摘要:

ABSTRACT:If the ultimate success of efforts to improve pregnancy outcome depends on assurance that prenatal care begins in the first trimester, it is important to identify potentially modifiable factors associated with the start of care as well as the groups in which it is most likely to be late. This topic was explored in a population‐based study of low birthweight in 766 black women and 462 white women who gave birth in Alameda County, California, in 1987. Variables related to insurance coverage and financial status showed the greatest difference between early and late attenders at prenatal care in both groups. At virtually every level of almost every variable studied, black women were less likely than white women to begin prenatal care in the first trimester. The data suggested that some of the difference in the timing of prenatal care may be due to lack of awareness of, or failure to pay attention to, the signs of early pregnancy. We conclude that, although addressing problems of insurance coverage and financial status is critical to the solution of the problem of late initiation of prenatal care, as financing difficulties are solved, attention should be paid to women's internal factors such as depression and denial as modifiers of the earliness of seeking prenatal car

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00001.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:This study examined the effect of ethnicity on health‐seeking attitudes and behavior, including patient compliance, use of the clinic, knowledge of childbirth, and the relationship between the patient and primary health care provider. Anthropologic techniques of observations and interviews were conducted longitudinally with 27 Puerto Rican women and 26 white women who received perinatal care at a tertiary‐level hospital throughout the antepartum, intrapartum, and postpartum periods. Approximately 500 standardized and open‐ended interviews and 150 observations of clinical interactions with resident physicians and nurse‐midwives compared reproductive knowledge, beliefs, and practices. Results of this three‐year study indicated that both groups of women were similar in age, years of education, and percentage receiving financial assistance. Puerto Rican women identified strongly as a separate ethnic group; all spoke Spanish and most were bilingual. Office visits and explanations from primary care providers were more important to women in both groups than information obtained from families, friends, or folk beliefs. Knowledge of pregnancy care procedures and childbirth, although limited, was no different between the groups. Long waits, depersonalized service, and a lack of continuity of care adversely affected patient and physician satisfaction and diminished effective doctor‐patient interactions. This study suggests that differences in ethnic background do not necessarily adversely affect the delivery of reproductive health care. Indigent white and Puerto Rican women wanted the same thing: quality perinatal care an

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00002.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00003.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:A prospective study of 825 women booked for delivery in six hospitals in southeastern England was conducted to determine their expectations of childbirth. Women completed three questionnaires, two before the birth and one six weeks after. Questions covered both objective and subjective aspects of birth, and gave particular attention to control, its importance and its relevance to psychological outcomes. Four different indices of psychological outcome were considered: fulfilment, satisfaction, emotional well‐being, and the words that women used to describe their babies, which were shown to be related to different patterns of independent variables and of intra‐partum events. Our results did not support popular stereotypes: high expectations were not found to be bad for women, although low expectations often were. Information and feeling in control were consistently associated with positive psychological outco

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00004.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00005.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The routine wearing of individual cover gowns by nurses and visitors for direct care of healthy newborns was usual practice on the maternity ward of a regional referral center. We conducted a randomized trial in which cover gowns were not provided for care of infants in the experimental group (n= 222), but were maintained for control infants (n= 230). The principal outcome measured was Staphylococcus aureus colonization of the newborn nares or umbilicus on day 3 or day of discharge. Twenty percent (n= 51) of the experimental group (no gown) had a positive culture compared with 21 percent (n= 47) of the controls. Of the infants with positive cultures, two in each group exhibited symptoms of overt S. aureus infection. Experimental infants were similar to controls with respect to feeding method, route of delivery, amount of time spent rooming‐in, and average number of visitors per day. In the group of positively cultured infants, the mothers experienced longer labor, and more vaginal examinations in labor, and the number of males undergoing circumcision was higher. We concluded that routine use of cover gowns was unwarranted, and we have altered the ward policy accordingly. This also has had a positive economic effec

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00006.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:We conducted a prospective study of the associations between several biologic and surgical breast factors and the onset of lactation in 319 healthy, motivated, primiparous women who were breastfeeding term, healthy, appropriate for gestational age or large for gestational age infants. During the last trimester of pregnancy, subjects' breasts were examined for surgical incisions, size, symmetry, and nipple protuberance, and women estimated their prenatal breast enlargement. At two visits in the first two weeks postpartum, infants were weighed naked, and mothers reported the magnitude of postpartum breast engorgement when their milk came in. Breastfeeding was evaluated at each visit, and interventions were recommended for problems, with emphasis on maximizing milk yield. Lactation was deemed sufficient when an exclusively breastfed infant achieved an average weight gain of 28.5 g or more per day between the two visits. Infants gaining less than 28.5 g per day with breast milk exclusively, and those requiring formula supplement returned for a third visit at or before 21 days of age, when final lactation outcome was assessed based on weight gain between the second and third visits.Within three weeks postpartum 85 percent of the mothers achieved sufficient lactation, whereas 15 percent had persistent milk insufficiency despite intensive intervention. Of the study population, 6.9 percent had undergone previous breast surgery. Women with periareolar breast incisions were nearly 5 times more likely to have lactation insufficiency than were those without surgery (relative risk [RR] = 4.55; 95 percent confidence interval [CI]= 2.21–9.43;P<0.001). Insufficient lactation was significantly associated with minimal prenatal breast enlargement (P<0.02) and minimal postpartum breast engorgement when milk came in (P<0.001). Although not statistically significant, women with inverted nipples were more likely to have lactation insufficiency compared with those with normal nipples (RR = 2.94; 95% CI 1.05–8.20;P= .07). The findings from this study indicate that certain biologic and surgical breast variables are associated with lactation insufficie

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00007.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:The development of health education materials for pregnant women involves the work of knowledgeable and experienced health professionals, writers, editors, and artists. Frequently, these materials are also extensively reviewed by various experts and organizations prior to publication. Even with all this expert input and review, however, they can miss the mark if they are not deemed appropriate and acceptable by the audience for whom they were created. In developing a new booklet on childbirth, the New York State Department of Health wanted to ensure that the material would be read and used by pregnant women from various income and educational levels and racial and ethnic groups. Research was conducted by the department to pretest the booklet for its appropriateness for and acceptance by the target audience. Based on the reactions and suggestions from 89 women in eight focus groups, the booklet was revised extensively before being made available to the general public

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00008.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00009.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

ABSTRACT:When inaccurate information is the basis for clinical decision making, patient care is likely to be incomplete, inappropriate, and potentially harmful. We identified 17 fallacies relating to lactation and breastfeeding that exist in the professional and lay literature and that continue to be perpetuated among care providers and shared with new mothers. The inappropriateness and inaccuracy of these beliefs, and how they influence attitudes about, and practices relating to, breastfeeding, are discussed. Alternatives to these fallacies exist, and their use may contribute to more relevant care and advice giving, and to successful breastfeeding.

ISSN:0730-7659    

DOI:10.1111/j.1523-536X.1990.tb00010.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY