Kyllike Christensson

Temperature, metabolic adaptation and crying in healthy full‐term newborns cared for skin‐to‐skin or in a cot

The aim of the present study was to compare temperatures, metabolic adaptation and crying behavior in 50 healthy, full‐term, newborn infants who were randomized to be kept either skin‐to‐skin with the mother or next to the mother in a cot “separated”. The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the skin‐to‐skin group; at 90 min after birth blood glucose was also significantly higher and the return towards zero of the negative base‐excess was more rapid as compared to the “separated” group. Babies kept in cots cried significantly more than those kept skin‐to‐skin with the mother. Keeping the baby skin‐to‐skin with the mother preserves energy and accelerates metabolic adaptation and may increase the well‐being of the newborn.

Separation distress call in the human neonate in the absence of maternal body contact

Few studies have used the babys cry as a means of evaluating the quality of neonatal care. In this randomized trial the newborns cry was registered during the first 90 min after birth when infants were cared for either: (a) skin–to–skin with the mother; (b) in a cot; or (c) in a cot for the first 45 min of the 90–min observation period and then skin–to–skin with the mother. The results suggested that human infants recognize physical separation from their mothers and start to cry in pulses. Crying stops at reunion. The observed postnatal cry may be a human counterpart to the “separation distress call” which is a general phenomenon among several mammalian species, and serves to restore proximity to the mother. Our results suggest that in human newborns this cry is not dependent on earlier social experience and may be a genetically encoded reaction to separation. The findings are compatible with the opinion that the most appropriate position of the healthy full–term newborn baby after birth is in close body contact with the mother.

Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study

Objective. The aim of this population‐based study was to measure the risk of adverse outcome for mother and child in planned home births in a Swedish population irrespective of where the birth actually occurred, at home or in hospital after transfer. Design. A population‐based study using data from the Swedish Medical Birth Register. Setting. Sweden 1992–2004. Participants. A total of 897 planned home births were compared with a randomly selected group of 11,341 planned hospital births. Main outcome measures. Prevalence of mortality and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared. Results. During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the home birth group and 0.7 in the hospital group (RR 3.6, 95% CI 0.2–14.7). No cases of emergency complications were found in the home birth group. The risk of having a sphincter rupture was lower in the planned home birth group (RR 0.2, 95% CI 0.0–0.7). The risk of having a cesarean section (RR 0.4, 95% CI 0.2–0.7) or instrumental delivery (RR 0.3, 95% CI 0.2–0.5) was significantly lower in the planned home birth group. Conclusion. In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference was found. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.

Lower body temperatures in infants delivered by caesarean section than in vaginally delivered infants

Clinical experience suggests that infants delivered by caesarean section have difficulties maintaining normal body temperature during the first hours after birth. To test this hypothesis, body and skin temperatures were measured and compared in healthy full‐term caesarean section and vaginally delivered newborn infants. The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the vaginally delivered group than in infants delivered by caesarean section. Infants born by non‐elective caesarean section were slightly warmer during the first 90 min after birth compared to infants born by elective caesarean section. There were no significant differences in temperatures between infants cared for in a cot as compared to those cared for in an incubator. An incubator creates a physical barrier between babies and parents and incubator care might cause parental anxiety. Thus the routine of putting healthy, full‐term caesarean section infants in incubators can be abandoned from a thermoregulatory point of view.

Fathers can effectively achieve heat conservation in healthy newborn infants.

The aim of the present study was to compare axillar and skin temperatures and metabolic adaptation in healthy, fullterm elective caesarean section delivered infants who were randomized to be cared‐for either in (a) an incubator, (b) a cot, or (c) skin‐to‐skin with the father. Forty‐four infants were studied. The mean axillary temperature increase was significantly greater in the skin‐to‐skin cared‐for infants than in the cot cared‐for group. There was no significant difference in mean temperature increase between skin‐to‐skin cared‐for and incubator cared‐for infants. Blood glucose increase was significant in the skin‐to‐skin group, but not in the other two groups. The catecholamine levels at 120 min after birth were all within normal range, and there were no differences between the three groups, suggesting that none of the groups was exposed to cold stress. Interestingly, at 24 h after birth the mean axillary temperature was significantly higher in the skin‐to‐skin group than in the incubator group. It can be concluded that fathers can effectively achieve heat conservation in healthy fullterm caesarean section delivered infants.

Perceptions of risk and risk management among 735 women who opted for a home birth

OBJECTIVE home birth is not included in the Swedish health-care system and the rate for planned home births is less than one in a thousand. The aim of this study was to describe womens perceptions of risk related to childbirth and the strategies for managing these perceived risks. DESIGN AND SETTING a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. PARTICIPANTS a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. MEASUREMENTS two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis. FINDINGS regarding perceived risks about hospital birth, three categories, all related to loss of autonomy, were identified: (1) being in the hands of strangers; (2) being in the hands of routines and unnecessary interventions; and (3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help: (1) worst-case scenario; and (2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour, and by avoiding discussions concerning risks with health-care professionals. CONCLUSION women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health-care professionals. IMPLICATIONS FOR PRACTICE to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so.

High prevalence of cardio-metabolic risk factors among adolescents with intellectual disability.

Adults with intellectual disabilities (IDs) have poor lifestyle‐related health compared with the general population. Our aim was to study whether such differences are present already in adolescents.

Sense of coherence and symptoms of post-traumatic stress after emergency caesarean section

Background. In this study of women who had undergone an emergency caesarean section (EmCS), the aim was to examine the associations between, on the one hand, the new mothers sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and on the other hand, post‐traumatic stress symptoms 3 months’ postpartum. Methods. In a prospective study, 122 Swedish‐ or English‐speaking new mothers completed 2 self‐assessment questionnaires, at 2 days and 3 months after an EmCS. To measure SOC, we used the Sense of Coherence Scale (SOC‐13), and to measure reactions to traumatic events, the Impact of Event Scale (IES‐15). Results. Independent risk factors associated with post‐traumatic stress symptoms were: imminent fetal asphyxia as an indication for the operation, and low SOC in the woman. The group of women with low SOC were those with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women. Conclusions. Symptoms of post‐traumatic stress following EmCS are associated both with the new mothers personal coping style and with the circumstances of the event. We recommend that women who belong to groups who more often report a low SOC or who had imminent asphyxia as an indication for the operation should be offered support and follow‐up.

Transfers in planned home births related to midwife availability and continuity: : a nationwide population-based study

BACKGROUND Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. METHODS A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. RESULTS Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8-3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1-9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1-9.4) and multiparas (RR 3.4; 95% CI 1.3-9.0). CONCLUSIONS The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwifes unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred.

Adaptation of health care seeking behavior during childbirth: Focus group discussions with women living in the suburban areas of Luanda, Angola

The aim of this study was to explore how various factors influenced womens decisions regarding place of confinement in Luanda, Angola. Ten focus group discussions were conducted with pregnant and nonpregnant women residing in suburban areas of Luanda and the data were analyzed using the grounded theory technique. Four patterns of action of the main theme, “the molding of womens care-seeking behavior during childbirth,” were identified: (I) the “labor process ‘on-course’ avoiding pattern”; (II) the “labor process ‘off-course’ avoiding pattern”; (III) the “labor process ‘on-course’ approaching pattern”; and (IV) the “labor process ‘off-course’ approaching pattern.” Our findings indicate that personal “courage” and social support empowered women and impacted on their preference for home birth, whereas demand for informal user fees and perceived low quality of care influenced women to avoid institutional care during childbirth, sometimes even in spite of complications. Ability to meet demands for informal user fees and knowledge of childbirth influenced women to seek institutional care. The study highlights the need to improve the quality of available maternal health care addressing the implicit educational, attitudinal, and ethical issues.