Marie Berg

Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews

Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full‐text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre‐eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large‐for‐gestational‐age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.

Relationships: The hidden threads in the tapestry of maternity care

Institute of Health Research, Swansea University, Vivian Tower, Swansea, Wales SA2 8PP, UK University of Gothenburg, Box 457, Goteborg SE-405 30, Sweden Boras University College of Health Sciences, Boras S-501 90, Sweden Faculty of Nursing, University of Iceland, Eirberg, Eiriksgata 34, Reykjavik 101, Iceland Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Cres, Sheffield S10, UK Corresponding author. E-mail address: b.j.hunter@swan.ac.uk (B. Hunter).

A Midwifery Model of Care for Childbearing Women at High Risk: Genuine Caring in Caring for the Genuine

According to this paper’s synthesis of research, three constituents of ideal midwifery care emerge. First, a dignity-protective action takes place in a midwife’s caring relationship with a childbearing woman at high risk and includes mutuality, trust, ongoing dialogue, enduring presence, and shared responsibility. Secondly, the midwife’s embodied knowledge is based on genuineness to oneself and consists of theoretical, practical, intuitive, and reflective knowledge. Finally, nurse-midwives have a special responsibility to balance the natural and medical perspectives in the care of childbearing women at high risk, especially by promoting the woman’s inborn capacity to be a mother and to give birth in a natural manner. This midwifery model of care is labeled “Genuine Caring in Caring for the Genuine.” Here, the word genuine expresses the nature of midwifery care, as well as the nature of each pregnant woman being cared for as a unique individual.

Is the childbirth experience improved by a birth plan

From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving womens experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.

Pregnancy and Diabetes: How Women Handle the Challenges

In order to optimize the possibilities for the birth of a healthy child, pregnant women with type 1 diabetes mellitus (type 1 DM) work hard to achieve normoglycemia. In the research presented here, pregnant, diabetic women’s experiences of dealing with life circumstances are summarized as a construct of duality: “to master or to be enslaved.” The overall experience of challenges and managing is understood to depend on the individual woman’s identity, attitude, and resources including health professionals and social environment. Health professionals in antenatal care have a special responsibility to give care that not only optimizes the biological possibility for a healthy child to be born but also supports the woman with type 1 DM to master the situation and, thus, promote her health, well-being, and motherhood.

Parental presence when their child is in neonatal intensive care

BACKGROUND AND AIM When a newborn baby needs care in a neonatal intensive care unit (NICU), the parents are welcome to stay with their child whenever they wish. The aim of the present study was to investigate the time per day parents are present together with their child at the NICU and to identify factors that facilitated and obstructed their presence. METHODS In a descriptive study 67 parents of 42 children from two NICUs registered all time they spent at the NICU and then took part in a structured interview. FINDINGS Parental presence at NICUs varied depending on types of accommodation offered. Those who stayed in parent rooms at the units showed a significantly higher presence with their children than parents who stayed at family hotel, at home or on a maternity ward. Factors that motivated parental presence were primarily the willingness to take parental responsibility, the childs condition requiring it, and the want to have control. Good treatment by the staff, a family-friendly environment and high quality care were main facilitating factors for parents to be present at the NICU. Obstructing factors were primarily ill health by parents, a non-family-friendly environment, care of the home and of children at home. CONCLUSIONS The result shows that there is a need to develop a family-friendly environment that provides optimal conditions for parents to be with their child in a NICU and to consider the parents own reason for being or not being present.

Use and abuse of oxytocin for augmentation of labor

Objective. To investigate the use of oxytocin for augmentation of labor and its relation to labor progress and delivery outcome. Design and setting. A retrospective observational study undertaken in a Swedish hospital during 2000–2001. Sample. Singleton pregnancies at ≥ 37 weeks of gestation with cephalic presentation and spontaneous onset of labor. Methods. Data were collected from 1,263 clinical records. The partogram was used to diagnose labor dystocia (LD). Main outcome measures. Prevalence of oxytocin administration, LD and operative delivery. Results. Oxytocin was administered to 55% of the women (75% of primiparas and 38.1% of multiparas); a majority did not meet LD criteria. LD frequency was 19.8% (32.7% in primiparas and 7.4% in multiparas). Oxytocin was started both ‘too early’ and ‘too late’ in relation to the diagnosis of LD. Cesarean section (CS) was performed on 17.1% of primiparous and 2.4% of multiparous oxytocin recipients with LD, compared to 2.3 and 1.5%, respectively, of oxytocin recipients without diagnosed LD. Conclusions. Oxytocin augmentation was undertaken in an unstructured manner; some women were inadequately treated and others were treated unnecessarily. Oxytocin recipients with LD underwent operative delivery to a higher extent than oxytocin recipients without LD, suggesting that the main reason for CS was the underlying problem of LD rather than the oxytocin augmentation itself.

QUALITY OF LIFE FOR COUPLES 4-5.5 YEARS AFTER UNSUCCESSFUL IVF TREATMENT

Objective. To describe quality of life in men and women who had terminated in vitro fertilization (IVF) within the public health system 4–5.5 years previously, and for whom treatment did not result in childbirth. Design. Cross‐sectional study. Setting. Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Four hundred pairs were invited to participate, 71% accepted and 68% completed questionnaires. Methods. Questionnaire study. Study subgroups were compared with a control group with children and with each other. Main outcome measure. Psychological General Well‐Being (PGWB), Sense of Coherence (SOC), experience of infertility, demographic–socio‐economic and health characteristics were measured. Results. Surprisingly, 76.7% had or lived together with children; 39.6% had biological children, 34.8% had adopted and 3.7% were parents to both biological and adopted children. No differences were found between the study and the control groups, except in SOC which scored lower in the study group. The study group with children had a higher PGWB index than the 23.3% without children and the controls. SOC scored higher in the subgroup with than those without children. Infertility was still a central issue in the subgroup without children. Conclusion. Despite having undergone unsuccessful IVF within the public health system, more than 75% lived with children 4–5.5 years later. This subgroup had a better quality of life, compared to those without children. Additional IVF treatment may result in increased quality of life.

Gender perspective on quality of life, comparisons between groups 4–5.5 years after unsuccessful or successful IVF treatment

Objective. To describe and compare quality of life in men and women who had in vitro fertilization (IVF) within the Swedish public health system 4–5.5 years previously, either unsuccessfully and were subsequently living without children, or successfully, having children aged 4–5.5 years. These groups were compared to a control group of men and women with children born at the same time as in the successful group. Design. Cross‐sectional study. Setting. Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Twenty‐six men and 37 women in the unsuccessful group, 135 men and 154 women in the successful group and 93 men and 118 women in the control group. Methods. Questionnaire study. The respective gender differences were studied in the control and study groups. Main outcome measures. Psychological general well‐being (PGWB), sense of coherence (SOC), experience of infertility, demographic‐socio‐economic, and health characteristics. Results. Men in the unsuccessful IVF group scored lower in total PGWB and SOC indices than the successful group men. They reported more depression, lower PGWB and lower SOC than the control group men. Women in the unsuccessful IVF group reported more anxiety, depression, and lower SOC than the successful group women and more depression and lower SOC indices than control group women. Men and women in the unsuccessful IVF group did not differ in any of the parameters. Men in the successful IVF group had higher PGWB, less signs of depression and more self‐confidence than women in that group. Conclusion. Quality of life in men seems more negatively affected by involuntary infertility than reported in earlier studies.

Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial.

Objective  To study the effects of early versus delayed oxytocin augmentation on the obstetrical and neonatal outcome in nulliparous women with spontaneous but prolonged labour.