Deborah Oakley

Posttraumatic Stress Disorder and Pregnancy Complications

Objective To assess the associations between specific pregnancy complications and posttraumatic stress disorder based on neurobiologic and behavioral characteristics, using Michigan Medicaid claims data from 1994–1996. Methods Two thousand, two hundred nineteen female recipients of Michigan Medicaid who were of childbearing age had posttraumatic stress disorder on the basis of International Classification of Diseases, 9th Revision (ICD-9) codes. Twenty percent (n = 455) of those recipients and 30% of randomly selected comparison women with no mental health diagnostic codes (n = 638; P < .001) had ICD-9 diagnostic codes for pregnancy complications. We used multiple logistic regression to investigate associations between specific pregnancy complications and posttraumatic stress disorder, controlling for demographic and psychosocial variables. Obstetric complications were hypothesized based on high-risk behaviors and neurobiologic alterations in stress axis function in posttraumatic stress disorder. Results After controlling for demographic and psychosocial factors, women with posttraumatic stress disorder had higher odds ratios (ORs) for ectopic pregnancy (OR 1.7, 95% confidence interval [CI] 1.1, 2.8), spontaneous abortion (OR 1.9, 95% CI 1.3, 2.9), hyperemesis (OR 3.9, 95% CI 2.0, 7.4), preterm contractions (OR 1.4, 95% CI 1.1, 1.9), and excessive fetal growth (OR 1.5, 95% CI 1.0, 2.2). Hypothesized labor differences were not confirmed and no differences were found for complications not thought to be related to traumatic stress. Conclusions Pregnant women with posttraumatic stress disorder might be at higher risk for certain conditions, and assessment and treatment for undiagnosed posttraumatic stress might be warranted for women with those obstetric complications. Prospective studies are needed to confirm present findings and to determine potential biologic mechanisms. Treatment of traumatic stress symptoms might improve pregnancy morbidity and maternal mental health.

Oral contraceptive pill use after an initial visit to a family planning clinic.

A retrospective study of 1,311 women making initial family planning visits to metropolitan-area health department clinics found that many women switch methods or discontinue use in the first year following the clinic visits. Among a subgroup of women, most of whom selected the pill as their primary method and who used the pill for at least one of the months in the study period, almost half either changed methods or used no method at some point during a follow-up period averaging eight months. This includes 13 percent of women who made two or more changes. In addition, only 42 percent said they took a pill every day, and only half of these said they always took their pill at about the same time every day. Despite such irregularities, pill users were approximately one-third as likely to get pregnant during the study period as women making an initial family planning visit to a health department clinic who did not use the pill at all.

Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives.

Objective To determine whether pregnancy outcomes differ by provider group when alternative explanations are taken into account. Methods Pregnancy outcomes were compared for 710 women cared for by private obstetricians and 471 cared for by certified nurse-midwives. At intake, all women qualified for nurse-midwifery care. They were retained in their original group for analysis, even if they were later referred to physicians. Infant and maternal mortality, 30 clinical indicators, satisfaction with care, and monetary charges were studied. The study sites history and philosophy of honoring consumer choice of provider precluded random assignment, but multivariate analyses minimized the effects of multiple confounding factors. The statistical power was adequate for the study design. Results Significant differences (P <.05) between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: infant abrasions (7 versus 4%), infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care, average hospital charges (

Prevalence of abuse among pregnant women choosing certified nurse-midwife or physician providers

5427 versus

PROCESSES OF CARE: Comparisons of Certified Nurse‐Midwives and Obstetricians

4296), and average professional fee charges (

Theory building in nurse-midwifery. The care process.

3425 versus

Perimenstrual symptoms among Chinese women in an urban area of China

3237). When maternal risk, selection bias, and the medical intensiveness of care were controlled, the provider group did not continue to have an independent effect on infant abrasions, hemorrhage, and professional fee charges; when womens preferences were added, the difference in hospital charges disappeared. However, the provider group continued to have significant independent effects on the other four outcomes. Interaction effects were not significant. Conclusion Although most outcomes were equally good, important differences between obstetrician and nursemidwife care remained after multivariate analysis.

Philosophy of care. A pilot study comparing certified nurse-midwives and physicians.

Despite the fact that violence against women is a widespread problem in the United States, many providers do not routinely screen for it, particularly if the woman is not from a lower socioeconomic group. This was a secondary analysis of survey data from 940 antenatal women in private CNM and MD practices. Median annual income was

Toward culturally sensitive research in a multicultural society

40,000 to

Adolescents' Experiences of Childbirth: Contrasts With Adults

49,000 and mean schooling completed was 15 years. It was found that 91 (9.7%) had a history of previous abuse and eight (0.9%) were currently in an abusive relationship. Women with a previous history of abuse were found in the CNM caseloads at higher than expected levels. Annual income was predictive of women currently being abused, but not for women with past history. Abused women had on average less education than nonabused, with the most marked difference seen in women reporting current abuse. These results provide further evidence that the problem of abuse is not restricted to women of lower socioeconomic status. The finding that women with history of abuse were more likely to appear in CNM caseloads adds further support to the need for routine screening.