This is a descriptive study of the relationship between labor patients' perceptions of type of nursing care and labor patients' ability to meet psychosocial needs. The hypothesis tested was labor patients who perceive their nursing care as supportive are better able to meet their psychosocial needs during labor than those labor patients who perceive their nursing care as physical. Physical care included nursing care that meets the physical needs of the patient, and supportive care included nursing care which consists of physical and supportive aspects of nursing care. Psychosocial needs during labor consisted of maintenance of control and self-esteem, and realization of expectations.A sample of 50 postpartum patients was obtained using systematic sampling. The author's tool, Patient's Perception of Labor Questionnaire, was administered within 48 hours postpartum. The patients were divided into two groups, supportive care and physical care, based on their responses on the questionnaire. The statistic ANOVA was used to compare mean scores in relation to meeting psychosocial needs. Those patients who perceived their nursing (p >.05) for maintenance of self-esteem, realization of care as supportive had significantly higher mean scores expectations and maintenance of psychosocial needs. There was not a significant difference in means for maintenance of control for the two groups.

There have been many breakthroughs in birth control technologies, many of which have been beneficial for women. However, many feminists who advocate reproductive freedom also warn that freedom for some might lead to further oppression for others. The case in point is the practice of tubal ligation in the United States. Conflict theory indicates that the field of medicine is a social structure that is based upon capitalistic ideology and serves to perpetuate inequality. Feminist theory argues that medicine systematically disempowers women and that notions of family are very narrowly defined. This study examined the prevalence of tubal ligation among women in the United States, specifically focusing on nonwhite and poor women in an effort to determine whether or not they are sterilized at higher rates than their white and nonpoor counterparts. Data from the National Survey for Family Growth (Cycle V) were examined using several bivariate crosstabulations, and three logistic regressions were run to see if living below the poverty level or being nonwhite had any effect on a woman's likelihood to have a tubal ligation. The results show that there is some indication that living below the poverty level and being nonwhite, among other variables including being counseled by a medical provider about tubal ligation, does increase the likelihood that a woman will have a tubal ligation.

Thesis (Ph. D.)--University of Queensland, 2002. / Includes bibliographical references.

<p> <b>OBJECTIVE:</b> To improve 6-week postpartum visit attendance, glucose test ordering, and test completion among postpartum GDM patients. </p><p> <b>METHODS:</b> Pre- and post-intervention GDM women at Mount Sinai were studied via chart review. Interventions included advanced order sets for glucose monitoring at the 35-week pregnancy visit, educational modules, and nutritionist phone calls reminding patients to attend postpartum visits fasting. </p><p> <b>RESULTS:</b> 107 pre-intervention and 42 post-intervention women were studied. Percentages of orders placed for postpartum testing was higher post-intervention vs. pre-intervention (57% vs. 42%, p=0.03). There were higher test completion rates post-intervention vs. pre-intervention (36% vs. 17%, p=0.01). Postpartum visit attendance rates didn&rsquo;t vary between groups (73% vs. 69% p=0.60). 6% pre-intervention fasted for postpartum visits vs. 60% post-intervention. </p><p> <b>CONCLUSION:</b> There was no increase in women attending their 6-week postpartum visits, yet rates of completed orders for postpartum testing, women attending visits fasting, and postpartum test completions were higher post-intervention. More research may identify the barriers to attendance at 6-week post-partum visits.</p>

Pre-eclampsia is a pregnancy-specific, multi-system disorder of placental origin. Affecting between 2-8% of women, it is one of the leading causes of both maternal and fetal morbidity and mortality in the United Kingdom. Although the disorder presents after 20 weeks gestation with the classic symptoms of hypertension and proteinuria, the pathological process(es) leading to this syndrome initiate early in the first trimester. In current clinical practice, prediction of those who will get the disease and those who will have a poor outcome once it develops is poor. This thesis focuses on novel ways to enhance the prediction of the development of pre-eclampsia and poor outcome once the syndrome manifests. Firstly, the current risk factors for pre-eclampsia were challenged. Racial variation in these risk factors has demonstrated the importance of considering maternal ethnicity when assessing the likelihood of developing the disease. Obese Black women were more likely to develop pre-eclampsia than obese white women (aOR 2.06 (95%CI 1.34-3.23) p=0.002). In the normal BMI group Black women were less likely to develop pre-eclampsia than White women (aOR 0.421 (95%CI 0.24-0.73) p<0.001). Younger (<20 years of age) Black women were less likely to develop pre-eclampsia than younger white women (aOR 0.628 (95%CI 0.49-0.83) p<0.001). Conversely, older (>35 years of age) Black women were more likely to develop pre-eclampsia than older White women (aOR 1.67 (95%CI 1.39-1.99) p<0.001). Secondly, first trimester maternal plasma studies have identified a cohort of potential disease (and pathophysiological) markers that may allow for the development of an early screening test for pre-eclampsia. The ratio of angiotensinogen to Kallikrein is raised in the first trimester of pregnancies that later develop pre-eclampsia (p<0.001). The receiver operator curve (ROC) for the ratio of angiotensinogen to kallikrein had an area under the curve (AUC) of 0.81 (SE=0.05). A cut-off value of >0.27 has a sensitivity of 0.9 (95% CI = 0.74 – 0.97), a specificity of 0.5 (95% CI = 0.24-0.65), positive predictive value (PPV) 0.63 (95%CI = 0.47-0.75) and negative predictive value (NPV) of 0.87 (95% CI = 0.53-0.96) in predicting the onset of preeclampsia. Common haematological and biochemical tests are presented as markers for both the development of the disease and poor outcome when it occurs. The ratio of Neutrophil to Lymphocyte (NLR) is raised in the first trimester of pregnancies that develop pre-eclampsia (p<0.001). The ROC of the ratio to Neutrophil to Lymphocyte has an AUC of 0.84 (95% CI = 0.85-0.95). A cut off value of 2.53 has a sensitivity of 0.92 (95%CI = 0.85-0.95), specificity of 0.6 (95%CI = 0.51-0.67), PPV 0.68 (95%CI = 0.6-0.74) NPV 0.87 (95%CI = 0.8-0.93) for predicting the onset of pre-eclampsia. At the time of diagnosis of pre-eclampsia, a raised NLR predicts poor maternal outcome and the need for a caesarean section due to fetal distress (p<0.05). In addition, a reduced level of bilirubin predicts both poor fetal and maternal outcome and the need for a caesarean section (p<0.05).

<p> Traumatic birth is a term used to describe a wide-range of negative physical and mental birthing events and outcomes. An estimated one-third of women perceive mental trauma during birth. Aside from deterioration of maternal mental health, the effects of perceived traumatic birth can be observed in the entire family. Although research shows the relationship of traumatic birth to mental health, the majority has focused on European or European-American women. The profound psychological impact of birth trauma has been passed off as common to all women without considering culture, race, or context. Little is known about birth trauma experiences of Mexican immigrant women. Since Mexican immigrants comprise the largest ethnic-minority group in the United States attention to perceived traumatic birth on their health status is clear. </p><p> The purpose of this dissertation research was to describe and understand the impact of a perceived traumatic birth, the range of responses produced, and the life course context in which it occurs in Latina immigrants from Mexico. </p><p> Although recruitment took place in a low-income community-based health center in Fresno, California, most interviews were conducted in the participants&rsquo; homes. In addition to field observation and photography, twenty-one interviews were conducted with seven Mexican immigrant mothers who provided first-person accounts of their perceived traumatic births and the life course context in which it occurred. Facilitated by a certified Spanish interpreter, all interviews were recorded, transcribed verbatim and analyzed via an iterative grounded theory process. </p><p> The results suggest that, in addition to the birth event, for these Mexican immigrant mothers, the process contributing to perceived traumatic birth is embedded in the profound adversity of their unique life context. The burden of crossing a militarized border, the fear of deportation, and lack of trust, mandates a self-protective silence that obscures both the adversity they endure and the resulting maladaptive psychological responses. Consequently, for Mexican immigrant mothers, undocumented status, adversity, mistrust, and the self-mandated silence that surrounds it, may be major factors affecting not only their perceived traumatic births, but their overall health. Findings inform further research, practice, and policy related to the unique needs of Mexican immigrant mothers. </p>

Maternal obesity increases the risk of numerous maternal and fetal complications of pregnancy. Women were recruited at booking for antenatal care. Each subject was examined in the first, Second and third trimester of pregnancy as well as twelve weeks post partum. Using non invasive techniques microvasular function was measured at each visit. Fasting bloods were taken. This assessment allowed us to observe microvascular function, inflammatory response, dislipidaemia and changes in fatty acid composition with advancing gestation and the degree of recovery in the post partum. By recruitment of women with varying body mass index (BMI) values we were able to examine the influence of maternal BMI on these responses to pregnancy.

Background: Venous thromboembolism (VTE) in one of the leading causes of maternal morbidity and mortality in high income countries. However there is a surprising shortage of evidence which allows us to accurately predict which women are at high risk which has hindered prevention to date. Therefore the aim of this thesis is to measure the occurrence of and risk factors for VTE during the antepartum and postpartum periods. Methods: Electronic health records from women of childbearing age (15-44 years) were identified from two separate databases; The Health Improvement Network (THIN) between 1995 and 2009 and the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) between 1997 and 2010. Five separate studies were then carried out to study the incidence and risk factors for VTE during antepartum and postpartum periods. In studies 1 and 2 I used the THIN database to assess the incidence of and risk factors for VTE during antepartum and postpartum periods separately. Studies 3, 4 and 5 incorporated the CPRD-HES linked data which enabled me to get better ascertainment of VTE and its potential risk factors. Using these data I externally validated my VTE definition which was followed by investigating the impact of non-delivery related hospitalisations on the incidence of antepartum VTE. I also examined the risk factors for postpartum VTE using a conceptual hierarchical analysis approach along with their impact on the timing of VTE during specific periods of postpartum. All results were presented in the form of absolute rates (AR) per 100,000 person-years and incidence rate ratios (IRR) were calculated using Poisson regression with adjustment for relevant covariates. Results: In THIN, there were a total of 1.7 million women of which 280,451 experienced 376,154 pregnancies resulting in live or stillbirths whereas the CPRD-HES linked data contained information on over 240,000 pregnancies among 204,929 women. Overall VTE rates were highest in the first few weeks postpartum. Women in their third trimester of antepartum were at a 5 fold increased risk of first VTE compared to their time outside pregnancy whereas in the first and second trimesters this rate was only marginally higher. However the use of CPRD-HES linked database gave me estimates of VTE risk with better precision in and around pregnancy that were comparable to the existing literature. For my risk factor analysis I found that the strongest risk factor for VTE during the antepartum period was hospitalisation corresponding to a 17-fold increase (IRR=17.7 95%CI=7.7-39.6) compared to time outside hospital. The rate of VTE was also high during the 28 days post-discharge (IRR=5.9; 95%CI=3.5-10.0; AR=646). These factors were not confounded by pregnancy related characteristics and complications, pre-existing medical co-morbidities or demographic or life style related characteristics. I also found that postpartum, women whose pregnancies resulted in stillbirth were at a 6- fold (IRR=6; 95%CI 3.17-14.6; AR=2570) increased risk of VTE. Those with caesarean delivery (elective or emergency), pre-term birth or postpartum haemorrhage had a 2-fold or higher risk of postpartum VTE compared to their respective baseline (AR>600/100,000 person-years). These findings were consistent across both the THIN and CPRD-HES linked data bases with respect women's risk factors for VTE. Finally the risk of VTE remains consistently high up to first six weeks postpartum (>700/100,000 person-years) for pregnancies of women complicated with BMI>30kg/m2 or caesarean delivery whereas risk of VTE was only high in the first three weeks postpartum (>1300/100,000 person-years) In those with pre-term birth or postpartum haemorrhage. Conclusion: I have provided some of the most precise estimates of absolute rates of VTE In and around pregnancy for better understanding of risks. The overall rate of antepartum VTE is substantially increased during non-delivery related hospitalisations and this increase is sustained in the 28 days post-discharge. Postpartum, delivery associated characteristics and complications including, stillbirth, caesarean delivery, BMI>30Kg/m2 postpartum haemorrhage are important risk factors for VTE particularly during the first three weeks postpartum. My analysis provides valuable information to clinicians for better decision making in terms of identifying high risk pregnant and postpartum women who may require some form of thromboprophylaxis.

<p>Birth doulas help women plan for and carry out the most &ldquo;satisfactory birth&rdquo; possible. The purpose of this study was to explore the roles of privately hired doulas serving women in the St. Louis and St. Louis Metro East region and their influence on patient-provider interactions before, during, and after childbirth, within the framework of patient-centered communication. This study is based on in-depth interviews with six doulas offering support to childbearing women giving birth at hospitals. The findings of this study suggest that doulas believe they enhance communication between patients and their providers, by taking on the roles of advocates and liaisons. Aspects of the training and scope of practice of participant doulas, the type of clients seeking their services and their motivations, as well as common misconceptions and challenges arising when communicating with clients and providers, are also discussed. </p><p> <i>Keywords</i>: doulas, patient-provider communication, patient-centered communication, childbirth, decision-making, advocacy </p>

According to the concept of perinatal programming environmental factors during fetal development and early postnatal life can influence phenotype in later life by modifying organ and tissue development and the epigenetic information of specific genes which, in turn, induce alteration in gene expression. Global nutrient restriction is a well-established intervention to study fetal programming but choline, a micronutrient essential for tissue growth and development, has not been extensively studied. The aim of this thesis is to investigate long term effects of modifications in maternal macro and micronutrient intake on the offsprings‟ appetite regulation and metabolic health. Twin-pregnant sheep were fed to requirements until 110 days of gestation and then randomised to stay on the same diet (R) or be restricted to 60% of caloric requirements (N) until term (~145 days). Offspring were subsequently subject either to a standard early postnatal growth rate as both twins remained with the mother (S) or to an accelerated growth rate resulting when only one twin remained to be mother fed (A). After weaning, offspring were reared in either a lean (L) or an obesogenic environment (O) until 17 months of age. These interventions gave rise to 4 groups: RAO, NAO, NSO and NSL. There were no differences in body weight, composition or adipocyte size with perinatal nutrient restriction but insulin response to a glucose tolerance test was increased in offspring born to N mothers. Measurement of hypothalamic gene expression in the latter offspring suggested a more orexigenic and cortisol-sensitive regulatory phenotype. During lactation, rats were fed a diet that was either choline-devoid (D), or contained a standard amount of choline either as bitartrate (C) or as phosphatidylcholine (PC). After weaning, female offspring were maintained on a standard choline diet until 11 weeks of age. D mothers had a substantial decrease in food intake and offspring were smaller at weaning but had similar glucose tolerance. Adult offsprings‟ brain phospholipid concentrations were reduced, which may suggest changes in brain development, but food intake and hypothalamic protein expression were unchanged. Intake of different forms of choline, i.e. bitartrate versus PC, during lactation had no long term effects on offspring. Both maternal dietary interventions had long term effects on offspring. Sheep developed the most adverse metabolic phenotype when the offspring were subjected to slow growth in late gestation followed by rapid growth and obesity, with the onset of insulin resistance mediated through changes in peripheral tissues. Maternal choline intake during lactation is essential for the health of the offspring as it alters brain composition. In conclusion, both studies produced results which are consistent with the concept of perinatal programming as adult metabolic health was affected in the sheep study and organ development was affected in a long term manner in the rat study.