criteria
using the Structured Clinical Interview.
: Four regional public hospitals in Chengdu.
: A convenience sample was composed of 300 and 342 postnatal women in study
I and II, respectively.
A receiver operating characteristic (ROC) analysis was carried out to
evaluate the global functioning of the scale. The Beck Depression Inventory
(BDI), Dyadic Adjustment Scale (DAS) and standard SF-12 Health Survey (SF-
12) were used to investigate the convergent, discriminant and construct
validity. An exploratory factor analysis was used to investigate the
structural validity of the scale. Confirmatory factor analysis (CFA) was
tested the proposed factor module by Linear Structural Relations (LISREL).
The Cronbach's alpha reliability coefficient, split-half reliability and
test-retest reliability were used to examine the internal consistency and
stability of the scale.
The prevalence of postnatal depression was 4.7%. Structural validity
revealed a three-factor structure for the EPDS and the CFA showed a good
overall fit of this three-factor model. Convergent and construct validity
was supported and discriminant validity suggested that the EPDS
successfully discriminated among the nondepressed, mildly and clinically
depressed groups. The area under curve (AUC) was 89.6% and the logistic
estimate for the threshold score was 10.5 (sensitivity, 81.25%;
specificity, 80.67%) for clinical depression. The split-half reliability of
the EPDS was 0.74, Cronbach's alpha was 0.78 and test-retest reliability
was 0.90.
Our data confirm the validity of the Mainland Chinese version of EPDS in
identifying postnatal depression among postnatal women in Chengdu by using
&gt;10 cut-off point. Because of its brevity and acceptability, it is
recommended that the EPDS be used in routine postnatal screening.
Keywords: Mainland Chinese version of the EPDS; Factor analysis; ROC
analysis; Sensitivity; Specificity

Debra S Penney, Jeanne Raisler, Meeting womens health needs in Yemen: a

midwifery perspective, Journal of Midwifery &amp; Women's Health, Volume
45, Issue 1, JanuaryFebruary 2000, Pages 72-78, ISSN 1526-9523,
Abstract: Maternal mortality in Yemen is one of the highest in the world.
Reaching the rural majority of the population with primary health care
services has been a continual priority for the nation. Despite efforts to
expand health services, access to maternal and child health care remains
low. The training of community midwives nationwide has been undertaken
recently to address the need for maternal and child health services,
particularly in rural areas. Several lessons have been gained through this
initial training that will improve future efforts.

Ricky Finzi-Dottan, Yael Segal Triwitz, Pavel Golubchik, Predictors of

stress-related growth in parents of children with ADHD, Research in
Developmental Disabilities, Volume 32, Issue 2, MarchApril 2011, Pages
510-519, ISSN 0891-4222, 10.1016/j.ridd.2010.12.032.
Abstract: This study was designed to investigate stress-related growth in
71 parents of children with ADHD, compared with 80 parents of non-clinical
children. Adopting Tedeschi and Calhoun's (2004) theoretical framework for
predicting personal growth, the study investigated the contribution of
emotional intelligence (individual characteristics), social support
(environmental factors), parental self-efficacy and perceptions of
parenting as a challenge vs. a threat (cognitive processing). Results
indicated that emotional intelligence was the main predictor of stress-
related growth, particularly for parents of ADHD children, emphasizing that
this personal trait is especially relevant to coping with on-going parental
strain; whereas social support made a greater contribution to growth for
the control group than for parents of children with ADHD. Path analysis
confirmed our research model, suggesting that parents sense of competence
and of parenthood as a challenge vs. a threat mediates between emotional
intelligence and social support on the one hand, and growth on the other.
Keywords: Children with ADHD; Emotional intelligence; Perceiving
parenthood; Social support; Stress-related growth

Truls stbye, Katrina M. Krause, Marissa Stroo, Cheryl A. Lovelady,

Kelly R. Evenson, Bercedis L. Peterson, Lori A. Bastian, Geeta K. Swamy,
Deborah G. West, Rebecca J.N. Brouwer, Nancy L. Zucker, Parent-focused
change to prevent obesity in preschoolers: Results from the KAN-DO study,
Preventive Medicine, Available online 13 June 2012, ISSN 0091-7435,
Abstract: Objective
The study presents the immediate post-intervention results of Kids and
Adults Now Defeat Obesity!, a randomized controlled trial to enhance
healthy lifestyle behaviors in motherpreschooler (25&#xa0;years
old) dyads in North Carolina (20072011). The outcomes include change
from baseline in the child's diet, physical activity and weight, and in the
mother's parenting behaviors, diet, physical activity, and weight.
The intervention targeted parenting through maternal emotion regulation,
home environment, feeding practices, and modeling of healthy behaviors. 400
mother-child dyads were randomized.
Mothers in the intervention arm, compared to the control arm, reduced
instrumental feeding (&#xa0;0.24 vs. 0.01, p&#xa0;&lt;&#xa0;0.001) and
TV snacks (.069 vs. &#xa0;0.24, p&#xa0;=&#xa0;0.001). There were
also improvements in emotional feeding (p&#xa0;=&#xa0;0.03), mother's
sugary beverage (p&#xa0;=&#xa0;0.03) and fruit/vegetable
(p&#xa0;=&#xa0;0.04) intake, and dinners eaten in front of TV
(p&#xa0;=&#xa0;0.01); these differences were not significant after
adjustment for multiple comparisons.
KAN-DO, designed to maximize the capacity of mothers as agents of change,
improved several channels of maternal influence. There were no group
differences in the primary outcomes, but differences were observed in the
parenting and maternal outcomes and there were trends toward improvement in
the preschoolers' diets. Long-term follow-up will address whether these
short-term trends ultimately improve weight status.
Keywords: Obesity; Randomized controlled trial; Parenting; Emotion
regulation; Physical activity; Dietary intake

Jennifer Hall, Effective community-based interventions to improve exclusive

breast feeding at four to six months in low- and lowmiddle-income
countries: a systematic review of randomised controlled trials, Midwifery,
Volume 27, Issue 4, August 2011, Pages 497-502, ISSN 0266-6138,
Abstract: Background
only about 25% of babies are exclusively breast fed until six months of age
in developing countries and, given their greater risk of infection and
infant mortality, there is a need to investigate ways of increasing this.
The aim of this review is to assess the effectiveness of community-based
interventions to improve the rates of exclusive breast feeding at four to
six months in infants in low- and lowmiddle-income countries.
a systematic review of literature identified through searches of Medline,
Global Health and CINAHL databases to identify randomised controlled trials
of community-based interventions to improve the rate of exclusive breast
feeding in low- and lowmiddle-income countries.
four studies, from four different countries, were included in the final
review. Although they evaluated slightly different interventions, all
showed a significant improvement in the rate of exclusive breast feeding
with a pooled odds ratio of 5.90 (95% confidence interval 1.8118.6) on
random effects meta-analysis.
community-based interventions in low- and lowmiddle-income countries can
substantially increase the rates of exclusive breast feeding and are
therefore a viable option. The interventions included in the review varied,
indicating that there are a number of ways in which this might be achieved;
it is recommended that these are used as a starting point for determining
the most appropriate intervention with regard to the setting. Given the
importance of this issue, the lack of research in the area is surprising.
The studies in the review demonstrate that good-quality randomised
controlled trials of this area are possible and should encourage further
Keywords: Systematic review; Exclusive breast feeding; Community-based
intervention; Developing countries

Monica Sarfi, Lars Smith, Helge Waal, Jon Martin Sundet, Risks and
realities: Dyadic interaction between 6-month-old infants and their mothers
in opioid maintenance treatment, Infant Behavior and Development, Volume
34, Issue 4, December 2011, Pages 578-589, ISSN 0163-6383,
Abstract: A number of studies point to methadone exposure in utero as a
possible risk factor in the developing motherinfant relationship in the
first year of life. This study is part of a larger, national follow-up of
38 infants prenatally exposed to methadone or buprenorphine and 36
comparison, low-risk infants. The aim of the present paper is to assess the
quality of motherinfant relationship when the infants are 6 months old.
Videotaped motherinfant interactions were rated in a global scale (NICHD).
Maternal and infant contributions collapsed into the variables infant
style and maternal style showed that the only factor making significant
contribution to the outcome measure dyadic mutuality was maternal style.
The importance of group membership (exposed versus non-exposed), was
reduced when controlling for maternal drug use prior to opioid maintenance
treatment (OMT), maternal depression and parenting stress as well as
infants developmental status and sensory-integrative functions. This
suggests that prediction of dyadic mutuality should be based on individual
characteristics rather than group characteristics. These results support
previous research findings that methadone and buprenorphine use per se does
not have direct influence on the quality of early motherinfant
relationship, but tailored follow-up procedures targeting drug-free
pregnancies and parenting support are beneficial for women in OMT and their
Keywords: Opioid maintenance treatment; Motherinfant relationship; Dyadic

S.T. Truitt, A.B. Fraser, D.A. Grimes, M.F. Gallo, K.F. Schulz, Hormonal
contraception during lactation: systematic review of randomized controlled
trials, Contraception, Volume 68, Issue 4, October 2003, Pages 233-238,
ISSN 0010-7824, 10.1016/S0010-7824(03)00133-1.
Abstract: Contraception choices may be limited for lactating women due to
concerns about hormonal effects on quality and quantity of milk, passage of
hormones to the infant and infant growth. We conducted a systematic review
of randomized controlled trials to determine the effect of hormonal
contraception on lactation. We sought all randomized controlled trials,
reported in any language, that included any form of hormonal contraception
compared with another form of hormonal contraception, nonhormonal
contraception or placebo during lactation. Seven reports from five
randomized controlled trials met the inclusion criteria. Most of the five
trials did not specify their method used to generate a random sequence,
method of allocation concealment, blinding of treatments or use of an
intention-to-treat analysis. Additionally, high loss-to-follow-up rates
invalidated at least two trials. The findings from two trials comparing
oral contraceptives to placebo during lactation were conflicting. Another
trial found no inhibitory effects on lactation from progestin-only
contraceptives. Finally, the World Health Organization trial found a
statistically significant decline in breast milk volume in women using