ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00832.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground:Intrapartum epidural analgesia has become increasingly popular because it is the most effective method of providing pain relief during labor. Much attention is given to its safety and efficacy, and many health care providers and consumers are unaware of its potential drawbacks. This article reviews the literature about the effects of epidural analgesia on the mother and infant.Methods:We performed a computer‐assisted MEDLINE search for articles and a review of bibliographies from articles on epidural analgesia. When reported data were incomplete, authors were contacted for more detailed information.Results:The most common procedure‐related complications, hypotension, inadvertent dural puncture, and headache, are easily treated and usually self‐limited. Permanent morbidity and mortality are rare. Retrospective studies and randomized controlled trials both demonstrate that epidural analgesia is associated with increases in duration of labor, instrument vaginal delivery, and cesarean birth. To date only three trials randomized patients to narcotic versus epidural groups, and all showed a twofold to threefold increase in cesarean section for dystocia. Limiting epidural use in nulliparous labor and delaying its placement until after 5 cm of cervical dilation may reduce the risk of operative intervention for dystocia. Epidural analgesia may also increase intervention for fetal distress. Several studies show its association with maternal fever in labor. Its association with chronic back pain, neonatal behavioral changes, and maternal‐infant bonding are more tenuous and require further study.Conclusions:Epidural analgesia is a safe and effective method of relieving pain in labor, but is associated with longer labor, more operative intervention, and increases in cost. It must remain an option; however, caregivers and consumers should be aware of associated risks. Women should be counseled about these risks and other pain‐relieving options before the duress

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00833.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground:Improving pregnancy outcomes for minorities is a major goal of health providers and policy makers. Since most strategies involve an intervention during pregnancy, it is important to know where minority women with various characteristics receive prenatal care and why. Our purpose was to evaluate services of prenatal care for white, African‐American, Mexican‐American, and Puerto Rican women.Methods:The National Maternal and Infant Health Survey (1988) was used to ascertain age, income, marital status, education level, and source of funding of the study population of 21,000 women, who were assigned to an ethnic group based on self‐identification in the survey. The sources of prenatal care were classified as private (private physician, nurse‐midwife, health maintenance organization) or public (state or local health department, community health center, hospital‐based clinic).Results:When categorized by ethnic group alone, 78 percent of white women received private care compared with 51 percent of Mexican‐American women, 44 percent of African‐American women, and 37 percent of Puerto Rican women. Private health insurance was held by 78 percent of white, 50 percent of African‐American, 49 percent of Mexican‐American, and 47 percent of Puerto Rican women. Of those with private insurance, 86, 62, 69, and 59 percent, respectively, received private care. Of white women with Medicaid funding, 52 percent received private care as opposed to a range of 20 to 42 percent for minority women.Conclusions:Substantial differences in sources of prenatal care exist between white and minority women and between different minority groups, suggesting that policy makers and health caregivers should tailor prenatal care intervention to the needs of specific min

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00834.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground:Nipple soreness is one reason why breastfeeding women wean their infants. This study examined the effectiveness of three topical agents—USP‐modified lanolin, warm water compresses, and expressed breast milk with air drying—in alleviating nipple pain, and if early predictors of breastfeeding at six weeks could be determined.Methods:One hundred seventy‐seven breastfeeding, primiparous women were randomly assigned to one of four groups. All women received education about breastfeeding technique. Numeric rating scales were used to discriminate levels of pain intensity, pain affect, and strength of sucking on day 1. Participants were interviewed by telephone on postpartum days 4, 7, and 14, and during week 6 using the same scales.Results:No significant differences were found among groups for pain intensity, pain affect, or duration of breastfeeding. Results of a logistic regression indicated that older mothers and those who were exclusively breastfeeding (no supplemental feeding) were most likely to be breastfeeding six weeks postpartum. Raw scores supported the use of warm compresses.Conclusion:Further investigation is required into ways of supporting young mothers and how caregivers provide support to breastfeeding mothers in the early weeks after chi

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00835.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground:Until recently, Canada was the only industrialized country that had not legalized midwifery. In the province of Quebec the government adopted a law to evaluate midwifery in eight pilot projects before generalizing the practice. This study examined the similarities and differences among midwives in Quebec.Methods:Using data from a 1991 mail survey, we compared 31 nurse‐midwives, 12 professional midwives, and 27 lay midwives to assess professional background and opinions about selected maternity care issues and aspects of future midwifery practice, such as midwife training options, responsibilities, setting for midwifery care, relationship to other maternity caregivers, autonomy, and control over their profession.Results:Midwives largely shared the same philosophy of care but had different viewpoints on two main professional aspects: compared with professional midwives and nurse‐midwives, lay midwives preferred to deliver antepartum, intrapartum, and postpartum care at a client's home or an independent birthing center; like professional midwives, they rejected nursing as a prerequisite to midwifery training. Other interrelated personal, social, political, and legal factors were also associated with different beliefs.Conclusions:Despite the differences among the three groups, the process under way in Canada is to recognize a single profession of midwife. Creating a unified profession is a challenge that Canadian midwives with different backgrounds face in the 19

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00836.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground:Maternal serum screening is used to detect pregnancies at risk for Down syndrome and neural tube defects, but most positive test results (6.6% of all) are false positives. This study examined the influence of positive test results on women's experiences of pregnancy.Methods:The study population was all 67 pregnant women who received a positive result on serum screening in two Finnish towns from September 1993 to March 1994. For each case woman a control woman, matched for age, parity, education, and previous miscarriages, was selected. Of those invited, 45 case women and 46 control women (79%) responded to semistructured interviews.Results:Of the 45 case women, 2 underwent termination of pregnancy after the diagnosis of an abnormality and 1 had a miscarriage. Of the remaining 42, 7 decided not to undergo further diagnostic tests, for 2 women the second serum test was normal, and 33 had amniocentesis or chorionic villus sampling. The positive screening result and wait for the final results negatively affected the emotional well‐being of most of these 33 women, and 6 were still worried after receiving final reassuring results. Of the 46 control women, 17 felt some worry or fear regarding abnormality in their fetus.Conclusion:The significant negative psychosocial effects of serum screening should be taken into account by caregivers when deciding whether and how to institutionalize these tests as part of antenatal car

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00837.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00838.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00839.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00841.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Book review in this ArticleEffective Group Practice in Midwifery: Working with WomenLesley PageCesarean Section: Guidelines for Appropriate UtilizationBruce L. Flamm and Edward J. QuilliganCesarean Birth: Personal Stories, Preparation for the Unexpected Cesarean

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00842.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY