Background: The current practice in northern Canada is to transfer pregnant women residing in communities without hospital facilities to larger centres at 37 weeks gestation. Little research has been conducted on how the practice of transferring women for childbirth affects available prenatal care continuity and prenatal care options, and whether or not this in turn affects health outcomes. Objectives: The aim of this study is to examine whether differences exist in prenatal care, risk factor distribution, and neonatal morbidity, between women who are transferred for childbirth, and women who are able to remain in their home community to give birth. Methods: Secondary analysis of the Canadian Maternity Experiences Survey 2006-2007 data was conducted in order to examine the relationship between transfer for childbirth, prenatal care, maternal risk factors, and neonatal morbidity. Crude odds ratios and adjusted odds ratios were calculated to assess the relationships between variables using multiple logistic regression, with bootstrap weights applied. Results: Women who were transferred for childbirth were more likely to experience a negative neonatal morbidity outcome (OR=1.9, 95% CIs 1.3-2.8), though this relationship disappeared when the relationship was adjusted for potential confounders. When these results were adjusted for potential confounding, smoking during pregnancy was the only risk factor shown to be significantly associated with neonatal morbidity in this study (OR=1.8, 95% CIs 1.0-3.0). Conclusion: More detailed and widespread data collection is needed to be able to properly assess prenatal care, maternal risk factors and neonatal morbidity in northern Canada. A perinatal database, constructed for surveillance purposes, would assist in further exploring the effect of transfer policy on prenatal care practices and maternal risk factor distribution, and the effect this has on neonatal health outcomes. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-09-29 14:55:33.977

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Background/Project Description: There is a growing interest in the contribution of late preterm (34 – 36 week gestational age (GA)) birth to neonatal morbidity and mortality. Late preterm infants have an increased incidence of both respiratory and non- respiratory complications over the first year of life. Rates of prematurity as well as morbidity/mortality in infancy are higher in lower socioeconomic status (SES) groups but how GA and SES interact is relatively unexplored. Methods/Participant Population: A retrospective cohort study was undertaken utilizing anonymized data housed at the Manitoba Centre for Health Policy (MCHP). A population-based cohort of infants born at 34 to 41 weeks of GA was assembled; individual and area-level income information was used to develop SES groups. Outcomes studied included diagnoses received during the birth hospitalisation, neonatal and post-neonatal admissions. Regression models were constructed to explore the effects of GA and SES as well as control for multiple perinatal variables. Appropriate approvals and safeguards for data privacy were maintained. Results: GA and SES exerted a gradient effect on morbidity, which persisted after controlling for multiple confounding variables. The effect of GA was strongest during the birth hospitalisation but persisted throughout the first year with increased morbidity evident with each week of decreasing GA. The detrimental association of low SES with morbidity increased in effect size throughout the first year surpassing that of GA for post-neonatal admissions. An interaction effect of maternal diabetes, respiratory morbidity and SES was suggested and merits further investigation. Neonatal stays of 3 days or longer negated the association of GA with readmission within the first 28 days; in addition shorter stay infants had the highest risks of readmission at 37 weeks as compared to the late preterm gestations. Conclusions: The consistent associations between poverty, prematurity and morbidity require both further study and attention. Attention to the neonatal health of both late preterm and term infants is important due to their large numbers and population impact. The added risk of poverty merits urgent and multifaceted interventions to lay the groundwork for healthy childhood and long-term success.

The psychometric properties of this Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were assessed, before using the scale to describe stress experienced by parents in a Neonatal Intensive Care Unit (NICU). The extent to which parental stress from the parent-infant relationship in the unit was linked to parenting they received as a child, and adjustment to their couple relationship, was also examined. The sample consisted of 182 mothers and 183 fathers, who were in a cohabitating relationship, of infants from the NICU at Christchurch Women's Hospital. The self-report questionnaires included the PSS:NICU, Parental Bonding Instrument, and the Dyadic Adjustment Scale, and were administered to parents within 2-3 weeks of their infant's birth. This study extends the finding of satisfactory psychometric properties of the PSS:NICU (Franck, Cox, Allen & Winter, 2005; Miles, Funk & Carlson, 1993; Reid & Bramwell, 2003) to this New Zealand sample. Mothers experienced significantly higher stress from the unit compared to fathers (p < .01). A previous finding, for mothers, of the parent-infant relationship being the most stressful aspect of the unit (Franck et al., 2005; Reid & Bramwell, 2003; Shields-Poe & Pinelli, 1997) extends to the New Zealand sample. The most stressful aspect of the unit for fathers was sights and sounds. Lack of evidence was found for associations between parental stress from the parent-infant relationship in the unit and parenting received as a child, or adjustment to their couple relationship. A weak but significant negative correlation was, however, found between stress from the mother-infant relationship and maternal care received in childhood. It is unnecessary to provide all parents with intervention further to what is already being practiced in the unit, as overall low levels of stress were reported. Some parents, however, did find the unit more stressful, and they may benefit from increased intervention.

When a woman discovers that she is pregnant, she begins a process of internal work to develop her mother role. This process has been outlined in the literature for the delivery of a healthy full-term baby, however little is known about the process for mothers of medically fragile babies. A threatened pregnancy and subsequent delivery of a medically fragile baby involves a different process of internal work by the mother to prepare for her role. Mothers with a baby in the Neonatal Intensive Care Unit (NICU) experience stress, uncertainty, and anxiety potentially causing a permanent impact on the successful development of her role. It is the purpose of this dissertation to explore the process of mother role development among those first-time mothers having a baby in the NICU. This study was conducted using a qualitative grounded theory method. Data collection consisted of personal journals, in-person interviews, researcher notes and observation. The specific aims include (1) describing the disruption in the individual’s preconceived idea of being a mother, (2) exploring specific strategies that support the mother in the development of her role while in the NICU, (3) describing the mother’s perception of her role during physiologic changes in her baby, (4) examining the mother’s evaluation of her mother-role success, (5) developing a deeper understanding of the process of developing the role of mother while in the NICU, and (6) constructing a theoretical model to illustrate the process of becoming a mother while in the NICU.

Vården på en neonatal intensivvårdsavdelning börjar i allt större utsträckning bli familjecentrerad. En familjecentrerad inriktning på vården är betydelsefull då den bidrar till såväl upplevelsen av delaktighet, känslan av trygghet som möjligheter för föräldrarna att knyta an till sitt barn. Anknytning till ett nyfött barn främjar tillväxt och utveckling. Pappan till det nyfödda barnet har en viktig roll för att barnet ska kunna förses med de trygga förhållandena som krävs för att tillväxt och utveckling ska gynnas. En aspekt av vården som dock skulle kunna störa bildandet av dessa trygga förhållanden är om pappan inte görs delaktig av sjuksköterskorna på avdelningen. Denna litteraturstudie syftar till att beskriva pappors upplevelser av att ha ett barn på en neonatal intensivvårdsavdelning. Resultatet baseras på nio kvalitativa artiklar analyserade med hjälp av Axelssons beskrivning. Resultatet visar att pappor har en stor önskan av att få vara tillsammans med sin familj, men att denna vilja ibland motverkas av faktorer som stöd från vårdpersonal samt tiden. Det har i resultatet även framkommit att interaktioner med vårdpersonal av papporna upplevts som såväl negativ som positiv i sin utformning. I interaktionen ingår att kommunikation och undervisning upplevs viktigt samt att miljön papporna befinner sig i kan påverka deras förståelse kring den situation de befinner sig i. I diskussionen fördjupas pappornas upplevelser av den neonatala vården med ny litteratur. Papporna upplevde en brist på delaktighet vilket kunde motverkas genom god kommunikation, möjlighet till samtal samt genom att få sova på neonatalavdelningen. Det sistnämnda är även relevant ur den hållbara samhällsutvecklingens synvinkel.

Bakgrund: Bröstmjölk har positiv inverkan på nyfödda barns hälsa, särskilt för förtidigt födda och sjuka barn. Donation av bröstmjölk ger fler nyfödda barn som behöver vård på sjukhus möjligheten att få bröstmjölk som näring under deras första tid i livet. Syfte: Att undersöka kvinnors upplevelser av att donera bröstmjölk samt att undersöka hur kvinnor som donerat bröstmjölk tror att antalet donatorer kan ökas. Metod: En kvalitativ enkätstudie. 23 enkäter skickades ut till kvinnor som donerat bröstmjölk till Akademiska Barnsjukhuset i Uppsala under perioden 130831 – 140901. Resultat: Kvinnorna hade övervägande positiva upplevelser av att donera bröstmjölk. Den främsta anledningen till valet av donation var viljan att hjälpa behövande barn. Det upplevdes som positivt att mjölken som blev över kom till användning då många av kvinnorna kände till vikten av att barn och speciellt förtidigt födda får bröstmjölk. Något som upplevdes negativt var hantering av bröstpumpen samt att det var besvärligt att diska delarna efter användning. För att få fler kvinnor att donera bröstmjölk angavs att det kunde bli enklare att donera bröstmjölk. Möjligheten till bröstmjölksdonation ansågs behöva bli synligare, med mer information samt beskrivningar av den brist som idag råder på bröstmjölk och hur viktig den faktiskt är för barnens liv. Slutsats: Kvinnornas upplevelser av att donera bröstmjölk var övervägande positiv och många kände att det var givande att hjälpa barn. De negativa upplevelserna bestod i att det var en del arbete och tid som krävdes för donationerna. För att få fler att donera bröstmjölk krävs mer information om möjligheten till donation och betydelsen av bröstmjölk.