摘要:

ABSTRACT:Background: This work sampling study examined how much time intrapartum unit nurses spend providing supportive care overall and during weekday and weekend shifts, and by patient and staff characteristics at a university hospital with 4000 births per year in Montréal, Québec.Methods: Four‐hour observation periods were randomly selected to represent each shift and day of the week. Within each period, eight 15‐minute observation times were randomly selected. Observers located each nurse assigned to the unit at that time and recorded her activity. Supportive activities included physical comfort, emotional support, instruction, and advocacy.Results: The percentage of time spent in supportive care was 6.1 percent (95% confidence interval 5.3%, 6.9%), based on 3367 observations. The time providing supportive care was similar for weekday and weekend shifts. Nurses with less than seven years of intrapartum experience spent 2.7 percent (0.9, 4.5) more time providing supportive care than nurses with seven years of experience or more. Supportive care was 9.2 percent (0.7, 17.7) greater for nulliparous than for parous women, and supportive care of women with epidural anesthesia was similar to those without it.Conclusions: We concluded that intrapartum unit nurses spent a small amount of time providing supportive care to women in labor. This suggests the need for perinatal caregivers and hospital administrators to reexamine how nurses spend their time, given the evidence from randomized trials showing the beneficial effects of continuous support on labor and birth out

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00453.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACT:Background: Despite caregiver and policy support for breastfeeding, rates for initiation and duration of breastfeeding fell far short of Healthy People 2000 goals during the 1980s.Methods: Data from the 1988 National Maternal‐Infant Health Survey, collected from January 1989 through June 1991, were analyzed to examine predictors of duration of lactation for a sample of 2372 breastfeeding women. We conducted comparisons between women who fully breastfed and those who partially breastfed using logistic regression analysis.Results: Mothers were more likely to breastfeed for longer than six months if they fully breastfed during the first month postpartum, were nonsmokers, were of higher parity, were consistent in their prenatal intent to breastfeed fully or partially and in their postpartum behaviors, participated in childbirth education classes, and delayed their return to work postpartum.Conclusions: In this study sample, although rates did not meet Healthy People 2000 goals for duration of breastfeeding, some predictors of duration were identified that can be affected by programmatic support or public policy. Our findings indicated that variables that are associated with breastfeeding and longer duration of the practice are typically correlated with social status. To support the development of breastfeeding as the cultural norm, interventions targeting breastfeeding outcomes should consider social status, ethnicity, and cultural factor

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00454.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACT:Background: Several randomized, controlled trials compared the policies of induction of labor and expectant management for women who reach 41 weeks' gestation, and although they suggest a better outcome for mothers and infants with such a policy in place, controversy continues as to which is the better form of care. The Canadian Multicenter Postterm Pregnancy Trial (CMPPT) enrolled 3407 women, of whom 1701 were randomized to a policy of induction of labor (induced group) and 1706 were randomized to a policy of expectant management (expectant group). Secondary analyses of data from the CMPPT were undertaken to explore a number of controversial issues.Methods: We used data from the CMPPT to explore further the timing of delivery for women enrolled between 41 0/7 and 41 6/7 weeks' gestation, the potential impact of more liberal use of prostaglandins on cesarean section rates, and the relative merits of induced versus spontaneous labor in the two groups.Results: Most women in the CMPPT (89%) were enrolled at 41 0/7 to 41 6/7 weeks' gestation, of whom 86.2 percent in the induced group and 63.6 percent in the expectant group gave birth before 42 weeks' gestation. Assuming that administration of prostaglandins would reduce the likelihood of cesarean section by 12 to 15 percent, cesarean section rates were reduced in the induction group from 21.2 percent to 20.8 to 20.9 percent, and in the expectant group from 24.5 percent to 23.3 to 24.2 percent. If labor was induced as part of a policy of expectant management, the cesarean section rate was much higher (33.5%) than if labor was either spontaneous or induced as part of a policy of induction (18.5%, 22.4%).Conclusions: Women should be informed of the benefits and risks associated with the policies of induction of labor and expectant management, and their preferences regarding these policies should be respected.

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00455.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACT:Background: Cesarean delivery is now the most frequently performed major operative procedure for childbearing women in the United States. Many of these operations are reported to be unnecessary, and millions of dollars could be saved by reducing their frequency.Methods: Method of delivery was added to the 1989 revision of the standard certificate of live birth. Alabama also added questions on the source of payment for delivery and the provider of prenatal care in 1991, which enabled an investigation of the risk factors for cesarean delivery that occurred in the state during this period.Results: One of every four births in Alabama is by cesarean delivery. The risk of cesarean delivery is not random, and the risk factors include mother's race and age, coverage by private insurance, birthweight, setting where the mother received prenatal care, mother's educational attainment, live birth order, and complications of labor and delivery.Conclusion: With present concerns about health care reform and the costs of health care, a reduction in the cesarean delivery rate could result in significant cost savings.

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00456.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACT:Background: Adequate prenatal care is important for ensuring a good outcome for pregnant women and their children, and its initiation in the first trimester is a major component. We investigated barriers and motivators for women receiving early versus late prenatal care.Methods: A self‐administered questionnaire was distributed to 205 women who began prenatal care at the University of New Mexico Hospital Obstetrics Clinic in Albuquerque, New Mexico. The questionnaire assessed demographic information, insurance status, feelings about the pregnancy, health behaviors, and barriers and motivators to initiating prenatal care. The participants were Hispanic (41%) and non‐Hispanic white (46%), low‐income women with Medicaid (42%) or no health insurance (41%). They were divided into early (1st trimester 67%) and late (after 1st trimester 33%) care groups.Results: Ethnicity, education, income, and age did not predict initiation of prenatal care. Late initiators cited financial problems (26%), not being aware of the pregnancy (15%), and dislike of going to doctors (14%) as reasons for the delay in seeking prenatal care. Over two‐thirds of the pregnancies were unplanned, but 82 percent of the women felt positive about the pregnancy.Conclusions: Our study documents the continuing need for public health efforts to encourage women to seek early prenatal care. Specific attention should be directed toward women's perceived reasons for not initiating ear

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00457.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACT:Background: Patient satisfaction is considered, together with health status, to be an outcome of the delivery of health care services as well as a measure of its quality. A focus group study of 50 low‐income Mexican‐American, Puerto Rican, African‐American, and white women in Chicago, Illinois, explored the characteristics of prenatal care that affect women's satisfaction.Methods: Transcripts from the focus groups were analyzed using researcher‐derived coding categories to develop broad themes.Results: Despite their diverse ethnic backgrounds, participants revealed few differences with respect to what they value in prenatal care. Aspects of care that appeared to affect women's satisfaction included the “art of care,” the technical competence of the practitioner, continuity of caregiver, and the atmosphere and physical environment of the care setting. The one characteristic that did not appear to affect satisfaction was the caregiver's ethnicity.Conclusion: Knowledge of how the characteristics of prenatal care affect women's satisfaction can help increase use of care and ultimately improve perinat

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1996.tb00458.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.tb00459.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.tb00460.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.tb00461.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.tb00462.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY