Preterm birth in the United States is the leading cause of infant morbidity and mortality. The United States spends more per capita on healthcare than any other nation in the world, and still perinatal outcomes are disappointing when compared to other industrialized nations. Research and current clinical practice guidelines support the use of early and consistent prenatal care to lower risks for preterm birth, by acting as a key mechanism to monitor pregnancy and provide timely and appropriate interventions. Significant research has been completed to identify causative factors that lead to preterm birth. Overall, this literature has not had a substantial impact on decreasing preterm birth rates in the United States. Access to healthcare is one modifiable factor that can be influenced by policy change and potentially have a positive impact on lowering preterm birth rates. This dissertation examines geographical access to prenatal care services in Florida and its influence on preterm birth rates. The researchers used quantitative methods coupled with Geographic Information Systems to evaluate the relationship between potential access to prenatal care and preterm birth rates.

Aim: The aim of this literature review was to explore the impacts of educational interventions integrated into antenatal care on knowledge of preeclampsia among pregnant women. Background: Preeclampsia has remained one of the leading causes of preventable maternal and infant mortality and morbidity. A lack of patient education and awareness of preeclampsia may lead to missed opportunities for diagnosis and preeclampsia complications. Methods: CINAHL Plus with Full Text, MEDLINE, and Education Full Text (H.W. Wilson) databases were utilized. Literature specifically focusing on preeclampsia educational interventions among pregnant women were considered. Results: There were eleven articles that fit the criteria of this review's search. The results of this review revealed that nine studies found positive outcomes and an increase in preeclampsia awareness among pregnant women when educational interventions were implemented into their antenatal care. Discussion: Educational interventions that improved patient knowledge on preeclampsia include booklets, pamphlets, videos, graphic cards, magnets, PowerPoint presentations, brochures, and verbal education. Nurses can implement these interventions in their practice to decrease maternal and infant mortality found among preeclampsia patients. Further research on preeclampsia knowledge is recommended among minority women and how educational interventions impact maternal and neonatal outcomes.

The purpose of this dissertation research was to explore the associations between, perceptions of, and patterns within the mother-father relationship and perceived stress among Black pregnant women. The conceptual framework guiding my dissertation research aligned with the Social Ecological Model and my interpretive framework upheld an intersectional, social constructivist positioning. First, I conducted an integrated literature review to identify what is known about the associations of mother-father relationship with perceived stress among pregnant and postpartum women, focusing on Black women in the U.S. This review included sixteen studies, six of which were conducted in the U.S., that reported significant associations of mother-father relationship with perceived stress among pregnant and/or postpartum women; however, data were limited among Black pregnant women. Next, I conducted a secondary analysis using a cross-sectional approach to examine the association of mother-father relationship with perceived stress among Black pregnant women. Women who reported higher levels of conflict and lower levels of involvement, closeness, and support within the mother-father relationship also reported higher levels of perceived stress. Finally, I conducted a secondary analysis using a convergent, mixed methods approach with ideal-type analysis to examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women. Women described unique, patterned experiences of mother-father relationship and perceived stress which emerged as five mother-father relationship typologies: (1) "Cared For," (2) "Managing Expectations," (3) "Just Friends, For the Kids," (4) "It's Complicated," and (5) "Can't be Bothered." This dissertation research adds knowledge related to: (1) associations of mother-father relationship with perceived stress among Black pregnant women; (2) comprehensive measures of mother-father relationship; and (3) an exemplar of ideal-type analysis which expands the discipline of nursing. These contributions inform future nursing research and clinical practice which address disparate health outcomes among this vulnerable population.

Delayed bathing of the newborn infant for twenty-four hours after birth can decrease potential newborn complications such as hypoglycemia, hypothermia, and improve the infants skin integrity and breastfeeding rates. The primary purpose of this literature review was to examine the health benefits of delaying initial bathing in newborns for twenty-four hours. A comprehensive review of the literature was performed using peer-reviewed, research articles from multiple databases focusing on delayed infant bathing after birth and health benefits. 15 articles met the inclusion criteria and answered the research questions. Two studies showed the effects of vernix caseosa on improved skin integrity and moisture in infants. Two additional studies revealed longer skin-to-skin contact with increased maternal satisfaction and comfort, allowing time for breastfeeding and sucking competence. Delayed bathing prevented hypothermia and decreased the incidence of hypoglycemia. All articles focused on infants’ health outcomes within hours of birth and physiologic findings of how delayed bathing can improve the infant’s adjustment to extrauterine environment. Delayed bathing in the neonate decreases the risk of hypoglycemia and hypothermia. Prolonging the time an infant remains covered in their mother’s vernix caseosa following birth is a viable measure for improving newborn health outcomes.

Exposure to incarceration through a partner or first-hand experience can lead to a higher probability of negative outcomes on either infant or maternal well-being postpartum. This can be measured by length of pregnancy, infant birth weight, and maternal depression screening. The purpose of this literature review was to identify the impact of incarceration on maternal and infant outcomes for women exposed to incarceration at some point during the length of their pregnancy. A comprehensive review of the literature using peer reviewed research articles from multiple databases on maternal and infant outcome disparities in pregnant incarcerated women. Seventeen articles met the inclusion criteria and focused on the research question. Of the 17 studies, 12 showed a negative impact on either infant or maternal outcomes. Four studies were inconclusive. One study found no negative impact of exposure to incarceration on either maternal or infant outcomes. Exposure to incarceration does provide some negative effects on infant/maternal outcomes, at this time, the effects are under researched and require further investigation to determine if this risk factor is more strongly correlated with negative outcomes when compared to other similar life-stress events.

The purpose of this dissertation research was to examine the associations among racial discrimination, social support, and psychological distress among Black pregnant women. The dissertation was guided by the Ecological Systems theory which has three domains that pertain to this research: individual, interpersonal, and community. A literature review was conducted to investigate what is known about the association between racial discrimination and psychological distress among Black pregnant women. This review found that seventeen of the nineteen studies included reported a positive association between racial discrimination and psychological distress among Black pregnant or postpartum women. Limited research focused on the potential moderating effect of social support on the association between racial discrimination with psychological distress among Black pregnant women. Using a cross-sectional design, this dissertation research examined the moderating effect of social support on the association of racial discrimination with psychological distress among a sample of 599 Black pregnant women. I found that experiences of racial discrimination were related to lower levels of social support and higher levels of psychological wellbeing among these women. Social support related to lower levels of psychological wellbeing; however, social support did not moderate the association of racial discrimination with psychological distress in this sample. Finally, I found that the most frequently reported experiences of discrimination were in a store or restaurant and on the street or public setting and the least frequently reported experience was getting medical care among women in this study. Women who reported discrimination in all, but one situation reported lower levels of psychological wellbeing compared with women who did not report discrimination in these situations. This dissertation research adds to the knowledge related to the associations among racial discrimination, social support, and psychological distress among Black pregnant women.

The purpose of this dissertation research was to examine the associations among experiences of racial discrimination, perceived stress and birth satisfaction among Black women, and to examine the mediating effect of perceived stress on the association of experiences of racial discrimination with birth satisfaction among Black women. The first manuscript is an integrative literature review which evaluates prior research of the association of stress with birth satisfaction, with consideration to studies that included Black women in their samples. This review revealed a need for further research evaluating stress and birth satisfaction specific to Black women. The second manuscript examines the associations among racial discrimination, perceived stress, and birth satisfaction among a sample of 154 Black women. Experiences of racial discrimination were positively correlated with perceived stress. Perceived stress was negatively correlated with birth satisfaction. Experiences of discrimination were not related to birth satisfaction. Racial discrimination had a positive effect on perceived stress, and perceived stress had a negative effect on birth satisfaction. Racial discrimination had no direct effect on birth satisfaction; therefore, perceived stress was not applicable as a mediator in the model. The third manuscript presents challenges and successful strategies faced in the recruitment and retention of Black women in the immediate postpartum period. This dissertation adds to the current body of knowledge regarding the effects of racial discrimination on perceived stress, and the relationship between perceived stress and birth satisfaction, while also presenting successful recruiting strategies of Black postpartum women in nursing research, which is crucial to reducing racial disparities in health care.

Thesis (MA (Psychology))--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Maternal filicide, the murder of a child by its mother, is a complex phenomenon with various causes and characteristics. Research, by means of the development of several classification systems and in identifying particular risk factors, has been conducted with the aim of better prevention of this emotionally evocative crime. Various disciplines have offered a wide range of perspectives on why women kill their biological children. These are intended to yield a better understanding of the aetiology of this crime. This literature review delineates three dominant perspectives: psychiatric, psychological, and sociological. The main findings of each perspective are discussed. However, these three perspectives frequently operate in conjunction with each other in that both intrapsychic and interpersonal dynamics play a role in acts of maternal filicide. The most vulnerable women appear to be those who have had a severely deficient developmental history (trauma and/or grossly inadequate parenting), those who experience current difficult psychosocial circumstances, and those who have been diagnosed with a psychiatric illness. However, not all women who experience such problems kill their children. In this regard, individual differences have an important role to play and more carefully delineated future research is suggested. One of the most significant findings of this literature review is that there appears to be a paucity of systematic research on the South African phenomenon of parental child homicide. / AFRIKAANSE OPSOMMING: Moedermoord, die moord van ’n kind deur sy of haar moeder, is ’n komplekse verskynsel met verskeie oorsake en karaktereienskappe. Navorsing deur die ontwikkeling van verskeie klassifikasiestelsels en die identifisering van spesifieke risikofaktore is uitgevoer met die doel om hierdie misdaad, wat soveel emosies ontlok, beter te voorkom. Verskeie dissiplines bied ’n wye verskeidenheid perspektiewe oor die redes waarom vroue hul biologiese kinders vermoor. Die doel van hierdie perspektiewe is om ’n beter etiologiese begrip van hierdie vorm van misdaad te verkry. Die literatuurstudie dui drie dominante perspektiewe aan: psigiatries, psigologies en sosiologies. Die hoofbevindinge van elke perspektief word bespreek. Hierdie drie perspektiewe werk dikwels saam aangesien sowel intrapsigiese en interpersoonlike dinamiek ’n rol in moedermoorddade speel. Die kwesbaarste vroue blyk dié te wees met ’n ernstig gebrekkige ontwikkelingsgeskiedenis (trauma en/of ernstig onvoldoende ouerskap), diegene wat hulle in moeilike psigososiale omstandighede bevind, en dié wat met ’n psigiatriese siekte gediagnoseer is. Nie alle vroue wat hierdie probleme ervaar, vermoor egter hulle kinders nie. In hierdie opsig speel individuele verskille ’n belangrike rol en word versigtig afgebakende toekomstige navorsing voorgestel. Een van die belangrikste bevindinge van hierdie literatuuroorsig is dat daar ’n gebrek aan sistematiese navorsing oor die Suid-Afrikaanse verskynsel van kindermoord deur ouers blyk te wees.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management APRIL 2014 / Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.

We explored the role that exogenous and endogenous competitors for attention play in infants’ abilities to encode and retain information over a 6‐month period. Sixty‐six children visited the laboratory at 15 months, and 32 returned for a second visit at 21 months. Children observed models of conventional‐ relation and enabling‐relation action sequences. Half the children were distracted by a “Mister Monkey” mechanical toy during the conventional‐relation sequence, while the other half was distracted during the enabling‐relation sequence. The Early Childhood Behavior Questionnaire indexed endogenous factors at both ages. Immediate postmodel production of target actions indexed encoding efficiency, and 6‐month production of target actions indexed long‐term recall. The exogenous distracter impacted encoding efficiency (i.e., immediate recall), but not long‐term recall. Endogenous factors (i.e., temperament) were primarily associated with long‐term recall. Of special interest was our finding that endogenous factors, especially surgency, moderated the effect of the exogenous distracter. It appears that when learning conventional‐relation sequences in the presence of exogenous distracters, surgency mobilizes attentional resources toward the learning objective; however, when learning enabling‐relation sequences under the same conditions, surgency either boosts the saliency of the distracters or boosts children’s susceptibility to them.