Pamela Adelson

Pain relief for childbirth: the preferences of pregnant women, midwives and obstetricians.

OBJECTIVE To compare the personal preferences of pregnant women, midwives and obstetricians regarding a range of physical, psychosocial and pharmacological methods of pain relief for childbirth. METHOD Self-completed questionnaires were posted to a consecutive sample of 400 pregnant women booked-in to a large tertiary referral centre for maternity care in South Australia. A similar questionnaire was distributed to a national sample of 500 obstetricians as well as 425 midwives at: (1) the same hospital as the pregnant women, (2) an outer-metropolitan teaching hospital and (3) a district hospital. Eligible response rates were: pregnant women 31% (n=123), obstetricians 50% (n=242) and midwives 49% (n=210). FINDINGS Overall, midwives had a greater personal preference for most of the physical pain relief methods and obstetricians a greater personal preference for pharmacological methods than the other groups. Pregnant womens preferences were generally located between the two care provider groups, though somewhat closer to the midwives. All groups had the greatest preference for having a support person for labour with more than 90% of all participants wanting such support. The least preferred method for pregnant women was pethidine/morphine (14%). CONCLUSION There are differences in the personal preferences of pregnant women, midwives and obstetricians regarding pain relief for childbirth. It is important that the pain relief methods available in maternity care settings reflect the informed preferences of pregnant women.

Low Birth-weight in NSW, 1987: a Population-based Study

Summary: The New South Wales perinatal data collection was used to examine the association between low birth‐weight and some of its potential risk factors. The study population comprised all recorded singleton births to residents of NSW in 1987. Low birth‐weight infants were categorized as either small for gestational age (SGA) or preterm (less than 37 weeks). Risk factors were analyzed separately for these categories. The risk factors examined were primarily demographic or reproductive history variables. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors. The factors associated with SGA birth were mainly demographic (maternal age, parity, marital status, socioeconomic status, and ethnic group) while those associated with preterm birth had more reproductive history variables (maternal age, parity, marital status, prior spontaneous abortion, prior induced abortion, prior stillbirth or neonatal death, sex of infant). A first antenatal visit after 12 weeks had a statistically significant but small effect on both SGA and preterm birth.

Neonatal Surgery in New South Wales—What Is Performed Where?

OBJECTIVES The aim of this study was to describe what surgical procedures are performed in the neonatal period in New South Wales (NSW) and where they are performed. METHODS Population-based descriptive study was conducted in NSW in a 2-year period from July 1, 1996 to June 30, 1998, inclusive, using information from the NSW Health Departments Inpatient Statistics Collection. All neonates undergoing major surgery (excluding circumcisions) in NSW. RESULTS In the first 4 weeks of life, 990 (0.6%) neonates underwent surgery. The most common surgical procedures were gastrointestinal, cardiovascular, hernia, genitourinary, and neurosurgical. Frenotomy accounted for 5% of all surgical procedures. Whereas 75% of neonatal surgery (including 88% of gastrointestinal and 97% cardiovascular surgery) occurs in childrens hospitals, only 13% of the babies requiring surgery are born in the co-located obstetric hospitals. Perinatal centers accounted for 5.3% of surgery; urban hospitals for 8.4%; rural hospitals, 5.5%, and private hospitals, 6.4%. The mortality rate in the neonatal period was 3.0% overall. CONCLUSIONS This is the first review of major neonatal surgery in Australia and provides baseline data for future comparisons. Whereas most neonates had surgery in a childrens hospital, few of them were born in the most appropriate place, the co-located obstetric hospital. Parents should be informed of the level of institutional surgical expertise and be involved in the decision-making regarding the place of surgery for their infant. Parents and children have a right to expect the best possible results.

A randomised controlled trial of outpatient compared with inpatient cervical ripening with prostaglandin E2 (OPRA study)

To compare clinical outcomes from outpatient with inpatient cervical prostaglandin E2 ripening for low risk labour induction.

Reproductive characteristics of Southeast Asian immigrants before and after migration

We describe the reproductive health and practices of Hmong immigrants before and after migration to the United States. Data were gathered as part of an ongoing study on the impact of perinatal exposure to environmental chemicals on children’s health in Hmong residents of Green Bay, Wisconsin between August 1999 and May 2002. Of the 742 pregnancies reported by 141 reproductive-aged couples, 669 were live births. The Hmong have an average of 5.2 children (range 0–14) and the sex ratio differed by country of birth. Prenatal care began in the first trimester for 60% of US-born infants, up from 12% prior to immigration. Breastfeeding decreased from 94% and 88% in Laos and Thailand to only 11% for Hmong born in the US. Contraceptive use was reported by 25.5% of women; few reported smoking and alcohol consumption. The results suggest that Hmong immigrants may benefit from public health support targeting prenatal care and breastfeeding practices.

A cost analysis of inpatient compared with outpatient prostaglandin E2 cervical priming for induction of labour: results from the OPRA trial

OBJECTIVE To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. METHODS Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. RESULTS Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of

Termination of pregnancy in New South Wales 1990.

319 per woman (95% CI -

Keratinocyte cancers in South Australia: incidence, geographical variability and service trends.

104 to

Authors' reply: How safe is safe for outpatient cervical ripening?

742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of

A survey of women seeking termination of pregnancy in New South Wales.

433 (95% CI -