No description available.

No description available.

No description available.

Background: The number of routine antenatal visits provided to low risk nulliparous women, has been reduced as recommended (NCCWCH 2008) . It was recognised that this change in care may result in women being less satisfied with care and having poorer psychosocial outcomes. The guidelines identified the need for further research to investigate alternative methods of providing women with information and support during pregnancy. Objectives: To investigate whether the provision of proactive telephone support with and without uterine artery Doppler screening (UADS) would reduce the total number of antenatal visits required and affect the psychological outcomes measured. Methods: The study used a mixed methods approach. 840 low risk nulliparous women were recruited to a three arm randomised controlled trial. Women in the control group received standard care, those in the Telephone intervention group (T), received a telephone call from a midwife at 28, 33 and 36 weeks and women in the telephone and Doppler group (T+D) received the telephone support intervention and uterine artery Doppler screening at 20 gestation. The primary outcome measure was the total number of antenatal visits received. Semi structured interviews were undertaken with 45 women to investigate their views of the interventions and the antenatal care they received. Results: The median number of unscheduled (n=2.0), scheduled visits (n=7.0) and mean number of total visits (n=8.8) were similar in the three groups. Additional support was not associated with differences in clinical outcomes, levels of anxiety, social support or satisfaction with care. Perceptions of antenatal care were affected by women’s perceptions of their pregnancy, the structure of care and the way the care was delivered by their midwife. Conclusion: Further research is required to investigate alternative methods of providing women with support during pregnancy, in particular the utilisation of new technologies.

There is a deficit of prospective, up-to-date research investigating gastrointestinal function during and after pregnancy, particularly in relation to non-starch polysaccharide (NSP) and water intakes, and physical activity levels. The aims of the work reported in this thesis were to investigate habitual dietary intake, patterns of physical activity and bowel function and their inter-relationships throughout and after pregnancy. Ninety-four subjects were recruited from three London Teaching Hospitals and a magazine advertisement. Seventy-two, 59, 62 and 55 subjects participated in the first, second, third and postpartum study stages respectively and 42 participants completed every study stage. Volunteers completed a screening questionnaire, 4-7 -day weighed inventory food diary, physical activity questionnaire and bowel function diary prospectively at mean weeks 13, 25, 35 of gestation and 6 weeks after birth, in addition to a postnatal questionnaire. No statistically significant differences were observed when data was compared between the 42 volunteers that completed the study longitudinally and higher subject numbers. Findings indicated that only 47% of women met the 18 g/d population average NSP recommendation during pregnancy and 41 % after birth. Women participated in statistically significantly higher levels of vigorous activities in the first trimester when compared with these activities in the puerperium (P<O.05). Sensations of incomplete evacuation and time spent defecating were significantly increased during all trimesters of pregnancy when compared with after birth (P<O.05). At 33% and 38% respectively, gestational constipation was most prevalent in the first and second trimesters. Statistically significant inverse associations were observed: between food weight, NSP intake and time spent defecating in the first trimester (P<O.Ol), and physical activity and reduced defecation frequencies in the third trimester (P<O.OI) and puerperium (P<O.05). Positive associations were identified: between water intakes and defecation frequency in the first trimester (P<O.05) and levels of physical activity and heartburn in the second trimester (P<O.05). On the basis of the results obtained, this study has confirmed that bowel habit perturbations and constipation associated with pregnancy may be attributed to a combination of factors, including: low food volumes, insufficient dietary NSP and water intakes, and high levels of vigorous activity.

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No description available.

No description available.

Recent research has shown an association between smoking in pregnancy and low birthweight. Many authors have concluded that the relationship is causal but some have argued that it is the smoker rather than the smoke which is responsible. This thesis examines the relationship between the smoking habit in pregnancy and birthweight corrected for gestational age using data from the St. George's Hospital Birthweight Study. Adjustment is made for confounding factors so that the effect of smoking can be estimated. The statistical problem of adjusting birthweight for gestational age when very early births are included is discussed and a solution presented in the form of a birthweight ratio. The relationship is examined between birthweight ratio and many socioeconomic and psychological factors and shows that few are associated with reduced birthweight. Those associations which are observed can be explained by smoking. Alcohol and caffeine are only related to birthweight in smokers. When the smoking habit is analysed in terms of quantity and constituents, a threshold is observed whereby women smoking a low number of low yield cigarettes have mean birthweight similar to non-smokers. For women smoking higher numbers of cigarettes but a low yield brand mean birthweight is reduced by the same amount (6% or more) as women smoking high yield brands. The effect on birthweight of alcohol and caffeine in smokers only is adjusted for smoking by using this threshold. This shows that smoking, alcohol and caffeine are all associated with reduced birthweight. For alcohol and caffeine consumption this relationship is strongest in early pregnancy and weakest near delivery. The association between smoking and birthweight is not explained by any of the wide range of confounding factors examined. This provides evidence that the relationship is a causal one.

Antenatal education classes are a popular source of learning and support related to labour, birth and early parenthood for pregnant women and their partners. Although in the UK National Health Service (NHS) classes are the most frequently attended, the National Childbirth Trust (NCT), a registered charity involved in political lobbying, teaching and support related to maternity issues, offers a widely available alternative. The involvement of male partners within NCT antenatal education has raised questions, addressed in this study, as to how the male pedagogic subject is produced, recognised and realised within the instructional practice of NCT teachers, and the purpose it serves. Concepts drawn from Basil Bernstein’s theory of the pedagogic device influenced an empirical investigation that involved observing participants at an NCT antenatal course, combined with interviewing three antenatal teachers and analysis of official texts. The analysis helped identify the distinctive voice of the NCT, which sits in opposition to the prevailing medical and technical childbirth discourse. Analysis of the interview and observation data revealed how teachers recontextualised this discourse, in line with their own views and affective influences, to produce individually unique pedagogies, which in turn were found to produce and regulate specific subject positions for men during childbirth and the early days of fatherhood. The men’s recognition and realisation of subject positions was found to relate to the relationships and contexts produced by the pedagogy and their own affective coping strategies. The study adds to existing understandings of the transition to fatherhood and the relationship between discourse, pedagogy and subjectivities, and it proposes emergent theory about potential affective influences during the recontextualisation of pedagogic discourse. The findings also contribute to the development and practice of antenatal education for men.