(Training and (Quality of Life) ) and Education) and Maternal) and Postpartum

Carlos Zubaran, Katia Foresti, Investigating quality of life and depressive
symptoms in the postpartum period, Women and Birth, Volume 24, Issue 1,
March 2011, Pages 10-16, ISSN 1871-5192, 10.1016/j.wombi.2010.05.002.
(http://www.sciencedirect.com/science/article/pii/S1871519210000417)
Abstract: SummaryBackground
Mood disturbances represent the most frequent form of maternal psychiatric
morbidity in the postpartum period. Nevertheless, few studies have examined
the impact of postpartum depression on the mother's quality of life.
Research question or problem
The present study aims to assess the quality of life of a sample of mothers
in Southern Brazil, in order to investigate the association between
postpartum depression and quality of life (QoL) standards.
Participants and methods
This study investigates a sample of 101 adult volunteers who completed the
Portuguese version World Health Organization Quality of Life Assessment-
Bref (WHOQOL-Bref) and Multicultural Quality of Life Index (MQLI)
questionnaires. Postnatal depressive symptoms were evaluated through the
Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal
Depression Scale (EPDS). Multiple regression analyses were conducted to
predict the overall PDSS and EPDS scores. Pearson Product-Moment
Correlation coefficients were computed between the global scores of the
quality of life measurements and the screening questionnaires for postnatal
depression.
Results
Both socio-economic status and quality of life have influenced
significantly the depressive symptomatology and correlated epiphenomena.
Significant correlations were observed among scores of postpartum
depression screening tools and quality of life questionnaires. The socio-
economic status of research participants was only significantly correlated
to the scores generated by the WHOQOL-Bref questionnaire.
Conclusions
These findings confirm that socio-economic deficiencies and low quality of
life can facilitate the expression of depressive symptomatology during the
postpartum period. The results also emphasize the salience of psychosocial
risk factors in the diathesis of postnatal depression.
Keywords: Quality of Life; Postpartum depression; Questionnaires; Brazil
Kalpana Upadhyay, Helen Scholefield, Risk management and medicolegal issues

related to postpartum haemorrhage, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 22, Issue 6, December 2008, Pages
1149-1169, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.08.007.
Abstract: Postpartum haemorrhage (PPH) is a major cause of maternal
mortality and morbidity. Despite several local and national guidelines and
recommendations, the incidence of major obstetric haemorrhage has not
declined significantly over the years. A high proportion of these cases
involve patient safety incidents. The major themes in such incidents are:
delay in diagnosis, failure to adhere to protocols, lack of consultant
supervision, communication and documentation problems, inefficient teamwork
and organizational failure. This chapter deals with ways of identifying the
major contributory factors for adverse events associated with PPH and
suggests solutions to minimize errors.
Keywords: postpartum haemorrhage; maternal morbidity; hysterectomy; risk
management; safety; adverse events; medicolegal
Hawley E. Montgomery-Downs, Salvatore P. Insana, Megan M. Clegg-Kraynok,

Laura M. Mancini, Normative longitudinal maternal sleep: the first 4
postpartum months, American Journal of Obstetrics and Gynecology, Volume
203, Issue 5, November 2010, Pages 465.e1-465.e7, ISSN 0002-9378,
10.1016/j.ajog.2010.06.057.
Abstract: Objective
To describe the normative course of maternal sleep during the first 4
months postpartum.
Study Design
Sleep was objectively measured using continuous wrist actigraphy. This was
a longitudinal, field-based assessment of nocturnal sleep during postpartum
weeks 2 through 16. Fifty mothers participated during postpartum weeks 2
through 13; 24 participated during postpartum weeks 9 through 16.
Results
Maternal nocturnal sleep time was 7.2 (SD 0.95) hours and did not change
significantly across postpartum weeks 2 through 16. Maternal sleep
efficiency did improve across weeks 2 (79.7%; SD 5.5) through 16 (90.2%;
SD 3.5) as a function of decreased sleep fragmentation across weeks 2
(21.7; SD 5.2) through 16 (12.8; SD 3.3).
Conclusion
Though postpartum mothers' total sleep time was higher than expected during
the initial postpartum months, this sleep was highly fragmented (similar to
fragmenting sleep disorders) and inefficient. This profile of disturbed
sleep should be considered in intervention designs and family leave
policies.
Keywords: actigraphy; maternal; normative; postpartum; sleep
Chia-Yen Li, Su-Chiu Chen, Chung-Yi Li, Meei-Ling Gau, Chiu-Mieh Huang,
Randomised controlled trial of the effectiveness of using foot reflexology
to improve quality of sleep amongst Taiwanese postpartum women, Midwifery,
Volume 27, Issue 2, April 2011, Pages 181-186, ISSN 0266-6138,
10.1016/j.midw.2009.04.005.
Abstract: Objective
to examine the effectiveness of using foot reflexology to improve sleep
quality in postpartum women.
Design and setting
randomised controlled trial, conducted at two postpartum centres in
northern Taiwan.
Participants
65 postpartum women reporting poor quality of sleep were recruited from
July 2007 to December 2007.
Interventions
participants were assigned randomly to either an intervention or a control
group. Participants in both groups received the same care except for
reflexology therapy. The intervention group received a single 30-minute
foot reflexology session at the same time each evening for five consecutive
days. Sessions were administered by a certified nurse reflexologist.
Measures and findings
the outcome measure was the Pittsburgh sleep quality index (PSQI), and this
was performed at baseline and post test. Mean PQSI scores for both groups
declined over time between baseline and post test. Using a generalised
estimation equation to control several confounding variables, the changes
in mean PSQI were found to be significantly lower in the intervention group
(=2.24, standard error=0.38, p<0.001) than in the control group.
Conclusion
an intervention involving foot reflexology in the postnatal period
significantly improved the quality of sleep.
Implications for practice
midwives should evaluate maternal sleep quality and design early
intervention programmes to improve quality of sleep in order to increase
maternal biopsychosocial well-being. Midwives interested in complementary
therapies should be encouraged to obtain training in reflexology and to
apply it in clinical settings if it is allowed.
Keywords: Foot reflexology; Complementary medicine; Postpartum quality of
sleep; Randomised controlled trial
Marie-Pierre Bonnet, Catherine Deneux-Tharaux, Marie-Hlne Bouvier-Colle,
Critical care and transfusion management in maternal deaths from postpartum
haemorrhage, European Journal of Obstetrics & Gynecology and
Reproductive Biology, Volume 158, Issue 2, October 2011, Pages 183-188,
ISSN 0301-2115, 10.1016/j.ejogrb.2011.04.042.
Abstract: Objectives
In postpartum haemorrhage (PPH), as for other causes of acute haemorrhage,
management can have a major impact on patient outcomes. The aim of this
study was to describe critical care management, particularly transfusion
practices, in cases of maternal deaths from PPH.
Study design
This retrospective study provided a descriptive analysis of all cases of
maternal death from PPH in France identified through the systematic French
Confidential Enquiry into Maternal Death in 20002003.
Results
Thirty-eight cases of maternal death from PPH were analysed. Twenty-six
women (68%) had a caesarean section [21 (55%) emergency, five (13%)
elective]. Uterine atony was the most common cause of PPH
(n = 13, 34%). Women received a median of 9 (range 264) units of
red blood cells (RBCs) and 9 (range 267) units of fresh frozen plasma
(FFP). The median delay in starting blood transfusion was 82 (range 0
320) min. RBC and FFP transfusions peaked 24 h and 1224 h
after PPH diagnosis, respectively. The median FFP:RBC ratio was 0.6 (range
02). Fibrinogen concentrates and platelets were administered to 18 (47%)
and 16 (42%) women, respectively. Three women received no blood products.
Coagulation tests were performed in 20 women. The haemoglobin concentration
was only measured once in seven of the 22 women who survived for more than
6 h. Twenty-four women received vasopressors, a central venous access
was placed in 11 women, and an invasive blood pressure device was placed in
two women. General anaesthesia was administered in 37 cases, with five
patients being extubated during active PPH.
Conclusions
This descriptive analysis of maternal deaths from PPH suggests that there
may be room for improvement of specific aspects of critical care
management, including: transfusion procedures, especially administration
delays and FFP:RBC ratio; repeated laboratory assessments of haemostasis
and haemoglobin concentration; invasive haemodynamic monitoring; and
protocols for general anaesthesia.
Keywords: Maternal death; Postpartum haemorrhage; Critical care management;
Resuscitation; Transfusion
Cindy-Lee Dennis, Postpartum depression peer support: Maternal perceptions

from a randomized controlled trial, International Journal of Nursing
Studies, Volume 47, Issue 5, May 2010, Pages 560-568, ISSN 0020-7489,
10.1016/j.ijnurstu.2009.10.015.
(http://www.sciencedirect.com/science/article/pii/S002074890900354X)
Abstract: Background
Peer support in the early postpartum period is effective in the prevention
of postpartum depression among women identified as high-risk.
Objectives
To describe maternal perceptions of peer support received while
participating in a trial.
Design
Cross-sectional survey of women participating in a randomized controlled
trial to evaluate the effect of peer support in the prevention of
postpartum depression.
Setting
Seven health regions across Ontario Canada.
Participants
701 women were recruited between November 2004 and September 2006. Women
eligible for the study were all mothers with an Edinburgh Postnatal
Depression Scale score >9 who were within 2 weeks postpartum, at least
18 years of age, able to speak English, had a live birth, and had been
discharged home from the hospital. Exclusion criteria included an infant
not discharged home with the mother and current use of antidepressant or
antipsychotic medication. Two hundred and twenty-one mothers completed the
mailed questionnaire.
Methods
Women were randomly allocated to receive usual postpartum care (control
group) or usual postpartum care plus telephone-based peer support
(intervention group). Maternal perceptions of peer support were evaluated
at 12 weeks postpartum using the validated Peer Support Evaluation
Inventory.
Results
Interactions provided by the peer volunteer included the provision of
emotional (92.7%), informational (72.4%), and appraisal (72.0%) support.
Mothers reported high levels of positive relationship qualities such as
trust (83.6%) and perceived acceptance (79.1%). Most (80.5%) mothers
indicated they were very satisfied with their peer support experience.
Maternal satisfaction was associated with the number and duration of peer
volunteer contacts.
Conclusions
The majority of mothers perceived their peer volunteer experience
positively lending further support to telephone-based peer support as a
preventative strategy for postpartum depression. The following program
modifications were suggested: (a) adapt training to enhance the provision
of appraisal support; (b) improve matching of volunteers to participants
based on age, number of children, and breastfeeding status; and (c) ensure
participating mothers want to receive peer support in order to facilitate
the development of relationships with their assigned peers.
Keywords: Peer support; Postpartum depression; Prevention; Randomized
controlled trial
Caroline Homer, Vanessa Clements, Nolan McDonnell, Michael Peek, Elizabeth

Sullivan, Maternal mortality: What can we learn from stories of postpartum
haemorrhage?, Women and Birth, Volume 22, Issue 3, September 2009, Pages
97-104, ISSN 1871-5192, 10.1016/j.wombi.2009.02.002.
Abstract: Summary
Death from pregnancy is rare in developed countries such as Australia but
is still common in third world and developing countries. The investigation
of each maternal death yields valuable information and lessons that all
health care providers involved with the care of women can learn from. The
aim of these investigations is to prevent future maternal morbidity and
mortality.
Obstetric haemorrhage remains a leading cause of maternal death

internationally. It is the most common cause of death in developing
countries. In Australia and the United Kingdom, obstetric haemorrhage is
ranked as the 4th and 3rd most common cause of direct maternal death
respectively. In a number of cases there are readily identifiable factors
associated with the care that the women received that may have contributed
to their death. It is from these identifiable factors that both midwives
and doctors can learn to help prevent similar episodes from occurring.
This article will identify some of the lessons that can be learnt from the
recent Australian and UK maternal death reports. This paper presents an
overview of the process and systems for the reporting of maternal death in
Australia. It will then specifically focus on obstetric haemorrhage, with a
focus on postpartum haemorrhage, for the 12-year period, 19942005.
Vignettes from the maternal mortality reports in Australia and the United
Kingdom are used to highlight the important lessons for providers of
maternity care.
Keywords: Maternal death; Maternal mortality; Midwives; Obstetricians;
Maternity; Obstetric haemorrhage; Postpartum haemorrhage
Lynn Sibley, Leila Caleb-Varkey, Jayant Upadhyay, Rajendra Prasad, Ekta

Saroha, Neerja Bhatla, Vinod K. Paul, Recognition of and Response to
Postpartum Hemorrhage in Rural Northern India, Journal of Midwifery &
Women's Health, Volume 50, Issue 4, JulyAugust 2005, Pages 301-308, ISSN
1526-9523, 10.1016/j.jmwh.2005.03.006.
Abstract: This study describes the results of a Morbidity and Performance
Assessment (MAP) conducted to provide insight into the medical factors
contributing to maternal and newborn morbidity and mortality in a rural
district of northern India, and to use these insights to develop a locally
appropriate, community-based safe motherhood program The MAP study was
based on verbal autopsy method. Five hundred ninety-nine women (or in the
case of 9 maternal deaths, a family member) participated in the study. This
article describes a subsample of women who reported signs or symptoms
suggesting excessive bleeding (n = 159). Findings include a poor knowledge
of danger signs; poor problem recognition during labor, birth, and the
immediate postpartum period; and a low level of health seeking that was
consistent with poor recognition. Maternal sociodemographic
characteristics, antenatal care use, and knowledge of danger signs were
generally not associated with problem recognition and health seeking. The
case fatality rate was 4%. These findings suggest an urgent need to
understand the phenomenon of problem recognition and to integrate this into
the design of interventions to reduce delays in health seeking.
Keywords: postpartum hemorrhage; maternal mortality; safe motherhood; birth
preparedness; health seeking behavior
Louise Seimyr, Barbara Welles-Nystrm, Eva Nissen, A history of mental

health problems may predict maternal distress in women postpartum,
Midwifery, Available online 18 January 2012, ISSN 0266-6138,
10.1016/j.midw.2011.11.013.
Abstract: Aim
to elucidate the effects of prior mental disorders on newly delivered
women's mental health and to compare the outcome of different instruments
to screen for maternal distress and depression after childbirth. The sample
of 232 Stockholm women responded to a questionnaire on background data and
three questionnaires, Beck Depression Inventory (BDI), Edinburgh Postnatal
Depression Scale (EPDS) and Postpartum Depression Symptoms Rating Scale
(PPDS) at 46 weeks and 1012 weeks after childbirth.
Results
show that maternal distress was experienced by 20% of the women as assessed
by the BDI and the EPDS at 46 weeks postpartum, and by 1316% of the women
at 1012 weeks after childbirth. A regression analysis showed that a
history of mental health problems influenced maternal self-assessment at
both points-in-time. The following background data showed a small but
significant impact on maternal self-assessment; younger age, lower
educational level, and a short-term partner relationship. The most
important emotional responses were sadness, guilt and self-blame across all
three instruments at both points in time. Loss of pleasure, self-
accusations, irritability, anger, worry and somatic symptoms such as
muscular tension, headaches and stomach cramps also occurred.
Conclusion
women with prior mental health problems are more vulnerable for maternal
distress and midwives at the antenatal health clinics should encourage
pregnant women to express emotional issues during their transition to
motherhood in order to offer appropriate professional support and care.
Keywords: Previous mental disorders; Maternal distress; Depressive mood
postpartum
Corinna Reck, Daniela Noe, Jakob Gerstenlauer, Eva Stehle, Effects of

postpartum anxiety disorders and depression on maternal self-confidence,
Infant Behavior and Development, Volume 35, Issue 2, April 2012, Pages 264-
272, ISSN 0163-6383, 10.1016/j.infbeh.2011.12.005.
Abstract: Low maternal self-confidence may damage the early motherinfant
relationship and negatively influence infant development. The goal of this
study was to test whether a current and previous history of DSM-IV anxiety
and depressive disorders is associated with maternal self-confidence two
weeks after delivery. Postpartum anxiety disorder and depression was
diagnosed according to DSM-IV criteria in a community sample of 798 women.
The data showed a significant link between current postpartum anxiety and
depressive disorders and maternal self-confidence. Furthermore, women with
a depression or anxiety disorder in their previous psychiatric history
scored lower in maternal self-confidence. There is a need for appropriate
preventive programmes to promote maternal self-confidence. With such
programmes it is possible to prevent infant developmental disorders which
might result from reduced feelings of maternal self-confidence and
associated maternal interaction behaviour.
Keywords: Maternal self-confidence; Anxiety disorder; Depression; DSM-IV-
criteria; Puerpartum; Previous psychiatric history
S.E.K. Bradley, N. Prata, N. Young-Lin, D.M. Bishai, Cost-effectiveness of

misoprostol to control postpartum hemorrhage in low-resource settings,
International Journal of Gynecology & Obstetrics, Volume 97, Issue 1,
April 2007, Pages 52-56, ISSN 0020-7292, 10.1016/j.ijgo.2006.12.005.
Abstract: Objective
To test the cost-effectiveness of training traditional birth attendants
(TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal
dose of misoprostol in areas with low access to modern delivery facilities.
Method
A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000
women each giving birth with TBAs: one under standard treatment (TBA
referral to hospital after blood loss 500 ml), and one attended by
TBAs trained to recognize PPH and to administer 1000 g of misoprostol at
blood loss 500 ml.
Result
The misoprostol strategy could prevent 1647 cases of severe PPH (range:
8102920) and save $115,335 in costs of referral, IV therapy and
transfusions (range: $13,991$1,563,593) per 10,000 births. By preventing
severe disease and saving money, it dominates the standard approach.
Conclusion
Training TBAs to administer misoprostol to treat PPH has the potential to
both save money and improve the health of mothers in low-resource settings.
Keywords: Maternal morbidity; Cost-effectiveness; Postpartum hemorrhage,
misoprostol; Traditional birth attendants
Ayfer Tezel, Sebahat Gzm, Comparison of effects of nursing care to

problem solving training on levels of depressive symptoms in post partum
women, Patient Education and Counseling, Volume 63, Issues 12, October
2006, Pages 64-73, ISSN 0738-3991, 10.1016/j.pec.2005.08.011.
Abstract: Objective
The aim of this study was to compare the effect of nursing intervention to
the effect of problem solving training on the level of postpartum
depressive symptom.
Methods
We utilized a pretestposttest mutual controlled semi experimental model
for this study. The study consisted of 62 women (30 in care group and 32 in
training group), all of who were at risk for postpartum depression, but
without major depressive symptoms. These women were not undergoing
pharmacologic or psychotherapeutic treatment, were all literate and
consented to join the study in Erzurum, Turkey. Participants
(N = 62), recruited over a 9 month, were randomly assigned to one
of two groups. Women in care group (average age = 21, 33.3%
primaparus) were given nursing care for her depressive symptoms. Women in
training group (average age = 25, 33.9% primaparus) were taught
problem solving skills.
Results
Depressive symptoms were assessed before and after nursing interventions.
We found that nursing care was effective women for with depressive symptoms
(McNemar test, p < 0.001), and problem-solving training was
also effective (McNemar test, p < 0.05). When the
effectiveness of nursing care and the problem solving education was
compared utilizing the BDI, it was found out that the nursing care was more
effective than education alone (t = 4.529,
p < 0.05).
Conclusion
Results from this study suggest that nursing care and problem solving
training may be use confidently in the primary care setting by nurses for
women with postpartum depressive symptoms.
Practice implication
Nurses play on important role in its detection and can reduce depressive
symptoms. Public health nurses are equipped with care paths addressing
specific health needs of depressed women in the primary care setting. Our
finding indicate that these two programs of study can converge with
meaningful results, and perhaps future research could address these points
in a theoretical frame work.
Keywords: Postpartum depression; Depressive symptoms; Nursing care; Problem
solving training
Terri L. Liberto, Screening for Depression and Help-Seeking in Postpartum

Women During Well-Baby Pediatric Visits: An Integrated Review, Journal of
Pediatric Health Care, Volume 26, Issue 2, MarchApril 2012, Pages 109-117,
ISSN 0891-5245, 10.1016/j.pedhc.2010.06.012.
Abstract: Purpose
The purposes of this integrated review are to examine the literature on
screening for depression and help-seeking behaviors by postpartum women
during pediatric well-baby visits; to identify gaps in the literature
relating to depression and help-seeking behaviors; and to discuss
implications for practice and future research.
Method
An extensive search of primary source documents was conducted in Academic
Search Premier, CINAHL, MEDLINE, Mental Measurements Yearbook, PsycINFO,
PsycARTICLES, and Women's Studies International using the key words
postpartum, postpartum depression (PPD), help seeking, and pediatric
setting or pediatrician. Thirty-five articles relevant to help seeking,
PPD, and screening in the pediatric setting were included in this review.
Research studies included both quantitative and qualitative articles.
Results
PPD affects 10% to 15% of all women after birth. Postpartum women generally
do not seek help for depression. Untreated PPD has significant adverse
affects on parenting, maternal bonding, and the infant's emotional and
behavioral development. Interaction with the woman's obstetric provider
ends shortly after the baby's birth. However, interactions with the
pediatric office are initiated and continue throughout the infant's first
two years of life.
Discussion
Early recognition of PPD and appropriate treatment are imperative for
positive maternal-infant outcomes. A majority of women do not seek help for
depression from any source. Because mothers have routine interactions with
pediatric office staff during the first few years after giving birth,
pediatric nurse practitioners and pediatricians have the perfect
opportunity to screen and educate women regarding symptoms, treatment, and
available resources for PPD.
Keywords: Postpartum; postpartum depression; help seeking; pediatric
setting; pediatrician
Laura J. Miller, Elizabeth M. LaRusso, Preventing Postpartum Depression,

Psychiatric Clinics of North America, Volume 34, Issue 1, March 2011, Pages
53-65, ISSN 0193-953X, 10.1016/j.psc.2010.11.010.
(http://www.sciencedirect.com/science/article/pii/S0193953X10001024)
Keywords: Postpartum depression; Prevention; Preconception counseling
Nelli Fisher, Lewis A. Eisen, Jyothshna V. Bayya, Alina Dulu, Peter S.

Bernstein, Irwin R. Merkatz, Dena Goffman, Improved performance of
maternal-fetal medicine staff after maternal cardiac arrest simulation-
based training, American Journal of Obstetrics and Gynecology, Volume 205,
Issue 3, September 2011, Pages 239.e1-239.e5, ISSN 0002-9378,
10.1016/j.ajog.2011.06.012.
Abstract: Objective
To determine the impact of simulation-based maternal cardiac arrest
training on performance, knowledge, and confidence among Maternal-Fetal
Medicine staff.
Study Design
Maternal-Fetal Medicine staff (n = 19) participated in a maternal arrest
simulation program. Based on evaluation of performance during initial
simulations, an intervention was designed including: basic life support
course, advanced cardiac life suppport pregnancy modification lecture, and
simulation practice. Postintervention evaluative simulations were
performed. All simulations included a knowledge test, confidence survey,
and debriefing. A checklist with 9 pregnancy modification (maternal) and 16
critical care (25 total) tasks was used for scoring.
Results
Postintervention scores reflected statistically significant improvement.
Maternal-Fetal Medicine staff demonstrated statistically significant
improvement in timely initiation of cardiopulmonary resuscitation (120 vs
32 seconds, P = .042) and cesarean delivery (240 vs 159 seconds, P = .017).
Conclusion
Prompt cardiopulmonary resuscitation initiation and pregnancy modifications
application are critical in maternal and fetal survival during cardiac
arrest. Simulation is a useful tool for Maternal-Fetal Medicine staff to
improve skills, knowledge, and confidence in the management of this
catastrophic event.
Keywords: maternal cardiac arrest; obstetric simulation training;
simulation education
Kimberly Campbell-Voytal, Judith Fry McComish, Joan M. Visger, Carolynn A.

Rowland, Jacqueline Kelleher, Postpartum doulas: Motivations and
perceptions of practice, Midwifery, Volume 27, Issue 6, December 2011,
Pages e214-e221, ISSN 0266-6138, 10.1016/j.midw.2010.09.006.
Abstract: Objective
to describe the perceptions of a US cohort of experienced birth doulas who
were among the first in the country to be trained to provide postpartum
support.
Design
a qualitative, longitudinal study using ethnographic methods; participant
observation and semi-structured interviews.
Setting
midwestern, urban, US; postpartum home care over three months.
Participants
four postpartum doulas; 13 families.
Measurements
participant observation during six postpartum home visits per family; 13
semi-structured interviews with doulas at the completion of each familys
care; four summative interviews with doulas at the end of the study.
Findings
when describing their postpartum practice, four themes emerged: supporting
women, taking the mothers perspective, empowering women and empowering
families. When speaking of the motivations, three themes emerged: being
called to practice, interest in preventing negative experiences, and
career development.
Key conclusions and implications for practice
in the US, new mothers see midwives and doctors sporadically after
discharge from the hospital. Postpartum doulas fill this gap in continuity
of care by providing support for families as they transition to life with
their new infant. Understanding the beliefs, values and practices of these
important paraprofessionals will help midwives effectively integrate
postpartum doula care into the care of women and infants.
Keywords: Postpartum doula; Qualitative analysis; United States; Postpartum
support
Suellen Miller, Hilarie B. Martin, Jessica L. Morris, Anti-shock garment in

postpartum haemorrhage, Best Practice & Research Clinical Obstetrics
& Gynaecology, Volume 22, Issue 6, December 2008, Pages 1057-1074, ISSN
1521-6934, 10.1016/j.bpobgyn.2008.08.008.
Abstract: The non-pneumatic anti-shock garment (NASG) is a first-aid device
that reverses hypovolaemic shock and decreases obstetric haemorrhage. It
consists of articulated neoprene segments that close tightly with Velcro,
shunting blood from the lower body to the core organs, elevating blood
pressure and increasing preload and cardiac output. This chapter describes
the controversial history of the predecessors of NASG, pneumatic anti-shock
garments (PASGs), relates case studies of PASG for obstetric haemorrhage,
compares pneumatic and non-pneumatic devices and posits why the NASG is
more appropriate for low-resource settings. This chapter discusses the only
evidence available about NASGs for obstetric haemorrhage two pre-post
pilot trials and three case series and describes recently initiated
randomized cluster trials in Africa. Instructions and an algorithm for ASGs
in haemorrhage and shock management are included. Much remains unknown
about the NASG, a promising intervention for obstetric haemorrhage
management.
Keywords: anti-shock trousers; maternal mortality; postpartum haemorrhage
J. Swain, H.G. Dahlen, Putting evidence into practice: A quality activity

of proactive pain relief for postpartum perineal pain, Women and Birth,
Available online 8 May 2012, ISSN 1871-5192, 10.1016/j.wombi.2012.03.004.
Perineal pain associated with perineal trauma is often underestimated.
Offering regular pain relief may be advantageous compared to waiting for
women to request it. Changing clinical practice in a sustained way needs a
whole of team approach.
Aim
To reduce women's pain following perineal trauma in the first 48 h
following childbirth and to undertake this as multidisciplinary, quality
activity.
Methods
In November 2008 a questionnaire was distributed to 18 new mothers who had
sustained perineal trauma during the birth in order to assess pain levels
in the first 48 h and to investigate pain management therapies used.
Following this survey a multidisciplinary project team undertook a series
of brainstorming sessions, reviewed the literature and undertook staff
surveys to identify key factors impacting on women's perineal pain. A
process of decision making led to education and support of women and staff.
An evidence based guideline, which involved prescribing regular pain relief
for women and offering an ice pack within 1 h of giving birth was
implemented, and a brochure was designed for women. A follow up
questionnaire was distributed in June 2010 to 18 women and pain scores
before and after the change in policy were compared.
Results
Prior to the practice change in 2008 67% of the women surveyed rated their
pain as moderate to a lot 48 h following the birth. Following the
change in practice and implementation of a new guideline a second survey in
2010 at 48 h postpartum found 60% of women in the post intervention
group rated their perineal pain as a lot to moderate. There had been a
33% increase in women's use of pain relief options compared to the pre-
intervention survey. The practice change was sustained and adopted by all
the staff.
Conclusion
By taking a multidisciplinary quality activity an effective practice change
was facilitated that appeared to decrease women's perineal pain in the
48 h following birth.
Keywords: Perineal; Pain; Postpartum; Quality activity; Trauma
Pamela Andreatta, Florence Gans-Larty, Domitilla Debpuur, Anthony Ofosu,

Joseph Perosky, Evaluation of simulation-based training on the ability of
birth attendants to correctly perform bimanual compression as obstetric
first aid, International Journal of Nursing Studies, Volume 48, Issue 10,
October 2011, Pages 1275-1280, ISSN 0020-7489,
10.1016/j.ijnurstu.2011.03.001.
Maternal mortality from postpartum hemorrhage remains high globally, in
large part because women give birth in rural communities where unskilled
(traditional birth attendants) provide care for delivering mothers.
Traditional attendants are neither trained nor equipped to recognize or
manage postpartum hemorrhage as a life-threatening emergent condition.
Recommended treatment includes using uterotonic agents and physical
manipulation to aid uterine contraction. In resource-limited areas where
Obstetric first aid may be the only care option, physical methods such as
bimanual uterine compression are easily taught, highly practical and if
performed correctly, highly effective. A simulator with objective
performance feedback was designed to teach skilled and unskilled birth
attendants to perform the technique.
Objectives
To evaluate the impact of simulation-based training on the ability of birth
attendants to correctly perform bimanual compression in response to
postpartum hemorrhage from uterine atony.
Methods
Simulation-based training was conducted for skilled (N = 111) and
unskilled birth attendants (N = 14) at two regional (Kumasi,
Tamale) and two district (Savelugu, Sene) medical centers in Ghana.
Training was evaluated using Kirkpatrick's 4-level model.
Results
All participants significantly increased their bimanual uterine compression
skills after training (p = 0.000). There were no significant
differences between 2-week delayed post-test performances indicating
retention (p = 0.52). Applied behavioral and clinical outcomes
were reported for 9 months from a subset of birth attendants in Sene
District: 425 births, 13 postpartum hemorrhages were reported without
concomitant maternal mortality.
Conclusions
The results of this study suggest that simulation-based training for
skilled and unskilled birth attendants to perform bi-manual uterine
compression as postpartum hemorrhage Obstetric first aid leads to improved
applied procedural skills. Results from a smaller subset of the sample
suggest that these skills could potentially lead to improved clinical
outcomes and additional study is merited.
Keywords: Bimanual uterine compression; Obstetric first aid; Maternal
mortality; Postpartum hemorrhage; Simulation-based training
Lisa M. Bodnar, Mary E. Cogswell, Thad McDonald, Have we forgotten the

significance of postpartum iron deficiency?, American Journal of Obstetrics
and Gynecology, Volume 193, Issue 1, July 2005, Pages 36-44, ISSN 0002-
9378, 10.1016/j.ajog.2004.12.009.
Abstract: The postpartum period is conventionally thought to be the time of
lowest iron deficiency risk because iron status is expected to improve
dramatically after delivery. Nonetheless, recent studies have reported a
high prevalence of postpartum iron deficiency and anemia among ethnically
diverse low-income populations in the United States. In light of the recent
emergence of this problem in the medical literature, we discuss updated
findings on postpartum iron deficiency, including its prevalence,
functional consequences, risk factors, and recommended primary and
secondary prevention strategies. The productivity and cognitive gains made
possible by improving iron nutriture support intervention. We therefore
conclude that postpartum iron deficiency warrants greater attention and
higher quality care.
Keywords: Postpartum; Iron deficiency; Anemia; Mass screening; Hemoglobin
Barbara E. Kwast, Quality of care in reproductive health programmes:

Education for quality improvement, Midwifery, Volume 14, Issue 3, September
1998, Pages 131-136, ISSN 0266-6138, 10.1016/S0266-6138(98)90027-4.
Abstract: The provision of high quality maternity care will make the
difference between life and death or lifelong maiming for millions of
pregnant women. Barriers preventing access to affordable, appropriate,
acceptable and effective services, and lack of facilities providing high
quality obstetric care result in about 1600 maternal deaths every day.
Education in its broadest sense is required at all levels and sectors of

society to enhance policy formulation that will strengthen programme
commitment, improve services with a culturally sensitive approach and
ensure appropriate delegation of responsibility to health staff at
peripheral levels.
This paper is the second in series of three which addresses quality of

care. The first (Kwast 1998) contains an overview of concepts, assessments,
barriers and improvements of quality of care. The third article will
describe selected aspects of monitoring and evaluation of quality of care.
Lynn M. Sibley, Lauren S. Blum, Nahid Kalim, Daniel Hruschka, Joyce K.

Edmonds, Marge Koblinsky, Womens Descriptions of Postpartum Health
Problems: Preliminary Findings from Matlab, Bangladesh, Journal of
Midwifery & Women's Health, Volume 52, Issue 4, JulyAugust 2007, Pages
351-360, ISSN 1526-9523, 10.1016/j.jmwh.2007.02.020.
Abstract: Complications of childbirth kill more than 500,000 women each
year. Postpartum hemorrhage (PPH) is the leading cause of death. Because
nearly half the women who give birth at home in developing countries are
cared for by unskilled attendants, it is critical to understand how women
and their caregivers recognize bleeding and decide to seek help when
needed. Using an approach that combined systematic qualitative data
collection and multivariate analysis, we identified local cultural theories
that women and traditional birth attendants in rural Bangladesh use to
recognize and care for postpartum problems, including PPH. These
preliminary findings will be used to further explore cultural norms related
to PPH and their possible modes of transmission. The overall approach may
be used to develop or improve birth preparedness and complication
readiness, a core global safe motherhood intervention.
Keywords: correspondence analysis; maternal morbidity; postpartum
hemorrhage; qualitative data analysis
Zeelha Abdool, Ranee Thakar, Abdul H. Sultan, Postpartum female sexual

function, European Journal of Obstetrics & Gynecology and Reproductive
Biology, Volume 145, Issue 2, August 2009, Pages 133-137, ISSN 0301-2115,
10.1016/j.ejogrb.2009.04.014.
Abstract: Although many women experience sexual problems in the postpartum
period, research in this subject is under-explored. Embarrassment and
preoccupation with the newborn are some of the reasons why many women do
not seek help. Furthermore, there is a lack of professional awareness and
expertise and recognition that a prerequisite in the definition of sexual
dysfunction is that it must cause distress to the individual (not her
partner). Sexual dysfunction is classified as disorders of sexual desire,
arousal, orgasm and pain. However, in the postpartum period the most common
disorder appears to be that of sexual pain as a consequence of perineal
trauma. Health care workers need to be made aware of this silent affliction
as sexual morbidity can have a detrimental effect on a women's quality of
life impacting on her social, physical and emotional well-being.
Keywords: Sexual dysfunction; Sexual function; Childbirth; Postpartum
Piyanee Klainin, David Gordon Arthur, Postpartum depression in Asian

cultures: A literature review, International Journal of Nursing Studies,
Volume 46, Issue 10, October 2009, Pages 1355-1373, ISSN 0020-7489,
10.1016/j.ijnurstu.2009.02.012.
Postpartum depression (PPD), a major health concern, produces insidious
effects on new mothers, their infant, and family. This literature review
aims to explore risk factors for postpartum depression among women in Asian
cultures, which has not been fully elaborated.
Data sources
A literature search was undertaken by using various electronic research
databases. Studies were eligible for this review if they (a) examined risk
factors for PPD, (b) were conducted in Asian countries using quantitative
or qualitative methodologies, and (c) were published in English in peer-
reviewed journals between 1998 and 2008. A total of 64 studies from 17
countries were reviewed, summarised, and synthesised.
Results
The prevalence of postpartum depression in Asian countries ranged from 3.5%
to 63.3% where Malaysia and Pakistan had the lowest and highest,
respectively. Risk factors for postpartum depression were clustered into
five major groups: biological/physical (e.g., riboflavin consumption),
psychological (e.g., antenatal depression), obstetric/paediatric (e.g.,
unwanted pregnancy), socio-demographic (e.g., poverty), and cultural
factors (e.g., preference of infants gender). Traditional postpartum
rituals were not found to provide substantial psychological benefits for
the new mothers.
Conclusions
This review informs a current state of knowledge regarding risk factors for
postpartum depression and has implications for clinical practice. Health
care professionals should be aware that the phenomenon is as prevalent in
Asian cultures as in European cultures. Women should be screened for
potential risk factors and depressive symptoms during pregnancy and
postpartum periods so that appropriate interventions, if needed, can be
initiated in a timely fashion.
Keywords: Postpartum depression; Risk factors; Asian cultures
Meeke Hoedjes, Durk Berks, Ineke Vogel, Arie Franx, Anke Oenema, Johannes
J. Duvekot, J. Dik F. Habbema, Eric A.P. Steegers, Hein Raat, Postpartum
physical activity after preeclampsia, Pregnancy Hypertension: An
International Journal of Women's Cardiovascular Health, Volume 2, Issue 2,
April 2012, Pages 143-151, ISSN 2210-7789, 10.1016/j.preghy.2012.01.003.
Abstract: Objective
After mild and severe preeclampsia, to assess whether women meet the
physical activity recommendation at 3 and 6 months postpartum, and
whether demographic, obstetric and anthropometric characteristics, mental
health, and health-related quality of life are associated with less
physical activity than recommended.
Study design
Prospective cohort study.
Main outcome measures
Self-reported physical activity in MET-min/week, percentage of women who
fail to meet the physical activity recommendation.
Methods
Of the 255 women diagnosed with preeclampsia invited to participate in this
prospective cohort study, 174 (68%) provided informed consent. Analyses
were restricted to 141 participants who completed the short form of the
International Physical Activity Questionnaire at 3 and/or 6 months
postpartum. Logistic regression analysis was used to evaluate changes in
physical activity level over time, and to establish which variables were
associated with failure to meet the postpartum physical activity
recommendation.
Results
At both 3 and 6 months postpartum, 38% of women failed to meet the
physical activity recommendation. Failure was associated with severe
preeclampsia, cesarean section, admission to the neonatal intensive care
unit, low gestational age at delivery, and low birth weight (all
p < 0.05).
Conclusions
There seems to be a need to stimulate physical activity in about one third
of women after a pregnancy complicated by preeclampsia, particularly in
case of severe preeclampsia and other adverse pregnancy outcomes. Tailored
lifestyle interventions are needed for women who fail to meet the
recommendation.
Keywords: Pre-eclampsia [mesh]; Postpartum period [mesh]; Physical activity
Andrea Gonzalez, Jennifer M. Jenkins, Meir Steiner, Alison S. Fleming, The

relation between early life adversity, cortisol awakening response and
diurnal salivary cortisol levels in postpartum women,
Psychoneuroendocrinology, Volume 34, Issue 1, January 2009, Pages 76-86,
ISSN 0306-4530, 10.1016/j.psyneuen.2008.08.012.
Abstract: Summary
Early life adversity has been associated with hypothalamicpituitary
adrenal (HPA) axis dysfunction in both children and adults. However, in
adulthood, most studies have focused on the effects of early adversity on
HPA axis stress reactivity rather than the cortisol awakening response or
diurnal cortisol profiles. The goal of this study was to examine the
cumulative effects of early life adversity on the cortisol awakening
response (CAR) and diurnal cortisol profiles in a sample of postpartum
women. Ninety women between 2 and 6 months postpartum completed two
retrospective reports assessing adverse early life experiences
(maltreatment and consistency of care). Eighteen women reported having
experienced both parental loss and some form of childhood maltreatment and
36 women reported having experienced one type of early life adversity,
either parental loss or maltreatment. HPA axis function was assessed
through salivary cortisol collections over two consecutive days for
measurement of the cortisol awakening response (n = 61) and
diurnal cortisol rhythm (n = 90). Women who reported experiencing
adverse early life experiences exhibited a tendency towards higher levels
of awakening cortisol compared to women who reported no adverse early life
experiences (p = .07). These higher awakening cortisol levels
were sustained throughout the morning in the groups who experienced early
adversity, with all groups exhibiting the typical diurnal decline in the
afternoon and evening (p < .05). Women reporting early
adversity exhibited more heterogeneity in their diurnal cortisol levels
across the two collection days (p < .01). Our findings suggest
that in a community sample of postpartum women, early adversity is
associated with current HPA axis function. These findings may have
implications for the nature of motherinfant interactions.
Keywords: Diurnal cortisol; Awakening response; Early adversity; Postpartum
mothers
Barbara E Kwast, Postpartum haemorrhage: its contribution to maternal

mortality, Midwifery, Volume 7, Issue 2, June 1991, Pages 64-70, ISSN 0266-
6138, 10.1016/S0266-6138(05)80229-3.
Abstract: Postpartum haemorrhage is the major cause of maternal mortality
in the developing world. This paper presents the incidences and discusses
the causes and strategies for its prevention. The paper is based on one
originally given at the ICM/WHO/UNICEF pre-congress workshop in Kobe,
Japan, Oct, 1990.
Deborah F. Perry, Anna K. Ettinger, Tamar Mendelson, Huynh-Nhu Le, Prenatal

depression predicts postpartum maternal attachment in low-income Latina
mothers with infants, Infant Behavior and Development, Volume 34, Issue 2,
April 2011, Pages 339-350, ISSN 0163-6383, 10.1016/j.infbeh.2011.02.005.
Abstract: Although maternal attachment is an important predictor of infant
attachment security and other developmental outcomes, little is known about
the formation of maternal attachment in the first few months of the
infant's life, particularly among ethnic minority mothers. The current
study examined the predictors of postpartum maternal attachment in a sample
of 217 Latina women enrolled in a perinatal depression prevention trial.
Mothers attachment to their infants was measured at 68 weeks postpartum
using the Maternal Postnatal Attachment Scale. A variety of predictors of
early attachment were explored including: depressive symptoms during
pregnancy, pregnancy intention, feelings about the pregnancy, and the
quality of the partner relationship. The strongest predictor of lower
maternal attachment was depressive symptoms late in pregnancy; pregnancy
intention was marginally predictive of attachment, with lower scores being
associated with unwanted pregnancies. The study fills a critical gap in our
understanding of the role of depressive symptoms during pregnancy in
shaping mothers early attachment to their infants.
Keywords: Attachment; Perinatal depression; Latina immigrants
Marion Righetti-Veltema, Elisabeth Conne-Perrard, Arnaud Bousquet, Juan

Manzano, Risk factors and predictive signs of postpartum depression,
Journal of Affective Disorders, Volume 49, Issue 3, 1 June 1998, Pages 167-
180, ISSN 0165-0327, 10.1016/S0165-0327(97)00110-9.
Abstract: Background: Depressed new mothers usually do not seek and
therefore do not receive any psychiatric help. Methods: In order to assess
predictive signs of postpartum depression (PPD), an unselected sample of
570 women were seen by midwives during their pregnancy, using a
questionnaire elaborated by ourselves and Derogatis' Hopkins Symptom
Checklist. Three months after delivery each new mother was examined again
by the same midwife using Cox' Edinburgh Postnatal Depression Scale. The
medical files were also examined. Results: Of the new mothers, 58 (10.2%)
suffered from PPD. Most significant factors were socioprofessional
difficulties, multiparity, deleterious life events, depressive mood prior
to delivery, early motherchild separation and negative birth experience.
The coping abilities of the depressed mother were decreased and her
vulnerability to new stress factors increased. Conclusion: It is possible
to detect women at risk for PPD already during pregnancy. We therefore
elaborated a very simple, short predictive scale which is in the process of
validation. Limitation: Protective factors still have to be studied.
Clinical Relevance: Knowledge of these factors should help all caregivers
to recognize, during pregnancy, women at risk for PPD, in order to initiate
preventive and/or therapeutic measures.
Keywords: Postpartum depression; Risk factors; Pregnancy; Predictive signs
Ruth Feldman, Adi Granat, Clara Pariente, Hannah Kanety, Jacob Kuint, Eva
Gilboa-Schechtman, Maternal Depression and Anxiety Across the Postpartum
Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity,
Journal of the American Academy of Child & Adolescent Psychiatry,
Volume 48, Issue 9, September 2009, Pages 919-927, ISSN 0890-8567,
10.1097/CHI.0b013e3181b21651.
Abstract: Objective
To examine the effects of maternal depression on infant social engagement,
fear regulation, and cortisol reactivity as compared with maternal anxiety
disorders and controls and to assess the role of maternal sensitivity in
moderating the relations between maternal depression and infant outcome.
Methods
Using an extreme-case design, 971 women reported symptoms of anxiety and
depression after childbirth and 215 of those at the high and low ends were
reevaluated at 6 months. At 9 months, mothers diagnosed with a major
depressive disorder (n = 22) and anxiety disorders (n = 19) and matched
controls reporting no symptoms across the postpartum year (n = 59) were
visited at home. Infant social engagement was observed during motherinfant
interaction, emotion regulation was microcoded from a fear paradigm, and
mother's and infant's cortisol were sampled at baseline, reactivity, and
recovery.
Results
The infants of depressed mothers scored the poorest on all three outcomes
at 9 monthslowest social engagement, less mature regulatory behaviors and
more negative emotionality, and highest cortisol reactivitywith anxious
dyads scoring less optimally than the controls on maternal sensitivity and
infant social engagement. Fear regulation among the children of anxious
mothers was similar to that of the controls and their stress reactivity to
infants of depressed mothers. Effect of major depressive disorder on social
engagement was moderated by maternal sensitivity, whereas two separate
effects of maternal disorder and mother sensitivity emerged for stress
reactivity.
Conclusions
Pathways leading from maternal depression to infant outcome are specific to
developmental achievement. Better understanding of such task-specific
mechanisms may help devise more specifically targeted interventions.
Keywords: maternal depression; maternal anxiety disorder; social
engagement; emotion regulation; cortisol
Lisa Kane Low, Joanne Motio Bailey, Emma Sacks, Lilian Medina, Hector
Oqueli Lopez Pieda, Postpartum Hemorrhage Prevention: A Case Study in
Northern Rural Honduras, Journal of Midwifery & Women's Health, Volume
53, Issue 1, JanuaryFebruary 2008, Pages e1-e6, ISSN 1526-9523,
10.1016/j.jmwh.2007.08.014.
Abstract: Postpartum hemorrhage (PPH) is the leading cause of maternal
mortality globally. Safe Motherhood policies have been directed towards the
reduction of PPH by recommending active management of third-stage labor as
the standard of care. One component of active management involves routine
use of a uterotonic agent within 1 minute of the delivery of the baby. A
case study at Clnica Materno-Infantil, a free-standing public birth center
in Honduras, is presented, focusing on methods to reduce PPH. The nursing
staff was trained to estimate blood loss and in methods to manage PPH,
including elements of active management of the third stage of labor.
Medical records were reviewed and an analysis of PPH management compared to
estimated blood loss (EBL) was conducted. There was no significant
correlation between PPH management techniques and EBL (r = .060; P = .368).
There was a statistically significant (P < .001) correlation between
oxytocin administration and lower EBL (r = .232), indicating that there
was less blood loss when oxytocin was administered. At Clnica Materno-
Infantil, routine use of a uterotonic agent appears beneficial and further
implementation of active management of the third stage of labor appears
warranted.
Keywords: Honduras; international maternal child health; postpartum
hemorrhage; Safe Motherhood; skilled birth attendants
Rafat Jan Rukanuddin, Tazeen Saeed Ali, Beth McManis, Midwifery Education
and Maternal and Neonatal Health Issues: Challenges in Pakistan, Journal of
398-405, ISSN 1526-9523, 10.1016/j.jmwh.2007.02.014.
Abstract: Although numerous health care interventions have been implemented
in Pakistan, the high maternal and neonatal mortality rates still remain a
challenge. Developed countries have reduced maternal and neonatal mortality
rates by improving the skill and knowledge levels of nurse-midwives. This
paper reviews maternal and neonatal health issues, challenges in current
midwifery education, and the role of government and international agencies
in Pakistan. The exact maternal and neonatal mortality rates in Pakistan
are unknown; a census has not occurred since 1998, and data provided in
more recent studies were presented in summary format. A number of factors
that contribute to the high mortality rate could easily be controlled by
using competent nurse-midwives throughout all levels of the Pakistani
health care system. A reduction in the maternal mortality rate is likely to
occur if the Pakistan government and international agencies work together
to implement specific recommendations in maternal and neonatal health.
These recommendations include: 1) holding an invitational conference; 2)
strengthening the existing midwifery and Lady Health Visitor curricula; 3)
pilot testing an expanded midwifery program; and 4) advocating for and
obtaining political commitments and resources for midwifery education.
Keywords: maternal and neonatal issues in Pakistan; midwifery in Pakistan;
midwifery education in Pakistan
Felicia Mancini, Cristina Carlson, Leah Albers, Use of the Postpartum
Depression Screening Scale in a Collaborative Obstetric Practice, Journal
of Midwifery & Women's Health, Volume 52, Issue 5, September 2007,
Pages 429-434, ISSN 1526-9523, 10.1016/j.jmwh.2007.03.007.
Abstract: Postpartum depression is a clinical depressive episode that
occurs in 13% to 20% of women after birth or miscarriage. This illness has
potentially devastating consequences for both mother and infant, and is
thought to be highly underreported and under-diagnosed. Our study examined
the use of the Postpartum Depression Screening Scale (PDSS) in a high-
volume collaborative obstetric and midwifery practice. The prevalence of
women with a positive screen for major postpartum depression in our study
was 16%, which is consistent with other studies. An additional 20% of the
participants had symptoms that indicated a potential postpartum depression.
Obstetric clinicians were willing to use the PDSS, and 15 of 20 clinicians
actively participated in the study. Women who had a positive screen at 6
weeks after birth were more likely to have not completed a high school
education, be unpartnered, be exclusively bottle feeding, and have a
history of depression. Two variables were statistically significant
predictors of screening positively with the PDSS following logistic
regression: history of depression (risk ratio, 4.8; 95% confidence
interval, 4.45.2) and exclusive bottle feeding (risk ratio, 2.0; 95%
confidence interval, 1.62.4).
Keywords: breastfeeding; depression; mental health; postpartum health;
screening tools
N.M.-C. Glangeaud-Freudenthal, A.-L. Sutter, A.-C. Thieulin, V. Dagens-

Lafont, M.-A. Zimmermann, A. Debourg, B. Massari, O. Cazas, R. Cammas, C.
Rainelli, F. Poinso, M. Maron, S. Nezelof, P.-Y. Ancel, B. Khoshnood,
Inpatient mother-and-child postpartum psychiatric care: Factors associated
with improvement in maternal mental health, European Psychiatry, Volume 26,
Issue 4, May 2011, Pages 215-223, ISSN 0924-9338,
10.1016/j.eurpsy.2010.03.006.
Abstract: Purpose
This study assessed the underexplored factors associated with significant
improvement in mothers mental health during postpartum inpatient
psychiatric care.
Methods
This study analyzed clinical improvement in a prospective cohort of 869
women jointly admitted with their infant to 13 psychiatric Mother-Baby
Units (MBUs) in France between 2001 and 2007. Predictive variables tested
were: maternal mental illness (ICD-10), sociodemographic characteristics,
mental illness and childhood abuse history, acute or chronic disorder,
pregnancy and birth data, characteristics and mental health of the mother's
partner, and MBU characteristics.
Results
Two thirds of the women improved significantly by discharge. Admission for
25% was for a first acute episode very early after childbirth. Independent
factors associated with marked improvement at discharge were bipolar or
depressive disorder, a first acute episode or relapse of such an episode.
Schizophrenia, a personality disorder, and poor social integration (as
measured by occupational status) were all related to poor clinical
outcomes.
Discussion
Most women improved significantly while under care in MBUs. Our results
emphasize the importance of the type of disease but also its chronicity and
the social integration when providing postpartum psychiatric care.
Keywords: Affective disorders; Schizophrenia and psychosis; Personality
disorders; Psychiatry in Europe; Epidemiology; Social and cross cultural;
Postpartum disorders; Mother-baby unit
Therese A. Wiegers, Adjusting to motherhood: Maternity care assistance
during the postpartum period: How to help new mothers cope, Journal of
Neonatal Nursing, Volume 12, Issue 5, October 2006, Pages 163-171, ISSN
1355-1841, 10.1016/j.jnn.2006.07.003.
Abstract: The overall aim of postpartum care is to detect health problems
of the mother and/or baby at an early stage, to encourage breastfeeding and
to give families a good start. This paper presents an overview of recent
literature about postpartum care in several developed countries and
elaborates on the Dutch model, which consists of professional postnatal
care, provided by MCAs (maternity care assistants), who are supervised by
midwives. The most important tasks of the maternity care assistant are, by
becoming part of the family for a number of hours each day, being able to
detect possible health problems, and to instruct, observe, and support the
mother (and father) in establishing a new routine in their family life and
help them to become confident in their parenting.
Keywords: Maternity care assistance; Postpartum care; The Netherlands
Wolfgang Hannver, Jochen Ren Thyrian, Kathrin Rske, Julia Grempler,

Hans-Jrgen Rumpf, Ulrich John, Ulfert Hapke, Smoking cessation and relapse
prevention for postpartum women: Results from a randomized controlled trial
at 6, 12, 18 and 24 months, Addictive Behaviors, Volume 34, Issue 1,
January 2009, Pages 1-8, ISSN 0306-4603, 10.1016/j.addbeh.2008.07.021.
Abstract: Aim
To test the efficacy of an aid to cessation/relapse prevention intervention
for women postpartum.
Method
Two-armed randomized controlled trial. Follow-ups at 6, 12, 18, and
24 months, screenings on maternity wards. Intervention group received face-
to-face counseling 40 days postpartum plus telephone counseling calls 4 and
12 weeks later. Control group received usual care plus self-help material
for each parent.
Results
With regard to smoking cessation, 4 week point prevalence abstinent rates
were higher in the treatment group at 6, 12, and 18 months (7% vs. 1%, 7%
vs. 2%, and 9% vs. 1%, respectively). Sustained abstinence was higher in
the treatment group at 6 months follow-up (3% vs. 0%). No difference was
observed with regard to relapse prevention.
Discussion
Regarding aid to cessation we observed small effects, regarding relapse
prevention no effect. In order to capitalize on the opportunity childbirth
poses with regard to smoking, theories on relapse prevention in smoking
cessation that guide in designing interventions are needed.
Keywords: Smoking; Smoking cessation; Relapse prevention; Postpartum;
Environmental tobacco smoke
Ann Starrs, Beverly Winikoff, Misoprostol for postpartum hemorrhage: Moving

from evidence to practice, International Journal of Gynecology &
Obstetrics, Volume 116, Issue 1, January 2012, Pages 1-3, ISSN 0020-7292,
10.1016/j.ijgo.2011.10.005.
Abstract: Clinical and operational evidence indicates that misoprostol is a
safe and effective technology for addressing postpartum hemorrhage, a major
cause of maternal death. This research has not yet been translated into
effective policies, programs, and practice in many parts of the world.
Efforts to expand evidence-based use of misoprostol are often complicated
by misoprostol's range of indications, insufficient availability, a lack of
evidence-based guidelines and provider training, and misconceptions about
the drug. The medical and health policy communities need to work together
to translate research findings into changes in policy, knowledge, and
clinical practice so that we can deliver on the world's promise to improve
maternal health.
Keywords: Misoprostol; Postpartum hemorrhage; Prevention; Treatment
Veena Jirapaet, Effects of an Empowerment Program on Coping, Quality of

Life, and the Maternal Role Adaptation of Thai HIV-Infected Mothers,
Journal of the Association of Nurses in AIDS care, Volume 11, Issue 4,
JulyAugust 2000, Pages 34-45, ISSN 1055-3290, 10.1016/S1055-3290(06)60394-
4.
Abstract: The objective of this study was to explore strategies for
improving the appropriateness of a health care delivery model to meet HIV-
infected mothers' complex needs. A participatory action research paradigm
was used as a process for an empowerment program (EP) and to elucidate the
essential components of the program identified by these mothers. To test
the EP's effectiveness, a nonequivalent control group pretestposttest,
quasi-experimental design was used. The participants included 94 Thai HIV-
infected mothers rearing their own infants, with 46 in the 6-week
experimental group and 48 in the control group. Study findings showed that
the mothers in the EP group significantly increased levels of coping
ability, quality of life, and maternal role adaptation when compared to
mothers in the control group. In addition, data analysis revealed five
components of the EP that were identified by mothers as essential for HIV-
infected mothers' psychological well-being and their maternal role
adaptation. These interventions included peer group meetings, professional
support on infant rearing and maternal self-care, stress management, access
to available social support, and alternative medicine. The mothers reported
greater autonomy, accountability, collegiality, and more effective
communication by the implication process of the EP.
Keywords: empowerment; coping; quality of life; maternal role adaptation;
HIV infected; Thai mothers
Katherine Turner, Ada Piazzini, Albertina Franza, Cristina Fumarola,

Rosanna Chifari, Anna Maria Marconi, Maria Paola Canevini, Raffaele Canger,
Postpartum depression in women with epilepsy versus women without epilepsy,
Epilepsy & Behavior, Volume 9, Issue 2, September 2006, Pages 293-297,
ISSN 1525-5050, 10.1016/j.yebeh.2006.06.003.
Abstract: The goal of this study was to determine if there is a significant
difference in the rate of postpartum depression among patients with
epilepsy and healthy controls. All patients were recruited from the
Epilepsy Center and the Department of Obstetrics and Gynecology, University
of Milan, St. Paolo Hospital (Milan, Italy). Thirty-five pregnant women
with epilepsy and an equal number of pregnant women without epilepsy were
assessed with the Edinburgh Postnatal Depression Scale (EPDS), a clinical
interview used to screen for postpartum depression (PPD), and a
sociodemographic questionnaire. The rate of PPD in patients with epilepsy
was statistically significantly higher than that of the controls
(P < 0.05). PPD was present in 29% of the patients with
epilepsy and 11% of the controls. In conclusion, it is very important to
point out that in our pilot study, the rate of PPD was higher among women
with epilepsy than among women without epilepsy. In this regard, women at
higher PPD risk can be identified earlier and treated as soon as possible
to alleviate their symptoms and improve their quality of life.
Keywords: Postpartum depression; Epilepsy; Pregnancy; Edinburgh Postnatal
Depression Scale
Ricardo F. Muoz, Huynh-Nhu Le, Chandra Ghosh Ippen, Manuela A. Diaz, Guido
G. Urizar Jr., Jos Soto, Tamar Mendelson, Kevin Delucchi, Alicia F.
Lieberman, Prevention of Postpartum Depression in Low-Income Women:
Development of the Mams y Bebs/Mothers and Babies Course, Cognitive and
Behavioral Practice, Volume 14, Issue 1, February 2007, Pages 70-83, ISSN
1077-7229, 10.1016/j.cbpra.2006.04.021.
Abstract: A prenatal intervention designed to prevent the onset of major
depressive episodes (MDEs) during pregnancy and postpartum was pilot tested
at a public sector womens clinic. The Mams y Bebs/Mothers and Babies
Course is an intervention developed in Spanish and English that uses a
cognitive-behavioral mood management framework, and incorporates social
learning concepts, attachment theory, and socio-cultural issues. The four
goals of this project were to develop the intervention, assess its
acceptability, test the feasibility of conducting a randomized trial with
public sector patients, and obtain estimates of its effect size. Forty-one
pregnant women at high risk for developing MDEs were randomized to the
Mothers and Babies Course (n = 21) or a comparison condition (n = 20).
Assessments occurred during pregnancy and at 1, 3, 6, and 12 months
postpartum. Differences in terms of depression symptom levels or incidence
of MDEs between the two groups did not reach statistical significance in
this pilot trial. However, the MDE incidence rates of 14% for the
intervention condition versus 25% for the comparison condition represent a
small effect size (h = 0.28) that will be further examined in a larger
scale study. The intervention was well received by the participants and
implementation of a randomized trial appeared quite feasible as indicated
by our follow-up rate of 91% at 12 months. Implications for the continuing
development of preventive interventions for perinatal depression are
discussed.
Pranee C. Lundberg, Trieu Thi Ngoc Thu, Vietnamese womens cultural beliefs
and practices related to the postpartum period, Midwifery, Volume 27, Issue
5, October 2011, Pages 731-736, ISSN 0266-6138, 10.1016/j.midw.2010.02.006.
Abstract: Objective
to describe cultural beliefs and practices related to the postpartum period
among Vietnamese women in Ho Chi Minh City.
Design
a descriptive cross-sectional study using triangulation.
Setting
the Postpartum Clinic, Department of Obstetrics and Gynaecology of a
university hospital in Ho Chi Minh City, Vietnam.
Participants
115 Vietnamese women, 95 in the first group and 20 in the second group.
Data collection and analysis
a questionnaire was used with the first group and a semi-structured in-
depth interview was used with the second group. Both groups were subjected
to the same four open-ended questions. The data obtained were first
analysed separately by use of qualitative content analysis and then cross-
checked.
Findings
four categories were identified: hygiene, behavioural precautions (lying by
a fire, keeping warm after birth, staying indoors and resting in bed, and
avoiding house work and sexual activity), dietary precautions, and breast
feeding and lactation.
Key conclusion and implications for practice
traditional beliefs and practices, often beneficial to the women and their
babies but sometimes potentially harmful, greatly influenced the Vietnamese
women during the postpartum period. Therefore, health-care professionals
need to give appropriate information and care to the women and their
families while paying due attention to the cultural context. These demands
make it imperative that knowledge about cultural values be included in
their education, not least in Western countries which have become
multicultural.
Keywords: Culture; Belief; Practice; Postpartum; Vietnamese women
Zulfiqar A. Bhutta, Zohra S. Lassi, Ann Blanc, France Donnay, Linkages

Among Reproductive Health, Maternal Health, and Perinatal Outcomes,
Seminars in Perinatology, Volume 34, Issue 6, December 2010, Pages 434-445,
ISSN 0146-0005, 10.1053/j.semperi.2010.09.002.
Abstract: Some interventions in women before and during pregnancy may
reduce perinatal and neonatal deaths, and recent research has established
linkages of reproductive health with maternal, perinatal, and early
neonatal health outcomes. In this review, we attempted to analyze the
impact of biological, clinical, and epidemiologic aspects of reproductive
and maternal health interventions on perinatal and neonatal outcomes
through an elucidation of a biological framework for linking reproductive,
maternal and newborn health (RHMNH); care strategies and interventions for
improved perinatal and neonatal health outcomes; public health implications
of these linkages and implementation strategies; and evidence gaps for
scaling up such strategies. Approximately 1000 studies (up to June 15,
2010) were reviewed that have addressed an impact of reproductive and
maternal health interventions on perinatal and neonatal outcomes. These
include systematic reviews, meta-analyses, and stand-alone experimental and
observational studies. Evidences were also drawn from recent work
undertaken by the Child Health Epidemiology Reference Group (CHERG), the
interconnections between maternal and newborn health reviews identified by
the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS),
as well as relevant work by the Partnership for Maternal, Newborn and Child
Health. Our review amply demonstrates that opportunities for assessing
outcomes for both mothers and newborns have been poorly realized and
documented. Most of the interventions reviewed will require more greater-
quality evidence before solid programmatic recommendations can be made.
However, on the basis of our review, birth spacing, prevention of indoor
air pollution, prevention of intimate partner violence before and during
pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring
during pregnancy, insecticide-treated mosquito nets, birth and newborn care
preparedness via community-based intervention packages, emergency
obstetrical care, elective induction for postterm delivery, Cesarean
delivery for breech presentation, and prophylactic corticosteroids in
preterm labor reduce perinatal mortality; and early initiation of
breastfeeding and birth and newborn care preparedness through community-
based intervention packages reduce neonatal mortality. This review
demonstrates that RHMNH are inextricably linked, and that, therefore,
health policies and programs should link them together. Such potential
integration of strategies would not only help improve outcomes for millions
of mothers and newborns but would also save scant resources. This would
also allow for greater efficiency in training, monitoring, and supervision
of health care workers and would also help families and communities to
access and use services easily.
Keywords: reproductive health; maternal health; neonatal health;
intrapartum; postpartum; perinatal
Dwenda Gjerdingen, Wayne Katon, Deborah E. Rich, Stepped Care Treatment of

Postpartum Depression: A Primary Care-Based Management Model, Women's
Health Issues, Volume 18, Issue 1, JanuaryFebruary 2008, Pages 44-52, ISSN
1049-3867, 10.1016/j.whi.2007.09.001.
Abstract: Background and Purpose
Postpartum depression (PPD), the most prevalent serious postpartum
complication, is a devastating illness that negatively impacts not only the
mother, but also her infant, other family members, and work performance.
There is an extensive body of research addressing systems-based quality
improvement efforts for treatment of depression in primary care
populations; however, little of this research has been directed toward
postpartum populations. This paper presents a health care systems-based
quality improvement model for the treatment of PPD derived from research
outcomes in general primary care populations.
Methods
OVID/MEDLINE and PsychINFO searches were performed using the following
terms: depression, postpartum depression, mass screening, collaborative
care, stepped care, psychotherapy, cognitivebehavioral therapy,
interpersonal therapy, and education as keywords.
Main Findings
The PPD management model described herein includes screening and diagnosis,
initiation of active treatment, and use of collaborative care, which
includes primary care visits, case manager follow-up, and more intensive
care, through specialty consultation or referral, for complicated or
difficult cases.
Conclusion
Stepped care, a form of collaborative depression treatment, is proposed as
a practical, cost-effective method for improving PPD diagnosis and clinical
outcomes.
M.F. Chersich, S.M. Luchters, E. Yard, J.M. Othigo, N. Kley, M. Temmerman,

Morbidity in the first year postpartum among HIV-infected women in Kenya,
January 2008, Pages 45-51, ISSN 0020-7292, 10.1016/j.ijgo.2007.06.053.
Abstract: Objective: To assess the effects of HIV infection on morbidity
and the needs of infected women for services in the first year postpartum.
Methods: A cross-sectional study with 500 women attending a child-health
clinic in Mombasa, Kenya. Results: Postpartum duration was a median of
3.3 months (interquartile range, 1.96.1 months). The 54 HIV-infected women
had a lower income and less financial support than the uninfected women,
and they were more likely to experience fever, dyspnea, and dysuria, and to
have genital warts (odds ratio [OR], 9.6; 95% confidence interval [CI],
2.635.6; P < 0.001), candidiasis (OR, 2.9; 95% CI, 1.26.8;
P = 0.012), and bacterial vaginosis (OR, 1.8; 95% CI, 0.953.3;
P = 0.066). Six (nearly 15%) of the HIV-infected women had low-
or high-grade squamous intraepithelial lesions, and 21 (42%) had an unmet
need for contraception. More than half of all women were anemic, and
normocytic anemia was predominant among the HIV infected. Conclusion:
Compared with uninfected women, morbidity was increased for HIV-infected
women during the year following delivery. This period could be used to
offer these, and all-women, family planning services, cervical cancer
screening, and treatment for anemia and reproductive tract infections.
Keywords: HIV-infected women; Kenya; Maternal morbidity; Postpartum
Noelita Melo de Sousa, Moussa Zongo, Were Pitala, Hamidou Boly, Laya
Sawadogo, Mahorobi Sanon, Jose Ricardo de Figueiredo, Paulo Bayard Dias
Gonalves, Bouchra El Amiri, Zsolt Pernyi, Jean-Franois Beckers,
Pregnancy-associated glycoprotein concentrations during pregnancy and the
postpartum period in Azawak Zebu cattle, Theriogenology, Volume 59, Issues
56, March 2003, Pages 1131-1142, ISSN 0093-691X, 10.1016/S0093-
691X(02)01160-3.
Abstract: Specific RIA systems were developed and used to measure
pregnancy-associated glycoprotein (PAG) concentrations during gestation and
the postpartum period in Azawak Zebu cows. Twelve females were palpated per
rectum and diagnosed as pregnant. Blood samples were taken at 510-day
intervals from approximately Week 8 of gestation until Week 10 postpartum
(pp). One Zebu cow (Z15) initially diagnosed as pregnant showed PAG
concentrations lower than the assay sensitivity (<0.20 ng/ml) and
did not calve. Another cow (ZSand) showed abnormally high PAG
concentrations during gestation and was excluded from the general PAG
profile. The 10 other Zebu cows exhibited a very similar PAG profile. In
these animals, concentrations increased progressively from Week 8 to 35 of
gestation (from 6.04.2 to 196.034.8 ng/ml), remaining relatively
constant until Week 39 (210.874.8 ng/ml), when they increased sharply
to reach their highest level (1095.6607.2 ng/ml) at around
parturition. After delivery, PAG concentrations declined significantly
(P<0.05) until Week 2 postpartum (348.485.6 ng/ml) and slowly
until Week 10 postpartum. Our results revealed that the PAG pattern in Zebu
cattle was similar to those of taurine breeds during the first two
trimesters of pregnancy, but differed in the peripartum period.
Keywords: Azawak Zebu; PAG; RIA; Gestation; Postpartum
Jemima Petch, W. Kim Halford, Psycho-education to enhance couples'

transition to parenthood, Clinical Psychology Review, Volume 28, Issue 7,
October 2008, Pages 1125-1137, ISSN 0272-7358, 10.1016/j.cpr.2008.03.005.
Abstract: A substantial proportion of couples struggle to adapt to
parenthood, feel stress in caring for their infant, and experience a
significant decline in their couple relationship adjustment. Moreover,
there is a substantial association between effective parenting of infants
and sustaining a mutually satisfying couple relationship. This paper
reviews randomized controlled trials of psycho-education to assist new
parent couples with parenting and their couple relationship. The majority
of programs target either the couple relationship or parenting, with few
programs addressing both areas. The best outcomes seem to be achieved when
programs are accessible by couples at home, when skill-training is
provided, and possibly when programs target couples at high-risk of
maladjustment to parenthood.
Keywords: Couple interventions; Parenting interventions; Review;
Relationship education; Transition to parenthood
Yann Le Strat, Caroline Dubertret, Bernard Le Foll, Prevalence and

correlates of major depressive episode in pregnant and postpartum women in
the United States, Journal of Affective Disorders, Volume 135, Issues 13,
December 2011, Pages 128-138, ISSN 0165-0327, 10.1016/j.jad.2011.07.004.
Little is known about the prevalence and comorbidity of Major Depressive
Episode (MDE) during pregnancy in the general population. This study
presents nationally representative data on the prevalence, correlates, and
psychiatric comorbidities of depression in women during pregnancy and
postpartum in the United States.
Method
Data were drawn from the 20012002 National Epidemiological Survey on
Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093
adults aged 18 years and older residing in households in the United
States of whom 14,549 were women 18 to 50 years old with known past-
year pregnancy status. Diagnoses of depression and other mood, anxiety, and
drug disorders were based on the Alcohol Use Disorder and Associated
Disabilities Interview Schedule DSM-IV version.
Results
The overall prevalence of MDE during pregnancy was 12.4%. Among pregnant
and postpartum women, depression was associated with younger age, ethnicity
other than Latino, being widowed, divorced, separated or never married,
traumatic events within the past 12 months and pregnancy complication.
Strong associations were found between MDE during pregnancy and postpartum
and nearly all 12-month psychiatric disorders. Past-year depressed pregnant
and postpartum women were more likely than nondepressed pregnant women to
use substances (including alcohol, illicit drugs and cigarettes). Past-year
pregnant and postpartum women were significantly less likely to receive
past-year treatment for depression than nonpregnant women although not
after adjusting for background sociodemographic characteristics.
Conclusions
These results indicate that depression during pregnancy and postpartum is
associated with a large range of psychiatric disorders. The high frequency
of psychiatric comorbidities, the elevated use of any substances and the
high rate of unmet needs should be kept in mind when considering the
management of depression during pregnancy and postpartum.
Keywords: Pregnancy; Depression; NESARC; Survey
Corinna Reck, Eva Stehle, Katja Reinig, Christoph Mundt, Maternity blues as
a predictor of DSM-IV depression and anxiety disorders in the first three
months postpartum, Journal of Affective Disorders, Volume 113, Issues 12,
February 2009, Pages 77-87, ISSN 0165-0327, 10.1016/j.jad.2008.05.003.
Maternity blues have been described as a relevant risk factor for
postpartum depression. Information regarding the influence of maternity
blues on the onset and course of clinical postpartum anxiety disorders is
scarce. The goal of this study was to determine whether maternity blues
significantly predict postpartum depression and anxiety disorders in the
first 3 months after delivery in a German sample. Demographic, psychiatric,
and obstetric correlates of maternity blues were also investigated.
Methods
Maternity blues were assessed 2 weeks after delivery in a community sample
of 853 women using a telephone interview and the Patient Health
Questionnaire-Depression. Depression and anxiety disorders were diagnosed
according to DSM-IV criteria over the first 3 months following delivery. A
two-stage screening procedure was applied. In a first stage, the Patient
Health Questionnaire-Depression, the Edinburgh Depression Scale, and two
anxiety-screening instruments were employed. In the case of clinically
relevant scores, the Structured Clinical Interview for DSM-IV was
administered in a second stage.
Results
The estimated prevalence rate of maternity blues among German women was
55.2%. We found a significant association between maternity blues and
postpartum depression (odds ratio: 3.8) and between maternity blues and
anxiety disorders (odds ratio = 3.9).
Limitations
Based on our predominantly middle class low-risk sample, maternity blues
prevalence may be underestimated. Retrospective assessment of maternity
blues 2 weeks postpartum might lead to biased results.
Conclusions
Women with maternity blues should be carefully observed in the first weeks
postpartum with the aim of identifying those at risk of developing
postpartum depression/anxiety disorders and providing treatment at an early
stage of the disorder.
Keywords: Maternity blues; Postpartum depression; Anxiety disorder;
Puerpartum
Bridget O. Akin-Otiko, Busisiwe R. Bhengu, Client education experiences and

expectations of women at the first level of maternal and child care in
Kaduna state, Nigeria, Midwifery, Available online 13 January 2012, ISSN
0266-6138, 10.1016/j.midw.2011.11.011.
Abstract: Purpose
to explore the client education experiences of women at first level
maternal and child health-care facilities in Kaduna State Nigeria. The lack
of access to appropriate information to assist women in making decisions
about their health and utilize available services is recognized as a major
contributory factor to the unabated high maternal and child mortality rates
in Nigeria.
Design
a qualitative descriptive study was conducted. Nine focus group discussions
were held with 65 women across the three senatorial zones of Kaduna State,
Nigeria. Participants were recruited using maximum variation sampling
technique. Audio recordings of the discussions were transcribed and the
content analysed. The themes were determined by a priory approach and
findings compared across groups through manually developed data matrices.
Findings
midwives were the major source of useful health information to the women
who wished the midwives could cover more issues. The information provided
by the midwives was skewed towards children and postnatal care, and some
midwives ignored, or considered some of the women's questions interrupting.
The harshness of midwives in emphasizing the need for prompt care, to women
who came late to register or deliver, kept some women away. Women who never
delivered in the facilities were not aware that the nurses at the clinics
were midwives, and desired to know more about midwifery in the facilities
being tired of traditional birth attendants.
Conclusion
the desire of women for more information and to know the midwife suggests
a gap between what the women expected and what they were provided.
Implication for practice
it is important to expand the scope of client education to include critical
pregnancy and labour related issues and friendly midwifery practices in the
facility.
Keywords: Prenatal classes; Midwife; Nigeria; Kaduna
Helen I Lugina, Kyllike Christensson, Siriel Massawe, Lennarth Nystrom,

Gunilla Lindmark, Change in maternal concerns during the 6 weeks postpartum
period: a study of primiparous mothers in Dar Es Salaam, Tanzania, Journal
of Midwifery & Women's Health, Volume 46, Issue 4, JulyAugust 2001,
Pages 248-257, ISSN 1526-9523, 10.1016/S1526-9523(01)00133-7.
Abstract: The purpose of this study was to describe the postpartum concerns
of primiparas. A cohort study included 79 mothers in Dar es Salaam,
Tanzania. Mothers sorted topics into worry, interest, and confidence.
Trends of decreasing worry and increasing interest and confidence for baby-
related and mother-related topics were observed from 1 to 6 weeks. At 1
week mothers worried about babys eyes, respiration, temperature, safety,
and crying; but, at 6 weeks only crying was a problem. Need for information
was constant about general health, baby behavior, and care of the baby. At
1 week mothers worried about swollen perineum, and feeling tired and
nervous. They wanted information about preventing hemorrhage and infection
and taking care of the perineum, breasts, and nipples. Trends of increasing
worry and decreasing confidence were observed with respect to family
relationships. At 6 weeks, mothers worried about the husband/partners
reaction to themselves and to the baby. Confidence in relatives reaction
to themselves and the baby decreased. Being aware of the changes in the way
concerns are expressed may guide nursing/midwifery interventions for
mothers as to the content and timing.
Paloma Toledo, Robert J. McCarthy, Carol A. Burke, Kristopher Goetz,

Cynthia A. Wong, William A. Grobman, The effect of live and web-based
education on the accuracy of blood-loss estimation in simulated obstetric
scenarios, American Journal of Obstetrics and Gynecology, Volume 202, Issue
4, April 2010, Pages 400.e1-400.e5, ISSN 0002-9378,
10.1016/j.ajog.2009.10.881.
Abstract: Objective
Visual estimation of blood loss has been shown to be inaccurate. The
objective of this study was to evaluate the impact of a didactic training
program on the accuracy of the estimation of blood loss and to compare the
effectiveness of training provided by a web-based vs live session.
Study Design
Multidisciplinary labor and delivery unit personnel participated in live or
web-based training. Both sessions comprised a 5-station pretest and
posttest. The primary outcome was the accuracy of estimated blood loss in
the pretest compared with the posttest with the use of the Mann-Whitney U
test.
Results
Among 372 providers, the median improvement between pre- and posttest
results was 34% (95% confidence interval, 1057%; P < .001). This
improvement did not differ significantly between the live sessions and web-
based sessions (4%; 95% confidence interval, 10% to 12%).
Conclusion
Our study supports the use of live or web-based training to improve blood
loss estimation accuracy.
Keywords: education; estimated blood loss; postpartum hemorrhage
A. Lalonde, B.A. Daviss, A. Acosta, K. Herschderfer, Postpartum hemorrhage

today: ICM/FIGO initiative 20042006, International Journal of Gynecology
& Obstetrics, Volume 94, Issue 3, September 2006, Pages 243-253, ISSN
0020-7292, 10.1016/j.ijgo.2006.04.016.
Abstract: Postpartum hemorrhage (PPH) is the main cause of maternal
mortality. Yet, even though solutions have been identified, governments and
donor countries have been slow to implement programs to contain the
problem. While poverty and low educational level remain the underlying
cause of PPH, the current literature suggests that active management of the
third stage of labor can prevent it. The International Confederation of
Midwives (ICM) and the International Federation of Gynecology and
Obstetrics (FIGO) are attempting to address the chronic PPH crisis by
educating their members on best practices and on troubleshooting where
resources are inadequate. Some studies found oxytocin to be preferable to
misoprostol in settings where active management is the norm. However,
secondary clinical effects may prove more troublesome with oxytocin than
with misoprostol, and misoprostol may prove to be more practical and
equally effective in low-resource settings. Two new interventions are also
proposed, the anti-shock garment and the balloon tamponade.
Keywords: Postpartum hemorrhage; Active management of the third stage of
labor; Misoprostol; Tamponade; Anti-shock garment
John A. Yozwiak, Postpartum Depression and Adolescent Mothers: A Review of

Assessment and Treatment Approaches, Journal of Pediatric and Adolescent
Gynecology, Volume 23, Issue 3, June 2010, Pages 172-178, ISSN 1083-3188,
10.1016/j.jpag.2009.09.003.
Abstract: Postpartum depression (PPD) affects a significant proportion of
adolescent mothers. Adolescence presents unique challenges that may make
the young mother more vulnerable than her adult counterparts to PPD. PPD
impacts a mother's ability to care for her infant and has been associated
with adverse effects on child development. A review of the literature on
adolescent PPD was undertaken. The prevalence and the effects of PPD are
reviewed, common screening instruments for PPD are compared, and the
results of treatment outcome studies are highlighted. There is a need for
randomized controlled studies of interventions for adolescents with PPD.
Findings from treatment outcome studies with adults with PPD and pregnant
adolescents who are depressed suggest that psychosocial interventions may
also be effective for adolescents with PPD. Issues in assessment and
treatment of PPD among adolescents are considered.
Keywords: Adolescent; Depression; Postpartum Period; Assessment; Treatment
Sarah Salway, Sufia Nurani, Uptake of contraception during postpartum

amenorrhoea: Understandings and preferences of poor, urban women in
Bangladesh, Social Science & Medicine, Volume 47, Issue 7, 1 October
1998, Pages 899-909, ISSN 0277-9536, 10.1016/S0277-9536(98)00154-3.
Abstract: In urban Bangladesh, as in many other settings, an immediate
postpartum family planning strategy prevails, where providers seek to
promote and provide contraception at 4045 days following birth to women
regardless of their breastfeeding or menstrual status. Despite such
practices, the majority of women choose to delay the initiation of
contraception until menses resumes, often several months after birth. The
present paper seeks to explain this discrepancy by describing poor, urban
women's understandings regarding the chances of conception and the risks
associated with contraceptive use in the postpartum period. Findings from
in-depth interviews reveal that the majority of women perceive no personal
risk of pregnancy during amenorrhoea, though most do not recognise an
association between this diminished risk of conception and breastfeeding.
In addition, the data illustrate that women are primarily concerned with
their own and their newly born child's health and well-being in the period
following childbirth, both of which are perceived to be extremely
vulnerable. These perceptions, plus an understanding that modern methods of
contraception are strong and potentially damaging to the health, mean
that the majority of women are reluctant to adopt family planning methods
soon after birth, particularly during postpartum amenorrhoea. The paper
advocates that, since breastfeeding affords good protection against
pregnancy for six to nine months following birth, efforts should be made to
actively incorporate lactational amenorrhoea into postpartum family
planning strategies in Bangladesh. Recommendations are also made for ways
in which women may be encouraged to adopt contraception during amenorrhoea
beyond the period of high natural protection. The paper highlights the
importance of taking the client's perspective into consideration in
attempts to improve the quality and effectiveness of family planning
programmes.
Keywords: postpartum contraception; lactational amenorrhoea; Bangladesh
Truls stbye, Nancy L. Zucker, Katrina M. Krause, Cheryl A. Lovelady, Kelly

R. Evenson, Bercedis L. Peterson, Lori A. Bastian, Geeta K. Swamy, Deborah
G. West, Rebecca J.N. Brouwer, Kids and Adults Now! Defeat Obesity (KAN-
DO): Rationale, design and baseline characteristics, Contemporary Clinical
Trials, Volume 32, Issue 3, May 2011, Pages 461-469, ISSN 1551-7144,
10.1016/j.cct.2011.01.017.
Prevention of childhood obesity is a public health priority. Parents
influence a child's weight by modeling healthy behaviors, controlling food
availability and activity opportunities, and appropriate feeding practices.
Thus interventions should target education and behavioral change in the
parent, and positive, mutually reinforcing behaviors within the family.
Methods
This paper presents the design, rationale and baseline characteristics of
Kids and Adults Now! Defeat Obesity (KAN-DO), a randomized controlled
behavioral intervention trial targeting weight maintenance in children of
healthy weight, and weight reduction in overweight children. 400 children
aged 25 and their overweight or obese mothers in the Triangle and Triad
regions of North Carolina are randomized equally to control or the KAN-DO
intervention, consisting of mailed family kits encouraging healthy
lifestyle change. Eight (monthly) kits are supported by motivational
counseling calls and a single group session. Mothers are targeted during a
hypothesized teachable moment for health behavior change (the birth of a
new baby), and intervention content addresses: parenting skills ((e.g.,
emotional regulation, authoritative parenting), healthy eating, and
physical activity.
Results
The 400 motherchild dyads randomized to trial are 75% white and 22% black;
19% have a household income of $30,000 or below. At baseline, 15% of
children are overweight (85th95th percentile for body mass index) and 9%
are obese ( 95th percentile).
Conclusion
This intervention addresses childhood obesity prevention by using a family-
based, synergistic approach, targeting at-risk children and their mothers
during key transitional periods, and enhancing maternal self-regulation and
responsive parenting as a foundation for health behavior change.
Keywords: Overweight; Obesity; Randomized controlled trial; Parenting;
Children; Postpartum period
Robert T. Ammerman, Frank W. Putnam, Nicole R. Bosse, Angelique R. Teeters,

Judith B. Van Ginkel, Maternal depression in home visitation: A systematic
review, Aggression and Violent Behavior, Volume 15, Issue 3, MayJune 2010,
Pages 191-200, ISSN 1359-1789, 10.1016/j.avb.2009.12.002.
Abstract: Depression is prevalent in new mothers and has been shown to have
profound negative impacts on parenting, maternal life course, and child
development. High rates of maternal depression have been found in home
visitation, a widely disseminated prevention approach for high risk mothers
and their children. This paper reviews the emerging literature on the
prevalence, impact, and treatment of depression in the context of home
visitation. Findings are synthesized and methodological and design
limitations are considered in interpretation of results. Promising
approaches to addressing maternal depression and supporting home visitors
in working with this clinical population are described. Recommendations for
research and practice are offered that build upon the strong foundation of
current efforts in this area.
Keywords: Maternal depression; Home visitation; Screening; Prevention
Bobbie Posmontier, The Role of Midwives in Facilitating Recovery in

Postpartum Psychosis, Journal of Midwifery & Women's Health, Volume 55,
Issue 5, SeptemberOctober 2010, Pages 430-437, ISSN 1526-9523,
10.1016/j.jmwh.2010.02.011.
Abstract: Postpartum psychosis, an emergency psychiatric condition
affecting one to two women per 1000 after childbirth, can result in a
significant increased risk for suicide and infanticide. Symptoms of
postpartum psychosis, such as mood lability, delusional beliefs,
hallucinations, and disorganized thinking, can be frightening for the women
who are affected and for families and obstetric care providers of those
women. Women experiencing postpartum psychosis are often thrust into a
mental health system that does not capitalize on the close relational bond
that forms between midwives and the women they care for over the course of
prenatal care. The purpose of this article is to propose using the Recovery
Advisory Group Model of mental illness as a theoretical framework for care
of women with postpartum psychosis, to assist midwives in recognizing
symptoms, define the role of the midwife in treatment, and learn the
importance of becoming part of the psychiatric mental health care team in
order to facilitate optimum recovery for women with postpartum psychosis.
Keywords: midwives; postpartum psychosis; recovery
K. Doyle, J. Heron, G. Berrisford, J. Whitmore, L. Jones, G. Wainscott, F.

Oyebode, The management of bipolar disorder in the perinatal period and
risk factors for postpartum relapse, European Psychiatry, Available online
15 September 2011, ISSN 0924-9338, 10.1016/j.eurpsy.2011.06.011.
Abstract: Aims
The perinatal period is a time of high risk of relapse for women with a
history of bipolar affective disorder (BPAD). We describe the pregnancy
management of women with BPAD and identify risk factors for postpartum
relapse.
Methods
The case records of 78 women with BPAD referred to perinatal mental health
services before conception, during pregnancy or the postpartum period,
between 1998 and 2009 in Birmingham UK, were screened. In women who were
managed during pregnancy, those who relapsed in the postpartum were
compared with those who remained well.
Results
Forty-seven percent of women with BPAD referred in pregnancy suffered
postpartum relapse. Women who were unwell at referral, younger, with
unplanned pregnancy, previous perinatal episodes or a family history of
BPAD were more likely to suffer postpartum illness.
Conclusion
Identifying risk factors for postpartum relapse enables us to individualise
the estimation of a woman's risk and modify care plans accordingly.
Duration of wellness prior to pregnancy is not associated with a lower risk
of postpartum illness and so it is imperative that all women with BPAD
receive referral in pregnancy.
Keywords: Bipolar disorder; Postpartum relapse; Risk factors; Management;
Pregnancy; Perinatal psychiatry
Ana Victoria Montoya Arizabaleta, Lorena Orozco Buitrago, Ana Cecilia

Aguilar de Plata, Mildrey Mosquera Escudero, Robinson Ramrez-Vlez,
Aerobic exercise during pregnancy improves health-related quality of life:
a randomised trial, Journal of Physiotherapy, Volume 56, Issue 4, 2010,
Pages 253-258, ISSN 1836-9553, 10.1016/S1836-9553(10)70008-4.
Abstract: Question
Does supervised aerobic exercise during pregnancy improve health-related
quality of life in nulliparous women?
Design
Analysis of secondary outcomes of a randomised trial with concealed
allocation, blinded assessors, and intention-to-treat analysis.
Participants
64 nulliparous, pregnant women attending for prenatal care at one of three
tertiary hospitals.
Intervention
The experimental group completed a 3-month supervised exercise program,
commencing at 16 to 20 weeks of gestation. Each session included walking
(10 min), aerobic exercise (30 min), stretching (10 min), and relaxation
(10 min). The control group continued usual activities and performed no
specific exercise.
Outcome measures
The primary outcome was health-related quality of life assessed by the
Colombian version of the Medical Outcome Study Short-Form Health Survey at
baseline and immediately after the 3-month intervention.
Results
Fifty women completed the study. After the 3-month intervention, the
experimental group had improved their health-related quality of life more
than the control group in the physical component summary of the
questionnaire by 6 points (95% CI 2 to 11), the physical function domain (7
points, 95% CI 0 to 14), the bodily pain domain (7 points, 95% CI 1 to 13)
and the general health domain (5 points, 95% CI 1 to 10).
Conclusions
A supervised 3-month program of primarily aerobic exercise during pregnancy
improves health-related quality of life.
Trial registration
NCT00741312.
Keywords: Aerobic exercise; Pregnant women; Health-related quality of life;
Randomised trial; Physiotherapy
Lynn Sibley, Deborah Armbruster, Obstetric first aid in the community

partners in safe motherhood a strategy for reducing maternal mortality,
Journal of Nurse-Midwifery, Volume 42, Issue 2, MarchApril 1997, Pages
117-121, ISSN 0091-2182, 10.1016/S0091-2182(97)00022-0.
Abstract: The unacceptably high levels of maternal mortality that are
prevalent throughout the developing world are a product of many factors;
most notably, these include nonexistent, inaccessible or inadequate
facility-based emergency care, poorly developed referral linkages,
predominance of home-based care by attendants and family members who are
poorly equipped to respond to emergencies, and the complexities of problem
recognition and decision making during emergencies leading to inappropriate
or delayed action. This paper describes an innovative community-oriented
strategy that has been designed to reduce maternal mortality and that
targets women, families, and traditional birth attendants (TBAs) using two
complimentary training interventions. The strategy reflects the authors'
conviction that the training of professional and paraprofessional health
workers in emergency care is essential, but that it must be complemented by
the education and mobilization of families, communities, and TBAs who must,
in turn, come to common perceptions on the need for and means of
intervening to prevent a maternal death. Collaborating with partners in the
US Agency for International Development-funded Primary Providers Training
and Education in Reproductive Health Project, Special Project staff of the
American College of Nurse-Midwives will lead development and testing of the
strategy through operations research activities in selected countries.
Marion Righetti-Veltema, Elisabeth Conne-Perrard, Arnaud Bousquet, Juan

Manzano, Postpartum depression and motherinfant relationship at 3 months
old, Journal of Affective Disorders, Volume 70, Issue 3, August 2002, Pages
291-306, ISSN 0165-0327, 10.1016/S0165-0327(01)00367-6.
Abstract: Background: This paper is part of a prospective, epidemiologic
study concerning postpartum depression (PPD). The women were first examined
during pregnancy; after delivery they were seen with their infants at 3 and
18 months. The present study focuses on the 3-months-postpartum results.
Methods: A sample of 570 women and their infants were examined 3 months
after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox
et al., 1987. Br. J. Psychiatry 150:782786), 10.2% of these new mothers
presented PPD. The focus of the study concerned the effects of this
neurotic disorder on the mother, the infant and on the motherinfant
relationship. Results: The deleterious effects concerning the infant were
functional disorders such as eating or sleeping difficulties. The
depressed dyads presented less vocal and visual communications, less
corporal interactions and less smiling. Conditions surrounding delivery and
tiredness at 3 months are linked to difficulties in motherinfant
relationship for the non-depressed mothers. Logistic models showed that
primiparous PPD mothers have difficulties bathing their infants, whereas
multiparous PPD mothers are more tired. Limitation: This study did not take
into account either protective factors or the effects of the infant
himself. Clinical relevance: Knowledge of the mothers and infants
difficulties may help caregivers to detect these at-risk dyads and initiate
therapeutic measures.
Keywords: Postpartum depression; Motherinfant relationship; Infant
development
Janice M. Morse, Corinne Jehle, Diane Gamble, Initiating breastfeeding: a
world survey of the timing of postpartum breastfeeding, International
Journal of Nursing Studies, Volume 27, Issue 3, 1990, Pages 303-313, ISSN
0020-7489, 10.1016/0020-7489(90)90045-K.
(http://www.sciencedirect.com/science/article/pii/002074899090045K)
Abstract: A survey of the Human Relations Area Files and ethnographic
infant feeding literature from all cultures on the timing of infant feeding
revealed that the practice of withholding colostrum from the infant was
widespread. Data obtained from 120 cultures showed that in 50 cultures this
delay in implementing breastfeeding was more than two days. In many groups,
substitute prelacteal feeds were given, while in others, practices such as
the use of purgatives exacerbated the risk of dehydration in the infant.
The authors warn that nurses and midwives must be aware of the practice of
withholding colostrum from the infant, and note that if a mother does not
wish to breastfeed in the immediate postpartum, this does not necessarily
mean that she wishes to bottle feed the infant.
Tara L. Hicks, Susan Forester Goodall, Evelyn M. Quattrone, Mona T. Lydon-

Rochelle, Postpartum sexual functioning and method of delivery: Summary of
the evidence, Journal of Midwifery & Women's Health, Volume 49, Issue
5, SeptemberOctober 2004, Pages 430-436, ISSN 1526-9523,
10.1016/j.jmwh.2004.04.007.
Abstract: Short-term postpartum sexual problems are highly prevalent,
ranging from 22% to 86%; however, there are few studies that address how
mode of delivery affects sexual functioning after childbirth. The objective
of this study was to perform a systematic review of the literature on
selected postpartum sexual function outcomes as affected by cesarean,
assisted vaginal, and spontaneous vaginal delivery. We searched PubMed,
CINAHL, and Cochrane databases from January 1990 to September 2003 and
focused on mode of delivery and the most commonly reported sexual health
outcomes, which included perineal pain, dyspareunia, resumption of
intercourse, and self-reported perception of sexual health/sexual problems.
The studies all showed increased risks of delay in resumption of
intercourse, dyspareunia, sexual problems, or perineal pain associated with
assisted vaginal delivery. Some studies showed no differences in sexual
functioning between women with cesarean delivery and those with spontaneous
vaginal delivery, whereas others reported less dyspareunia for women with
cesarean delivery. A systematic review of the literature suggests an
association between assisted vaginal delivery and some degree of sexual
dysfunction. Reported associations between cesarean delivery and sexual
dysfunction were inconsistent. Continued research is necessary to identify
modifiable risk factors for sexual problems related to method of delivery.
Keywords: postpartum sexual functioning; postpartum sexual health;
dyspareunia
Colleen Keller, Kathie Records, Barbara Ainsworth, Michael Belyea, Paska

Permana, Dean Coonrod, Sonia Vega-Lpez, Allison Nagle-Williams, Madres
para la Salud: Design of a theory-based intervention for postpartum
Latinas, Contemporary Clinical Trials, Volume 32, Issue 3, May 2011, Pages
418-427, ISSN 1551-7144, 10.1016/j.cct.2011.01.003.
Weight gain in young women suggests that childbearing may be an important
contributor to the development of obesity in women. Depressive symptoms can
interfere with resumption of normal activity levels following childbirth or
with the initiation of or adherence to physical activity programs essential
for losing pregnancy weight. Depression symptoms may function directly to
promote weight gain through a physiologic mechanism. Obesity and its
related insulin resistance may contribute to depressed mood
physiologically. Although physical activity has well-established beneficial
effects on weight management and depression, women tend to under
participate in physical activity during childbearing years. Further, the
mechanisms underpinning the interplay of overweight, obesity, physical
activity, depression, and inflammatory processes are not clearly explained.
Objectives
This report describes the theoretical rationale, design considerations, and
cultural relevance for Madres para la Salud [Mothers for Health].
Design and methods
Madres para la Salud is a 12 month prospective, randomized controlled trial
exploring the effectiveness of a culturally specific intervention using
bouts of physical activity to effect changes in body fat, systemic and
fat tissue inflammation, and postpartum depression symptoms in sedentary
postpartum Latinas.
Summary
The significance and innovation of Madres para la Salud includes use of a
theory-driven approach to intervention, specification and cultural
relevance of a social support intervention, use of a Promotora model to
incorporate cultural approaches, use of objective measures of physical
activity in post partum Latinas women, and the examination of biomarkers
indicative of cardiovascular risk related to physical activity behaviors in
postpartum Latinas.
Keywords: Latinas; Hispanics; Physical activity; Intervention; Social
support; Overweight; Obesity; Culture; Postpartum; Exercise
Columba K. Mbekenga, Helen I. Lugina, Kyllike Christensson, Pia Olsson,

Postpartum experiences of first-time fathers in a Tanzanian suburb: A
qualitative interview study, Midwifery, Volume 27, Issue 2, April 2011,
Pages 174-180, ISSN 0266-6138, 10.1016/j.midw.2009.03.002.
to explore postpartum experiences of first-time fathers in a multicultural,
low-income, suburban Tanzanian setting.
Design, setting and participants
individual qualitative interviews with ten first-time fathers, four to ten
weeks post partum in Ilala suburb, Dar es Salaam, Tanzania.
Findings
these first-time fathers enjoyed fatherhood and revealed a sincere concern
for the well-being of the mother and infant during the postpartum period.
They described themselves as active in mother and infant care and household
chores; however, they were limited by breadwinning responsibilities. The
families were supported by relatives or laypersons. The mothers and
infants nutrition had high priority but poverty was an obstacle. Timing of
resumption of sex after childbirth was problematic as traditions prescribed
abstinence while the woman is breast feeding. The risk of contracting HIV
to the family was a concern. Reproductive and child health care often
excluded fathers and gave unclear information.
Conclusion
these new fathers struggled to gain confidence and experience while
engaging in family matters during post partum. Changing gender roles in the
suburban Tanzanian society in general and their personal experiences of
transition to fatherhood both facilitated and made the postpartum period
problematic. The health sector does not respond with respect to fathers
concerns for family health and needs for support.
Recommendations
these findings call for programmes on gender relations, which are
supporting constructive masculinities and facilitate new fathers active
participation and responsibilities in parenting, family health and their
relations with their partners. Such programmes should not only target
people in childbearing age but also their potential support persons. Health
workers should welcome fathers and discuss strategies for good family
health during post partum. Counselling couples together could facilitate
their support for each other in optimising health post partum.
Keywords: Post partum; Fathers; Experiences; Qualitative; Interviews;
Tanzania
Vanessa Reid, Mikki Meadows-Oliver, Postpartum Depression in Adolescent

Mothers: An Integrative Review of the Literature, Journal of Pediatric
Health Care, Volume 21, Issue 5, SeptemberOctober 2007, Pages 289-298,
ISSN 0891-5245, 10.1016/j.pedhc.2006.05.010.
Abstract: Research on adolescent mothers has revealed increasing rates of
depressive symptoms in the postpartum period. This review integrated 12
research-based articles to provide a better understanding of depression
among adolescent mothers in the first year postpartum. The results revealed
that more family conflict, fewer social supports, and low self-esteem all
were associated with increased rates of depressive symptoms in adolescent
mothers during the first postpartum year. To prevent adverse outcomes
associated with depression, it is important that nurse practitioners
working with these families screen adolescent mothers for depression and
refer them for treatment as needed.
Nathan L. Hale, Janice C. Probst, Jihong Liu, Amy Brock Martin, Kevin J.
Bennett, Saundra Glover, Postpartum Screening for Diabetes among Medicaid-
Eligible South Carolina Women with Gestational Diabetes, Women's Health
Issues, Volume 22, Issue 2, MarchApril 2012, Pages e163-e169, ISSN 1049-
3867, 10.1016/j.whi.2011.08.003.
Abstract: Purpose
To examine the rate of timely postpartum screening for diabetes among
Medicaid-eligible women with gestational diabetes mellitus (GDM).
Methods
We examined a retrospective cohort of Medicaid women with a live birth
between 2004 and 2007. Women with singleton live births at greater than 28
weeks gestation were included in the cohort and their screening receipt
tracked. Only the first qualifying pregnancy within the observation period
was assessed. Birth certificate records were linked with hospital discharge
data, outpatient prenatal care claims to identify women with GDM (n =
6,239). Medicaid postpartum claims for these women were examined to
determine receipt of postpartum screening for diabetes within 5 to 13
weeks. Women with any indication of a dedicated plasma glucose test
identified by CPT codes 82947, 82950, 82951, and 82952 during this time
period were considered to meet the definition of screening.
Results
Approximately 3.4% of women identified as having GDM were screened for
diabetes postpartum. Adjusted analysis found women not attending the
postpartum visit (odds ratio [OR], 0.58; 95% confidence interval [CI],
0.370.91) and women receiving inadequate prenatal care (OR, 0.57; 95% CI,
0.340.95) were less likely to receive postpartum screening for diabetes.
Conversely, women 20 to 34 years of age (OR, 1.79; 95% CI, 1.212.66) and
women who were obese (OR, 2.28; 95% CI, 1.563.32) were more likely to be
screened.
Conclusions
Medicaid is a primary source of insurance for many women; however, for most
coverage ends at 60 days postpartum, leaving a narrow window of opportunity
for postpartum screening. Extended periods of coverage may be beneficial in
ensuring the opportunity to receive adequate postpartum care, including
screening for diabetes.
Lynn Sibley, Theresa Ann Sipe, What can a meta-analysis tell us about
traditional birth attendant training and pregnancy outcomes?, Midwifery,
Volume 20, Issue 1, March 2004, Pages 51-60, ISSN 0266-6138, 10.1016/S0266-
6138(03)00053-6.
Abstract: Objective:
to summarise the available published and unpublished studies on traditional
birth attendant (TBA) training effectiveness.
Design:
a meta-analysis.
Study sample:
sixty studies (n=60) spanning 19711999 from 24 countries and three
regions.
Measurements:
the effect size index, Cohen's h for each outcome; the variance-weighted
mean effect size and 95% confidence interval for sub-group of outcomes;
homogeneity tests on the distribution of the weighted mean effect sizes;
and sensitivity analysis to detect the presence of publication bias.
Findings:
TBA training was associated with significant increases in attributes such
as TBA knowledge (90%), attitude (74%), behaviour (63%) and advice
(90%) over the untrained TBA baseline. Results for behaviour and advice
in specific content areas related to peri-neonatal health outcome, however,
reveal sources of variability and underscore the conflicting evidence on
TBA training. TBA training was also associated with small but significant
decreases in peri-neonatal mortality (8%) and birth asphyxia mortality
(11%). Incomplete reporting limited the assessment of neonatal mortality
due to tetanus and acute respiratory infection, maternal mortality, as well
as assessment of the relationship between intervention characteristics and
outcomes. The quality of studies included in the meta-analysis lack
sufficient rigour to address the question of causality. Thus, while the
data suggest that TBA training is effective in terms of the outcomes
measured, we are unable to demonstrate that it is a cost-effective
intervention.
Implications:
skilled attendance at birth is a distant reality in many developing
countries and effective community-based strategies are needed to help
reduce high levels of mortality. Given the magnitude of peri-neonatal
mortality, the associations observed between TBA training peri-neonatal and
birth asphyxia mortality, and TBA attributes in content relevant to peri-
neonatal survival, we suggest that these strategies may usefully include
TBA training in appropriate settings. If TBAs are to be trained, however,
it is imperative that their training be adequately evaluated in order to
develop the strong evidence base that is lacking to-date and that is
necessary for sound policy and programming.
Isobel R. Contento, Jill S. Randell, Charles E. Basch, Review and Analysis

of Evaluation Measures Used in Nutrition Education Intervention Research,
Journal of Nutrition Education and Behavior, Volume 34, Issue 1, January
February 2002, Pages 2-25, ISSN 1499-4046, 10.1016/S1499-4046(06)60220-0.
Abstract: The purpose of this review is to provide a summary of the kinds
of evaluation measures used in 265 nutrition education intervention studies
conducted between 1980 and 1999 and an analysis of psychometric issues
arising from such a review. The data are summarized in terms of tables for
interventions with each of six key population groups: preschool children,
school-aged children, adults, pregnant women and breastfeeding promotion,
older adults, and inservice preparation of professionals and
paraprofessionals. Measures evaluating knowledge and skills or behavioral
capabilities were most widely used in studies with preschool, school-aged,
and inservice populations (50%85%) and less widely used in studies with
the other groups, particularly breast-feeding promotion (5%). Measures of
potential psychosocial mediators or correlates of behavior such as outcome
expectancies, self-efficacy, or behavioral intention were used in 90% of
behaviorally focused studies with school-aged children and in about 20% of
studies with adults. Dietary intake measures were used in almost all
studies, primarily food recalls, records, and quantitative food frequency
questionnaires. Short frequency instruments involving only foods targeted
in the intervention such as fruits and vegetables are increasingly being
used. Measures of specific observable behaviors are also increasingly being
used. Physiologic parameters were used in about 33% of behaviorally focused
interventions with school-aged children and adults, 20% with older adults,
and 65% with pregnant women and/or their infants. Criterion validity of
newly developed intake instruments and content validity of instruments
measuring mediating variables were reported in the majority (range 50%90%)
of studies. Reliability and stability of measures of mediating variables
were reported in 50% to 75% of studies, with reliability coefficients
mostly about .6 to .7. Two major conclusions from this review are that
evaluation measures should be appropriate to the purpose, duration, and
power of the intervention and that measures should have adequate validity
and reliability in relation to both the outcomes and characteristics of the
target audience. Major implications are that considerable preliminary work
needs to be done before any intervention study to develop and test
evaluation instruments so that they are appropriate and have adequate
psychometric properties, and cognitive testing of published instruments
with each new target audience is essential. We will then be better able to
make judgments about the effectiveness of nutrition education.
Keywords: evaluation; nutrition education; interventions
Sheela Saravanan, Gavin Turrell, Helen Johnson, Jennifer Fraser, Carla

Maree Patterson, Re-examining authoritative knowledge in the design and
content of a TBA training in India, Midwifery, Volume 28, Issue 1, February
2012, Pages 120-130, ISSN 0266-6138, 10.1016/j.midw.2011.04.006.
Abstract: Since the 1990s, the TBA training strategy in developing
countries has been increasingly seen as ineffective and hence its funding
was subsequently reallocated to providing skilled attendants during
delivery. The ineffectiveness of training programmes is blamed on TBAs
lower literacy, their inability to adapt knowledge from training and
certain practices that may cause maternal and infant health problems.
However most training impact assessments evaluate post-training TBA
practices and do not assess the training strategy. There are serious
deficiencies noted in information on TBA training strategy in developing
countries. The design and content of the training is vital to the
effectiveness of TBA training programmes.
We draw on Jordan's concept of authoritative knowledge to assess the

extent to which there is a synthesis of both biomedical and locally
practiced knowledge in the content and community involvement in the design
of TBA a training programme in India.
Findings
The implementation of the TBA training programme at the local level
overlooks the significance of and need for a baseline study and needs
assessment at the local community level from which to build a training
programme that is apposite to the local mother's needs and that fits within
their comfort zone during an act that, for most, requires a forum in
which issues of modesty can be addressed. There was also little scope for
the training to be a two way process of learning between the health
professionals and the TBAs with hands-on experience and knowledge. The
evidence from this study shows that there is an overall authority of
biomedical over traditional knowledge in the planning and implementation
process of the TBA training programme. Certain vital information was not
covered in the training content including advice to delay bathing babies
for at least six hours after birth, to refrain from applying oil on the
infant, and to wash hands again before directly handling mother or infant.
Information on complication management and hypothermia was not adequately
covered in the local TBA training programme.
Key conclusions
The suggested improvements include the need to include a baseline study,
appropriate selection criteria, improve information in the training manual
to increase clarity of meaning, and to encourage beneficial traditional
practices through training.
Keywords: TBA training content and design; Authoritative knowledge;
Birthing practices
Zulfiqar A Bhutta, Samana Ali, Simon Cousens, Talaha M Ali, Batool Azra
Haider, Arjumand Rizvi, Pius Okong, Shereen Z Bhutta, Robert E Black,
Interventions to address maternal, newborn, and child survival: what
difference can integrated primary health care strategies make?, The Lancet,
Volume 372, Issue 9642, 1319 September 2008, Pages 972-989, ISSN 0140-
6736, 10.1016/S0140-6736(08)61407-5.
Abstract: Summary
Several recent reviews of maternal, newborn, and child health (MNCH) and
mortality have emphasised that a large range of interventions are available
with the potential to reduce deaths and disability. The emphasis within
MNCH varies, with skilled care at facility levels recommended for saving
maternal lives and scale-up of community and household care for improving
newborn and child survival. Systematic review of new evidence on
potentially useful interventions and delivery strategies identifies 37 key
promotional, preventive, and treatment interventions and strategies for
delivery in primary health care. Some are especially suitable for delivery
through community support groups and health workers, whereas others can
only be delivered by linking community-based strategies with functional
first-level referral facilities. Case studies of MNCH indicators in
Pakistan and Uganda show how primary health-care interventions can be used
effectively. Inclusion of evidence-based interventions in MNCH programmes
in primary health care at pragmatic coverage in these two countries could
prevent 2030% of all maternal deaths (up to 32% with capability for
caesarean section at first-level facilities), 2021% of newborn deaths, and
2940% of all postneonatal deaths in children aged less than 5 years.
Strengthening MNCH at the primary health-care level should be a priority
for countries to reach their Millennium Development Goal targets for
reducing maternal and child mortality.
Ponndara Ith, Angela Dawson, Caroline S.E. Homer, Anna Klinken Whelan,
Practices of skilled birth attendants during labour, birth and the
immediate postpartum period in Cambodia, Midwifery, Available online 16
February 2012, ISSN 0266-6138, 10.1016/j.midw.2012.01.010.
Abstract: Objective
maternal and perinatal morbidity and mortality rates in Cambodia are high.
The provision of quality care by skilled birth attendants (SBAs) in a
supportive working environment is an important strategy to reduce morbidity
and mortality. There has been little emphasis on examining this issue in
Cambodia. The objective of this study was to establish SBA reported
practices during labour, birth and the immediate postpartum periods and the
factors affecting this.
Methods
a descriptive qualitative design was employed using in-depth interviews and
focus group discussions with midwives, nurses and doctors with midwifery
skills in two health centres and three referral hospitals in one province
of Cambodia. Data were analysed using a thematic framework.
Findings
SBA practice is not always consistent with evidence-based standards known
to reduce morbidity and mortality. Ten inter-related themes emerged, which
described patterns of SBA practice, were identified. These were: skills in
the care of labouring women; provision of support in labour; interventions
in the second stage of labour; management of the third stage of labour;
cleanliness during birth; immediate care of the newborn infant and
immediate postnatal care; lack of policy and authority; fear of litigation;
workload and lack of human resources; and financial incentives and socio-
economic influences.
Conclusions
a gap exists between evidence-based standards and current SBA practice
during labour, birth and the immediate postpartum care. This is largely
driven by the lack of a supportive working environment.
the findings of this research provide maternal health services, workforce
planners and policy makers with valuable information to contribute to the
continuous quality improvement of maternity care. The findings highlight
implications for practice that may improve the quality of maternal health
care. Recommendations for decision makers were made and further research is
needed in order to develop theories and recommendations to improve SBA
practice in Cambodia, to the benefit of the Cambodia women and newborn
babies.
Keywords: Practices; Skilled birth attendant; Birth; Cambodia
Brian E. Vaugn, Leslie Crichton, Bryon Egeland, Individual differences in

qualities of caregiving during the first six months of life: antecedents in
maternal and infant behavior during the newborn period, Infant Behavior and
Development, Volume 5, Issue 1, January 1982, Pages 77-95, ISSN 0163-6383,
10.1016/S0163-6383(82)80018-0.
Abstract: A large sample of infants and mothers from an ecnomically
disadvantaged population was assessed during the first two weeks of life
with two instruments, a rating of the mothers and infants completed by the
nurses in the newborn nursery, and the Neonatal Behavioral Assessment Scale
(NBAS). At three-and six-months postpartum, observations were made on these
mother-infant paris during feeding and play situations. Additional ratings
of the quality of maternal caregiving were made at six monthas. The data
were examined both within and across time periods. Ratings of how
relaxed/skilled the mother appeared in the newborn nursery were unrelated
to the assessments of newborn infant behavior, however, multiple regression
analyses indicated that both the ratings of maternal variables and the
assessments of newborn behavioral organization added signifacantly to the
prediction of the quality of maternal caregiving during the first six
montha of lfe. Separate analyses of these data by gender of the infant
revealed a small, but possibly important, difference favoring females on
NBAS performance. Further, the organization of newborn behavior increased
the predictions to later maternal behavior for males somewhat more than for
female infants. The results sare interpreted as evidence for the validity
of both the NBAS, and of the rating scale completed by the nurses in the
neonatal nursery. The results are also seen as consistent with a
transactional perspective on development, indicatinig that neonatal
behavioral organization is important in eliciting optimal transactions with
the caregiver
Sheela Saravanan, Gavin Turrell, Helen Johnson, Jenny Fraser, Carla

Patterson, Traditional birth attendant training and local birthing
practices in India, Evaluation and Program Planning, Volume 34, Issue 3,
August 2011, Pages 254-265, ISSN 0149-7189,
10.1016/j.evalprogplan.2011.02.012.
Abstract: Training birth attendants (TBAs) provide essential maternal and
infant health care services during delivery and ongoing community care in
developing countries. Despite inadequate evidence of relevance and
effectiveness of TBA training programmes, there has been a policy shift
since the 1990s in that many donor agencies funding TBA training programmes
redirected funds to providing skilled attendants during delivery. This
study aimed to assess the ways in which a TBA training programme in India
has been successful in disseminating evidence-based knowledge on birthing
practices. TBAs practicing within 16 villages targeted by training
programme initiatives were administered with structured questionnaires. The
post training birthing practices of trained (24) and untrained (14) TBAs
was compared and birthing practices adopted by women assisted by trained
(16) and untrained (9) TBAs was analysed. Positive post training practices
were hand washing, use of a clean blade for cutting the cord, immediate
breastfeeding and weighing of babies. Nevertheless, the training could be
further improved with up to date and evidence-based information and more
comprehensive instructions. The findings suggest an integration of local
and evidence-based knowledge is needed to improve the training. Raising
community awareness of public health measures related to maternal and child
health is also recommended.
Keywords: Maternal and infant health; Traditional birth attendants
training; Traditional birthing practices; Home births; Warm chain;
Hypothermnia; Community awareness
Jennifer Foster, Angela Anderson, Jennifer Houston, Maya Doe-Simkins, A

report of a midwifery model for training traditional midwives in Guatemala,
Midwifery, Volume 20, Issue 3, September 2004, Pages 217-225, ISSN 0266-
6138, 10.1016/j.midw.2004.01.004.
to describe the specific characteristics of one model of training
traditional birth attendants (TBAs) in Guatemala.
Design:
participant observation, unstructured and semi-structured interviews
undertaken between 1997 and 2003 to gather the data to report on the
characteristics of this training programme as it is evolving in the field.
Setting:
the birth centre site of Ixmucane in Antigua, Guatemala, as well as
community sites in the Departments of Saquetepequez, Chimaltenango, and
Quetzaltenango in the western highlands of Guatemala.
Participants:
traditional midwives, certified nurse-midwives and certified professional
midwives, as well as many allied health professionals and volunteers.
Intervention:
training philosophy, participant selection, curriculum content, intensity,
and planned follow-up are the key components of the training programme
described.
Measurement and findings:
93 TBAs have received training through the development of a 150 hrs contact
course for self-selected TBAs in the Midwives for Midwives Program. Formal
evaluation of this training is underway but results are not yet available.
Key conclusions and implications for practice:
the value of incorporating midwifery philosophy and praxis in TBA training
has received scant attention in the TBA literature. This report suggests
that TBA training programme characteristics are important considerations in
any evaluation of training efficacy of TBAs to improve maternalchild
health.
Keywords: Traditional midwives; Guatemala; TBA training; Maternal-baby;
Mortality
Justin Oliver Parkhurst, Syed Azizur Rahman, Life saving or money wasting?:
Perceptions of caesarean sections among users of services in rural
Bangladesh, Health Policy, Volume 80, Issue 3, March 2007, Pages 392-401,
ISSN 0168-8510, 10.1016/j.healthpol.2006.03.015.
Abstract: Bangladesh has a high level of maternal mortality, corresponding
to one of the world's lowest rates of use of skilled birth attendance
(12.1%), and a similarly low rate of caesarean births (2.4%). While
increasing the proportion of women who deliver with professional medical
care is essential to prevent maternal deaths, past work has identified
distrust of caesarean procedures in Bangladesh. The reasons behind this
distrust can manifest itself in health seeking behaviour around maternal
care. This paper presents findings from a qualitative study of 30 women in
a rural district of Bangladesh who recently delivered in a health facility.
It finds that the distrust in doctor's recommendations for surgery stemmed
from high costs incurred and a belief that it was used when not medically
justified. This could lead to women avoiding or leaving medical facilities
in extreme cases. Some women's experiences further illustrated disagreement
among medical staff as to whether or not a caesarean procedure should be
done, with conflicting financial incentives for doctors to perform
caesarean deliveries, and for nurses and midwives to conduct normal
deliveries. Policy makers must recognise that the fears women hold of
caesarean deliveries may not simply be rooted in ignorance and may, in
fact, reflect legitimate concerns with medical practice. Ultimately, it
will be essential to address problems in the health systems environment,
which may promote improper service provision.
Keywords: Maternal health; Caesarian sections; Health seeking behaviour;
Skilled attendance; Bangladesh
Eleni Tsigas, Laura A. Magee, Advocacy organisations as partners in pre-

eclampsia progress: patient involvement improves outcomes, Best Practice
& Research Clinical Obstetrics & Gynaecology, Volume 25, Issue 4,
August 2011, Pages 523-536, ISSN 1521-6934, 10.1016/j.bpobgyn.2011.03.001.
Abstract: Optimal maternal and neonatal health requires the expertise of
maternity-care providers who base their decisions on solid research.
Optimal care, however, also requires active patient participation, which is
best accomplished through advocacy organisations that represent the
perspective of diverse patient populations. Patients who come together
under the auspices of a patient advocacy organisation, sometimes called
consumer groups, can have a unique and powerful voice to advance the goals
(or overcome the inertia) of the healthcare system. For pre-eclampsia, a
condition that still carries the burden of no cure and seriously adverse or
deadly outcomes, all three components care providers, researchers and
patients are required to realise progress. In this chapter, we briefly
describe the effect of pre-eclampsia on women, discuss the role of patient
advocacy organisations, and propose a six-point call to action that can
serve as a compass for patients to collaborate with practitioners,
investigators, funders, non-governmental organisations, and policy makers
on a set of articulated and comprehensive goals.
Keywords: patient advocacy; pre-eclampsia; eclampsia; hypertensive
disorders; cardiovascular disease; maternal outcome; public advocacy;
health education; patient education as topic; prenatal care; pregnancy;
public policy; consumer groups
Eugene J. Kongnyuy, Grace Mlava, Nynke van den Broek, Facility-Based

Maternal Death Review In Three Districts In The Central Region of Malawi:
An Analysis of Causes and Characteristics of Maternal Deaths, Women's
Health Issues, Volume 19, Issue 1, JanuaryFebruary 2009, Pages 14-20, ISSN
1049-3867, 10.1016/j.whi.2008.09.008.
Abstract: Purpose
We sought to determine the causes and characteristics maternal deaths that
occur in health facilities in Malawi.
Methods
Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in
Central Malawi over a 1-year period. Causes and avoidable factors of
maternal deaths were identified during the review, and recommendations made
and implemented.
Main Findings
There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect
obstetric deaths. The major causes of maternal deaths were postpartum
hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured
uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum
hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were
referred either from another health facility (51.2%) or by a traditional
birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on
admission. Four groups of factors that contributed to maternal deaths were
identified: 1) health worker factors, 2) administrative factors, 3)
patient/family factors, and 4) TBA factors. The major health worker factors
were inadequate resuscitation (69.8%), lack of obstetric life-saving skills
(60.5%), inadequate monitoring (55.8%), initial assessment incomplete
(46.5%), and delay in starting treatment (46.5%). The most common
administrative factor was lack of blood for transfusion (20.9%). The major
problems encountered include shortage of staff and other resources,
difficulty in maintaining anonymity, poor quality of data, and difficulty
in implementing recommendations.
Conclusion
Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and
raising community awareness could be important factors for reducing
maternal mortality in Malawi and countries with similar socioeconomic
profiles.
Donna Vivio, Judith T. Fullerton, Rosha Forman, Reuben Kamoto Mbewe, Masuka
Musumali, Patrick M. Chewe, Integration of the Practice of Active
Management of the Third Stage of Labor Within Training and Service
Implementation Programming in Zambia, Journal of Midwifery & Women's
Health, Volume 55, Issue 5, SeptemberOctober 2010, Pages 447-454, ISSN
1526-9523, 10.1016/j.jmwh.2010.02.015.
Abstract: Introduction
Postpartum hemorrhage (PPH) is the leading cause of pregnancy-related
mortality (cited at 591 per 100,000 Zambian women), and is responsible for
up to 60% of maternal deaths in developing countries. Active management of
the third stage of labor (AMTSL) has been endorsed as a means of reducing
the risk of PPH. The Ministry of Health/Zambia has incorporated the use of
AMTSL into its reproductive health guidelines.
Methods
Midwives employed in five public hospitals and eight health centers were
interviewed (N = 62), and 82 observations were conducted during the second
through fourth stages of labor.
Results
Data from facilities in which oxytocin was available (62 births in 11
settings) indicated that a uterotonic was used in 53 of the births (85.5%);
however, AMTSL was conducted in strict accord with the currently
recommended protocol (a time-specific use of the uterotonic, controlled
cord traction, and fundal massage) in only 25 (40.4%) of births.
Discussion
Midwives have concerns about risks of maternal to newborn HIV blood
transfusion; it is doubtful that they will adopt the currently recommended
practice of delayed cord clamping and cutting. Infrastructure issues and
supply shortages challenged the ability to correctly and safely implement
the AMTSL protocol; nevertheless, facilities were generally ready to
support it.
Keywords: active management of the third stage of labor; midwifery care;
postpartum hemorrhage; reproductive health
Hind A. Beydoun, Ban Al-Sahab, May A. Beydoun, Hala Tamim, Intimate Partner
Violence as a Risk Factor for Postpartum Depression Among Canadian Women in
the Maternity Experience Survey, Annals of Epidemiology, Volume 20, Issue
8, August 2010, Pages 575-583, ISSN 1047-2797,
10.1016/j.annepidem.2010.05.011.
Abstract: Purpose
Intimate partner violence is a worldwide public health concern that
predominantly affects women of reproductive age. The purpose of this study
was to evaluate the effect of exposure to intimate partner violence before,
during, or after pregnancy on postpartum depression in a nationally
representative sample of Canadian women.
Methods
A cross-sectional analysis was performed with the use of data from the
Maternity Experience Survey conducted by Statistics Canada in 2006. A
population-based sample of 8542 women 15 years and older who delivered
singleton live births was selected from all Canadian provinces and
territories; of those, 6421 completed a computer-assisted telephone
interview. Recent experiences with and threats of physical or sexual
violence by an intimate partner were examined in relation to postpartum
depression assessed through the Edinburgh Postpartum Depression Scale.
Results
The prevalence of postpartum depression was 7.5% (95% confidence interval,
6.88.2). Controlling for confounders, odds of postpartum depression were
significantly greater among women who reported partner violence in the past
two years as opposed to those who did not (adjusted odds ratio, 1.61; 95%
confidence interval, 1.062.45).
Conclusions
Intimate partner violence is positively associated with postpartum
depression among Canadian women. Implications for healthcare practice are
discussed.
Keywords: Intimate Partner Violence; Postpartum Depression; Pregnancy;
Survey
Ian Brockington, Postpartum psychiatric disorders, The Lancet, Volume 363,

Issue 9405, 24 January 2004, Pages 303-310, ISSN 0140-6736, 10.1016/S0140-
6736(03)15390-1.
Abstract: Summary
This review summarises the psychiatry of the puerperium, in the light of
publications during the past 5 years. A wide variety of disorders are seen.
Recognition of disorders of the motherinfant relationship is important,
because these have pernicious long-term effects but generally respond to
treatment. Psychoses complicate about one in 1000 deliveries. The most
common is related to manic depression, in which neuroleptic drugs should be
used with caution. Post-traumatic stress disorder, obsessions of child
harm, and a range of anxiety disorders all require specific psychological
treatments. Postpartum depression necessitates thorough exploration.
Cessation of breastfeeding is not necessary, because most antidepressant
drugs seem not to affect the infant. Controlled trials have shown the
benefit of involving the child's father in therapy and of interventions
promoting interaction between mother and infant. Owing to its complexity,
multidisciplinary specialist teams have an important place in postpartum
psychiatry.
Judith M. O'Heir, Midwifery education for safe motherhood, Midwifery,
10.1016/S0266-6138(97)90001-2.
Abstract: Objective: to determine the useability (relevance, clarity and
quality of content), applicability (ease of use) and accessibility
(structure and form) of a series of new safe motherhood midwifery education
modules.
Design: questionnaire survey and focus group discussions, preceded by a two

week clinical skills course and an eight day orientation to using the
modules.
Setting: nursing and midwifery education institutions, regional training

centres, acute-care hospital facilities and community settings in Ethiopia,
Fiji, Lesotho, Mozambique and Nepal.
Participants: thirty-six teachers, 82 midwives, nurse-midwives and

auxiliary nurse-midwives from practice settings, and 60 post basic
midwifery students.
Key findings: overall it was found that the introductory information and
the technical content of the modules were easy to understand and use as
were the instructions for both teachers and students. The presentation of
the material was orderly and easy to follow; the language was
comprehensible; and the illustrations were appropriate, clear and
facilitated teaching. The teachers found that they were able to use most of
the teaching/learning methods, teach most of the skills in the modules, and
use the guidelines for assessing competence. The main difficulties
encountered included adherence to the recommended time frame for some of
the classroom sessions; the limited availability of clinical cases for
teaching the specific skills in the modules and time limitations in the
clinical area for practising the skills; and the provision of transport for
community visits, data to complete community profiles, and time to complete
other planned community activities. The students identified the need for a
set of learning materials which they could take with them for future
reference, and both teachers and students expressed concern about resources
to support, and legislation to cover, the application of the skills
taught/learned.
Key conclusions: the modules have the potential to strengthen and support
the education of midwives in developing countries, enabling them to make
motherhood safer and contribute to a reduction in maternal mortality by
providing better midwifery care.
Joy M. Camp, Norma Finkelstein, Parenting training for women in residential

substance abuse treatment: Results of a demonstration project, Journal of
Substance Abuse Treatment, Volume 14, Issue 5, SeptemberOctober 1997,
Pages 411-422, ISSN 0740-5472, 10.1016/S0740-5472(97)00004-4.
Abstract: This paper presents findings on the impact of implementing a
parenting component in two urban residential treatment programs in
Massachusetts for pregnant and parenting chemically-dependent women. The
parenting component consisted of multiple services for both women and their
infants while they were in residential treatment as well as aftercare
services after discharge from treatment. Findings presented focus on: (a)
the characteristics of the 170 pregnant and parenting women who
participated in the parenting component during its 48 months of
implementation; (b) changes in the parenting skills and self-esteem of
women who completed parenting training; (c) the quality of mother-child
interaction; and (d) the participants' perceptions about the impact of the
parenting training. Women in both programs made dramatic improvements in
self-esteem and experienced significant gains in parenting knowledge and
attitudes. The participants were also overwhelmingly positive about the
impact of the parenting training on their lives. Study findings underline
the importance of parenting services for pregnant and parenting women in
residential substance abuse treatment.
Keywords: parenting training; pregnant women; drug treatment; self-esteem;
residential treatment
Fariyal F Fikree, Tazeen Ali, Jill M Durocher, Mohammad H Rahbar, Health

service utilization for perceived postpartum morbidity among poor women
living in Karachi, Social Science & Medicine, Volume 59, Issue 4,
10.1016/j.socscimed.2003.11.034.
Abstract: To explore traditional beliefs and practices, to assess puerperal
morbidity, and to understand care-seeking behaviors, a qualitative and
quantitative study was conducted in low socio-economic settlements of
Karachi, Pakistan. Five focus group discussions and 15 in-depth interviews
were conducted in July and August 2000. 525 Muslim women, who were 68
weeks post-partum, were then interviewed at home. Maternal care was
relatively goodmore than three-quarters of recent mothers sought antenatal
care and more than half (267/525) delivered in a hospital or maternity
home. Counseling to attend post-partum clinics among facility deliveries
was 16% (43/267), of which only 26% (11/43) attended. Practices during the
delivery and puerperium, such as massaging the vaginal walls with mustard
oil during labor to facilitate delivery and inserting vaginal or rectal
herbal pessaries to facilitate shrinkage of the uterus and/or
strengthening of the backbone, were pervasive.
The core symptoms that are clinically significant during the puerperium are
heavy vaginal bleeding and high fever, since they are potentially fatal
symptoms if appropriate and timely care is not sought. About half of the
study women (53.3%) reported at least one illness symptom, high fever
(21.1%), heavy vaginal bleeding (13.9%), and foul smelling vaginal
discharge (9.6%). Women did not know the underlying biologic cause of their
perceived post-partum morbidity; weakness was frequently mentioned. Women
sought care initially from close relatives or traditional healers and if
they continued to suffer from their morbidity they finally approached a
trained health care (allopathic) provider. The high prevalence of perceived
post-partum morbidity illustrates the demand for post-partum community-
based health care programs. We suggest promoting maternal health education
that encourages women to seek appropriate and timely care by accessing
public or private health services.
Keywords: Traditional practices; Care-seeking behavior; Pakistan; Post-
partum morbidity; Puerperium; Socioeconomic status,Karachi
Charles Ameh, Adetoro Adegoke, Jan Hofman, Fouzia M. Ismail, Fatuma M.

Ahmed, Nynke van den Broek, The impact of emergency obstetric care training
in Somaliland, Somalia, International Journal of Gynecology &
Obstetrics, Volume 117, Issue 3, June 2012, Pages 283-287, ISSN 0020-7292,
10.1016/j.ijgo.2012.01.015.
Abstract: Objective
To provide and evaluate in-service training in Life Saving Skills
Emergency Obstetric and Newborn Care in order to improve the availability
of emergency obstetric care (EmOC) in Somaliland.
Methods
In total, 222 healthcare providers (HCPs) were trained between January 2007
and December 2009. A beforeafter study was conducted using quantitative
and qualitative methods to evaluate trainee reaction and change in
knowledge, skills, and behavior, in addition to functionality of healthcare
facilities, during and immediately after training, and at 3 and
6 months post-training.
Results
The HCPs reacted positively to the training, with a significant improvement
in 50% of knowledge and 100% of skills modules assessed. The HCPs reported
improved confidence in providing EmOC. Basic and comprehensive EmOC
healthcare facilities provided 100% of expected signal functionscompared
with 43% and 56%, respectively, at baselinewith trained midwives
performing skills usually performed by medical doctors. Lack of drugs,
supplies, medical equipment, and supportive policy were identified as
barriers that could contribute to nonuse of new skills and knowledge
acquired.
Conclusion
The training impacted positively on the availability and quality of EmOC
and resulted in up-skilling of midwives.
Keywords: Evaluation; Maternal mortality; Skilled birth attendance; Task
shifting; Training in emergency obstetric and newborn care
Fabio Uxa, Alberta Bacci, Viviana Mangiaterra, Gian Paolo Chiaffoni,

Essential newborn care training activities: 8 years of experience in
Eastern European, Caucasian and Central Asian countries, Seminars in Fetal
and Neonatal Medicine, Volume 11, Issue 1, February 2006, Pages 58-64, ISSN
1744-165X, 10.1016/j.siny.2005.10.006.
Abstract: Summary
There is still an alarming gap in neonatal healthcare and outcome between
Western and Eastern European countries and the former USSR countries in
particular. Most of the causes of neonatal mortality and morbidity can be
prevented or managed by simple cost-effective interventions aimed at
improving quality of healthcare, health system organisation and family and
community participation. Training of health professionals and health
policy-makers in the field of essential neonatal care and breastfeeding
promotion is one of the cornerstones of the World Health Organization (WHO)
initiatives Making Pregnancy Safer (MPS) and Promoting Effective Perinatal
Care (PEPC) the latter specifically tailored to the European Region
aimed at ensuring safe pregnancy and childbirth through ensuring the
availability, access and use of quality skilled care. After 8 years of
experience of training in essential neonatal care, positive changes in
planning for and delivering neonatal care are taking place, even in
challenging contexts, and this model of intervention should be further
implemented in the region.
Keywords: Neonatal health; Newborn health; Neonatal mortality rate; Newborn
deaths; Neonatal survival; Newborn survival; Maternal, newborn and child
health (MNCH); Essential neonatal care training; Essential newborn care
training; Former USSR countries; New independent states
Michelle Dynes, Sandra T. Buffington, Mary Carpenter, Anna Handley, Maureen

Kelley, Lelisse Tadesse, Hanna Tessema Beyene, Lynn Sibley, Strengthening
maternal and newborn health in rural Ethiopia: Early results from frontline
health worker community maternal and newborn health training, Midwifery,
Available online 16 February 2012, ISSN 0266-6138,
10.1016/j.midw.2012.01.006.
Abstract: Objective
to describe early results from the Community Maternal and Newborn Health
(CMNH) training programme of the Maternal and Newborn Health in Ethiopia
Partnership (MaNHEP) project.
Design
a non-experimental, descriptive design was employed to assess training
implementation.
Setting
six rural districts of Amhara and Oromiya regions, Ethiopia.
Participants
91 Health Extension Workers (HEWs) and 626 Guide Team members including
Traditional Birth Attendants (TBAs) and volunteer Community Health
Promoters (vCHPs).
Intervention
CMNH is one aspect of a broader strategy to improve maternal and newborn
health at the community level in rural areas of Ethiopia where pregnant
women have limited access to health facilities.
Measurements
performance testing of HEWs, TBAs, and vCHPs was conducted to assess
transfer of knowledge and skills from CMNH Master Trainer level to CMNH
Trainer level, and from CMNH Trainer level to CMNH Guide Team (GT) level on
the topic areas of Prevent Problems before Baby is Born and Prevent
Problems after Baby is Born.
Findings
post-training performance scores were significantly higher than immediate
pre-training scores for Amhara and Oromiya regions on both topic areas
(p<0.001). For HEWs and GT members, respectively, average scores
increased over 250% and 300% for Prevent Problems before Baby is Born, and
over 300% and 400% for Prevent Problems after Baby is Born.
Key conclusions
CMNH was successful in transferring knoweldge to HEWs at the CMNH Trainer
level and to Guide Team members at the community level. In order for gains
to be realised and sustained, the CMNH programme will be nested within an
enabling environment created through behaviour change communication to
increase demand for CMNH services, emphasising evidence-based maternal and
newborn care practices, teamwork among frontline health workers, and an
enhanced role of HEWs in provision of safe care during pregnancy, birth,
and the early postnatal period.
Keywords: Maternal health services; Newborn health; Ethiopia; Community-
based
Debra P Bonollo, Jane G Zapka, Anne M Stoddard, Yunsheng Ma, Lori Pbert,
Judith K Ockene, Treating nicotine dependence during pregnancy and
postpartum: understanding clinician knowledge and performance, Patient
Education and Counseling, Volume 48, Issue 3, December 2002, Pages 265-274,
ISSN 0738-3991, 10.1016/S0738-3991(02)00023-X.
Abstract: This study investigated the relationship of clinicians knowledge
of treatments for nicotine dependence during pregnancy and postpartum and
explored what provider characteristics are associated with knowledge
levels. Survey data from community health center (CHC)-based prenatal,
pediatric (PED), and WIC program (Special Supplemental Nutrition Program
for Women, Infants, and Children) providers participating in a randomized
clinical study were used. Providers reported low awareness of the health
risks of smoking to the developing fetus/child of pregnant and postpartum
women and of the effectiveness of nicotine replacement therapy (NRT) for
doubling quit rates. Obstetric (OB) and WIC providers were more aware than
PED providers that provider-delivered interventions are effective.
Confidence in using counseling steps was significantly associated with
general and NRT-related knowledge. NRT-related knowledge, but not general
knowledge, was associated with higher performance of intervention steps.
Educational programs targeting OB, WIC, and PED providers knowledge about
effective smoking cessation counseling strategies and their confidence in
being effective with patients are needed.
Keywords: Smoking; Pregnant women; Health center clinicians; WIC; Nicotine
replacement therapy
Laurence E. Shields, Kathy Smalarz, Lester Reffigee, Sandra Mugg, Theodore
J. Burdumy, Marilyn Propst, Comprehensive maternal hemorrhage protocols
improve patient safety and reduce utilization of blood products, American
Journal of Obstetrics and Gynecology, Volume 205, Issue 4, October 2011,
Pages 368.e1-368.e8, ISSN 0002-9378, 10.1016/j.ajog.2011.06.084.
Abstract: Objective
The purpose of this study was to assess the effectiveness of instituting a
comprehensive protocol for the treatment of maternal hemorrhage.
Study Design
The protocol was separated into 4 stages, designated 0-3, based on the
degree of blood loss and the patient response to interventions. Key
components included admission risk assessment, measurement of blood loss,
early but limited use of uterotonic agents, early presence of obstetrical
and anesthesia staff, and transfusion with fixed ratios of blood products.
Data were collected retrospectively and prospectively relative to the start
of the protocol.
Results
We noted a significant shift toward resolution of maternal bleeding at an
earlier stage (P < .01), use of fewer blood products (P < .01), and a
64% reduction in the rate of disseminated intravascular coagulation. In
addition, there were significant improvements in staff and physician
perceptions of patient safety (P < .01).
Conclusion
Comprehensive maternal hemorrhage treatment protocols improve patient
safety and reduce utilization of blood products.
Keywords: comprehensive; maternal hemorrhage; patient safety; protocol
Tami Rowen, Ndola Prata, Paige Passano, Evaluation of a traditional birth

attendant training programme in Bangladesh, Midwifery, Volume 27, Issue 2,
April 2011, Pages 229-236, ISSN 0266-6138, 10.1016/j.midw.2009.06.003.
Abstract: Background and context
the 1997 Safe Motherhood Initiative effectively eliminated support for
training traditional birth attendants (TBAs) in safe childbirth. Despite
this, TBAs are still active in many countries such as Bangladesh, where 88%
of deliveries occur at home. Renewed interest in community-based approaches
and the urgent need to improve birth care has necessitated a re-examination
of how provider training should be conducted and evaluated.
Objective
to demonstrate how a simple evaluation tool can provide a quantitative
measure of knowledge acquisition and intended behaviour following a TBA
training program.
Design
background data were collected from 45 TBAs attending two separate training
sessions conducted by Bangladeshi non-governmental organization (NGO)
Gonoshasthaya Kendra (GK). A semi-structured survey was conducted before
and after each training session to assess the TBAs knowledge and reported
practices related to home-based management of childbirth.
Setting
two training sessions conducted in Vatshala and Sreepur in rural
Bangladesh.
Participants
45 active TBAs were recruited for this training evaluation.
Findings
there were significant improvements following the training sessions
regarding how TBAs reported they would: (a) measure blood loss, (b) handle
an apneic newborn, (c) refer women with convulsions and (d) refer women who
are bleeding heavily. A greater degree of improvement, and higher scores
overall, were observed among TBAs with no prior training and with less
birth experience.
Key conclusions and recommendations for practice
as the Safe Motherhood community strives to improve safe childbirth care,
the quality of care in pregnancy and childbirth for women who rely on less-
skilled providers should not be ignored. These communities need assistance
from governments and NGOs to help improve the knowledge and skill levels of
the providers upon which they depend. Gonoshasthaya Kendra's extensive
efforts to train and involve TBAs, with the aim of improving the quality of
care provided to Bangladeshi women, is a good example of how to effectively
integrate TBAs into safe motherhood efforts in resource-poor settings. The
evaluation methodology described in this paper demonstrates how trainees
prior experiences and beliefs may affect knowledge acquisition, and
highlights the need for more attention to course content and pedagogic
style.
Keywords: Traditional birth attendant; Training; Home births; Skilled birth
attendant; Bangladesh safe motherhood; Global maternal health
Keng-Yen Huang, Margaret O'Brien Caughy, Janice L. Genevro, Therese L.

Miller, Maternal knowledge of child development and quality of parenting
among White, African-American and Hispanic mothers, Journal of Applied
Developmental Psychology, Volume 26, Issue 2, MarchApril 2005, Pages 149-
170, ISSN 0193-3973, 10.1016/j.appdev.2004.12.001.
Abstract: This study examined the relationship between early maternal
knowledge of child development and later quality of parenting behaviors.
Differences by race/ethnic group were also examined. Motherinfant dyads
(N=378) participated in the study. Mothers completed the Knowledge of
Infant Development Inventory (KIDI) when the infant was 24 months, and
mothertoddler dyads were videotaped in their homes at 1618 months. The
Home Observation for Measurement of the Environment Inventory (HOME),
Parent/Caregiver Involvement Scale (P/CIS), and Nursing Child Assessment by
Satellite Training (NCAST) were used to measure quality of mothertoddler
interaction. A series of hierarchical multiple regression analyses was
conducted controlling for confounding demographic variables. Results
revealed no significant main effect of maternal correct estimation of child
development on quality of parenting, but there was a significant main
effect of maternal underestimation of child development on quality of
parenting during a teaching task. There was also a significant interaction
of maternal knowledge and race in relation to quality of parenting
behavior. Implications for generalizability and interventions are
discussed.
Keywords: Parenting; Maternal teaching behavior; Maternal knowledge of
development; Race and ethnic differences; Maternal cognition
Renaud Jardri, Michel Maron, Jrme Pelta, Pierre Thomas, Xavier

Codaccioni, Michel Goudemand, Pierre Delion, Impact of midwives training
on postnatal depression screening in the first week post delivery: a
quality improvement report, Midwifery, Volume 26, Issue 6, December 2010,
Pages 622-629, ISSN 0266-6138, 10.1016/j.midw.2008.12.006.
postnatal depression (PND) is a major public health problem. The objective
of this study was to improve early PND screening by midwives in a maternity
unit. Professional screening techniques were evaluated and compared with
reference screening techniques [Edinburgh Postnatal Depression Scale
(EPDS), Mini International Neuropsychiatric Interview (MINI-DSM-IV)].
Methods
the evaluation took place before and after the midwife training in order to
determine the effectiveness of specific clinical recommendations for two
successive 10-week inclusion periods (from November 2004 to September
2005). A short training course and posters were used to convey the
recommendations, agreed by obstetricians, paediatricians and psychiatrists.
Results
a total of 463 postpartum women were included in the two phases of the
study. Quantitative and qualitative PND screening by midwives improved
significantly following training (Z=2.07, p=0.04; Z=2.62, p=0.008,
respectively). Early detection of major depressive episodes increased by
37.7% (95% confidence interval 25.749.7) following training. A combination
of midwives perception of poor emotional well-being and the EPDS led to a
significant improvement in early detection of PND (Q=8.00, p=0.04).
Discussion
targeted recommendations given to the midwives led to an improvement in the
early detection of PND. Suitable programmes need to be offered to reduce
the number of cases of PND. Perinatal psychiatrists should be seen to be
meticulous and available for such prevention action.
Keywords: Postnatal depression; Early screening; Primary prevention;
Midwives; Quality improvement; EPDS; MINI
Joanne Borg-Stein, Sheila A. Dugan, Musculoskeletal Disorders of Pregnancy,

Delivery and Postpartum, Physical Medicine and Rehabilitation Clinics of
North America, Volume 18, Issue 3, August 2007, Pages 459-476, ISSN 1047-
9651, 10.1016/j.pmr.2007.05.005.
Abstract: Gender-specific care of musculoskeletal impairments is
increasingly important in women's health. This is most relevant and of
paramount importance as it relates to identification and management of
musculoskeletal and peripheral neurologic disorders of pregnancy, delivery,
and postpartum. The specific anatomic and physiologic changes of pregnancy
predispose to a specific set of diagnoses. Virtually all women experience
some degree of musculoskeletal discomfort during pregnancy. This article
provides an overview of the more common pregnancy-related musculoskeletal
conditions and includes a discussion of epidemiology, risk factors,
diagnosis, prognosis, and management.
Fei-Wan Ngai, Sally Wai-Chi Chan, Wan-Yim Ip, The effects of a childbirth
psychoeducation program on learned resourcefulness, maternal role
competence and perinatal depression: A quasi-experiment, International
Journal of Nursing Studies, Volume 46, Issue 10, October 2009, Pages 1298-
1306, ISSN 0020-7489, 10.1016/j.ijnurstu.2009.03.007.
Learned resourcefulness plays a significant role in facilitating maternal
coping during the transition to motherhood. Given the growing evidence of
perinatal depression and the frequent feeling of incompetence in the
maternal role, the implementation of an effective intervention to promote
maternal role competence and emotional well-being is essential.
Objectives
To determine the impact of a childbirth psychoeducation program based on
the concept of learned resourcefulness on maternal role competence and
depressive symptoms in Chinese childbearing women.
Design
A pretestposttest, control group quasi-experimental design with repeated
measures was used.
Setting
The study was conducted in two regional public hospitals in Hong Kong that
provide routine childbirth education programs with similar content and
structure. One hospital was being randomly selected as the experimental
hospital.
Participants
A convenience sample of 184 Chinese pregnant women attending the childbirth
education was recruited between October 2005 and April 2007. Inclusion
criteria were primiparous with singleton and uneventful pregnancy, at
gestation between 12 and 35 weeks, and did not have a past or familial
psychiatric illness.
Methods
The intervention was a childbirth psychoeducation program that was
incorporated into the routine childbirth education in the experimental
hospital. The experimental group (n = 92) received the childbirth
psychoeducation program and the routine childbirth education. The
comparison group (n = 92) received the routine childbirth
education alone in the comparison hospital. Outcomes were measured by the
Self-Control Schedule, Parenting Sense of Competence ScaleEfficacy
subscale and Edinburgh Postnatal Depression Scale at baseline, immediately
post-intervention, at 6 weeks and 6 months postpartum. Analysis was by
intention to treat.
Results
Women receiving the childbirth psychoeducation program had significant
improvement in learned resourcefulness at 6 weeks postpartum
(p = 0.004) and an overall reduction in depressive symptoms
(p = 0.01) from baseline to 6 months postpartum compared with
those who only received the routine childbirth education after adjusting
for baseline group differences on age and social support. No significant
group difference was found on maternal role competence.
Conclusions
The childbirth psychoeducation program appears to be a very promising
intervention for promoting learned resourcefulness and minimizing the risk
of perinatal depression in first-time Chinese childbearing women. Future
empirical work is required to determine the effectiveness of extending the
childbirth psychoeducation program into the early postpartum for the
promotion of maternal role competence in Chinese childbearing women.
Keywords: Childbirth psychoeducation program; Learned resourcefulness;
Maternal role competence; Perinatal depression
Andrea Gonzalez, Jennifer M. Jenkins, Meir Steiner, Alison S. Fleming,

Maternal Early Life Experiences and Parenting: The Mediating Role of
Cortisol and Executive Function, Journal of the American Academy of Child
& Adolescent Psychiatry, Volume 51, Issue 7, July 2012, Pages 673-682,
ISSN 0890-8567, 10.1016/j.jaac.2012.04.003.
Abstract: Objective
Research suggests that early life adversity may affect subsequent
parenting. Animal studies investigating mechanisms of transmission have
focused on biological factors; whereas research in humans has emphasized
cognitive and psychosocial factors. We hypothesized that neuropsychological
and physiological factors would act as mediators between maternal
retrospective reports of early life experiences (ELE) and current
parenting.
Method
We recruited a community sample of 89 mothers and their infants (26 months
of age). Maternal ELE consisted of self-reports of consistency of care and
childhood maltreatment. Diurnal salivary cortisol samples were collected as
the measure of hypothalamic-pituitary-adrenal (HPA) function. Executive
function measures included attentional set-shifting and spatial working
memory. Maternal sensitivity was assessed through videotapes of mothers
interacting with their infants.
Results
A series of path analyses indicated that maternal ELE was indirectly
related to maternal sensitivity via two pathways: one through HPA function,
and the other through HPA function and spatial working memory. There was no
direct path between maternal ELE and parenting.
Conclusion
These findings provide support for the notion that mediators linking early
life experiences to parenting in humans may be similar to physiological
mechanisms found in animal models. As maternal care is associated with
numerous infant outcomes, our findings may have broad relevance to
understanding the risk associated with parenting and adverse outcomes in
infants. A greater understanding of mechanism is important to informing
interventions targeted at disrupting maladaptive trajectories of parenting.
Keywords: early life experiences; parenting; diurnal cortisol; executive
function
William Coleman, Family-focused pediatrics: A primary care family systems

approach to psychosocial problems, Current Problems in Pediatric and
Adolescent Health Care, Volume 32, Issue 8, September 2002, Pages 260-305,
ISSN 1538-5442, 10.1067/mps.2002.125468.
Abstract: Summary
Every child comes with a familythe single greatest, most enduring
influence on a child. Forces within the familytheir socioeconomic status,
parental medical and mental health, parenting practices, nature of the
spousal/partner relationship, behavior, cultural beliefs, and communication
stylepowerfully affect children's physical and mental health, self-image,
behavior, educational attainment, and overall well-being. It follows
logically that the family is the domain of the pediatrician and other
primary providers.
Pediatricians are trained with the biomedical model, but they increasingly
encounter problems for which they should consider incorporating a
biopsychosocial-family systems-model: (1) psychosocial problems that prove
resistant to traditional child-centered, or symptom-centered interventions,
(2) problems that are affected by and/or impact the family context, and (3)
families who actively seek help for behavioral and interactive-emotional
problems.
This article has described (1) the family systems model and techniques
(with an illustrative case study of a common pediatric problem); (2) the
rationale for adopting (and adapting) this model to better address
psychosocial problems that are increasing in America; (3) the unique
qualifications and position of primary care pediatricians in the health
care system to address these problems; (4) the impact of family
relationships and other family-social factors on children's behavior,
development, and emotions; and finally, (5) a variety of clinical
strategies and interviewing techniques for pediatricians (and other primary
care providers) who want to enhance their skills in working with children
and adolescents within the context of their families. This article
concludes with recommendations (from the AAP Task Force on the Family) for
future pediatric training, education, and policymaking.
The family is the pediatrician's greatest resource, and the family is the
best expert on their children. Using an admixture of the family's strengths
and values and the pediatrician's knowledge, skills, and guidance,
pediatricians and families can coconstruct solutions to ensure the best
outcome for children and their families.98,204
Vivienne Jung, Robert Short, Nicole Letourneau, Debra Andrews,

Interventions with depressed mothers and their infants: Modifying
interactive behaviours, Journal of Affective Disorders, Volume 98, Issue 3,
March 2007, Pages 199-205, ISSN 0165-0327, 10.1016/j.jad.2006.07.014.
Postpartum depression (PPD) has a prevalence ranging from 3% to 30% and is
associated with serious infant growth and developmental problems.
Interventions directed at improving maternal mood have been unsuccessful in
producing changes in observed face-to-face interactions between mother and
infant. The Keys to Caregiving (KTC) is an intervention program that helps
parents to understand and respond to infant behaviours, with a goal of
increasing positive affective expressions in infants. In this pilot study,
KTC was used with mothers suffering from mild to moderate PPD and their
infants.
Methods
PPD was confirmed by scores on the Edinburgh Postnatal Depression Scale and
the Beck Depression Inventory. Eleven dyads completed the study. KTC was
carried out in 5 weekly group sessions, beginning at infant age of
3 months. Dyads were videotaped prior to and after KTC, using the Face-to-
Face Still-Face paradigm, which assesses infants' responses during normal
play and the effects of the Still-Face perturbation. The tapes were scored
for infant facial emotion expressions.
Results
After intervention, infants displayed a marked increase in Interest and Joy
when interacting face-to-face with their mothers, even though mothers'
depression ratings did not change.
Limitations
This pilot study is limited by lack of control dyads, however, it provides
the foundation necessary for a full trial.
Conclusions
This study suggests that intervention that focuses on what mothers do with
their infants instead of how they feel can be effective in increasing
infants' positive responsiveness and improving infant outcomes. Such
interventions can be an essential component of treatment when mothers
present with postpartum depression.
Keywords: Postpartum depression; Motherinfant intervention; Still-Face
perturbation; Infant facial emotion
P.S. Chandra, V.N.G.P. Raghunandan, V.A.S. Krishna, Women's Mental Health,

In: Editor-in-Chief: Kris Heggenhougen, Editor(s)-in-Chief, International
Encyclopedia of Public Health, Academic Press, Oxford, 2008, Pages 608-617,
ISBN 9780123739605, 10.1016/B978-012373960-5.00044-7.
(http://www.sciencedirect.com/science/article/pii/B9780123739605000447)
Abstract: Women's mental health is determined by a complex interplay of
several biological, social, and cultural factors. Women are more prone to
several mental health problems because of their lower status in society and
the impact of stressors that are often gandered, including poverty,
violence, and poor physical health. Depression, somatization, posttraumatic
stress disorders, and eating disorders are much more common in women than
in men. Conditions such as schizophrenia, anxiety disorders, and substance
use disorders, though not more common in women, have specific clinical and
long-term implications among women. Sexual trauma and intimate partner
violence are other important determinants of mental health problems in
women. Pregnancy and the postpartum period may also be associated with
mental health problems due to a combination of hormonal, biological, and
psychosocial vulnerability. Postpartum depression has been identified as a
significant cause of morbidity the world over. Reproductive and sexual
health and disease also have associations with help-seeking for both
physical and unexplained somatic symptoms. The article discusses each of
these issues and also reflects on interventions and health policies that
would have a positive impact in improving mental health of women the world
over.
Keywords: Interventions; Mental health; Postpartum depression; Violence;
Women
Sue Kruske, Lesley Barclay, Effect of shifting policies on traditional

birth attendant training, Journal of Midwifery & Women's Health, Volume
49, Issue 4, JulyAugust 2004, Pages 306-311, ISSN 1526-9523,
10.1016/j.jmwh.2004.01.005.
Abstract: Traditional birth attendant (TBA) training commenced in many
places in the non-Western world in the 1970s, supported by the World Health
Organization and other funding bodies. By 1997, senior policy makers
decided to refocus priorities on the provision of skilled attendants to
assist birthing women. The definition of skilled attendants excluded TBAs
and resulted in the subsequent withdrawal of funding for TBA training
globally. A review of the health and sociological literature and
international policy documents that address TBA training revealed how
international policy and professional orientation are reflected in
education programs designed for the TBA. Policy makers risk ignoring the
important cultural and social roles TBAs fulfill in their local communities
and fail to recognize the barriers to the provision of skilled care. The
provision of skilled attendants for all birthing women cannot occur in
isolation from TBAs who in themselves are also highly skilled. This article
argues a legitimacy of alternative worldviews and acknowledges the
contribution TBAs make to childbearing women across the world.
Keywords: traditional birth attendants; skilled attendants; maternal
mortality; midwives
ALICE S. CARTER, F. ELIZABETH GARRITY-ROKOUS, RACHEL CHAZAN-COHEN,

CHRISTINA LITTLE, MARGARET J. BRIGGS-GOWAN, Maternal Depression and
Comorbidity: Predicting Early Parenting, Attachment Security, and Toddler
Social-Emotional Problems and Competencies, Journal of the American Academy
of Child & Adolescent Psychiatry, Volume 40, Issue 1, January 2001,
Pages 18-26, ISSN 0890-8567, 10.1097/00004583-200101000-00012.
Abstract: ABSTRACTObjective
To examine relations between maternal depression (in pure and comorbid
forms) and motherinfant interactions, infant attachment, and toddler
social-emotional problems and competencies. A second objective was to
explore sex differences.
Method
Sixty-nine motherinfant dyads were followed from pregnancy to 30 months
postpartum. Depression was measured at multiple times with self-report and
interview assessments. Play was assessed at 4 months and attachment status
at 14 months postpartum. At 30 months, mothers completed the Child Behavior
Checklist and Infant-Toddler Social and Emotional Assessment.
Results
Lifetime maternal depression predicted less optimal motherinfant
interactions and insecure infant attachment. However, this depression
effect was accounted for by mothers with comorbid diagnoses, who had less
optimal interactions, and infants with higher rates of insecurity than
either mothers with depression only or mothers with no psychopathology.
Prenatal and postpartum depressive symptoms were associated with problem
behaviors and lower competencies for boys. In contrast, quality of early
interactions predicted problem behaviors in girls.
Conclusions
It is important to examine the context of maternal depression with respect
to additional psychopathology and environmental risks. Maternal depression
in the presence of other psychopathology confers risk to the motherchild
dyad. Consistent with previous work, risk pathways appear to differ for
boys and girls. Early identification and prevention efforts are warranted.
Keywords: maternal depression; infancy; attachment; problem behaviors;
competencies
Goldy C. George, Tracey J. Milani, Henry Hanss-Nuss, Jeanne H. Freeland-

Graves, Compliance with Dietary Guidelines and Relationship to Psychosocial
Factors in Low-Income Women in Late Postpartum, Journal of the American
Dietetic Association, Volume 105, Issue 6, June 2005, Pages 916-926, ISSN
0002-8223, 10.1016/j.jada.2005.03.009.
The goals were to evaluate compliance with the Dietary Guidelines among
low-income women during late postpartum and to examine the relationship
between psychosocial variables and dietary compliance.
Subjects/setting
Participants were 146 triethnic, low-income women who were recruited 0 to 1
days after childbirth and who visited a clinic site at 1 year postpartum.
Design
At 1 year postpartum, multiple psychosocial characteristics were measured,
and food choices and nutrient intakes were assessed via a validated food
frequency questionnaire. Dietary guidelines index scores and measures of
adherence to dietary recommendations were computed.
Statistical analyses performed
Descriptive statistics, analysis of variance with post-hoc Scheffe tests,
2 with follow-up tests of independent proportions, and Pearson correlation
coefficients were utilized.
Results
For dietary compliance, 60% had adequate intakes of meat, but less than 30%
met recommendations for grains, vegetables, fruits, dairy foods, total fat,
and added sugar. Healthful weights (body mass index <25) were observed
in 37% of women. Those in the highest tertile of dietary compliance had a
more positive body image than those in the lowest tertile, and less neglect
of self-care, weight-related distress, stress, depressive symptoms, and
perceived barriers to weight loss (P<.05). Dietary compliance and
psychosocial scale scores did not vary by ethnicity.
Conclusions
Adherence to dietary guidelines was limited in the low-income, postpartum
women. Psychosocial variables, such as neglect of self-care, weight-related
distress, negative body image, stress, and depressive symptoms were
associated with less healthful diets and lifestyle in late postpartum.
Programs that target diet-related behavior change in low-income women might
be improved by inclusion of psychosocial assessment and counseling
components.
Ruben Barakat, Mireia Pelaez, Rocio Montejo, Maria Luaces, Maria

Zakynthinaki, Exercise during pregnancy improves maternal health
perception: a randomized controlled trial, American Journal of Obstetrics
and Gynecology, Volume 204, Issue 5, May 2011, Pages 402.e1-402.e7, ISSN
0002-9378, 10.1016/j.ajog.2011.01.043.
Abstract: Objective
We have studied the effect of moderate physical activity that is performed
by healthy women during their entire pregnancy on their perception of
health status.
Study Design
Eighty sedentary women were assigned randomly to either an exercise group
(n = 40) or a control group (n = 40). Maternal perception of health status
and several pregnancy outcomes were recorded.
Results
Significant differences (P = .03) were found between study groups in the
percentage of women who perceived their health status as very good; the
values that corresponded to the exercise group (n = 18; 54.5%) were better
than those of the control group (n = 9; 27.3%). In addition, the women of
the exercise group gained less weight (11,885 3146 g) than those of the
control group (13,903 2113; P = .03).
Conclusion
A moderate physical activity program that is performed over the first,
second, and third trimester of pregnancy improves the maternal perception
of health status.
Keywords: exercise; pregnancy; maternal health; weight gain
Nikolaos Vrachnis, Stamatina Iliodromiti, Evi Samoli, Zoe Iliodromiti,
Spyridon Dendrinos, Georgios Creatsas, Maternal mortality in Greece, 1996
2006, International Journal of Gynecology & Obstetrics, Volume 115,
Issue 1, October 2011, Pages 16-19, ISSN 0020-7292,
10.1016/j.ijgo.2011.04.014.
Abstract: Objective
To present retrospective data for maternal deaths in Greece from 1996 to
2006.
Methods
Demographic information and information on the causes of death was provided
by the Hellenic Statistical Authority. Maternal deaths were assessed by
cause of death, maternal age, and place of residence. The maternal
mortality ratio (MMR) was estimated and expressed as the number of deaths
per 100 000 live births.
Results
From 1996 to 2006, 29 deaths were attributed to pregnancy and childbirth,
yielding a total MMR of 2.63. The leading cause of direct deaths was
hemorrhage and that of indirect deaths was cardiac disease. There was a
borderline significant decline in the MMR during the study period. The MMR
was significantly higher at the extremes of the reproductive age range.
Conclusion
Maternal mortality in Greece is low; however, no formal data have been
published since 1996. Knowledge of the causes of maternal death can lead to
the prevention of maternal deaths and safer motherhood.
Keywords: Cardiac disease; Embolism; Greece; Maternal death; Postpartum
hemorrhage
J. Campion, K. Bhui, D. Bhugra, European Psychiatric Association (EPA)

guidance on prevention of mental disorders, European Psychiatry, Volume 27,
Issue 2, February 2012, Pages 68-80, ISSN 0924-9338,
10.1016/j.eurpsy.2011.10.004.
Abstract: There is considerable evidence that various psychiatric
conditions can be prevented through the implementation of effective
evidence-based interventions. Since a large proportion of lifetime mental
illness starts before adulthood, such interventions are particularly
important during childhood and adolescence. Prevention is important for the
sustainable reduction of the burden of mental disorder since once it has
arisen, treatment can only reduce a relatively small proportion of such
burden. The challenge for clinicians is to incorporate such interventions
into non-clinical and clinical practice as well as engaging with a range of
other service providers including public health. Similar strategies can be
employed in both the European and global contexts. Promotion of mental
well-being can prevent mental disorder but is also important in the
recovery from mental disorder. This guidance should be read in conjunction
with the EPA Guidance on Mental Health Promotion. This guidance draws on
preparatory work for the development of England policy on prevention of
mental disorder which used a wide range of sources.
Keywords: Prevention; Health promotion; Mental health; Mental illness
Michelle Dynes, Aminur Rahman, Diana Beck, Allisyn Moran, Anisur Rahman,
Jesmin Pervin, Mohammad Yunus, Md. Harunor Rashid, Tamanna Gazi, Kamal
Kanti Biswas, Sandra Buffington, Joan M. Patterson, Lynn Sibley, Home-based
life saving skills in Matlab, Bangladesh: a process evaluation of a
community-based maternal child health programme, Midwifery, Volume 27,
10.1016/j.midw.2009.07.009.
Abstract: Objective
to conduct and describe results from a process evaluation of home-based
life saving skills (HBLSS) one year post-implementation.
Design
a non-experimental, descriptive design was utilised employing both
qualitative and quantitative techniques for data collection including: (1)
key informant interviews, (2) group discussions, (3) performance testing,
and (4) review of programme data.
Setting
rural Matlab, Bangladesh in the sub-district of Chandpur.
Participants
41 community health research workers (CHRW), five pregnant women, 14
support persons and four programme co-ordinators.
Intervention
HBLSS is a family-centred approach to improving recognition of and referral
for potentially life-threatening maternal and newborn complications. In
June 2007, four HBLSS meetings were implemented in Matlab by 41 CHRW with
all pregnant women in the study area.
Measurements
(1) knowledge retention among CHRW, (2) programme coverage, and (3)
strengths and challenges in HBLSS implementation.
Findings
results revealed rapid integration of the programme into the Matlab
community with nearly 4500 HBLSS contacts with 2409 pregnant women between
15 June 2007 and 31 March 2008. Over 51% of pregnant women attended all
four HBLSS meetings. Knowledge testing of CHRW showed strong retention with
an increase in mean scores between immediate post-training and one-year
post-training (from 78.7% to 92.7% and from 77.8% to 97.7% for two
different HBLSS modules). Strengths of the HBLSS programme include high
satisfaction among pregnant women, dedication of CHRW to the community, and
strong organisation and supervision by programme staff. Challenges include
lack of involvement of men, loss of two master trainers, and limited access
to comprehensive emergency obstetric care at some referral sites.
Key conclusions
the HBLSS programme was successfully implemented as a result of the high
level of support and supervision by the maternal, newborn and child health
staff at ICDDR,B. This evaluation highlights the value of community health
workers in the fight against maternal and newborn mortality. Findings
emphasise the strength of the HBLSS training approach in transferring
knowledge from trainer to HBLSS guide.
Keywords: Pregnancy; Midwifery; Maternal; Newborn survival; HBLSS;
Community-based evaluation; Home-based life saving skills; Training of
trainers
, Position of the American Dietetic Association: Promoting and Supporting

Breastfeeding, Journal of the American Dietetic Association, Volume 109,
Issue 11, November 2009, Pages 1926-1942, ISSN 0002-8223,
10.1016/j.jada.2009.09.018.
Abstract: It is the position of the American Dietetic Association that
exclusive breastfeeding provides optimal nutrition and health protection
for the first 6 months of life and breastfeeding with complementary foods
from 6 months until at least 12 months of age is the ideal feeding pattern
for infants. Breastfeeding is an important public health strategy for
improving infant and child morbidity and mortality, improving maternal
morbidity, and helping to control health care costs. Breastfeeding is
associated with a reduced risk of otitis media, gastroenteritis,
respiratory illness, sudden infant death syndrome, necrotizing
enterocolitis, obesity, and hypertension. Breastfeeding is also associated
with improved maternal outcomes, including a reduced risk of breast and
ovarian cancer, type 2 diabetes, and postpartum depression. These
reductions in acute and chronic illness help to decrease health care-
related expenses and productive time lost from work. Overall breastfeeding
rates are increasing, yet disparities persist based on socioeconomic
status, maternal age, country of origin, and geographic location. Factors
such as hospital practices, knowledge, beliefs, and attitudes of mothers
and their families, and access to breastfeeding support can influence
initiation, duration, and exclusivity of breastfeeding. As experts in food
and nutrition throughout the life cycle, it is the responsibility of
registered dietitians and dietetic technicians, registered, to promote and
support breastfeeding for its short-term and long-term health benefits for
both mothers and infants.
Andr Lalonde, Prevention and treatment of postpartum hemorrhage in low-

resource settings, International Journal of Gynecology & Obstetrics,
Volume 117, Issue 2, May 2012, Pages 108-118, ISSN 0020-7292,
10.1016/j.ijgo.2012.03.001.
Joan L. Bottorff, John Oliffe, Cecilia Kalaw, Joanne Carey, Lawrence Mroz,
Men's constructions of smoking in the context of women's tobacco reduction
during pregnancy and postpartum, Social Science & Medicine, Volume 62,
Issue 12, June 2006, Pages 3096-3108, ISSN 0277-9536,
10.1016/j.socscimed.2005.11.058.
Abstract: Men's smoking is largely under-examined despite research that has
consistently linked partner smoking to pregnant women's smoking and smoking
relapse in the postpartum. An on-going qualitative study involving 31
couples in Canada exploring the influence of couple interactions on women's
tobacco reduction provided the opportunity to examine men's smoking in the
context of women's tobacco reduction or cessation during pregnancy and
postpartum. Individual open-ended interviews with 20 men who smoked were
conducted at 06 weeks following the birth of their infants and again at
1624 weeks postpartum. Constant comparative methods were used along with
social constructivist perspectives of fatherhood and gender to guide data
analysis and enhance theoretical sensitivity. Four themes emerged in men's
accounts of their tobacco use: (1) expressing masculinity through smoking,
(2) reconciling smoking as a family man, (3) losing the freedom to smoke,
and (4) resisting a smoke-less life. Men's reliance on and commitment to
dominant ideals of masculinity seemed to preclude them from viewing their
partner's tobacco reduction or cessation for pregnancy as an opportunity
for cessation. Expectant and new fathers who smoke, however, may be
optimally targeted for cessation interventions because it is a time when
men experience discomfort with their smoking and when discontinuities in
everyday life associated with the transition to fatherhood and presence of
a new baby provide opportunities for establishing new routines.
Implications for gender-sensitive smoking cessation interventions are
discussed.
Keywords: Fathers; Masculinity; Smoking; Pregnancy; Infants; Tobacco
reduction; Canada
Lucia DAmbruoso, Peter Byass, Siti Nurul Qomariyah, Moctar Oudraogo, A

lost cause? Extending verbal autopsy to investigate biomedical and socio-
cultural causes of maternal death in Burkina Faso and Indonesia, Social
Science & Medicine, Volume 71, Issue 10, November 2010, Pages 1728-
1738, ISSN 0277-9536, 10.1016/j.socscimed.2010.05.023.
Abstract: Maternal mortality in developing countries is characterised by
disadvantage and exclusion. Women who die whilst pregnant are typically
poor and live in low-income and rural settings where access to quality care
is constrained and where deaths, within and outside hospitals, often go
unrecorded and unexamined. Verbal autopsy (VA) is an established method of
determining cause(s) of death for people who die outside health facilities
or without proper registration. This study extended VA to investigate
socio-cultural factors relevant to outcomes. Interviews were conducted with
relatives of 104 women who died during pregnancy, childbirth or postpartum
in two rural districts in Indonesia and for 70 women in a rural district in
Burkina Faso. Information was collected on medical signs and symptoms of
the women prior to death and an extended section collected accounts of care
pathways and opinions on preventability and cause of death. Illustrative
quantitative and qualitative analyses were performed and the implications
for health surveillance and planning were considered. The cause of death
profiles were similar in both settings with infectious diseases,
haemorrhage and malaria accounting for half the deaths. In both settings,
delays in seeking, reaching and receiving care were reported by more than
two-thirds of respondents. Relatives also provided information on their
experiences of the emergencies revealing culturally-derived systems of
explanation, causation and behaviour. Comparison of the qualitative and
quantitative results suggested that the quantified delays may have been
underestimated. The analysis suggests that broader empirical frameworks can
inform more complete health planning by situating medical conditions within
the socio-economic and cultural landscapes in which healthcare is situated
and sought. Utilising local knowledge, extended VA has potential to inform
the relative prioritisation of interventions that improve technical aspects
of life-saving services with those that address the conditions that
underlie health, for those whom services typically fail to reach.
Keywords: Maternal mortality; Verbal autopsy; Health planning; Burkina
Faso; Indonesia; Interdisciplinarity
Lynn Sibley, Theresa Ann Sipe, Marge Koblinsky, Does traditional birth
attendant training improve referral of women with obstetric complications:
a review of the evidence, Social Science & Medicine, Volume 59, Issue
8, October 2004, Pages 1757-1768, ISSN 0277-9536,
10.1016/j.socscimed.2004.02.009.
Abstract: This narrative and meta-analytic review of the effectiveness of
traditional birth attendant (TBA) training to improve access to skilled
birth attendance for obstetric emergencies produced mixed results. Among 16
studies that fit the inclusion criteria, there is a medium, positive, non-
significant association between training and TBA knowledge of risk factors
and conditions requiring referral; and small, positive, significant
associations between TBA referral behavior and maternal service use. These
results cannot be causally attributed to TBA training because of the
overall quality of studies; moreover, in several studies TBA training was a
component of integrated intervention packages.
The effort and expense of more rigorous research focusing on TBA training
to improve access to emergency obstetric care are difficult to justify. The
referral process is complex; the real effects of TBA training on TBA and
maternal behavior are likely to be small; and while the proportion of TBA-
attended births worldwide varies, it is, on average, quite low. The
behavioral determinants and logistical barriers to care seeking for
emergency obstetric care are generally well known. We suggest a more
promising research agenda would reposition the questions surrounding
referral into a broader ecological perspective.
Keywords: Traditional birth attendant training; Obstetric complications;
Emergency obstetric care; Safe motherhood; Referral system; Meta-analysis
F. Richard, C. Oudraogo, V. De Brouwere, Quality cesarean delivery in

Ouagadougou, Burkina Faso: A comprehensive approach, International Journal
of Gynecology & Obstetrics, Volume 103, Issue 3, December 2008, Pages
283-290, ISSN 0020-7292, 10.1016/j.ijgo.2008.08.008.
Abstract: Objective
To assess the effects of a comprehensive intervention (staff training,
equipment, internal clinical audits, cost sharing system, patients
providers meetings) in improving cesarean delivery access and quality in an
urban district of Burkina Faso.
Methods
We conducted a before-after study in the health district sector 30 in
Ouagadougou between 2003 and 2006. We measured cesarean delivery quality
(accessibility, diagnosis, procedure, postoperative follow-up) and maternal
and neonatal health in 1371 sections.
Results
The number of cesarean deliveries performed increased each year, from 42 in
2003 to 630 in 2006. This increase happened without increase in maternal
and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006).
The cesarean delivery rate for women of the district increased from 1.9% to
3.3% of expected births between 2003 and 2005.
Conclusion
To improve access to quality cesarean delivery, we have shown that it was
necessary to have a systemic approach combining technical, operational,
sociocultural, and political factors.
Keywords: Cesarean delivery;; Quality of care;; Standards;; Obstetrics;;
Burkina Faso
L. Birch, N. Jones, P.M. Doyle, P. Green, A. McLaughlin, C. Champney, D.

Williams, K. Gibbon, K. Taylor, Obstetric skills drills: Evaluation of
teaching methods, Nurse Education Today, Volume 27, Issue 8, November 2007,
Pages 915-922, ISSN 0260-6917, 10.1016/j.nedt.2007.01.006.
Abstract: SummaryObjective
To determine the most effective method of delivering training to staff on
the management of an obstetric emergency.
Subjects
The research was conducted in a District General Hospital in the UK,
delivering approximately 3500 women per year. Thirty-six staff, comprising
of junior and senior medical and midwifery staff were included as research
subjects. Each of the staff members were put into one of six multi-
professional teams. Effectively, this gave six teams, each comprising of
six members.
Method
Three teaching methods were employed. Lecture based teaching (LBT),
simulation based teaching (SBT) or a combination of these two (LAS). Each
team of staff were randomly allocated to undertake a full day of training
in the management of Post Partum Haemorrhage utilising one of these three
teaching methods. Team knowledge and performance were assessed pre-
training, post training and at three months later. In addition to this
assessment of knowledge and performance, qualitative semi-structured
interviews were carried out with 50% of the original cohort one year after
the training, to explore anxiety, confidence, communication, knowledge
retention, enjoyment and transferable skills.
Results
All teams improved in their performance and knowledge. The teams taught
using simulation only (SBT) were the only group to demonstrate sustained
improvement in clinical management of the case, confidence, communication
skills and knowledge. However, the study did not have enough power to reach
statistical significance. The SBT group reported transferable skills and
less anxiety in subsequent emergencies. SBT and LAS reported improved
multidisciplinary communication. Although tiring, the SBT was enjoyed the
most.
Conclusion
Obstetrics is a high risk speciality, in which emergencies are to some
extent, inevitable. Training staff to manage these emergencies is a
fundamental principal of risk management. Traditional risk management
strategies based on incident reporting and event analysis are reactive and
not always effective. Simulation based training is an appropriate proactive
approach to reducing errors and risk in obstetrics, improving teamwork and
communication, whilst giving the student a multiplicity of transferable
skills to improve their performance.
Keywords: Postpartum haemorrhage; Skills drills; Emergency training;
Teaching methods; Teamwork; Simulation based training
Pulani Tlebere, Debra Jackson, Marian Loveday, Lyness Matizirofa,

Nomafrench Mbombo, Tanya Doherty, Alyssa Wigton, Latasha Treger, Mickey
Chopra, Community-Based Situation Analysis of Maternal and Neonatal Care in
South Africa to Explore Factors that Impact Utilization of Maternal Health
Services, Journal of Midwifery & Women's Health, Volume 52, Issue 4,
JulyAugust 2007, Pages 342-350, ISSN 1526-9523,
10.1016/j.jmwh.2007.03.016.
Abstract: This community situational analysis determined factors impacting
the utilization of maternal health services in South Africa. Quantitative
and qualitative research methods were used, including semistructured
household interviews, case studies of women with no antenatal care and/or
home birth, and verbal/social autopsies of maternal and infant deaths,
conducted in three diverse sites across the country. Data analysis used
quantitative statistics for the semistructured interviews and a qualitative
thematic content approach for the case studies and verbal/social autopsies.
Each component was analyzed separately and then triangulated. The following
themes emerged: 1) transport and distance to care were the biggest
problems, particularly in rural areas; 2) providers communication with
families was very poor; 3) health-seeking behavior was better than
anticipated; 4) treatment by health providers and quality of care showed
mixed results; 5) HIV/AIDS is a major issue; however, basic maternity and
neonatal service quality cannot be overlooked; and 6) families and
communities are an untapped resource for improving maternal and neonatal
health. Implications for maternal and infant health care in developing
countries are discussed, with a particular focus on barriers to utilization
and involvement of communities and families in maternity care.
Keywords: HIV/AIDS; infant mortality; maternity care; maternal mortality;
neonatal follow-up; postpartum care; situation analysis; utilization of
health services; verbal autopsy
Kimberly D. Gregory, Clark T. Johnson, Timothy R.B. Johnson, Stephen S.

Entman, The content of prenatal care: Update 2005, Women's Health Issues,
Volume 16, Issue 4, JulyAugust 2006, Pages 198-215, ISSN 1049-3867,
10.1016/j.whi.2006.05.001.
The Content of Prenatal Care report of the US Preventative Health Service
(USPHS) Expert Panel established an important benchmark when published in
1989, but has not been significantly updated since that time.
Methods
The literature since 1989 is reviewed to assess which recommendations have
been validated and/or implemented. Additionally, new findings that support
the recommendations put forth or expand the scope of prenatal care outlined
in the 1989 report are examined and discussed.
Results
The USPHS recommendation of a reduced prenatal visit schedule has support,
and new content for the preconception visit has been identified, although
this preconception visit has not been validated or widely implemented.
Conclusions
We identified new opportunities and initiatives for the content of prenatal
care, particularly improvement in the electronic medical record, attention
to multidisciplinary approaches to patient education and improved patient
literacy, and an extended maternal life span approach, including
postgestation visits.
Pamela Andreatta, Domatilla Debpuur, Abraham Danquah, Joseph Perosky, Using

cell phones to collect postpartum hemorrhage outcome data in rural Ghana,
May 2011, Pages 148-151, ISSN 0020-7292, 10.1016/j.ijgo.2010.11.020.
Abstract: Objective
To evaluate the use of cell phones by professional and traditional birth
attendants in rural Africa for reporting postpartum hemorrhage (PPH) data.
Methods
Ten birth attendants from the remote Sene District of Ghana participated in
the study. Subjects were trained to send Short Message Service text
messages from cell phones using a simple numeric protocol to report data
regarding PPH: maternal age; PPH; use of bimanual uterine compression;
maternal and neonatal mortality; and prenatal care. Participants sent texts
to a pre-programmed number to report data for all births they attended over
a 90-day period.
Results
In total, 425 births and 13 (3.1%) cases of PPH were reported during the
90-day period after training. All attendants followed the reporting
protocol correctly, although with uncertain data integrity.
Conclusion
The results indicate that it is possible to train professional and
traditional birth attendants to use cell phones to report health-related
outcome data via a specified protocol. Reporting from rural-based providers
may present a more accurate picture of what occurs in remote communities
because it happens in real time. These findings could be exportable to
other program evaluation or population-monitoring applications (healthcare
and other) where rural outcome tracking is necessary.
Keywords: Cell phones; Field research; Health services networks;
Information and communication technologies; M-health; Rural health
Nicola A Conners, Patti Bokony, Leanne Whiteside-Mansell, Robert H Bradley,

Jeffrey Liu, Addressing the treatment needs of children affected by
maternal addiction: challenges and solutions, Evaluation and Program
Planning, Volume 27, Issue 2, May 2004, Pages 241-247, ISSN 0149-7189,
10.1016/j.evalprogplan.2004.01.014.
Abstract: This paper examines treatment needs of the children of women
served in the Center for Substance Abuse Treatment's Residential Women and
Children and Pregnant and Postpartum Women (RWC/PPW) program. It integrates
statistical information from CSAT's cross-site evaluation of the program
and clinical insights obtained from one RWC treatment site, the Arkansas
CARES project. The cross-site data provide broad-based information about
the extent to which clients' children experience various risk factors,
while the project data provide concrete information about major
administrative and clinical challenges to the provision of needed child
services in a parent-focused residential treatment setting. Data from both
perspectives suggest that many children admitted into residential treatment
with their mothers need an array of long-term supportive services,
requiring a new focus and a commitment of resources from substance abuse
treatment providers.
Keywords: Residential treatment; Children; Substance abuse; Comprehensive
care; Risk factors
Kim Yiong Wee, Helen Skouteris, Ciaran Pier, Ben Richardson, Jeannette
Milgrom, Correlates of ante- and postnatal depression in fathers: A
systematic review, Journal of Affective Disorders, Volume 130, Issue 3, May
2011, Pages 358-377, ISSN 0165-0327, 10.1016/j.jad.2010.06.019.
Contemporary research findings suggest that depression during the ante- and
postnatal periods is a significant problem not only for women but also for
many men. This paper provides a conceptual and methodological review of the
literature on cross-sectional and prospective correlates of depressive
symptoms in men during both pregnancy and the postpartum period.
Methods
The search, via several electronic databases, was limited to English papers
published between January 1996 and August 2009, and identified 30 relevant
articles.
Results
The most common correlate of paternal depressive symptoms pre- and post
birth was having a partner with elevated depressive symptoms or depression;
poor relationship satisfaction was also frequently associated with elevated
depressive symptoms or depression in men.
Limitations
There were significant methodological limitations of existing studies,
including small sample sizes; the use of cross-sectional designs; varied
measures of depression; focus on depression in the postpartum only; and in
the few longitudinal gestational studies, the inclusion of only one
assessment point. The limitations of the current systematic review include
the inclusion of only papers written in English and potential publication
bias, where studies with null findings are less likely to be published.
Conclusion
The scientific study of predictors of men's depressive symptoms pre and
post birth remains in its infancy. Given the implications of clinical
depression in men both during the gestational and postpartum periods,
further systematic investigation of direct and indirect predictors of
elevated depressive symptoms in men during this time is warranted.
Keywords: Father; Men; Antenatal depression; Postnatal depression;
Pregnancy; Postpartum
Carol Henshaw, Psychological and social approaches to treatment,

Psychiatry, Volume 8, Issue 1, January 2009, Pages 28-32, ISSN 1476-1793,
10.1016/j.mppsy.2008.10.011.
Abstract: Psychological and social interventions can be used singly or as
adjuncts to drug treatment in a variety of settings. Health visitor
counselling is effective; its acceptability depends on the quality of the
relationship with the health visitor. Individual psychotherapies such as
cognitive behavioural therapy and interpersonal psychotherapy are effective
and, like some other interventions, can be given in a group setting. They
can be adapted to treat women with other disorders, for instance anxiety
and obsessivecompulsive disorder, and pregnant women. Interventions may be
delivered in the home or in a day-hospital setting. Mental health services
should relate to maternity care and primary care professionals, and to the
voluntary sector (which provides and meets the needs of both mothers and
fathers), and refer women with severe disorders to specialist perinatal
mental health services. Services should ensure that they meet the needs of
any minority communities in their area, including migrants, asylum seekers,
and refugees.
Keywords: counselling; health visitors; postnatal or postpartum depression;
psychological interventions; psychotherapy; social interventions
Lisa D. Lieberman, Overview of substance abuse prevention and treatment

approaches in urban, multicultural settings: the center for substance abuse
prevention programs for pregnant and postpartum women and their infants,
Women's Health Issues, Volume 8, Issue 4, JulyAugust 1998, Pages 208-217,
ISSN 1049-3867, 10.1016/S1049-3867(98)00010-3.
Samiye Mete, Kerziban Yenal, Hlya Okumu, An Investigation into
Breastfeeding Characteristics of Mothers Attending Childbirth Education
Classes, Asian Nursing Research, Volume 4, Issue 4, December 2010, Pages
216-226, ISSN 1976-1317, 10.1016/S1976-1317(11)60006-6.
Abstract: Purpose
This paper is a report of a study of the effects of breastfeeding education
on the breastfeeding success and breastfeeding characteristics of mothers
in a Turkish context.
Methods
The research was designed as quasi-experimental. The sample consisted of 93
mothers who participated in (n = 46) and did not participate in childbirth
education classes (n= 47). The date was collected between 2005 and 2007.
The childbirth education class comprised 16 hours in total. Two hours of
this class involved breastfeeding education. The course was carried out
with the principles of adult education principles. Data on mothers'
breastfeeding were collected in the sixth week postpartum.
Results
The majority of the mothers (63.4%) were university graduates. No
difference was found between breastfeeding frequency in the control and
experimental groups and starting supplemental food. It was found that 80.4%
of the women in the experimental group breastfed in line with the
techniques. This rate was found to be 48.9% in the control group. It was
documented that the first breastfeeding times were earlier in the
experimental group, their babies slept longer after being fed, their
perceived spouse support was higher, and had even higher perceived
breastfeeding success.
Conclusions
On the basis of the study results it could be argued that attending
childbirth preparation class with the husband has a positive effect over
breastfeeding. Childbirth education classes will greatly contribute to the
health of the society by affecting breastfeeding positively.
Keywords: breastfeeding; childbirth; education; nursing; Turkey
Kristen F. Bean, Differential ratings of and maternal impact on anxiety and

depression among African American children in special education, Children
and Youth Services Review, Available online 2 June 2012, ISSN 0190-7409,
10.1016/j.childyouth.2012.05.024.
Abstract: African American children are overrepresented in special
education based on diagnoses of internalizing behaviors, such as anxiety
and depression. Differential ratings of depression and anxiety between
self-report and children's mothers and teachers have caused skepticism
around the accuracy of teachers' ratings of signs and symptoms of anxiety
and depression among African American children. If African American
children are truly suffering from disproportionate rates of anxiety and
depression, prevention and intervention efforts should be targeted to
improve their mental health. According to the ecological systems theory and
the social cognitive theory, children's mental health development is
impacted by their environments and efficacy beliefs. This study aimed to
see if teachers, mothers, and African American children in special
education rate internalizing behaviors of children differently and to
understand what factors impact these behaviors among African American
children in special education. A secondary data analysis of a sample of 126
African American children in special education found that children's self-
report of internalizing behaviors was significantly higher than mothers'
and teachers' ratings of African American children's internalizing
behaviors. Higher reports of mothers' mastery were associated with fewer
internalizing behaviors of African American children in special education.
In addition, African American girls were more likely to experience anxiety
and depression than boys. There was not a statistically significant
relationship between children's environment, receipt of the NurseFamily
Partnership intervention, and their internalizing behaviors.
Keywords: African American children; Internalizing behavior; Anxiety;
Depression; Special education; Disability
Rebecca Reay, Stephen Matthey, David Ellwood, Maureen Scott, Long-term

outcomes of participants in a perinatal depression early detection program,
Journal of Affective Disorders, Volume 129, Issues 13, March 2011, Pages
94-103, ISSN 0165-0327, 10.1016/j.jad.2010.07.035.
Long-term follow-up studies are required to better understand the extent of
the effectiveness of early detection programs for perinatal depression. We
followed up participants in such a program to investigate the long-term
depression, treatment and relationship outcomes of mothers originally
identified as probably depressed (screened positive).
Methods
At 2 years postpartum all participants who had screened positive
(N = 159) and a random sample of participants who had screened
negative were invited to participate in a mailed survey. Measures
included: current mood; coping; access to treatment; quality of partner
relationship; and motherinfant bonding.
Results
Mothers originally detected as probably depressed (n = 98) fared
significantly worse than screened negative mothers (n = 101)
both in terms of their higher mean depression scores (EPDS:
Ms = 11.0 vs. 6.4) and greater proportions categorised as
probably depressed at 2 years postpartum (40% vs. 11% respectively,
p < .001, phi = .33). Elevated depression symptoms
at 2 years postpartum were associated with poorer partner
relationships and motherinfant bonding. Moreover, there appears to be a
double dose effect for women who screen positive on two occasions. Thirty-
seven percent of depressed mothers did not take up treatment, frequently
citing a preference for using their own resources.
Limitations
Limitations include the use of self-report measures to assess depression
symptoms and motherinfant bonding. Treatment data was collected
retrospectively.
Conclusions
Despite being offered treatment options, a substantial proportion of women
who screened positive had poor long-term mental health and relationship
outcomes. This paper discusses some of the implications for perinatal early
detection and treatment programs.
Keywords: Perinatal; Screening; Postnatal depression; Postpartum; Maternal
bonding; Partner
Jan Brunson, Confronting maternal mortality, controlling birth in Nepal:

The gendered politics of receiving biomedical care at birth, Social Science
& Medicine, Volume 71, Issue 10, November 2010, Pages 1719-1727, ISSN
0277-9536, 10.1016/j.socscimed.2010.06.013.
Abstract: One way of reducing maternal mortality in developing countries is
to ensure that women have a referral system at the local level that
includes access to emergency obstetric care. Using a 13-month ethnographic
study from 2003 to 2005 of womens social positions and maternal health in
a semi-urban community of Hindu-caste women in the Kathmandu Valley, this
paper identifies impediments to receiving obstetric care in a context where
the infrastructure and services are in place. As birth in Nepal
predominantly takes place at home, this paper identifies the following
areas for potential improvement in order to avoid the loss of womens lives
during childbirth: the frequency of giving birth unaided, minimal planning
for birth or obstetric complications, and delayed responses at the
household level to obstetric emergencies. Focusing particularly on the last
item, this study concludes that women do not have the power to demand
biomedical services or emergency care, and men still viewed birth as the
domain of women and remained mostly uninvolved in the process. As the
cultural construction of birth shifts from a natural phenomenon that did
not require human regulation toward one that is located within the domain
of biomedical expertise and control, local acceptance of a biomedical model
does not necessarily lead to the utilization of services if neither women
nor men are in a culturally-defined position to act.
Keywords: Nepal; Gender; Maternal health care; Childbirth loss; Birth;
Obstetric emergencies; Medicalization; Women
Farideh Bastani, Alireza Hidarnia, Anoshirvan Kazemnejad, Maryam Vafaei,

Maryam Kashanian, A Randomized Controlled Trial of the Effects of Applied
Relaxation Training on Reducing Anxiety and Perceived Stress in Pregnant
Women, Journal of Midwifery & Women's Health, Volume 50, Issue 4, July
August 2005, Pages e36-e40, ISSN 1526-9523, 10.1016/j.jmwh.2004.11.008.
Abstract: The purpose of this study was to investigate the effect of
applied relaxation training on reducing anxiety and perceived stress among
pregnant women. A randomized controlled trial with a prospective pretest-
posttest experimental design was used. One hundred ten primigravid women
(mean age = 23.8 years) in their second trimester (mean of gestational age
= 17.8 weeks) were randomly assigned into experimental and control groups.
The experimental group received routine prenatal care with applied
relaxation training, and the control group received only routine prenatal
care. State/trait anxiety was measured with the Spielberger State-Trait
Anxiety Inventory, and perceived stress was measured with the Cohen
Perceived Stress Scale. There were significant reductions in state/trait
anxiety and perceived stress for the experimental group compared with the
control group after the intervention. The findings suggest beneficial
effects of relaxation on reducing anxiety and perceived stress in pregnant
women. Teaching relaxation techniques could serve as a resource for
improving maternal psychological health.
Keywords: anxiety; stress; pregnancy; relaxation
Anna L. Papero, Is early, high-quality daycare an asset for the children of

low-income, depressed mothers?, Developmental Review, Volume 25, Issue 2,
June 2005, Pages 181-211, ISSN 0273-2297, 10.1016/j.dr.2004.10.001.
Abstract: This paper reviews the relations found in the literature among
poverty, maternal depression, early intervention, and child developmental
outcome and a theoretical model is suggested. Motherchild transactional
processes have been found to be impaired under conditions of poverty and
maternal depression, leading to non-optimal outcomes in children. The first
2 years of life are particularly sensitive to deficits in parenting,
suggesting that effective intervention might appropriately target this age
group. High-quality daycare may offer an effective pathway for intervention
with depressed mothers and their children due to the compensatory
caregiving children receive and the opportunity for early identification of
maternal mental health needs. However, most current daycare intervention
programs are designed to begin between 3 or 4 years of age. Further
research that addresses the relative efficacy of interventions dependent on
age of entry is needed to determine whether early daycare is an asset to
families with a depressed caregiver.
J.E. Taylor, Life-saving skills training for midwives: report on the

Ghanaian experience, International Journal of Gynecology & Obstetrics,
Volume 38, Supplement, 1992, Pages S41-S43, ISSN 0020-7292, 10.1016/0020-
7292(92)90029-I.
(http://www.sciencedirect.com/science/article/pii/002072929290029I)
Abstract: The shortage of rural-based physicians in Ghana has led to a
decision to provide short term courses to rural midwives on the treatment
of those obstetric conditions that are the main causes of maternal
mortality. A description of this ongoing training is provided.
Keywords: Midwifery training; Maternal mortality
Cynthia J. Berg, From Identification and Review to ActionMaternal

Mortality Review in the United States, Seminars in Perinatology, Volume 36,
10.1053/j.semperi.2011.09.003.
Abstract: The maternal mortality review process is an ongoing quality
improvement cycle with 5 steps: identification of maternal deaths,
collection of medical and other data on the events surrounding the death,
review and synthesis of the data to identify potentially alterable factors,
the development and implementation of interventions to decrease the risk of
future deaths, and evaluation of the results. The most important step is
utilization of the data to identify and implement evidence-based actions;
without this step, the rest of the work will not have an impact. The review
committee ideally is based in the health department of a state (or large
city) as a core public health function. This provides stability for the
process as well as facilitates implementation of the review committees'
recommendations. The review committee should be multidisciplinary, with its
members being official representatives of their organizations or
departments, again to improve buy-in of the stakeholders.
Keywords: maternal mortality; audit; surveillance
Jerker Liljestrand, Mean Reatanak Sambath, Socio-economic improvements and

health system strengthening of maternity care are contributing to maternal
mortality reduction in Cambodia, Reproductive Health Matters, Volume 20,
Issue 39, June 2012, Pages 62-72, ISSN 0968-8080, 10.1016/S0968-
8080(12)39620-1.
Abstract: Maternal mortality has been falling significantly in Cambodia
since 2005 though it had been stagnant for at least 15 years before that.
This paper analyzes the evolution of some major societal and health system
factors based on recent national and international reports. The maternal
mortality ratio fell from 472 per 100,000 live births in 20002005 to 206
in 20062010. Background factors have included peace and stability,
economic growth and poverty reduction, improved primary education,
especially for girls, improved roads, improved access to information on
health and health services via TV, radio and cellphones, and increased
ability to communicate with and within the health system. Specific health
system improvements include a rapid increase in facility-based births and
skilled birth attendance, notably investment in midwifery training and
numbers of midwives providing antenatal care and deliveries within an
expanding primary health care network, a monetary incentive for facility-
based midwives for every live birth conducted, and an expanding system of
health equity funds, making health care free of cost for poor people.
Several major challenges remain, including post-partum care, family
planning, prevention and treatment of breast and cervical cancer, and
addressing sexual violence against women, which need the same priority
attention as maternity care.
Keywords: maternal mortality; maternity care; midwifery; human resources;
health system strengthening; economic and social development;
communications; Cambodia
Brenda Dobson, Maureen A Murtaugh, Position of the American Dietetic
Association: Breaking the Barriers to Breastfeeding, Journal of the
American Dietetic Association, Volume 101, Issue 10, October 2001, Pages
1213-1220, ISSN 0002-8223, 10.1016/S0002-8223(01)00298-X.
Abstract: It is the position of the American Dietetic Association (ADA)
that broad-based efforts are needed to break the barriers to breastfeeding
initiation and duration. Exclusive breastfeeding for 6 months and
breastfeeding with complementary foods for at least 12 months is the ideal
feeding pattern for infants. Increases in initiation and duration are
needed to realize the health, nutritional, immunological, psychological,
economical, and environmental benefits of breastfeeding. Breastfeeding
initiation rates have increased, but cultural barriers to breastfeeding,
especially against breastfeeding for 6 months and longer, still exist. Gaps
in rates of breastfeeding based on age, race, and socioeco-nomic status
remain. Children benefit from the biologically unique properties of human
milk including protection from illness with resulting economic benefits.
Mother's benefits include reduced rates of premenopausal breast and ovarian
cancers. Appropriate lactation management is a critical component of
successful breastfeeding for healthy women. Lactation support and
management is even more important in women and children with special needs
caused by physical or developmental disability, disease, or limited
resources. Dietetics professionals have a responsibility to support
breastfeeding through appropriate education and training, advocacy, and
legislative action; through collaboration with other professional groups;
and through research to eliminate the barriers to breastfeeding.
Rima Azar, Daniel Paquette, Mark Zoccolillo, Franziska Baltzer, Richard E.

Tremblay, The Association of Major Depression, Conduct Disorder, and
Maternal Overcontrol with a Failure to Show a Cortisol Buffered Response in
4-Month-Old Infants of Teenage Mothers, Biological Psychiatry, Volume 62,
Issue 6, 15 September 2007, Pages 573-579, ISSN 0006-3223,
10.1016/j.biopsych.2006.11.009.
Adolescent pregnancy can be associated with major depression (MD) and
conduct disorder (CD). Some infants of adolescent mothers are prenatally
exposed to these factors, which may result in heightened risk for
perturbations of their stress systems. Between 2 and 4 months, a normal
shift occurs in the adrenocortical system in which we observe a marked
decrease in infant cortisol response when facing mild stressors. This study
aimed to explore whether MD (lifetime, during pregnancy, postpartum), CD,
and maternal overcontrol are associated with increased cortisol reactivity
in 4-month-old infants of teenage mothers.
Methods
Using arm restraint as a stressor, morning salivary cortisol was taken
prestressor and poststressor in 212 infants during a laboratory visit.
Major depression and CD were measured with the computerized National
Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS),
postpartum depressive mood was measured with the Edinburgh Postnatal
Depression Scale, and overcontrol was observed with the CARE-Index.
Results
Independent of the predictors, there was a dampened cortisol response.
Infants of mothers with lifetime MD and of average to highly
overcontrolling mothers showed increased cortisol reactivity. Conduct
disorder and cortisol levels were not associated.
Conclusions
Future studies should detect whether the absence of a dampened cortisol
response in infants whose mothers have lifetime MD or display
overcontrolling parenting is stable over time.
Keywords: Conduct disorder; infant cortisol; major depression; maternal
overcontrol
Donna Karl, Maternal responsiveness of socially high-risk mothers to the

elicitation cues of their 7-month-old infants, Journal of Pediatric
Nursing, Volume 10, Issue 4, August 1995, Pages 254-263, ISSN 0882-5963,
10.1016/S0882-5963(05)80022-3.
Abstract: This descriptive study of 19 socially high-risk mother-infant
dyads in naturalistic interaction focused on maternal response to infant
elicitation cues. Maternal response behavior was coded on a continuum from
underresponsive to adequate to overresponsive. Maternal affect was rated
separately using selected items from an existing scale. As a whole, the
maternal sample was emotionally depressed and largely underresponsive to
infant cues. When placed by maternal response into adequate,
overresponsive, and underresponsive subgroups, adequate mothers more often
responded appropriately to infant cues, were never physically unavailable
to their infants, showed no anxiety, and were more positively responsive to
their infants' smiles and cries. Adequate mothers scored higher in all
affective areas. Maternal depression was associated with both overresponse
and underresponse. Angry maternal mood was significantly related to
underresponse. Considerable maternal strength lies in this high-risk sample
and could be the basis for therapeutic intervention to normalize parenting.
Yoko Yamamoto, Susan D. Holloway, Sawako Suzuki, Maternal involvement in

preschool children's education in Japan: Relation to parenting beliefs and
socioeconomic status, Early Childhood Research Quarterly, Volume 21, Issue
3, 3rd Quarter 2006, Pages 332-346, ISSN 0885-2006,
10.1016/j.ecresq.2006.07.008.
Abstract: Studies conducted in the US consistently demonstrate that
parenting self-efficacy and construction of the parent role are critical
elements associated with parents involvement in their children's
elementary school education. Less is known about the dynamics of parent
involvement during the preschool period, or in nations outside the US. This
study examined the relation of maternal beliefs and family SES to three
dimensions of parent involvement in Japan: preschool selection strategies,
engagement in reading at home, and involvement in activities at the
preschool. Interview and questionnaire data were obtained from 108 Japanese
mothers, all of whom had a child in the last year of preschool. Consistent
with theory and findings in the US, parenting self-efficacy and family role
construction were associated with Japanese mothers strategies for
selecting preschools and frequency of engaging in home reading. Findings
regarding family SES demonstrated a culturally specific pattern; mothers of
higher SES background were more likely to access formal sources of
information and to engage in daily home reading but less likely to
participate at the school site.
Keywords: Parent involvement; Parenting self-efficacy; Maternal role;
Preschool; Japan; Early literacy; Socioeconomic status
Jeanne-Marie Guise, Anticipating and responding to obstetric emergencies,

Best Practice & Research Clinical Obstetrics & Gynaecology, Volume
21, Issue 4, August 2007, Pages 625-638, ISSN 1521-6934,
10.1016/j.bpobgyn.2007.02.004.
Abstract: During the last 10 years, international attention has focused on
the importance of medical errors and patient safety. When obstetric
emergencies occur, effective and efficient care is essential for good
outcome and safety. This chapter presents a framework for obstetric safety,
reviews the impact of obstetric emergencies on global health, and discusses
possible interventions to improve the anticipation of and responses to
obstetric emergencies.
Keywords: patient safety; obstetric emergencies; obstetric delivery;
pregnancy; simulation; human factors; medical errors
Stephen N. Wall, Anne C.C. Lee, Waldemar Carlo, Robert Goldenberg, Susan
Niermeyer, Gary L. Darmstadt, William Keenan, Zulfiqar A. Bhutta, Jeffrey
Perlman, Joy E. Lawn, Reducing Intrapartum-Related Neonatal Deaths in Low-
and Middle-Income CountriesWhat Works?, Seminars in Perinatology, Volume
34, Issue 6, December 2010, Pages 395-407, ISSN 0146-0005,
10.1053/j.semperi.2010.09.009.
Abstract: Each year, 814,000 neonatal deaths and 1.02 million stillbirths
result from intrapartum-related causes, such as intrauterine hypoxia.
Almost all of these deaths are in low- and middle-income countries, where
women frequently lack access to quality perinatal care and may delay care-
seeking. Approximately 60 million annual births occur outside of health
facilities, and most of these childbirths are without a skilled birth
attendant. Conditions that increase the risk of intrauterine hypoxiasuch
as pre-eclampsia/eclampsia, obstructed labor, and low birth weightare
often more prevalent in low resource settings. Intrapartum-related neonatal
deaths can be averted by a range of interventions that prevent intrapartum
complications (eg, prevention and management of pre-eclampsia), detect and
manage intrapartum problems (eg, monitoring progress of labor with access
to emergency obstetrical care), and identify and assist the nonbreathing
newborn (eg, stimulation and bag-mask ventilation). Simple, affordable, and
effective approaches are available for low-resource settings, including
community-based strategies to increase skilled birth attendance, partograph
use by frontline health workers linked to emergency obstetrical care
services, task shifting to increase access to Cesarean delivery, and
simplified neonatal resuscitation training (Helping Babies BreatheSM).
Coverage of effective interventions is low, however, and many opportunities
are missed to provide quality care within existing health systems. In sub-
Saharan Africa, recent health services assessments found only 15% of
hospitals equipped to provide basic neonatal resuscitation. In the short
term, intrapartum-related neonatal deaths can be substantially reduced by
improving the quality of services for all childbirths that occur in health
facilities, identifying and addressing the missed opportunities to provide
effective interventions to those who seek facility-based care. For example,
providing neonatal resuscitation for 90% of deliveries currently taking
place in health facilities would save more than 93,000 newborn lives each
year. Longer-term strategies must address the gaps in coverage of
institutional delivery, skilled birth attendance, and quality by
strengthening health systems, increasing demand for care, and improving
community-based services. Both short- and long-term strategies to reduce
intrapartum-related mortality should focus on reducing inequities in
coverage and quality of obstetrical and perinatal care.
Keywords: neonatal mortality; intrapartum; birth asphyxia; developing
countries; stillbirths; emergency obstetrical care; neonatal resuscitation
Thalia Dragonas, George N Christodoulou, PRENATAL CARE, Clinical Psychology

Review, Volume 18, Issue 2, March 1998, Pages 127-142, ISSN 0272-7358,
10.1016/S0272-7358(97)00085-8.
Abstract: This paper describes the psychological and psychosocial aspects
of prenatal care, which are believed to be of particular importance for
medical/psychological practice. The emotional changes that normally take
place during pregnancy are surveyed and evidence is provided linking these
changes with potential adverse effect on pregnancy and labour. The salience
of anxiety and life stresses in pregnancy research is highlighted as well
as their intricate inverse relationship with social support. Antenatal
classes are offered as an example of social support provision. The
different kinds of such classes and evaluation of their effectiveness are
briefly presented, as well as a number of controlled trials of enhanced
support during pregnancy. Finally, the effect provision of prenatal care
has on women as well as their role in their own care are raised. The need
is stressed for further sophisticated longitudinal and multivariate
research exploring further the causative links between quality of prenatal
care, pregnancy outcome, and subsequent child development.
Barbara E. Kwast, Reduction of maternal and perinatal mortality in rural

and peri-urban settings: what works?, European Journal of Obstetrics &
Gynecology and Reproductive Biology, Volume 69, Issue 1, October 1996,
Pages 47-53, ISSN 0301-2115, 10.1016/0301-2115(95)02535-9.
(http://www.sciencedirect.com/science/article/pii/0301211595025359)
Abstract: The purpose of this article is two-fold: (i) to lay out
conceptual frameworks for programming in the fields of maternal and
neonatal health for the reduction of maternal and peri/neonatal mortality;
(ii) to describe selected MotherCare demonstration projects in the first 5
years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria.
In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's
groups in remote rural villages in the Andean mountains. Through a
participatory research process, the autodiagnosis, actions identified by
women's groups included among others: provision of family planning through
a local non-governmental organization (NGO), training of community birth
attendants, income generating projects. In Quetzaltenango, Guatemala,
access was improved through training of traditional birth attendants (TBAs)
in timely recognition and referral of pregnancy/delivery/neonatal
complications, while quality of care in health facilities was improved
through modifying health professionals' attitude towards TBAs and clients,
and implementation of management protocols. In Indonesia, the University of
Padjadjaran addressed issues of referral and emergency obstetric care in
the West-Java subdistrict of Tanjunsari. Birthing homes with radios were
established in ten of the 27 villages in the district, where trained
nurse/midwives provided maternity care on a regular basis. In Nigeria
professional midwives were trained in interpersonal communication and
lifesaving obstetric skills, while referral hospitals were refurbished and
equipped. While reduction in maternal mortality after such a short
implementation period is difficult to demonstrate, all projects showed
improvements in referral and in reduction in perinatal mortality.
Keywords: Maternal mortality; Perinatal mortality; Safe Motherhood
programmes; Traditional birth attendants (TBAs)
Janet Molzan Turan, Hacer Nalbant, Ayen Bulut, Yusuf Sahip, Including
expectant fathers in antenatal education programmes in Istanbul, Turkey,
Reproductive Health Matters, Volume 9, Issue 18, November 2001, Pages 114-
125, ISSN 0968-8080, 10.1016/S0968-8080(01)90098-9.
Abstract: In this article we present the results of three studies
investigating methods for including men in antenatal education in Istanbul,
Turkey. Participants were first-time expectant parents living in low and
middle-income areas. After a formative study on the roles of various family
members in health during the period surrounding a first birth, an
antenatal-clinic-based education programme for women and for couples was
carried out as a randomised, controlled study. Based on the results,
separate community-based antenatal education programmes for expectant
mothers and expectant fathers were tested. There was demand among many
pregnant women and some of their husbands for including expectant fathers
in antenatal education. In the short term, these programmes seemed to have
positive effects on women and men's reproductive health knowledge,
attitudes and behaviours. In the clinic-based programme the positive
effects of including men were mainly in the area of post-partum family
planning, while in the community-based programme positive effects among men
were also seen in the areas of infant health, infant feeding and spousal
communication and support. Free an tenatal education should be made
available to all expectant mothers and when possible, men should be
included, either together with their wives or in a culture such as that of
Turkey, in separate groups.
Keywords: maternal and child health; antenatal education; male involvement;
community-based programmes; Turkey
Gabriela Gonzlez-Mariscal, Pascal Poindron, 3 - Parental Care in Mammals:

Immediate Internal and Sensory Factors of Control, In: Donald W. Pfaff,
Arthur P. Arnold, Susan E. Fahrbach, Anne M. Etgen and Robert T. Rubin,
Editor(s), Hormones, Brain and Behavior, Academic Press, San Diego, 2002,
Pages 215-298, ISBN 9780125321044, 10.1016/B978-012532104-4/50005-6.
Abstract: The strategies by which animals succeed in reproducing and
spreading their genes vary greatly across species. Whereas those using the
r strategy (or opportunistic breeders) tend to produce many small
offspring in a short time, K breeders (also called stable species)
produce fewer but larger offspring at longer intervals. There are numerous
internal and environmental factors that influence the type of reproductive
strategy that a species will develop. Overall, mammals tend to be K
breeders: They generally show a relatively long gestation period and give
birth to few neonates of reasonable wieght compared to the adult (May and
Rubenstein, 1984). Nonetheless, within this range, striking differences
exist: Some species produce in a single reproductive cycle more young than
others do in a lifetime (e.g., rodents versus most large herbivores and
primates). In other words, some mammalian species tend to show r
reproductive strategies. The degree of maturity of the offspring also
varies greatly, from a rather underdeveloped larva (marsupials) to a fully
developed young, able to follow its dam within less than an hour after
birth (ungulates). Given this extraordinary variation in the
characteristics of the neonate, it is not surprising that selective
pressure by ultimate factors (i.e., those ensuring the successful
transmission of the parent's genes) has resulted in a remarkable
diversification in the patterns of parental care in mammals (Section II).
Rebecca S Black, Peter Brocklehurst, A systematic review of training in

acute obstetric emergencies, BJOG: An International Journal of Obstetrics
and Gynaecology, Volume 110, Issue 9, September 2003, Pages 837-841, ISSN
1470-0328, 10.1016/S1470-0328(03)02488-1.
Abstract: Objective
To describe models used for the training of labour ward personnel in acute
obstetric emergencies and to describe how these models have been evaluated
and compared.
Design
A systematic review of the following databases: Medline, the Cumulative
Index of Nursing and Allied Health Literature, Embase, PsycLit, Allied and
Alternative Medicine, Education Resources Information Center and the
Cochrane Library using a structured search strategy.
Setting
Labour ward.
Population or Sample
Labour ward personnel.
Inclusion criteria
All papers that described or evaluated any form of drill or training in
acute obstetric emergencies involving any personnel in a labour ward
environment were included. Descriptions of training in developing countries
were excluded.
Methods
Papers were classified as editorials or commentaries, papers describing a
training programme or papers evaluating a training method. A data
collection form was used to extract relevant information by two
investigators independently.
Main outcome measure
Description of training models.
Results
Of 44 relevant papers, 22 were classed as editorials or commentaries. Six
descriptions of training programmes were found and four papers involved an
evaluation of such programmes. All evaluations involved the use of
questionnaires to course participants. No studies comparing one form of
training with another were found.
Conclusions
With regard to training in acute obstetric emergencies, few training
programmes have been described, and even fewer have been evaluated.
Training methods need to be developed, described and evaluated; further
well-conducted research for this important intervention is urgently
required.
Barbara E. Kwast, Quality of care in reproductive health programmes:

Monitoring and evaluation of quality improvement, Midwifery, Volume 14,
Issue 4, December 1998, Pages 199-206, ISSN 0266-6138, 10.1016/S0266-
6138(98)90091-2.
Abstract: As 200 million women become pregnant every year, at least 30
million will develop life-threatening complications requiring emergency
treatment at any level of society where they live. But it is a basic human
right that pregnancy be made safe for all women as complications are mostly
unpredictable. This requires reproductive health programmes which are
responsive to women's and their families' needs and expectations on the one
hand and enhancement of community participation, high quality obstetric
services, and both provider collaboration and satisfaction on the other.
Monitoring and evaluation of these facets need to be an integral part of

any safe motherhood programme, not only to assess progress, but also to use
this information for subsequent planning and implementation cycles of
national programmes. Lessons learned from ten years' implementation of Safe
Motherhood programmes indicate that process and outcome indicators are more
feasible for short-term evaluation purposes than impact indicators, such as
maternal mortality reduction. The former are described in this paper with
relevant country examples.
This is the third, and last, article in a series on quality of care in

reproductive health programmes. The first (Kwast 1998a) contains an
overview of concepts, assessments, barriers and improvements of quality of
care. The second (Kwast 1998b) addresses education issues for quality
improvement.
JosM. Belizn, Fernando Barros, Ana Langer, Ubaldo Farnot, Cesar Victora,
Jos Villar, Impact of health education during pregnancy on behavior and
utilization of health resources, American Journal of Obstetrics and
Gynecology, Volume 173, Issue 3, Part 1, September 1995, Pages 894-899,
ISSN 0002-9378, 10.1016/0002-9378(95)90362-3.
Abstract: OBJECTIVE: Our purpose was to assess whether an intervention in
the education of the mother and the support person involves a change in
health-related behavior and use of health facilities.
STUDY DESIGN: A randomized, controlled trial was conducted in four cities

of Latin America on pregnant women at risk. Half of them (n = 1115)
received a home intervention of four to six visits dealing with
psychosocial support and education about health-related habits, alarm
signs, hospital facilities, antismoking and antialcohol programs, and a
reinforcement of adequate health services utilization for the pregnant
woman and a support person. The control group (n = 1120) received routine
prenatal care.
RESULTS: The distribution of risk factors and demographic, obstetric, and

psychologic characteristics at baseline was similar in both groups. Women
in the intervention group showed a statistically significant better
knowledge of seven of the nine alarm signs considered and of two of the
three labor-onset signs required. No differences between groups were
observed in improvement on diet, cigarette and alcohol consumption,
maternal physicial strain, lactation at 40 days postpartum, and utilization
of health facilities.
CONCLUSIONS: An intervention of psychosocial support and health education

during pregnancy failed to show any benefit on perinatal outcome, health-
related behavior, or utilization of health facilities.
Keywords: Health education; health knowledge; health-related behavior
Upul Senarath, Dulitha N. Fernando, Graham Vimpani, Ishani Rodrigo, Factors

associated with maternal knowledge of newborn care among hospital-delivered
mothers in Sri Lanka, Transactions of the Royal Society of Tropical
Medicine and Hygiene, Volume 101, Issue 8, August 2007, Pages 823-830, ISSN
0035-9203, 10.1016/j.trstmh.2007.03.003.
Abstract: Summary
The aim of this study was to assess mothers knowledge on newborn care as
well as factors associated with poor knowledge. A cross-sectional study
sampled 446 mothernewborn pairs from five hospitals in the Puttalam
district of Sri Lanka by stratified random sampling. Maternal knowledge on
newborn care was assessed using a questionnaire with 50 statements via exit
interview. A knowledge score was created by allocating 1 point for each
correct response, which was dichotomised as satisfactory or poor by the
median score. Only 21.7% correctly answered that surgical spirit (70%
isopropyl alcohol) should not be applied on the umbilical stump. More than
90% of mothers knew about breastfeeding on demand, the advantages of
colostrum and the duration of exclusive breastfeeding. Except for a few
conditions, mothers demonstrated a satisfactory knowledge in recognising
danger signs of the newborn. According to multivariate analysis, primiparae
(odds ratio (OR) = 2.31; 95% CI 1.533.50), unemployed women
(OR = 3.31; 95% CI 1.895.80) and those with delayed antenatal
booking visits (OR = 2.02; 95% CI 1.262.23) were more likely to
have poor knowledge. In conclusion, mothers had a satisfactory level of
knowledge about breastfeeding and recognition of danger signs, but
knowledge about care of the umbilical cord was poor. Maternal education
programmes should place more emphasis on first-time mothers, unemployed
women and those with delayed booking visits.
Keywords: Newborn infant; Newborn care; Health education; Maternal welfare;
Maternal knowledge; Sri Lanka
Sindhu K. Srinivas, Scott A. Lorch, The laborist model of obstetric care:

we need more evidence, American Journal of Obstetrics and Gynecology,
Volume 207, Issue 1, July 2012, Pages 30-35, ISSN 0002-9378,
10.1016/j.ajog.2011.10.009.
Abstract: Literature suggesting improved patient outcomes and patient
satisfaction with the hospitalist model of inpatient medical care coupled
with the desire to improve provider satisfaction led to the introduction of
the laborist in obstetrics. This represents a significant change in the way
obstetrics has been experienced and practiced from both a patient and
provider perspective. The laborist was designed as a plausible model of
obstetric care delivery where hospitals employ physicians to provide
continuous coverage of labor and delivery units without other competing
clinical duties. Anecdotal use of the laborist model in the provision of
obstetric care is growing rapidly, despite the lack of research regarding
its impact on maternal outcomes, neonatal outcomes, patient and provider
satisfaction, and graduate medical education. We provide an overview of
both the positive and negative attributes of this model of obstetric care
delivery, discuss the current state of research addressing these
attributes, and propose a research strategy to improve understanding of the
impact of this model of care delivery.
Keywords: care delivery; laborist; obstetrics; pregnancy
Fangbiao Tao, Kun Huang, Xiang Long, Rachel Tolhurst, Joanna Raven, Low
postnatal care rates in two rural counties in Anhui Province, China:
Perceptions of key stakeholders, Midwifery, Volume 27, Issue 5, October
2011, Pages 707-715, ISSN 0266-6138, 10.1016/j.midw.2009.10.001.
Abstract: Objective
to explore the perceptions of stakeholders on postnatal care and to
describe the rate of postnatal home visits in two rural counties in Anhui
Province, China.
Design
this was a mixed methods study which uses mainly qualitative methods
including focus group discussions, in- depth interviews and key informant
interviews. A household survey of postpartum women was used to calculate
the rates of postnatal home visits.
Setting
two rural counties in Anhui Province, China.
Participants
qualitative study participants: officials responsible for maternal health
care at county level, health providers at township and village level and
maternal health-care users. Household survey participants: 2326 women who
gave birth in the two counties from January 2005 to December 2006.
Findings
the survey of postpartum women revealed that only 4.2% and 4.5% of women
received one or more postnatal visits at home in County A and County B.
Qualitative interviews revealed a range of perceived reasons for this low
rate of provision and utilisation of postnatal care, including: inadequate
funding for maternal health care; limited human resources; lack of
transport in township hospitals; and limited value placed on postnatal care
by women and providers. In addition, where services were provided, a number
of factors were likely to restrict health providers from delivering high-
quality postnatal health service, such as: weak skills and knowledge of
staff; inadequate in-service training; lack of equipment in township
hospitals; and poor supervision and monitoring.
Key conclusions
the rate of postnatal visits was extremely low in two counties in rural
China. Understaffing and inadequate funding are the main factors that
affect provision of postnatal health care.
more emphasis should be attached to political support and funding for
postnatal care. Research into feasible ways to provide quality postnatal
care needs to be conducted.
Keywords: Postnatal care; Quality of care; Health seeking behaviour;
Utilisation
Simon Cooper, Robyn Cant, Jo Porter, Fiona Bogossian, Lisa McKenna,

Susannah Brady, Stephanie Fox-Young, Simulation based learning in midwifery
education: A systematic review, Women and Birth, Volume 25, Issue 2, June
2012, Pages 64-78, ISSN 1871-5192, 10.1016/j.wombi.2011.03.004.
Abstract: Aim
To critically examine the evidence for simulation based learning in
midwifery education.
Background
Simulated Learning Programs (SLPs) using low to high fidelity techniques
are common in obstetric professionals education and focus on the
development of team work, labour and obstetric emergencies.
Review methods
A systematic review incorporating critical appraisal approaches, setting
clear objectives and a defined search and analysis strategy. Evidence from
obstetrics, neonatology, technical and non-technical skills (teamwork) was
included where it informed the development of midwifery curricula. Studies
in English from 2000 to 2010 were included searching CINAHL Plus, OVID
Medline, Cochrane, SCOPUS and ProQuest and Google Scholar.
Results
Twenty-four papers were identified that met the inclusion criteria. All
were quantitative reports; outcomes and levels of evidence varied with two
notable papers indicating that simulation had an impact on clinical
practice. Benefits of SLP over didactic formats were apparent, as were the
development of non-technical skills confidence and competence. The study
outcomes were limited by the range of evidence and context of the reports
which focussed on obstetric emergency training using a number of simulation
techniques.
Conclusion
There is evidence that simulated learning of midwifery skills is
beneficial. Simulation learning has an educational and clinical impact and
advantages over didactic approaches. Where clinical practice is infrequent
i.e. obstetric emergencies, simulation is an essential component of
curricula. Simulation enhances practice and therefore may reduce the time
taken to achieve competence; however there is no evidence from the
literature that simulation should replace clinical practice.
Keywords: Midwifery; Simulation; Education; Obstetrics; Review
Carine Ronsmans, Wendy J Graham, on behalf of The Lancet Maternal Survival

Series steering group, Maternal mortality: who, when, where, and why, The
Lancet, Volume 368, Issue 9542, 30 September6 October 2006, Pages 1189-
1200, ISSN 0140-6736, 10.1016/S0140-6736(06)69380-X.
Abstract: Summary
The risk of a woman dying as a result of pregnancy or childbirth during her
lifetime is about one in six in the poorest parts of the world compared
with about one in 30000 in Northern Europe. Such a discrepancy poses a
huge challenge to meeting the fifth Millennium Development Goal to reduce
maternal mortality by 75% between 1990 and 2015. Some developed and
transitional countries have managed to reduce their maternal mortality
during the past 25 years. Few of these, however, began with the very high
rates that are now estimated for the poorest countriesin which further
progress is jeopardised by weak health systems, continuing high fertility,
and poor availability of data. Maternal deaths are clustered around labour,
delivery, and the immediate postpartum period, with obstetric haemorrhage
being the main medical cause of death. Local variation can be important,
with unsafe abortion carrying huge risk in some populations, and HIV/AIDS
becoming a leading cause of death where HIV-related mortaliy rates are
high. Inequalities in the risk of maternal death exist everywhere.
Targeting of interventions to the most vulnerablerural populations and
poor peopleis essential if substantial progress is to be achieved by 2015.
Katherine C. Teela, Luke C. Mullany, Catherine I. Lee, Eh Poh, Palae Paw,

Nicole Masenior, Cynthia Maung, Chris Beyrer, Thomas J. Lee, Community-
based delivery of maternal care in conflict-affected areas of eastern
Burma: Perspectives from lay maternal health workers, Social Science &
Medicine, Volume 68, Issue 7, April 2009, Pages 1332-1340, ISSN 0277-9536,
10.1016/j.socscimed.2009.01.033.
Abstract: In settings where active conflict, resource scarcity, and
logistical constraints prevail, provision of maternal health services
within health centers and hospitals is unfeasible and alternative
community-based strategies are needed. In eastern Burma, such conditions
necessitated implementation of the Mobile Obstetric Maternal Health
Worker (MOM) project, which has employed a community-based approach to
increase access to essential maternal health services including emergency
obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM
service delivery model and, because they are accessible to both the
communities inside Burma and to outside project managers, they serve as key
informants for the project. Their insights can facilitate program and
policy efforts to overcome critical delays and insufficient management of
maternal complications linked to maternal mortality. Focus group
discussions (n = 9), in-depth interviews (n = 18), and
detailed case studies (n = 14) were collected from MHWs during
centralized project management meetings in February and October of 2007.
Five case studies are presented to characterize and interpret the realities
of reproductive health work in a conflict-affected setting. Findings
highlight the process of building supportive networks and staff ownership
of the MOM project, accessing and gaining community trust and participation
to achieve timely delivery of care, and overcoming challenges to manage and
appropriately deliver essential health services. They suggest that some
emergency obstetric care services that are conventionally delivered only
within healthcare settings might be feasible in community or home-based
settings when alternatives are not available. This paper provides an
opportunity to hear directly from community-based workers in a conflict
setting, perspectives seldom documented in the scientific literature. A
rights-based approach to service delivery and its suitability in settings
where human rights violations are widespread is highlighted.
Keywords: Burma; Reproductive health; Emergency obstetrical care; Community
health; Internally displaced populations; Health workers; Conflict setting;
Childbirth
Dwenda K. Gjerdingen, Elizabeth Ann Shaw, Sharon S.-L. Wong, CHAPTER 21 -

Postpartum Psychosocial Concerns, In: Stephen D. Ratcliffe, MD, MSPH,
Elizabeth G. Baxley, MD, Matthew K. Cline, MD, and Ellen L. Sakornbut, MD,
Editor(s), Family Medicine Obstetrics (Third Edition), Mosby, Philadelphia,
2008, Pages 645-663, ISBN 9780323043069, 10.1016/B978-032304306-9.50026-4.
Stacy Leigh Pigg, Acronyms and effacement: Traditional medical

practitioners (TMP) in international health development, Social Science
& Medicine, Volume 41, Issue 1, July 1995, Pages 47-68, ISSN 0277-9536,
10.1016/0277-9536(94)00311-G.
(http://www.sciencedirect.com/science/article/pii/027795369400311G)
Abstract: International development draws on a globalized vision of
traditional medicine when constructing country-specific programs that use
local practitioners to further health objectives. This paper looks at the
tension between this mobile notion of the traditional and the local
social ground. Categories such as traditional birth attendant (TBA) and
traditional medical practitioner (TMP) emerge from a process of translation
that links local realities to development in specific ways. Examination of
training programs for two kinds of indigenous practitioners in Nepal
birth attendants and shamansshows that various Nepalese specialists are
constructed as TBAs and TMPs in a discursive process that emphasizes some
differences while eliding others. The acronyms TBA and TMP encapsulate
numerous acts of translation through which diverse local practices are
subsumed into an overarching development framework. The many layers of this
process include: how traditional healers are understood in international
health policy; how, in national planning, these conceptions are made to fit
with existing Nepalese healers; and how research on local ideas and
practices becomes authoritative knowledge about traditions, which then,
in turn, form a basis for the planning and implementation of training
programs.
The conceptual categories evident in development discourse on traditional

healers take concrete, practical form in the design and implementation of
training programs. At the same time development attempts to create programs
tailored to local conditions, it generates frameworks that efface or
exclude much of what local people think, believe and do. Although training
programs for TBAs and TMPs have been advocated as a way to bridge the gap
between the realities of local peoples lives and development institutions'
visions, it is important to realize that, at another level, development
discourse produces the very problems it aims to solve.
The case study of training programs for TMPs and TBAs in Nepal shows how
the universalizing principles inherent in development discourse
systematically dismantle and decontextualize different socio-cultural
realities in the course of taking them into account. Development
institutions are thus positioned as authoritative mediators of all local
worlds. Translation is a social act that, through the management of the
circulation of discourses, reinforces the particular global-local power
relations of international development. Relations of power, as well as
states of health, are at stake in health development encounters. This paper
questions whether health development can achieve its humanitarian goals
within the existing conceptual framework.
Keywords: traditional medical practitioners; health development policy;
development discourse; Nepal
G. Justus Hofmeyr, Rachel A. Haws, Staffan Bergstrm, Anne CC Lee, Pius

Okong, Gary L. Darmstadt, Luke C. Mullany, Eh Kalu Shwe Oo, Joy E. Lawn,
Obstetric care in low-resource settings: What, who, and how to overcome
challenges to scale up?, International Journal of Gynecology &
Obstetrics, Volume 107, Supplement, October 2009, Pages S21-S45, ISSN 0020-
7292, 10.1016/j.ijgo.2009.07.017.
Each year, approximately 2 million babies die because of complications
of childbirth, primarily in settings where effective care at birth,
particularly prompt cesarean delivery, is unavailable.
Objective
We reviewed the content, impact, risk-benefit, and feasibility of
interventions for obstetric complications with high population attributable
risk of intrapartum-related hypoxic injury, as well as human resource,
skill development, and technological innovations to improve obstetric care
quality and availability.
Results
Despite ecological associations of obstetric care with improved perinatal
outcomes, there is limited evidence that intrapartum interventions reduce
intrapartum-related neonatal mortality or morbidity. No interventions had
high-quality evidence of impact on intrapartum-related outcomes in low-
resource settings. While data from high-resource settings support planned
cesarean for breech presentation and post-term induction, these
interventions may be unavailable or less safe in low-resource settings and
require risk-benefit assessment. Promising interventions include use of the
partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for
shoulder dystocia, improved management of intra-amniotic infections, and
continuous labor support. Obstetric drills, checklists, and innovative low-
cost devices could improve care quality. Task-shifting to alternative
cadres may increase coverage of care.
Conclusions
While intrapartum care aims to avert intrapartum-related hypoxic injury,
rigorous evidence is lacking, especially in the settings where most deaths
occur. Effective care at birth could save hundreds of thousands of lives a
year, with investment in health infrastructure, personnel, and research
both for innovation and to improve implementation.
Keywords: Birth asphyxia/asphyxia neonatorum; Childbirth care; Emergency
obstetric care; Intrapartum care; Intrapartum-related mortality; Low-income
countries; Neonatal mortality; Perinatal mortality
Angelo Fernando Robledo-Colonia, Natalia Sandoval-Restrepo, Yannier Ferley

Mosquera-Valderrama, Celia Escobar-Hurtado, Robinson Ramrez-Vlez, Aerobic
exercise training during pregnancy reduces depressive symptoms in
nulliparous women: a randomised trial, Journal of Physiotherapy, Volume 58,
Issue 1, 2012, Pages 9-15, ISSN 1836-9553, 10.1016/S1836-9553(12)70067-X.
Abstract: Question
Does supervised aerobic exercise during pregnancy reduce depressive
symptoms in nulliparous women?
Design
Randomised trial with concealed allocation, blinded assessors, and
intention-to-treat analysis.
Participants
80 nulliparous, pregnant women attending for prenatal care at one of three
tertiary hospitals in Cali, Colombia.
Intervention
The experimental group completed a 3-month supervised exercise program,
commencing at 16 to 20 weeks of gestation. Each session included walking
(10 min), aerobic exercise (30 min), stretching (10 min), and relaxation
(10 min). The control group continued usual activities and performed no
specific exercise.
Outcome measures
:The primary outcome was symptoms of depression assessed by the Center for
Epidemiological Studies Depression Scale (CES-D) at baseline and
immediately after the 3-month intervention.
Results
74 women completed the study. After the 3-month intervention, the
experimental group reduced their depressive symptoms on the CES-D
questionnaire by 4 points (95% CI 1 to 7) more than the control group.
Conclusions
A supervised 3-month program of primarily aerobic exercise during pregnancy
reduces depressive symptoms.
Trial registration
NCT00872365.
Keywords: Aerobic exercise; Pregnant women; Depression; Randomised trial;
Physiotherapy
Mohammad Tajul Islam, Yasmin Ali Haque, Rachel Waxman, Abdul Bayes Bhuiyan,
Implementation of Emergency Obstetric Care Training in Bangladesh: Lessons
Learned, Reproductive Health Matters, Volume 14, Issue 27, May 2006, Pages
61-72, ISSN 0968-8080, 10.1016/S0968-8080(06)27229-X.
Abstract: The Women's Right to Life and Health project aimed to reduce
maternal morbidity and mortality in Bangladesh through provision of
comprehensive emergency obstetric care (EmOC) in the country's district and
sub-district hospitals. Human resources development was one of the
project's major activities. This paper describes the project in 20002004
and lessons learned. Project documents, the training database, reports and
training protocols were reviewed. Medical officers, nurses, facility
managers and laboratory technicians received training in the country's
eight medical college hospitals, using nationally accepted curricula. A 17-
week competency-based training course for teams of medical officers and
nurses was introduced in 2003. At baseline in 1999, only three sub-district
hospitals were providing comprehensive EmOC and 33 basic EmOC, mostly due
to lack of trained staff and necessary equipment. In 2004, 105 of the 120
sub-district hospitals had become functional for EmOC, 70 with
comprehensive EmOC and 35 with basic EmOC, while 53 of 59 of the district
hospitals were providing comprehensive EmOC compared to 35 in 1999. The
scaling up of competency-based training, innovative incentives to retain
trained staff, evidence-based protocols to standardise practice and improve
quality of care and the continuing involvement of key stakeholders,
especially trainers, will all be needed to reach training targets in
future.
Keywords: training of service providers; human resources; emergency
obstetric care; Bangladesh
Carl M. Corter, Alison S. Fleming, Maternal Responsiveness in Humans:

Emotional, Cognitive, and Biological Factors, In: Peter J.B. Slater, Jay S.
Rosenblatt and Colin Beer, Editor(s), Advances in the Study of Behavior,
Academic Press, 1990, Volume 19, Pages 83-136, ISSN 0065-3454, ISBN
9780120045198, 10.1016/S0065-3454(08)60201-6.
Lesley M. Barclay, Beverly Lloyd, The misery of motherhood: alternative

approaches to maternal distress, Midwifery, Volume 12, Issue 3, September
1996, Pages 136-139, ISSN 0266-6138, 10.1016/S0266-6138(96)90057-1.
Abstract: This paper was developed from a presentation delivered to the
Marce Society Pacific Rim Conference, Childbearing and mental health: risks
and remedies (Barclay & Lloyd 1995). Midwives involved in education and
clinical care are challenged to carefully consider the implications of
accepting a psychiatric approach to new motherhood. While acknowledging the
importance of understanding and treating clinical depression, the authors
question the appropriateness of extending the psychiatric model to the
psychological and social changes inherent in parenting. We focus our
discussion on new motherhood and illustrate our argument with quotations
from our own research.
Christopher S. Ennen, Andrew J. Satin, Training and assessment in

obstetrics: the role of simulation, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 24, Issue 6, December 2010, Pages 747-
758, ISSN 1521-6934, 10.1016/j.bpobgyn.2010.03.003.
Abstract: Simulation is becoming an integral part of the training and
assessment of obstetricians. Given the variety of manual skills that must
be learned, awake patients and high-risk environment, obstetrics is
uniquely suited for simulation. Simulation provides opportunities to
rehearse and learn from mistakes without risks to patients. The use of
simulation can help overcome some limitations of the current medical
education and practice environment, including work-hour limitations and
concerns for patient safety. Both low- and high-fidelity simulation models
can be used to accomplish educational goals. Basic and advanced skills as
well as the management of obstetric emergencies are amenable to simulation.
For a simulation programme to be successful, one must identify the learner
and the skills that are to be learned. In the future, simulation will be
more available and realistic and will be used not only for education, but
also for ongoing assessment of providers.
Keywords: simulation; skills; assessment; training; obstetrics; curriculum
Lynn Sibley, Sandra Tebben Buffington, Degafech Haileyesus, The American
College of Nurse-Midwives home-based lifesaving skills program: a review
of the Ethiopia field test, Journal of Midwifery & Women's Health,
Volume 49, Issue 4, JulyAugust 2004, Pages 320-328, ISSN 1526-9523,
10.1016/j.jmwh.2004.03.013.
Abstract: The Home-Based Lifesaving Skills program (HBLSS) is a family- and
community-focused, competency-based program that aims to reduce maternal
and newborn mortality by increasing access to basic lifesaving measures
within the home and community and by decreasing delays in reaching referral
facilities where obstetric complications, such as postpartum hemorrhage and
newborn asphyxia, can be managed. HBLSS was field tested in rural southern
Ethiopia where over 90% of births take place at home with unskilled
attendants. The program review assessed 1) the performance of HBLSS-trained
guides; 2) management of postpartum hemorrhage and newborn infection by
women, family, and birth attendants; 3) exposure of women and families to
HBLSS training; and 4) community support. There was improved performance in
management of postpartum hemorrhage, a leading cause of maternal death.
Findings for management of newborn infection were less compelling. None of
the communities had established reliable emergency transportation. Exposure
to HBLSS training in the community was estimated at 38%, and there was
strong community support. Organizations incorporating HBLSS into proposals
focusing on maternal and newborn health during birth and the immediate
postpartum period are encouraged to conduct research necessary to establish
the evidence base for this promising new approach.
Keywords: Ethiopia; safe motherhood; lifesaving skills; maternal mortality;
newborn mortality; community mobilization
Leon Chaitow, Hal Brown, Nick Buratovich, Brian Isbell, Lisa Maeckel, Dean
E. Neary Jr, David Russ, Roger Newman Turner, Chapter 10 - Naturopathic
Physical Medicine Approaches to General Health Enhancement and Specific
Conditions, In: Leon Chaitow, ND DO, Editor(s), Naturopathic Physical
Medicine, Churchill Livingstone, Edinburgh, 2008, Pages 417-513, ISBN
9780443103902, 10.1016/B978-044310390-2.50015-8.
Marge Koblinsky, Zo Matthews, Julia Hussein, Dileep Mavalankar, Malay K

Mridha, Iqbal Anwar, Endang Achadi, Sam Adjei, P Padmanabhan, Wim van
Lerberghe, on behalf of The Lancet Maternal Survival Series steering group,
Going to scale with professional skilled care, The Lancet, Volume 368,
Issue 9544, 1420 October 2006, Pages 1377-1386, ISSN 0140-6736,
10.1016/S0140-6736(06)69382-3.
Abstract: Summary
Because most women prefer professionally provided maternity care when they
have access to it, and since the needed clinical interventions are well
known, we discuss in their paper what is needed to move forward from
apparent global stagnation in provision and use of maternal health care
where maternal mortality is high. The main obstacles to the expansion of
care are the dire scarcity of skilled providers and health-system
infrastructure, substandard quality of care, and women's reluctance to use
maternity care where there are high costs and poorly attuned services. To
increase the supply of professional skilled birthing care, strategic
decisions must be made in three areas: training, deployment, and retention
of health workers. Based on results from simulations, teams of midwives and
midwife assistants working in facilities could increase coverage of
maternity care by up to 40% by 2015. Teams of providers are the efficient
option, creating the possibility of scaling up as much as 10 times more
quickly than would be the case with deployment of solo health workers in
home deliveries with dedicated or multipurpose workers.
Melissa Page, Mari S. Wilhelm, Wendy C. Gamble, Noel A. Card, A comparison
of maternal sensitivity and verbal stimulation as unique predictors of
infant socialemotional and cognitive development, Infant Behavior and
Development, Volume 33, Issue 1, February 2010, Pages 101-110, ISSN 0163-
6383, 10.1016/j.infbeh.2009.12.001.
Abstract: Although maternal sensitivity has been shown to influence social
emotional development, the role of verbal stimulation on infant
developmental outcomes has received less exploration. Recent research has
focused on intentional behaviors within the context of a motherinfant
interaction as a critical influence and as distinct from sensitivity. In
this investigation 6377 motherinfant dyads participated in a teaching task
as part of the sample from the Early Childhood Longitudinal Study Birth
Cohort (ECLS-B). Analyses focused in deciphering the role of maternal
sensitivity and verbal stimulation as contributors to the infant's social
emotional (SE) and cognitive (Cog) development. We further hypothesized
that inclusion of infant age as a moderator of maternal behaviors would
illuminate any differences between younger and older infants. Results: For
the infant's SE development, our hypothesis that maternal sensitivity
would be a stronger predictor than verbal stimulation was not supported;
nor did we find support for our hypothesis that the association would be
moderated by age. For Cog development, only verbal stimulation had a direct
positive effect on the infant's cognitive ability; our findings for
moderation showed that mothers spoke more to older infants than younger
infants. Conclusion: Identification of specific maternal behaviors
associated with infant outcomes informs the child development field, and
also provides strategies for early intervention to assist mothers with
developing or maintaining a consistent relationship that includes
sensitivity and verbal stimulation.
Keywords: Maternal sensitivity; Verbal stimulation; Socialemotional;
Cognitive
Simon Cooper, Bree Bulle, Mary Anne Biro, Jan Jones, Maureen Miles, Carole
Gilmour, Penny Buykx, Rosemarie Boland, Leigh Kinsman, Julie Scholes, Ruth
Endacott, Managing women with acute physiological deterioration: Student
midwives performance in a simulated setting, Women and Birth, Available
online 22 September 2011, ISSN 1871-5192, 10.1016/j.wombi.2011.08.009.
Abstract: Objective
Midwives ability to manage maternal deterioration and failure to rescue
are of concern with questions over knowledge, clinical skills and the
implications for maternal morbidity and, mortality rates. In a simulated
setting our objective was to assess student midwives ability to assess,
and manage maternal deterioration using measures of knowledge, situation
awareness and skill, performance.
Methods
An exploratory quantitative analysis of student performance based upon
performance, ratings derived from knowledge tests and observational
ratings. During 2010 thirty-five student, midwives attended a simulation
laboratory completing a knowledge questionnaire and two video, recorded
simulated scenarios. Patient actresses wearing a birthing suit simulated
deteriorating, women with post-partum and ante-partum haemorrhage (PPH and
APH). Situation awareness was, measured at the end of each scenario.
Applicable descriptive and inferential statistical tests were, applied to
the data.
Findings
The mean total knowledge score was 75% (range 4691%) with low skill
performance, means for both scenarios 54% (range 3970%). There was no
difference in performance between the scenarios, however performance of key
observations decreased as the women deteriorated; with significant
reductions in key vital signs such as blood pressure and blood loss
measurements. Situation, awareness scores were also low (54%) with
awareness decreasing significantly (t(32) = 2.247,
p = 0.032), in the second and more difficult APH scenario.
Conclusion
Whilst knowledge levels were generally good, skills were generally poor and
decreased as the women deteriorated. Such failures to apply knowledge in
emergency stressful situations may be resolved by repetitive high stakes
and high fidelity simulation.
Keywords: Education; Midwifery; Simulation; Patient deterioration; Decision
making; Situation awareness
Young-Mi Kim, Partamin Zainullah, Jaime Mungia, Hannah Tappis, Linda

Bartlett, Nabila Zaka, Availability and quality of emergency obstetric and
neonatal care services in Afghanistan, International Journal of Gynecology
& Obstetrics, Volume 116, Issue 3, March 2012, Pages 192-196, ISSN
0020-7292, 10.1016/j.ijgo.2011.10.017.
Abstract: Objective
To assess the availability and utilization of emergency obstetric and
neonatal care (EmONC) facilities in Afghanistan, as defined by UN
indicators.
Methods
In a cross-sectional study of 78 first-line referral facilities located in
secure areas of Afghanistan, EmONC service delivery was evaluated by using
Averting Maternal Deaths and Disabilities (AMDD) Program assessment tools.
Results
Forty-two percent of peripheral facilities did not perform all 9 signal
functions required of comprehensive EmONC facilities. The study facilities
delivered 17% of all neonates expected in their target populations and
treated 20% of women expected to experience direct complications. The
population-based rate of cesarean delivery was 1%. Most maternal deaths
(96%) were due to direct causes. The direct and indirect obstetric case
fatality rates were 0.8% and 0.2%, respectively.
Conclusion
Notable progress has been made in Afghanistan over the past 8 years in
improving the quality, coverage, and utilization of EmONC services, but
gaps remain. Re-examination of the criteria for selecting and positioning
EmONC facilities is recommended, as is the provision of high-quality,
essential maternal and neonatal health services at all levels of the
healthcare system, linked by appropriate communication and functional
referral systems.
Keywords: Afghanistan; Delivery (obstetric/standards); Emergency obstetric
and neonatal care; Health services availability; Maternal health; Neonatal
health
Catherine Stevens-Simon, Donna Nelligan, Strategies for identifying and

treating adolescents at risk for maltreating their children, Aggression and
Violent Behavior, Volume 3, Issue 2, Summer 1998, Pages 197-217, ISSN 1359-
1789, 10.1016/S1359-1789(97)00015-3.
Abstract: Using data published in English since 1970, the analyses
presented in this article examine the identification and treatment of the
antecedents of child maltreatment by adolescent parents. Reviewed studies
indicate that (a) the sensitivity and specificity of predictors of child
abuse is poor, (b) children of adolescents are at increased risk for
maltreatment, (c) controlling for background sociodemographic factors
decreases but does not eliminate this risk, (d) home visitation programs
help at-risk adolescent parents improve their parenting skills.
Maltreatment of children by their adolescent parents is a preventable
problem. Short-term programs that address behavioral manifestations of the
social ills and developmental conflicts that antedate child maltreatment
without touching the underlying causes are unlikely to be successful.
Young-Mee Ahn, Nam-Hee Kim, Parental Perception of Neonates, Parental

Stress and Education for NICU Parents, Asian Nursing Research, Volume 1,
1317(08)60022-5.
Abstract: Purpose
The purpose of this study was to conduct a comparative analysis between the
perception of parents with premature infants in the NICU and parents with
full-term newborns, and in the process to evaluate the effects of NICU
educational support on parents with regard to their perception of neonate
and parental stress.
Methods
A mixed quantitative design was employed to compare parental perception of
neonates using the Neonatal Perception Index (NPI) between the parents of
26 full-term infants (full-term group) and the parents of 22 premature
infants in the NICU (NICU group), and also to evaluate the effect of NICU
educational support on NPI and parental stress using the Parental Stress
Scale (PSS) between the mothers and fathers in the NICU group.
Results
NICU mothers showed the lowest NPI score among full-term and NICU parents.
However, no difference in direction of NPI scores was observed between
parents in either the full-term or NICU group. NICU education improved NPI
and decreased PSS in fathers but not in mothers.
Conclusion
Environmental modifications of the nursery setting, particularly its remote
location to the NICU, could improve mothers' perception of full-term
neonates. NICU mothers, as the principal caregivers, may suffer from
culturally-grounded, psychoemotional disturbances after giving birth to a
sick infant, which may not be applicable to fathers. The quality of family-
centered care in the NICU environment, parental role alteration, and the
condition of infants need to be improved to decrease parental stress in the
NICU. Fathers may have significant potential in caring for mothers and sick
infants during the transition to parenthood. Education for NICU parents
should be done for both mothers and fathers in the acute postpartum period.
Keywords: education; intensive care units; neonatal; parenting; premature
infant; stress
Sadatoshi Matsuoka, Hirotsugu Aiga, Lon Chan Rasmey, Tung Rathavy, Akiko
Okitsu, Perceived barriers to utilization of maternal health services in
rural Cambodia, Health Policy, Volume 95, Issues 23, May 2010, Pages 255-
263, ISSN 0168-8510, 10.1016/j.healthpol.2009.12.011.
Abstract: Objective
The aim of this study was to identify the underlying causes of Cambodian
women's non-use of maternal health services provided by skilled birth
attendants.
Method
A qualitative study of 66 reproductive-age women was conducted in Kampong
Cham Province, Cambodia. Data were collected through 30 semi-structured
interviews and 6 focus groups.
Results
We identified 5 barriers to the utilization of maternal health services:
(i) financial barriers; (ii) physical barriers; (iii) cognitive barriers;
(iv) organizational barriers; and (v) psychological and socio-cultural
barriers.
Conclusions
The Cambodian Ministry of Health and its development partners should take
these barriers into account when promoting the use of maternal health
services. These barriers should be addressed proactively. A successful
approach to increasing use of maternal health services should involve
changes to both service programs and public education.
Keywords: Cambodia; Maternal health services; Health seeking behaviour;
Barriers to health services; Qualitative study
Leon Speroff, Daniel R. Mishell Jr., The postpartum visit: it's time for a
change in order to optimally initiate contraception, Contraception, Volume
78, Issue 2, August 2008, Pages 90-98, ISSN 0010-7824,
10.1016/j.contraception.2008.04.005.
Nicole L. Letourneau, Miriam J. Stewart, Alison K. Barnfather, Adolescent

mothers: Support needs, resources, and support-education interventions,
Journal of Adolescent Health, Volume 35, Issue 6, December 2004, Pages 509-
525, ISSN 1054-139X, 10.1016/j.jadohealth.2004.01.007.
Abstract: Adolescent mothers are prone to live in poor conditions, lack
adequate financial resources, suffer high stress, encounter family
instability, and have limited educational opportunities. These factors
contribute to inadequate parent-child interactions and diminished infant
development. Social support can promote successful adaptation for
adolescent mothers and their children. This review article describes the
support needs and challenges faced by adolescent parents and their
children, the support resources available to and accessed by adolescent
parents, and existing support-education intervention studies, to provide
directions for future research. Relevant research published between January
1982 and February 2003 was obtained from online database indices and
retrieved article bibliographies. Frequently encountered problems included
small sample sizes and attrition, lack of suitable comparison groups, and
measurement inconsistencies. When planning support-education interventions,
content, duration, intensity, mode, level, intervention agents, and targets
should be considered. Future research can address these challenges.
Keywords: Adolescent parents; Support needs; Support resources; Support-
education interventions
Sina Haeri, Gary A. Dildy III, Maternal Mortality From Hemorrhage, Seminars
in Perinatology, Volume 36, Issue 1, February 2012, Pages 48-55, ISSN 0146-
0005, 10.1053/j.semperi.2011.09.010.
Abstract: Hemorrhage remains as one of the top 3 obstetrics related causes
of maternal mortality, with most deaths occurring within 24-48 hours of
delivery. Although hemorrhage related maternal mortality has declined
globally, it continues to be a vexing problem. More specifically, the
developing world continue to shoulder a disproportionate share of
hemorrhage related deaths (99%) compared with industrialized nations (1%).
Given the often preventable nature of death from hemorrhage, the
cornerstone of effective mortality reduction involves risk factor
identification, quick diagnosis, and timely management. In this monograph
we will review the epidemiology, etiology, and preventative measures
related to maternal mortality from hemorrhage.
Keywords: hemorrhage; pregnancy; maternal; mortality; morbidity
S. Bhattacharya, J. Tucker, Maternal Health Services, In: Editor-in-

Chief: Kris Heggenhougen, Editor(s)-in-Chief, International Encyclopedia
of Public Health, Academic Press, Oxford, 2008, Pages 210-221, ISBN
9780123739605, 10.1016/B978-012373960-5.00522-0.
Abstract: This article describes the objectives, scope, and organization of
maternity services during the antenatal, intranatal, and postnatal periods
in developing and developed countries. It also discusses the epidemiology
and sociodemographic determinants of maternal mortality and morbidity and
reviews some relevant issues such as utilization and financing of maternity
services. Finally, it discusses some of the challenges of providing
comprehensive maternity services and the implications for health policy.
Keywords: Antenatal; Health services; Intrapartum; Maternal mortality;
Maternity; Perinatal mortality; Postnatal
Julie M. Turner-Cobb, Psychological and neuroendocrine correlates of

disease progression, In: A. Clow and F. Hucklebridge, Editor(s),
International Review of Neurobiology, Academic Press, 2002, Volume 52,
Pages 353-381, ISSN 0074-7742, ISBN 9780123668530, 10.1016/S0074-
7742(02)52016-X.
Heather O'Mahen, Gina Fedock, Erin Henshaw, Joseph A. Himle, Jane Forman,
Heather A. Flynn, Modifying CBT for Perinatal Depression: What Do Women
Want?: A Qualitative Study, Cognitive and Behavioral Practice, Volume 19,
10.1016/j.cbpra.2011.05.005.
Abstract: The evidence for the efficacy of CBT for depression during the
perinatal period is mixed. This was a qualitative study that aimed to
understand the perinatal-specific needs of depressed women in an effort to
inform treatment modifications that may increase the relevance and
acceptability of CBT during this period. Stratified purposeful sampling
resulted in 23 participants selected by pregnancy, socioeconomic, and
depression status. Participants completed semistructured interviews
exploring their experiences of pregnancy and the postpartum period and its
relationship to mood, and perspectives on ideal treatment content. Thematic
analysis revealed a number of perinatal-specific themes that were relevant
to CBT in three key domains: self, motherhood, and interpersonal. Mothers
particularly struggled with: internalization of motherhood myths, self-
sacrifice, and managing social support during this period. Shifts in
women's themes across the perinatal period, and between racial and
socioeconomic groups are discussed as are implications for modification of
CBT to improve relevance for perinatal depression.
Keywords: pregnancy; postpartum; antenatal; cognitive behavioral therapy;
treatment
Michael Baker, Kevin Milligan, Maternal employment, breastfeeding, and

health: Evidence from maternity leave mandates, Journal of Health
Economics, Volume 27, Issue 4, July 2008, Pages 871-887, ISSN 0167-6296,
10.1016/j.jhealeco.2008.02.006.
Abstract: Public health agencies around the world have renewed efforts to
increase the incidence and duration of breastfeeding. Maternity leave
mandates present an economic policy that could help achieve these goals. We
study their efficacy, focusing on a significant increase in maternity leave
mandates in Canada. We find very large increases in mothers time away from
work post-birth and in the attainment of critical breastfeeding duration
thresholds. We also look for impacts of the reform on self-reported
indicators of maternal and child health captured in our data. For most
indicators we find no effect.
Keywords: Maternity leave; Maternal employment; Breastfeeding; Child health
Yuri Sasaki, Moazzam Ali, Kazuhiro Kakimoto, Ou Saroeun, Koum Kanal, Chushi
Kuroiwa, Predictors of Exclusive Breast-Feeding in Early Infancy: A Survey
Report from Phnom Penh, Cambodia, Journal of Pediatric Nursing, Volume 25,
Issue 6, December 2010, Pages 463-469, ISSN 0882-5963,
10.1016/j.pedn.2009.04.010.
Exclusive breast-feeding (EBF) is recommended in the first 6 months of an
infant's life. This study aims to investigate the present status of infant
feeding practices and identify factors that affect EBF practices during the
first 6 months following infant birth in Phnom Penh, Cambodia.
Methods
A cross-sectional survey with a semistructured questionnaire was given to
312 mothers with children aged 6 to 24 months who visited the immunization
clinic in the National Maternal and Child Health Centre in Phnom Penh,
Cambodia, from December 2005 to February 2006.
Results
Eighty-three percent of mothers fed breast milk exclusively in the first
month, whereas only 51.3% continued EBF in the first 6 months. Within 30
minutes after delivery, 39% of mothers began breast-feeding. Results from
logistic regression analysis indicate that the lack of a maternal antenatal
EBF plan (odds ratio [OR] = 10.01, 95% confidence interval [CI] = 3.68
27.24, p < .001), working mothers (OR = 4.71, 95% CI = 2.778.01, p <
.001), and lack of paternal attendance at breast-feeding classes (OR =
1.93, 95% CI = 1.133.28, p < .05) have independently positive
associations with cessation of EBF during the first 6 months of infant
life.
Conclusion
The findings have helped to identify some important factors affecting EBF
practices in the study area in Cambodia. The findings revealed that it is
important to educate pregnant mothers, probably through exposure to trained
midwives and media, so they may recognize the significance of EBF and will
develop intention and plan to feed their babies, keeping in mind the
benefits it may yield. Paternal involvement in breast-feeding classes may
increase their awareness and consequently complement EBF practices.
Finally, development of conducive working environments and policies for
working mothers should be carefully explored because it could have positive
influence in better care and promotion of EBF.
Keywords: Antenatal feeding plan; Breast-feeding education; Exclusive
breast-feeding (EBF); Paternal involvement; Working mothers; Cambodia
Chelsea M. Weaver, Daniel S. Shaw, Thomas J. Dishion, Melvin N. Wilson,

Parenting self-efficacy and problem behavior in children at high risk for
early conduct problems: The mediating role of maternal depression, Infant
Behavior and Development, Volume 31, Issue 4, December 2008, Pages 594-605,
ISSN 0163-6383, 10.1016/j.infbeh.2008.07.006.
Abstract: Parenting self-efficacy (PSE) has been positively linked to
children's adjustment and negatively associated with maternal depression.
However, most PSE research has been cross-sectional, limited to
predominantly white, middle-class samples, and has not examined potential
mechanisms underlying associations of PSE with children's behavior. The
present study investigates: (1) how PSE changes over time, (2) the
relationship between age 2 PSE and children's behavior problems 2 years
later, and (3) the potential mediating role of maternal depression in
relation to the association between PSE and child problem behavior.
Participants are 652 ethnically and geographically diverse mothers and
their children, at high risk for conduct problems. PSE increased between
ages 2 and 4 and higher initial levels predicted lower caregiver-reported
age 4 conduct problems after controlling for problem behavior at age 2. The
relationship between PSE and later conduct problems was mediated, however,
by maternal depression. These findings suggest maternal depression as a
potential disruptor of caregiver confidence in early childhood, which has
implications for the design and focus of parenting interventions.
Keywords: Parenting self-efficacy; Child problem behavior; Early childhood;
Maternal depression
Neriman Sogukpinar, Birsen K. Saydam, zlem D. Bozkurt, Hafize Ozturk,
Aytl Pelik, Past and present midwifery education in Turkey, Midwifery,
Volume 23, Issue 4, December 2007, Pages 433-442, ISSN 0266-6138,
10.1016/j.midw.2007.01.011.
Abstract: Among criteria relating to the level of development in a country
are health indicators such as total fertility, maternal mortality, infant
mortality, and rates of life expectancy at birth. These have a close
relationship with the quality of health-care services, especially those
provided by midwives. An improvement in midwifery services can be achieved
to a great extent by standardised and high-quality midwifery education.
Until recently, midwifery education has not been standardised in Turkey.
Although improvements have been made, more needs to be accomplished. In
this paper, we report the development of midwifery education in Turkey from
a historical perspective, dealing with past and present applications, and
make recommendations to overcome existing problems.
Keywords: Midwifery; Midwifery education; Turkey; History of Midwifery
Masumi Imura, Hanako Misao, Hiroshi Ushijima, The Psychological Effects of

Aromatherapy-Massage in Healthy Postpartum Mothers, Journal of Midwifery
& Women's Health, Volume 51, Issue 2, MarchApril 2006, Pages e21-e27,
ISSN 1526-9523, 10.1016/j.jmwh.2005.08.009.
Abstract: This study examined the effect of aromatherapy-massage in healthy
postpartum mothers. A quasi-experimental between-groups design was used.
Mothers who received aromatherapy-massage were compared with a control
group who received standard postpartum care. Thirty-six healthy, first-time
mothers with vaginal delivery of a full-term, healthy infant participated
in this study. Sixteen mothers received a 30-minute aromatherapy-massage on
the second postpartum day; 20 mothers were in the control group. All
mothers completed the following four standardized questionnaires before and
after the intervention: 1) Maternity Blues Scale; 2) State-Trait Anxiety
Inventory; 3) Profile of Mood States (POMS); and 4) Feeling toward Baby
Scale. In the aromatherapy-massage group, posttreatment scores
significantly decreased for the Maternity Blues Scale, the State-Anxiety
Inventory, and all but one of the Profile of Mood States subscales.
Posttreatment scores in the intervention group significantly increased in
Profile of Mood States-Vigor subscale and the Approach Feeling toward Baby
subscale. Scores in the intervention group significantly decreased in
Conflict Index of Avoidance/Approach Feeling toward Baby subscale. Our
results suggest that aromatherapy-massage might be an effective
intervention for postpartum mothers to improve physical and mental status
and to facilitate mother-infant interaction.
Keywords: puerperium; mothers; aromatherapy; massage; anxiety; depression;
mother-child relations; clinical trial
Michael H. Antoni, Neil Schneiderman, Frank Penedo, Chapter 32 - Behavioral

Interventions: Immunologic Mediators and Disease Outcomes, In: Robert Ader,
Editor(s), Psychoneuroimmunology (Fourth Edition), Academic Press,
Burlington, 2007, Pages 675-703, ISBN 9780120885763, 10.1016/B978-
012088576-3/50038-1.
Abstract: Behavioral interventions are the mainstay of the biobehavioral
arsenal used to prevent the development of disease, and to foster
adaptation to the stress of diagnosis and treatment for major conditions
including cancers, cardiovascular disease, and immunologic disorders such
as Acquired Immune Defi ciency Syndrome (AIDS). There is growing interest
in the question of whether the effects of these interventions in diagnosed
patients may extend beyond improving adjustment and quality of life (QOL)
to the possibility of improving health outcomes including decreased risk of
recurrence and slowed disease progression. In the interest of exploring the
mechanisms underlying these effects, there has accumulated a small but
important empirical base demonstrating that behavioral interventions may
also modulate immune system functioning by modifying stress responses and
negative mood states. The major behavioral interventions directed toward
disease management are those designed to reduce anxiety, depressed affect,
hostility, and stress/distress; modify cognitive appraisals about stress
and disease; teach new behavioral and interpersonal coping skills; and
provide social support.
Emily Hannum, Claudia Buchmann, Global Educational Expansion and Socio-

Economic Development: An Assessment of Findings from the Social Sciences,
World Development, Volume 33, Issue 3, March 2005, Pages 333-354, ISSN
0305-750X, 10.1016/j.worlddev.2004.10.001.
Abstract: Summary
Among development agencies, conventional wisdom holds that educational
expansion improves economic welfare and health, reduces inequalities, and
encourages democratic political systems. We investigate the empirical
foundations for these expectations in recent social science research.
Consistent evidence indicates that health and demographic benefits result
from educational expansion, and suggests that education enhances, but does
not ensure, individuals economic security. However, the impact of
educational expansion on growth remains debated, and decades of
sociological studies offer evidence that educational expansion does not
necessarily narrow social inequalities. Finally, considerable controversy
surrounds the implications of educational expansion for democratization.
Reasonable forecasts of the consequences of further educational expansions
need to consider the diverse social contexts in which these expansions will
occur.
Keywords: health; growth; poverty; inequality; demographic change;
democratization
Julie Jomeen, The importance of assessing psychological status during

pregnancy, childbirth and the postnatal period as a multidimensional
construct: A literature review, Clinical Effectiveness in Nursing, Volume
8, Issues 34, SeptemberDecember 2004, Pages 143-155, ISSN 1361-9004,
10.1016/j.cein.2005.02.001.
Abstract: Summary
This paper presents a comprehensive review of the literature surrounding
womens psychological health in pregnancy, childbirth and the postnatal
periods. The content will provide clinically useful information to midwives
and health care professionals involved in caring for women during the
antenatal, intranatal and postnatal periods. The impact of psychological
health status in pregnancy on clinical outcomes such as preterm labour,
pre-eclampsia, epidural use, caesarean section, instrumental deliveries and
increased rates of admission to neonatal intensive care, alongside the
cognitive and social development of the infant and child are well
documented. Less research to date has considered the impact of
psychological well-being on the mother throughout pregnancy, the
peripartum, postpartum and beyond. Psychological status for these women has
traditionally been characterised by anxiety and depression, largely
ignoring the complex psychological interrelations that characterise
pregnancy. Psychological status in pregnancy cannot be defined within a
unidimensional framework but must include a comprehensive assessment of all
the dimensions that attribute to mood and emotional status for women during
pregnancy, childbirth and the postnatal period. This paper intends to
address the constructs of anxiety and depression, worry, control, quality
of life, sleep and self-esteem. Screening for, and identification of,
maternal psychological distress from a multidimensional perspective enables
healthcare professionals to recognise and acknowledge normal and abnormal
adjustment and offer interventions, strategies and support to facilitate a
womans transition to motherhood.
Keywords: Pregnancy; Psychological status; Maternity care
Jasmeet Soar, Gavin D. Perkins, Gamal Abbas, Annette Alfonzo, Alessandro

Barelli, Joost J.L.M. Bierens, Hermann Brugger, Charles D. Deakin, Joel
Dunning, Marios Georgiou, Anthony J. Handley, David J. Lockey, Peter Paal,
Claudio Sandroni, Karl-Christian Thies, David A. Zideman, Jerry P. Nolan,
European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.
Cardiac arrest in special circumstances: Electrolyte abnormalities,
poisoning, drowning, accidental hypothermia, hyperthermia, asthma,
anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution,
Resuscitation, Volume 81, Issue 10, October 2010, Pages 1400-1433, ISSN
0300-9572, 10.1016/j.resuscitation.2010.08.015.
Grgoire Lagger, Zoltan Pataky, Alain Golay, Efficacy of therapeutic

patient education in chronic diseases and obesity, Patient Education and
Counseling, Volume 79, Issue 3, June 2010, Pages 283-286, ISSN 0738-3991,
10.1016/j.pec.2010.03.015.
Abstract: Objective
To evaluate the clinical, methodological and reporting aspects of
systematic reviews and meta-analyses in order to determine the efficacy of
therapeutic patient education (TPE).
Methods
A thorough search of the medical and nursing literature recorded in MedLine
database from 1999 to August 2009 was conducted using the keywords: patient
education, efficacy, diabetes, asthma, COPD, hypertension, cardiology,
obesity, rheumatology, and oncology.
Results
Thirty five relevant meta-analyses were identified and initially selected
for critical analyses (598 studies concerning approximately 61,000
patients). The detailed description of the educative intervention was
present in 4% of articles whereas in 23% the interventions were briefly
described. In the majority of studies, the educative interventions were
only named (49%) or totally absent (24%).
The majority of studies reported improvement of patient outcomes due to the

TPE (64%), 30% of studies reported no effect of TPE and 6% of the analysed
reviews and meta-analyses reported worsening of measured outcomes.
Conclusion
Patient education could improve patient outcomes. The high benefit from TPE
was shown by articles with detailed description of educational intervention
as well as by those who report multidimensional and multidisciplinary
educational intervention.
Practice implications
The impact of therapeutic patient education on health outcomes is 5080%.
Keywords: Patient education; Efficacy; Systematic review; Meta-analysis
Barbara E Kwast, Joan Bentley, Introducing confident midwives: Midwifery

education action for safe motherhood, Midwifery, Volume 7, Issue 1, March
1991, Pages 8-19, ISSN 0266-6138, 10.1016/S0266-6138(05)80129-9.
Abstract: The present crisis in midwifery and the seriousness of maternal
mortality and morbidity demands a rethink about the background and training
requirements of each level of midwifery worker. This paper describes the
background of the present shortage and mal-distribution of midwives. The
reduction of maternal mortality by 50% at the turn of this century requires
the development of a maternal health care team in which the midwife
functions as the linchpin. In order to equip the midwife for the leadership
functions in this team, the present educational system needs to be
fundamentally improved. The rationale for the acquisition of
epidemiological, managerial specialised technical and teaching skills by
midwives is discussed. Implications for futher education are high-lighted.
Collaborative actions taken by the WHO, ICM, UNICEF and other governmental
and non-governmental agencies to address the issue of midwifery are
outlined.
This paper was given at the 1990 ICM, WHO, UNICEF Pre-Congress Workshop on
Midwifery Education Action for Safe Motherhood in Kobe, Japan.
Sydney L. Hans, Victor J. Bernstein, Candice Percansky, Adolescent

parenting programs: Assessing parent-infant interaction, Evaluation and
Program Planning, Volume 14, Issues 12, 1991, Pages 87-95, ISSN 0149-7189,
10.1016/0149-7189(91)90042-F.
(http://www.sciencedirect.com/science/article/pii/014971899190042F)
Abstract: With the increasing awareness that the offspring of adolescent
parents are at high risk for developmental problems, programs serving
adolescent parents are introducing services designed to improve the quality
of interaction between adolescent mothers and their infants. Since most
program planners and evaluation researchers have had little training or
experience in the highly specialized field of parent-infant interaction,
this paper will provide orientation to some academic and applied issues in
this area. First we will give evidence documenting the key role that the
parent-infant relationship plays as a foundation for the child's later
developmentand in particular the evidence suggesting that adolescent
parent-infant relationships place the child at risk. Second, by drawing
upon experiences with the Ounce of Prevention Fund adolescent parenting
programs, we will describe some of the challenges in selecting a parent-
infant interaction assessment instrument for use in community-based
programs.
Ann Olsson, Eva Robertson, Katarina Falk, Eva Nissen, Assessing women's
sexual life after childbirth: the role of the postnatal check, Midwifery,
10.1016/j.midw.2009.04.003.
Abstract: Objective
to describe midwives reflections on counselling women at the postnatal
check with special focus on sexual life after childbirth.
Design
qualitative descriptive study with focus group discussions as the method of
data collection.
Setting
antenatal clinics in Stockholm greater catchments area.
Participants
during 2006 and 2007, a voluntary sample of midwives from 10 different
antenatal clinics were invited.
Analysis
content analysis was undertaken through identification of codes, categories
and themes.
Findings
Two themes emerged: balancing between personal perceptions of the woman's
needs and the health system restrictions and strategies for counselling
about sexual life after childbirth. The midwives tried to create a picture
for themselves of the woman coming for the postnatal check and her needs
before the consulation. This picture guided the midwives, but lack of time
and knowledge restricted them when counselling on sexual life after
childbirth. Two different strategies in counselling were identified, one
task-oriented and one subject-oriented. Demands and time restrictions led
midwives to distance themselves from their clients. A task-oriented
approach was more visible in midwives encounters with foreign-born women,
where linguistic difficulties, cultural diversity and narrow time frames
restricted the midwives effectiveness and/or sensitivity as caregivers. In
contrast, the subject-oriented strategy meant getting in tune, i.e.
listening to the woman when she expressed her feelings and emotions,
encouraging the woman to be an active participant in decisions involving
her care. This strategy is used for women who arouse midwives empathy and
when there is some form of recognition and understanding.
Conclusion
The picture created of the woman and her needs guided the midwives, but
lack of knowledge and time limitations restricted counselling on sexual
life after childbirth. Two counselling strategies were identified, one
task-oriented and one subject-oriented. Balancing these two counselling
strategies improves both the ethical aspects and the quality of the
counselling.
Keywords: Postnatal visit; Sexual life; Midwifery care; Focus group
S. Miller, M. Cordero, A.L. Coleman, J. Figueroa, S. Brito-Anderson, R.

Dabagh, V. Calderon, F. Cceres, A.J. Fernandez, M. Nunez, Quality of care
in institutionalized deliveries: the paradox of the Dominican Republic,
July 2003, Pages 89-103, ISSN 0020-7292, 10.1016/S0020-7292(03)00148-6.
Abstract: Objectives: To better understand the paradox in the Dominican
Republic of a relatively high maternal mortality ratio despite nearly
universal institutionalized deliveries with trained attendants, a rapid
assessment using an adaptation of the strategic assessment method was
conducted. Methods: A multi-disciplinary team reviewed national statistics
and hospital records, inventoried facilities, and observed peripartum
clientprovider interactions at 14 facilities. Results: The major referral
hospitals, where more than 40% of births in the country occur, were
overcrowded and understaffed, with inexperienced residents overseeing care
provided by medical students, interns and nurses. Uncomplicated labor and
deliveries were overmedicalized, while complicated ones were not managed
appropriately; emergencies were not dealt with in a timely fashion. In the
peripheral hospitals physicians were seldom present and clients were either
turned away or delivered by unprepared nursing staff. Providers in the
busiest facilities suffered from compassion fatigue, and were demoralized
and overworked. In all facilities, quality of care was lacking and the
delivery and birthing process was dehumanized. Conclusions: Access and
availability of institutional delivery alone is not enough to decrease MMR,
it is also the quality of emergency obstetric care that saves lives.
Keywords: Maternal mortality; Emergency obstetric care; Quality of care
Susanne Steinberg, Laurence Kruckman, Stephanie Steinberg, Reinventing

fatherhood in Japan and Canada, Social Science & Medicine, Volume 50,
Issue 9, May 2000, Pages 1257-1272, ISSN 0277-9536, 10.1016/S0277-
9536(99)00368-8.
Abstract: This article summarizes the findings of a transnational study of
Japanese and Canadian families. Fathers' perceptions are presented for a
critical developmental phase of life: pregnancy, labor, birth, the early
and late postpartum periods. Using qualitative and quantitative research
methods, 33 fathers and 194 mothers were interviewed: Japanese in Tokyo and
Montreal, and English and French Canadians in Montreal. In addition, the
study examines the impact of pregnancy and birth on the relationship of
marriage. The results suggest that the social meaning of fatherhood has
been transformed, legitimizing the presence of the father in the domestic
sphere as a consequence of shifting extended family household structures,
economic conditions and the empowerment of women. Other significant
(p<0.05) patterns were identified. (1) Canadian fathers participate in
labor and delivery to a higher degree than Japanese fathers in Montreal and
Tokyo do (mothers in Tokyo felt more isolated). (2) Canadian men (60%) are
more likely to take time off from work during this phase than the Japanese.
(3) Overall, the majority of fathers, in all four groups, cared for the
child to a higher degree than expected and (4). Birth and early child
rearing appears to have a significant impact on marriage in all four
groups. Public policy issues are addressed and potential responses
provided.
Keywords: Fatherhood; Birth; Postpartum; Social support; In-laws
Nathalie Kapp, Kathryn Curtis, Kavita Nanda, Progestogen-only contraceptive

use among breastfeeding women: a systematic review, Contraception, Volume
82, Issue 1, July 2010, Pages 17-37, ISSN 0010-7824,
10.1016/j.contraception.2010.02.002.
The use of progestogen-only contraceptives by breastfeeding women raises
theoretical concerns regarding possible adverse effects on breastfeeding
success, and infant health or growth. This review was conducted to
determine from the literature whether use of progestogen-only
contraceptives by breastfeeding women leads to adverse effects on
lactation, or infant growth or health when compared to nonuse.
Study Design
We searched the Medline, Popline, Cochrane and LILACS databases for all
articles published from database inception through May 2009. Studies were
included if they investigated the use of progestogen-only methods in
breastfeeding women and reported on clinical outcomes in either women or
their infants. Standard data abstraction templates were used to
systematically assess and summarize. Summary odds ratios were not
calculated, given the heterogeneity of interventions, results and non-
quantifiable outcomes reported.
Results
We identified 43 articles for this review. Overall, five randomized trials
and 38 observational studies demonstrated no adverse effects of various
progestogen-only methods of contraception on multiple measures of
breastfeeding performance through 12 months in women using these methods in
the postpartum period. Many of these studies also demonstrated no adverse
effects of progestogen-only methods on infant growth, health or development
from 6 months to 6 years of age. Additional studies demonstrated no effects
on infant immunoglobulins or sex hormones of exposed male infants. A single
study of a desogestrel pill reported two cases of gynecomastia in exposed
infants.
Conclusions
Evidence suggests that progestogen-only methods of contraception do not
adversely affect breastfeeding performance when used during lactation.
Evidence that progestogen-only contraception does not adversely affect
infant growth, health, or development when used by breastfeeding women is
consistent but methodologically limited.
Keywords: Breastfeeding; Lactation; Postpartum contraception; Progestogen-
only contraception
John T. Walkup, Allison Barlow, Britta C. Mullany, William Pan, Novalene

Goklish, Ranelda Hasting, Brandii Cowboy, Pauline Fields, Elena Varipatis
Baker, Kristen Speakman, Golda Ginsburg, Raymond Reid, Randomized
Controlled Trial of a Paraprofessional-Delivered In-Home Intervention for
Young Reservation-Based American Indian Mothers, Journal of the American
Academy of Child & Adolescent Psychiatry, Volume 48, Issue 6, June
2009, Pages 591-601, ISSN 0890-8567, 10.1097/CHI.0b013e3181a0ab86.
Abstract: Objective
To evaluate the efficacy of a paraprofessional-delivered, home-visiting
intervention among young, reservation-based American Indian (AI) mothers on
parenting knowledge, involvement, and maternal and infant outcomes.
Method
From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were
randomized (1:1) to one of two paraprofessional-delivered, home-visiting
interventions: the 25-visit Family Spirit intervention addressing
prenatal and newborn care and maternal life skills (treatment) or a 23-
visit breast-feeding/nutrition education intervention (active control). The
interventions began during pregnancy and continued to 6 months postpartum.
Mothers and children were evaluated at baseline and 2, 6, and 12 months
postpartum. Primary outcomes included changes in mothers' parenting
knowledge and involvement. Secondary outcomes included infants' social and
emotional behavior; the home environment; and mothers' stress, social
support, depression, and substance use.
Results
Participants were mostly teenaged, first-time, unmarried mothers living in
reservation communities. At 6 and 12 months postpartum, treatment mothers
compared with control mothers had greater parenting knowledge gains, 13.5
(p < .0001) and 13.9 (p < .0001) points higher, respectively (100-
point scale). At 12 months postpartum, treatment mothers reported their
infants to have significantly lower scores on the externalizing domain ( =
.17, p < .05) and less separation distress in the internalizing domain
( = .17, p < .05). No between-group differences were found for
maternal involvement, home environment, or mothers' stress, social support,
depression, or substance use.
Conclusions
This study supports the efficacy of the paraprofessional-delivered Family
Spirit home-visiting intervention for young AI mothers on maternal
knowledge and infant behavior outcomes. A longer, larger study is needed to
replicate results and evaluate the durability of child behavior outcomes.
J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):591-601.
Keywords: American Indian; home visiting; parenting; infant development
Charles D. Deakin, Laurie J. Morrison, Peter T. Morley, Clifton W.

Callaway, Richard E. Kerber, Steven L. Kronick, Eric J. Lavonas, Mark S.
Link, Robert W. Neumar, Charles W. Otto, Michael Parr, Michael Shuster,
Kjetil Sunde, Mary Ann Peberdy, Wanchun Tang, Terry L. Vanden Hoek, Bernd
W. Bttiger, Saul Drajer, Swee Han Lim, Jerry P. Nolan, on behalf of the
Advanced Life Support Chapter Collaborators, Part 8: Advanced life support:
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations, Resuscitation,
Volume 81, Issue 1, Supplement, October 2010, Pages e93-e174, ISSN 0300-
9572, 10.1016/j.resuscitation.2010.08.027.
Jeanne Raisler, Jonathan Cohn, Mothers, Midwives, and HIV/AIDS in Sub-

Saharan Africa, Journal of Midwifery & Women's Health, Volume 50, Issue
4, JulyAugust 2005, Pages 275-282, ISSN 1526-9523,
10.1016/j.jmwh.2005.03.021.
Abstract: This article reviews clinical and program issues in the
prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan
Africa. Topics include prevention of infection, voluntary counseling and
testing, prenatal care, labor and birth, postpartum, family planning,
infant feeding, and the role of traditional birth attendants. Programs
providing short-course antiretroviral therapy to prevent infant infection
are contrasted with comprehensive programs offering antiretroviral therapy
and medical care to mothers, children, and families. Feminization of the
epidemic is related to gender inequalities that facilitate the spread of
HIV and make pregnant women an especially vulnerable group. Nurses and
midwives are the primary health care providers for most of the population
in sub-Saharan Africa. They are the backbone of the new PMTCT programs and
will be the largest group of health workers available to diagnose and treat
opportunistic infections and dispense antiretroviral therapy. But they have
received little training and support to provide AIDS care and treatment and
are rarely consulted when plans are made about workforce issues and
capacity development in the health sector. Clinical training, leadership
skills, salary support, expansion of the nursing workforce, and development
of expanded roles for nurses and midwives in AIDS care are needed to help
them turn the tide of the epidemic.
Keywords: HIV/AIDS; midwifery care; maternal to child transmission
Huynh Nhu Le, Michelle A. Ramos, Ricardo F. Muoz, The relationship between
alexithymia and perinatal depressive symptomatology, Journal of
Psychosomatic Research, Volume 62, Issue 2, February 2007, Pages 215-222,
ISSN 0022-3999, 10.1016/j.jpsychores.2006.09.012.
Abstract: Objective
The purpose of this study was to examine the relationship between
alexithymia and perinatal depressive symptoms and the stability of the
alexithymia construct in a sample of low-income, predominantly Latina women
during pregnancy and the early postpartum period.
Methods
Seventy-seven pregnant women completed self-report questionnaires and were
classified as high risk or low risk for developing a major depressive
episode based on a history of depression and/or current high depressive
symptom scores. Measures included the Toronto Alexithymia Scale, the Center
for Epidemiological Studies Depression Scale, and the Maternal Mood
Screener, and were completed during pregnancy and at postpartum month 2.
Results
Alexithymia was positively associated with depressive symptoms during
pregnancy and early postpartum. Women at high risk for depression had
significantly higher alexithymia levels than low-risk women during
pregnancy but not during postpartum. Alexithymia and depressive symptoms
were independently and strongly correlated across the ante- and postpartum
periods. Hierarchical regression analyses indicate that alexithymia scores
at postpartum were predicted by alexithymia scores during pregnancy, above
and beyond the variance explained by the depressive symptom scores during
pregnancy and postpartum.
Conclusion
Alexithymia is positively correlated with depressive symptoms during the
perinatal period and is a stable phenomenon.
Keywords: Alexithymia; Depression; Pregnancy; Postpartum
Mary Philip Sebastian, M.E. Khan, Sohini Roychowdhury, Promoting healthy

spacing between pregnancies in India: Need for differential education
campaigns, Patient Education and Counseling, Volume 81, Issue 3, December
2010, Pages 395-401, ISSN 0738-3991, 10.1016/j.pec.2010.10.019.
Abstract: Objective Birth spacing intervals are relatively short in India.
Healthy spacing of 35 years between births is an effective way to prevent
maternal and child mortality and morbidities. Socio-cultural and structural
barriers, including limited awareness, socio-cultural norms, and
misconceptions need to be addressed for behavior change. Hence the
objective was to understand these barriers and accordingly develop separate
messages for young women, her husband and her mother-in-law.
Methods Data were collected from young women, husbands and mothers-in-law
using qualitative methods. Altogether 16 Focus Group Discussions and 30 in-
depth interviews were conducted. Beliefs related to need of spacing,
disadvantages of closely spaced pregnancies and messages considered
suitable for different stakeholders were investigated. Messages were
identified for women, husband and mother-in-law; communication aids
prepared and community workers trained to appropriately communicate the
messages to stakeholders. Quantitative data were collected to measure the
effect of the intervention.
Results Educational campaign resulted in higher use of contraceptives for

spacing among registered pregnant women from experimental area compared to
control area.
Conclusion Differential audience specific educational campaign is feasible

and effective.
Practice implications For an effective communication in the community,

workers should know how exactly to convey the different health messages to
different target population.
Keywords: Communication; Reproductive health; Birth spacing; Education
campaign; Qualitative research
Sereen Thaddeus, Deborah Maine, Too far to walk: Maternal mortality in

context, Social Science & Medicine, Volume 38, Issue 8, April 1994,
Pages 1091-1110, ISSN 0277-9536, 10.1016/0277-9536(94)90226-7.
Abstract: The Prevention of Maternal Mortality Program is a collaborative
effort of Columbia University's Center for Population and Family Health and
multidisciplinary teams of researchers from Ghana, Nigeria and Sierra
Leone. Program goals include dissemination of information to those
concerned with preventing maternal deaths. This review, which presents
findings from a broad body of research, is part of that activity.
While there are numerous factors that contribute to maternal mortality, we

focus on those that affect the interval between the onset of obstetric
complication and its outcome. If prompt, adequate treatment is provided,
the outcome will usually be satisfactory; therefore, the outcome is most
adversely affected by delayed treatment. We examine research on the factors
that: (1) delay the decision to seek care; (2) delay arrival at a health
facility; and (3) delay the provision of adequate care.
The literature clearly indicates that while distance and cost are major
obstacles in the decision to seek care, the relationships are not simple.
There is evidence that people often consider the quality of care more
important than cost. These three factorsdistance, cost and qualityalone
do not give a full understanding of decision-making process. Their salience
as obstacles is ultimately defined by illness-related factors, such as
severity. Differential use of health services is also shaped by such
variables as gender and socioeconomic status.
Patients who make a timely decision to seek care can still experience
delay, because the accessibility of health services is an acute problem in
the developing world. In rural areas, a woman with an obstetric emergency
may find the closet facility equipped only for basic treatments and
education, and she may have no way to reach a regional center where
resources exist.
Finally, arriving at the facility may not lead to the immediate

commencement of treatment. Shortages of qualified staff, essential drugs
and supplies, coupled with administrative delays and clinical
mismanagement, become documentable contributors to maternal deaths.
Findings from the literature review are discussed in light of their

implications for programs. Options for health programs are offered and
examples of efforts to reduce maternal deaths are presented, with an
emphasis on strategies to mobilize and adapt existing resources.
Keywords: maternal mortality; obstetric complication; developing countries;
health services utilization
Patrick Casey, Michael Sharp, Frank Loda, Child-health supervision for

children under 2years of age: A review of its content and effectiveness,
The Journal of Pediatrics, Volume 95, Issue 1, July 1979, Pages 1-9, ISSN
0022-3476, 10.1016/S0022-3476(79)80073-6.
Stephanie S. Daniel, Joseph G. Grzywacz, Esther Leerkes, Jenna Tucker, Wen-

Jui Han, Nonstandard maternal work schedules during infancy: Implications
for children's early behavior problems, Infant Behavior and Development,
10.1016/j.infbeh.2008.12.008.
Abstract: This paper examines the associations between maternal nonstandard
work schedules during infancy and children's early behavior problems, and
the extent to which infant temperament may moderate these associations.
Hypothesized associations were tested using data from the National
Institute of Child Health and Human Development (NICHD) Study of Early
Child Care (Phase I). Analyses focused on mothers who returned to work by
the time the child was 6 months of age, and who worked an average of at
least 35 h per week from 6 through 36 months. At 24 and 36 months,
children whose mothers worked a nonstandard schedule had higher
internalizing and externalizing behaviors. Modest, albeit inconsistent,
evidence suggests that temperamentally reactive children may be more
vulnerable to maternal work schedules. Maternal depressive symptoms
partially mediated associations between nonstandard maternal work schedules
and child behavior outcomes.
Keywords: Maternal nonstandard work schedules; Early behavior problems;
Infant temperament; Maternal depressive symptoms
The Transforming Maternity Care Symposium Steering Committee, Peter B.

Angood, Elizabeth Mitchell Armstrong, Diane Ashton, Helen Burstin, Maureen
P. Corry, Suzanne F. Delbanco, Barbara Fildes, Daniel M. Fox, Paul A.
Gluck, Sue Leavitt Gullo, Joanne Howes, R. Rima Jolivet, Douglas W. Laube,
Donna Lynne, Elliott Main, Anne Rossier Markus, Linda Mayberry, Lynn V.
Mitchell, Debra L. Ness, Rachel Nuzum, Jeffrey D. Quinlan, Carol Sakala,
Alina Salganicoff, Blueprint for Action: Steps Toward a High-Quality, High-
Value Maternity Care System, Women's Health Issues, Volume 20, Issue 1,
Supplement, JanuaryFebruary 2010, Pages S18-S49, ISSN 1049-3867,
10.1016/j.whi.2009.11.007.
Abstract: Childbirth Connection hosted a 90th Anniversary national policy
symposium, Transforming Maternity Care: A High Value Proposition, on April
3, 2009, in Washington, DC. Over 100 leaders from across the range of
stakeholder perspectives were actively engaged in the symposium work to
improve the quality and value of U.S. maternity care through broad system
improvement. A multi-disciplinary symposium steering committee guided the
strategy from its inception and contributed to every phase of the project.
The Blueprint for Action: Steps Toward a High Quality, High Value
Maternity Care System, issued by the Transforming Maternity Care Symposium
Steering Committee, answers the fundamental question,
Who needs to do what, to, for, and with whom to improve the quality of
maternity care over the next five years?
Five stakeholder workgroups collaborated to propose actionable strategies

in 11 critical focus areas for moving expeditiously toward the realization
of the long term 2020 Vision for a High Quality, High Value Maternity Care
System, also published in this issue. Following the symposium these
workgroup reports and recommendations were synthesized into the current
blueprint. For each critical focus area, the Blueprint for Action
presents a brief problem statement, a set of system goals for improvement
in that area, and major recommendations with proposed action steps to
achieve them. This process created a clear sightline to action that if
enacted could improve the structure, process, experiences of care, and
outcomes of the maternity care system in ways that when anchored in the
culture can indeed transform maternity care.
Ana Fonseca, Brbara Nazar, Maria Cristina Canavarro, Parental

psychological distress and quality of life after a prenatal or postnatal
diagnosis of congenital anomaly: A controlled comparison study with parents
of healthy infants, Disability and Health Journal, Volume 5, Issue 2, April
2012, Pages 67-74, ISSN 1936-6574, 10.1016/j.dhjo.2011.11.001.
Parental early adjustment to a prenatal or postnatal diagnosis of
congenital anomaly has been studied mainly within a pathological and
deterministic perspective, giving us an inadequate view of the impact of
the diagnosis.
Objectives
Adopting a comprehensive approach on parental adjustment, we aimed to
characterise the impact of the diagnosis on psychological distress and
quality of life, in the early postdiagnosis stage. The effects of gender
and the timing of the diagnosis were also examined.
Methods
In this cross-sectional study, 42 couples with healthy infants and 42
couples whose infants were prenatal or postnatally diagnosed with a
congenital anomaly responded to the Brief Symptom Inventory-18 and to the
World Health Organization Quality of LifeBrief instrument.
Results
In the early postdiagnosis stage, parents whose infants were diagnosed with
a congenital anomaly presented higher levels of psychological distress than
did the parents of healthy infants (F2,79 = 6.23, p = .003), although they
displayed similar levels of quality of life (F4,78 = 0.62, p = .647).
Mothers reported more adjustment difficulties than fathers in both groups.
Receiving the diagnosis in the prenatal period was associated with higher
maternal psychological quality of life (Z = 2.00, p = .045).
Conclusion
The occurrence of a diagnosis of congenital anomaly during the transition
to parenthood adds to an accumulation of stress-inducing events and
manifests itself in psychopathological symptoms. Maintaining a positive
evaluation of well-being may be understood as a parental resource to deal
with the diagnosis. The importance of adopting a comprehensive perspective
on parental adjustment is highlighted.
Keywords: Parental adjustment; Postnatal diagnosis of congenital anomaly;
Prenatal diagnosis of congenital anomaly; Psychological distress; Quality
of life
Mary E. Young, Maternal health in China - challenges of the next decade,

Health Policy, Volume 14, Issue 2, MarchApril 1990, Pages 87-125, ISSN
0168-8510, 10.1016/0168-8510(90)90369-O.
(http://www.sciencedirect.com/science/article/pii/016885109090369O)
Abstract: In China, about 10 000 women die every year in pregnancy and
childbirth. These women are young, aged 24 to 34. Morbidity among all women
is still high. About one-third of married women surveyed in some regions
have cervicitis or vaginitis. Ninety percent of the total population have
hepatitis A by young adulthood. Because increasing proportions of
pregnancies are first pregnancies, the risks of complications, such as
toxemia and difficult labor, are higher.
Even though there are still wide regional differences in the mortality
rate, from 18 maternal deaths per 100000 live births in Shanghai to 108 in
Ningxia Autonomous Region, China's achievements in reducing the maternal
deaths to levels less than those found in other developing countries are
impressive. China's policy 1960 - 1980 concentrated on providing access to
basic care, including a rapid expansion of a network of maternal and child
health services, a large group of community health workers trained to
provide basic care, drugs, family planning services, and attendance to
deliveries, and the full political support of the government to improve
women's literacy and the Institution of laws increased the minimum legal
age for marriage.
However, the level of maternal mortality has not declined much in the past
nine years. Furthermore, the difference in the level of morbidity and
mortality varies with the economic status of the region and access to
health services. A strategy to improve maternal health would include
developing a comprehensive approach to strengthen the epidemiological,
clinical, and managerial expertise of the health system. Interventions
would also have to be tailored to local health priorities. Most maternal
deaths in rural areas occur at home as a result of hemorrhage. In the
cities, almost all deliveries occur in hospitals, and the major cause of
death is toxemia. Resources can be used better If targeted to programs that
match these problems. The maternal and child health centers must avoid
overexpansion of curative services that duplicate the existing network of
hospital services. Early intervention to decrease the risks of maternal
deaths, such as correcting anemia, providing tetanus toxoid immunization,
and managing excessive weight gain or hypertension, require patient
cooperation and compliance. Thus, health education is necessary to Increase
patients' awareness of the progression of normal pregnancy and the early
signs of risk factors.
Maternal deaths are preventable. So is most of the morbidity related to

pregnancy. To further reduce the maternal mortality rate and reduce
morbidity, China needs to provide basic maternal health care in the poorest
regions, and needs to experiment with innovative planning and management
methods, such as the risk approach, to match Interventions with priority
health problems.
Keywords: Maternal health; Maternal health care; Population policy; One-
child family policy; Rural health care service; Alternative health service
management; China
May Loo, Chapter 10 - Common Pediatric ConditionsEast and West, Pediatric

Acupuncture, Churchill Livingstone, Saint Louis, 2002, Pages 164-317, ISBN
9780443070327, 10.1016/B978-0-443-07032-7.50014-7.
Helen Scholefield, Safety in obstetric critical care, Best Practice &

Research Clinical Obstetrics & Gynaecology, Volume 22, Issue 5, October
2008, Pages 965-982, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.06.009.
Abstract: High-profile inquiries in several countries have helped to raise
public awareness of safety issues and driven policy change. In obstetric
critical care, various publications have highlighted organizational
factors, communication, absence of guidelines, failure to follow local
protocols, poor documentation and delay in identifying the deteriorating
woman as issues. Patient safety in obstetric critical care is paramount
because of its complexity and the vulnerability of the critically ill
patient to error. The principles of risk management and its various
components can be used to make improvements. A framework to achieve this is
as follows: building a safety culture; leading and supporting staff;
integrating risk management activity; promoting reporting; involving and
communicating with patients and the public; learning and sharing safety
lessons; and implementing solutions to prevent harm.
Keywords: patient safety; risk management; human error; risk assessment;
in-service training; guidelines; medical audit; communication
Elisabeth Kurth, Holly Powell Kennedy, Elisabeth Spichiger, Irene Hsli,

Elisabeth Zemp Stutz, Crying babies, tired mothers: What do we know? A
systematic review, Midwifery, Volume 27, Issue 2, April 2011, Pages 187-
194, ISSN 0266-6138, 10.1016/j.midw.2009.05.012.
Abstract: Objective
to synthesise the evidence on the interconnectedness of infant crying and
maternal tiredness in the postpartum period, both from quantitative as well
as from qualitative studies.
Methods
a systematic review was conducted including studies in English, French and
German published from 1980 to 2007. Studies were included in the systematic
review if they had extractable data on infant crying as well as maternal
tiredness in the period of 03 months post partum. Of 100 retrieved
publications, 10 met these criteria.
Findings
evidence from this review indicated that the amount of infant crying during
the first three months postpartum is associated with the experience of
tiredness and fatigue in new mothers. Significant associations were found
in five of six quantitative studies. The four identified qualitative
studies describe how infant crying disrupts new mothers circadian rhythms,
reducing opportunities to rest and exacerbating tiredness. Incremental
exhaustion diminished parents ability to concentrate, raising the fear of
harming their children, triggering depressive symptoms and burdening
parentchild interaction.
if healthcare professionals are to address the prominent concerns of
parents caring for a neonate, it is essential to review current care
practices and tailor them to maternal and infant needs. A care strategy
alleviating the burden of infant crying and maternal fatigue has the
potential to strengthen family health from the earliest stage.
Keywords: Postpartum period; Infant crying; Colic; Postpartum fatigue
M. Carlough, M. McCall, Skilled birth attendance: What does it mean and how
can it be measured? A clinical skills assessment of maternal and child
health workers in Nepal, International Journal of Gynecology &
Obstetrics, Volume 89, Issue 2, May 2005, Pages 200-208, ISSN 0020-7292,
10.1016/j.ijgo.2004.12.044.
Abstract: The presence of a skilled birth attendant at delivery is
important in averting maternal and neonatal mortality and morbidity. It has
now shown that even trained traditional birth attendants (TBAs) cannot, in
most cases, save women's lives effectively because they are unable to treat
complications, and are often unable to refer. Qualified midwives and
doctors are often not available in the rural areas and community settings
where most women in developing countries deliver. Defining the minimum
competency level necessary to meet the definition of skilled birth
attendant is important, particularly in countries such as Nepal with
limited availability of facility-based emergency obstetric care. Maternal
and child health workers are local women aged 1835 who completed a 15-week
course in maternal and child health. As the role of MCHWs has expanded to
meet the country's needs for skilled attendance, a 6-week refresher
course in midwifery skills is offered. The results of this clinical skills
assessment of 104 randomly selected MCHWs from 15 districts across Nepal
supports the premise that MCHWs with appropriate training have an
acceptable level of knowledge and skill, demonstrated in a practice
situation, to meet the definition of community level skilled birth
attendants. Yet, competency alone will not necessarily improve the
situation. To affect maternal mortality in Nepal, MCHWs must be widely
available, they must be allowed to do what they are trained to do, and they
must have logistical and policy support.
Keywords: Skilled birth attendants; Emergency obstetrics; Safe motherhood;
Clinical assessment
Karen McCurdy, The influence of support and stress on maternal attitudes,

Child Abuse & Neglect, Volume 29, Issue 3, March 2005, Pages 251-268,
ISSN 0145-2134, 10.1016/j.chiabu.2004.12.007.
Abstract: Objectives:
This study examines an expanded version of Belsky's (1984) multi-
dimensional process model of parenting to determine whether changes in
stress and support influence maternal attitudes during the first year of a
child's life.
Method:
Data were collected from mothers of newborns eligible for Hawaii's Healthy
Start program who had been randomly assigned to home visitation
(n = 108) or control (n = 104) status. Multiple
regression analyses were used to test hypotheses regarding the influence of
change in contextual sources of support and stress on parenting attitudes
as measured by the Child Abuse Potential Inventory (CAPI) Abuse Scale. A
post hoc analysis of variance was conducted to explore interactions among
the predictor variables and home visitation.
Results:
Stress in the form of change in public assistance status led to more
punitive parenting attitudes while increased support from the partner and
from close associates emerged as significant predictors of less punitive
parental attitudes. The exploratory analyses suggest that home visitation
may moderate the impacts of stress and support on maternal attitudes.
Conclusions:
In line with Belsky's (1984) process model of parenting, increased stress
adversely impacted maternal attitudes regarding physical punishment while
increased support exerted favorable effects. The results also support
further elaboration of Belsky's model including the expansion of marital
support to include unmarried partners and the need to consider the impact
of formal support sources on parenting.
Keywords: Child Abuse Potential Inventory; Home visitation; Maternal social
support; Public assistance; Parenting
Kiki V. Roe, Vocal interchange with mother and stranger as a function of

infant age, sex, and parental education, Early Childhood Research
Quarterly, Volume 5, Issue 1, March 1990, Pages 135-145, ISSN 0885-2006,
10.1016/0885-2006(90)90011-O.
(http://www.sciencedirect.com/science/article/pii/088520069090011O)
Abstract: This study explored whether sex and socio-educational differences
could be detected in young infants' pattern of vocal interaction with
mother and stranger. Sixteen male and 16 female normal infants from either
highly educated or lower educated parents were tested at ages 2 and 3
months at their home. Mother and a female experimenter-stranger each tried
to engage the infant in conversation for 3 min. All vocalizations were
recorded and decoded later. Infants at both ages vocalized more to mother
than stranger. Infants from the higher education group and female infants
(particularly in the higher education group) vocalized significantly more
to mother than to stranger at both ages than both male and female infants
in the lower education group. The results suggest that young infants'
pattern of vocal interaction with mother and stranger, which appears to be
influenced by early environmental factors, may be a meaningful behavior to
discern early group differences in linguistic skills.
Joan Forns, Jordi Julvez, Raquel Garca-Esteban, Mnica Guxens, Muriel

Ferrer, James Grellier, Martine Vrijheid, Jordi Sunyer, Maternal
intelligence-mental health and child neuropsychological development at age
14 months, Gaceta Sanitaria, Available online 28 January 2012, ISSN 0213-
9111, 10.1016/j.gaceta.2011.10.011.
Abstract: Objective
To examine the relationship between maternal intelligence-mental health and
neuropsychological development at age 14 months in a normal population,
taking into account maternal occupational social class and education.
Methods
We prospectively studied a population-based birth cohort, which forms part
of the INMA (Environment and Childhood) Project. Cognitive and psychomotor
development was assessed at 14 months using Bayley Scales of Infant
Development. Maternal intelligence and mental health were assessed by the
Cattell and Cattell test and the General Health Questionnaire-12
respectively.
Results
We observed a crude association between maternal intelligence and cognitive
development in children at 14 months but this association disappeared when
maternal education was included. The associations were stratified by
maternal education and occupational social class. Within the manual
maternal occupational social class, there was a significant difference in
cognitive development between children whose mothers scored in the highest
tertile of maternal IQ and those whose mothers scored in the lowest
tertile. In contrast, no differences were observed among children whose
mothers were in the non-manual occupational social class.
Conclusions
The association between maternal intelligence and child cognitive
development differed by occupational social class. While this association
was not confounded by education or other variables in manual occupational
social classes, maternal education explained this association among
advantaged occupational social classes.
Keywords: Child development; Intelligence; Mental health; Neuropsychology;
Desarrollo infantil; Inteligencia; Salud mental; Neuropsicologa
, CHAPTER 20 - Postpartum Biomedical Concerns: Breastfeeding, In: Stephen

D. Ratcliffe, MD, MSPH, Elizabeth G. Baxley, MD, Matthew K. Cline, MD, and
Ellen L. Sakornbut, MD, Editor(s), Family Medicine Obstetrics (Third
Edition), Mosby, Philadelphia, 2008, Pages 618-643, ISBN 9780323043069,
10.1016/B978-032304306-9.50025-2.
Christine Norton, Fecal Incontinence and Biofeedback Therapy,

Gastroenterology Clinics of North America, Volume 37, Issue 3, September
2008, Pages 587-604, ISSN 0889-8553, 10.1016/j.gtc.2008.06.008.
Abstract: Biofeedback as delivered in most clinical settings in Western
medicine has been consistently reported to improve symptoms of fecal
incontinence. Closer scrutiny of the elements of the intervention and
controlled studies, however, have consistently failed to find any benefit
of the biofeedback element of this complex package of care; nor has any
superiority been found for one modality over another. There is a need for
further well-designed and adequately powered randomized controlled trials.
Meanwhile, there can be little doubt that conservative interventions
improve many patients with fecal incontinence to the point where most
report satisfaction with treatment and do not wish to consider more
invasive options, such as surgery.
Keywords: Fecal incontinence; Biofeedback; Pelvic floor muscle training;
Conservative management
Maureen O. Marcenko, Michael Spence, Linda Samost, Outcomes of a home

visitation trial for pregnant and postpartum women at-risk for child
placement, Children and Youth Services Review, Volume 18, Issue 3, 1996,
Pages 243-259, ISSN 0190-7409, 10.1016/0190-7409(96)00003-5.
Abstract: This study is a randomized clinical trial designed to test the
psychosocial efficacy of a pre- and postpartum home visitation model for
women at-risk for out-of-home placement of their newborns. Two hundred
twenty-five pregnant women with high risk pregnancies for psychosocial
reasons were recruited into the study and randomly assigned to an
experimental (n = 125) or control condition (n = 100) when they presented
for prenatal care at a large urban clinic. After an average of 16 months of
exposure to the intervention, women in the experimental group reported
significantly greater access to services and there was a trend for the
experimental group to show a decrease in psychological distress. At 10
months, there was a trend for experimental group women to experience an
increase in social support, but this was not sustained at 16 months.
Although the difference was not statistically significant, a higher
percentage of women in the experimental group had children in out-of-home
living arrangements. There was also a trend among those with children in
placement, for children of experimental group women to be placed in
extended family care rather than foster care more frequently than controls.
The implications of the findings for interventions with at-risk families
are discussed.
Barbara L Philipp, Anne Merewood, The Baby-Friendly way: the best

breastfeeding start, Pediatric Clinics of North America, Volume 51, Issue
3, June 2004, Pages 761-783, ISSN 0031-3955, 10.1016/j.pcl.2004.01.007.
Rajesh Kumar Rai, Prashant Kumar Singh, Lucky Singh, Utilization of

Maternal Health Care Services among Married Adolescent Women: Insights from
the Nigeria Demographic and Health Survey, 2008, Women's Health Issues,
Volume 22, Issue 4, JulyAugust 2012, Pages e407-e414, ISSN 1049-3867,
10.1016/j.whi.2012.05.001.
An ongoing social catastrophe of very poor performance in maternal health
coupled with an unacceptably high number of maternal deaths is evident in
Nigeria, especially among adolescent women. This study examines the factors
associated with selected maternity servicesmarried adolescent women who
have had at least four antenatal care (ANC) visits, those who have
undergone safe delivery care, and those who received postnatal care within
42 days of delivery.
Methods
Data from Nigeria Demographic and Health Survey, 2008, were used. An
eligible sample of 2,434 married adolescent (aged 1519 years) women was
included in the analysis. Pearson chi-square test and binary logistic
regression were performed to fulfill the study objective.
Results
It was found that about 35% of adolescent women had at least four ANC
visits, a little over 25% had undergone safe delivery care, and nearly 32%
received postnatal care within 42 days of delivery. Women's education,
husband's education, wealth quintile, and region of residence were
documented as the most important factors associated with maternal
healthcare service utilization. The ANC visit was found to be vital in the
utilization of safe delivery and postnatal care.
Conclusion
Findings indicate that programs to improve maternal healthcare have not
succeeded in overcoming the socioeconomic obstacles in the way of
adolescents' utilizing maternity services. In the long run, the content and
service delivery strategy of maternity programs must be designed in keeping
with the socioeconomic context with special attention to adolescent women
who are uneducated, poor, and residing in rural areas.
Lorraine B. Sanders, Assessing and Managing Women With Depression: A

Midwifery Perspective, Journal of Midwifery & Women's Health, Volume
51, Issue 3, MayJune 2006, Pages 185-192, ISSN 1526-9523,
10.1016/j.jmwh.2005.10.002.
Abstract: Women are at disproportionate risk for depression. Depression
often goes untreated because of lack of recognition by providers. The
Institute of Medicine maintains that primary care providers are essential
in the management of mental health disorders. The assessment and management
of depression in women are sensitive topics and may require advanced
training and skills.
Keywords: depression; midwifery; screening; postpartum depression
Susanna Rose Cohen, Leslie Cragin, Bob Wong, Dilys M. Walker, Self-Efficacy
Change With Low-Tech, High-Fidelity Obstetric Simulation Training for
Midwives and Nurses in Mexico, Clinical Simulation in Nursing, Volume 8,
Issue 1, January 2012, Pages e15-e24, ISSN 1876-1399,
10.1016/j.ecns.2010.05.004.
This prospective descriptive study examined the relationship between low-
tech, high-fidelity simulationbased training and pre- and posttraining
changes in participant self-efficacy (SE).
Method
A 3-week training was followed by a 2-day session 4 months later in
Cuernavaca, Mexico. Midwives and obstetrical nurses either participated in
or observed 41 scenarios during a clinical update in emergency obstetric
skills.
Results
SE increased significantly. It decreased at 4 months posttraining but
remained higher than pretraining levels.
Conclusion
The training positively affected participants' perceived readiness for the
technical, behavioral, and cognitive dimensions of obstetric emergencies.
After simulation training, participants faced the critical, high-pressure,
and often abusive real world in clinical sites, which may explain the
drop in SE scoresr.
Keywords: patient simulation; self-efficacy; high-fidelity; nursing
education; teaching methods; Mexico; midwifery education
Fiona Bogossian, Lisa McKenna, Monica Higgins, Christine Benefer, Susannah

Brady, Stephanie Fox-Young, Simon Cooper, Simulation based learning in
Australian midwifery curricula: Results of a national electronic survey,
Women and Birth, Volume 25, Issue 2, June 2012, Pages 86-97, ISSN 1871-
5192, 10.1016/j.wombi.2011.02.001.
The primary aim of this paper is to describe the extent, nature and types
of simulation used as a learning method in contemporary Australian
midwifery curricula.
Method
An electronic survey was developed using Graduate e-Cohort Pro and
administered to key midwifery academics who had responsibility for 38
curricula leading to initial midwifery registration in Australia.
Findings
Engagement of midwifery academics in the survey was high with a response
rate of 82%. There is a range of midwifery programs by type and level of
award across Australia that vary in duration, enrolments, and by component
theoretical and clinical hours. The proportion of simulation hours in
curricula varied across programs accounting for up to 17% of clinical
program hours. However simulation was used extensively to teach all
identified generic technical skills (n = 16) midwifery technical
skills (n = 51) and generic non-technical skills
(n = 6). Most commonly used simulation types were scenarios,
peer-to-peer learning, partial task trainers and standardised patients.
Simulation types were suited to the learning tasks.
Conclusion
Simulation is used extensively in midwifery education in Australia. Further
research is required to understand the curriculum development imperatives
of simulation and there is a need to adequately resource and support staff
in the use of simulation to provide high quality simulation learning
experiences for students.
Keywords: Midwifery; Simulation; Clinical education; Curricula; Electronic
survey; Technical skills; Non-technical skills
M.C. Lu, J.S. Lu, Prenatal Care, In: Editors-in-Chief: Marshall M. Haith
and Janette B. Benson, Editor(s)-in-Chief, Encyclopedia of Infant and Early
Childhood Development, Academic Press, San Diego, 2008, Pages 591-604, ISBN
9780123708779, 10.1016/B978-012370877-9.00127-4.
Abstract: Prenatal care is healthcare provided to a woman during pregnancy.
It consists of a series of clinical visits and ancillary services designed
to promote the health and well-being of the mother, fetus, and family. Its
major components include early and continuing risk assessment, health
promotion, and medical and psychosocial interventions and follow-up. Risk
assessment includes comprehensive evaluation of the womans or couples
reproductive history, medical risks, medication use, family history and
genetic risks, psychosocial factors, nutritional and behavioral risks, and
laboratory testing. Health promotion includes alleviating unpleasant
symptoms during pregnancy, providing lifestyle advice, promoting healthy
nutrition, reducing environmental exposures, promoting family planning and
breastfeeding. Medical and psychosocial interventions address identified
medical and psychosocial risks. Ideally, prenatal care should begin before
pregnancy (preconception care) and continue after (postpartum care) and
between pregnancies (internatal care), as part of a longitudinally and
contextually integrated strategy to promote optimal development of womens
reproductive health not only during pregnancy, but over the life course.
Keywords: Family planning; Genetic screening; Health promotion; Internatal
care; Life course; Nutrition; Postpartum care; Preconception care;
Pregnancy; Prenatal care; Prenatal laboratory tests; Psychosocial support;
Reproductive life plan; Risk assessment; Stress resilience; Teratogens
Vanessa E. Murphy, Peter G. Gibson, Asthma in Pregnancy, Clinics in Chest

Medicine, Volume 32, Issue 1, March 2011, Pages 93-110, ISSN 0272-5231,
10.1016/j.ccm.2010.10.001.
Keywords: Asthma; Pregnancy; Exacerbation; Inhaled corticosteroid
Gijs Walraven, Sikolia Wanyonyi, William Stones, Management of post-partum

hemorrhage in low-income countries, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 22, Issue 6, December 2008, Pages
1013-1023, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.08.002.
Abstract: The provision of safe and effective delivery care for all women
in poor countries remains elusive, resulting in a continuing burden of
mortality in general and mortality from post-partum haemorrhage in
particular. Deployment of a functional health system and effective linkage
of the health system to communities are the necessary prerequisites for the
provision of the life-saving technical interventions that will make a
difference in individual cases. Sadly, two factors militate against
progress: the mantra that we know what works (resulting in some serious
gaps in evidence for best practice in resource-poor settings) and a lack of
large-scale investment in maternity services to counteract the degradation
of infrastructure and depletion of human resources evident in many
countries.
Keywords: barriers to access to care; developing countries; health systems;
post-partum haemorrhage
Susan Panzarine, Elisa Slater, Phyllis Sharps, Coping, social support, and
depressive symptoms in adolescent mothers, Journal of Adolescent Health,
Volume 17, Issue 2, August 1995, Pages 113-119, ISSN 1054-139X,
10.1016/1054-139X(95)00064-Y.
(http://www.sciencedirect.com/science/article/pii/1054139X9500064Y)
Abstract: Purpose:
The purpose of this study was to determine how the degree of depressive
symptomatology among adolescent mothers differentiated maternal outcomes,
social support, and coping at 6 months postpartum.
Methods:
Fifty primiparous adolescents, predominantly black and of low income,
participated in the study. During a home visit at 6 months postpartum, a
research assistant, blind to the study's hypotheses, administered
questionnaires related to depressive symptoms, coping with motherhood,
social support, maternal confidence, and maternal gratification. Feeding
and teaching interactions between mother and child were observed.
Results:
Fifty-six percent of the subjects had no depressive symptoms (group 1), 20%
reported mild symptoms (group 2), and 24% reported moderate to severe
symptoms (group 3). Adolescents with mild or moderate depressive symptoms
had more negative feeding interactions with their infants, reported less
maternal confidence and gratification, and used more emotion-focused coping
than their nondepressed counterparts. While the groups did not differ in
the frequency with which they received social support, adolescents with
mild or moderate depressive symptoms were less satisfied with this support.
No differences were found among groups with regard to the size of their
conflicted networks.
Conclusions:
This study extends the research findings related to depressive symptoms
among adult mothers to a sample of adolescent mothers. Although the study
design is crosssectional and therefore causal sequences cannot be
determined, the results identify factors that may place certain adolescents
at risk for problems in parenting. The authors suggest screening adolescent
mothers during the first postpartum year for symptoms of depression.
Keywords: Adolescent mothers; Depression; Coping; Social support
Lydia Furman, Richard J. Schanler, Chapter 65 - Breastfeeding, Avery's

Diseases of the Newborn (Ninth Edition), W.B. Saunders, Philadelpia, 2012,
Pages 937-951, ISBN 9781437701340, 10.1016/B978-1-4377-0134-0.10065-4.
Olga de Haan, From patient to client, Patient Education and Counseling,

10.1016/j.pec.2010.09.028.
Abstract: Objective
To gain insight in the knowledge, attitude and practices of users and
providers of reproductive health services in rural areas of Kyrgyzstan and
Tajikistan before and after interventions.
Methods
KAP (Knowledge, Attitude, Practices) studies under 500 respondents.
Results
Training that addressed the determinants of behavioural change contributed
to the motivation under health care providers to improve performances. The
simultaneously implemented education program for users of health services
enhanced the preparedness for birth of pregnant women and their family
members. Both interventions had positive effects on health outcomes.
Conclusions
Behavioural change, from hierarchic and directive into client-centred and
supportive, can be realized in Central Asia by enhancing the decision-
making capacities of providers. A client-centred attitude of health care
providers is the key condition for sustainable improvement of service
delivery. Improving clientprovider communication is a cost-effective way
to enhance the quality of care in low resource settings, such as in Central
Asia.
The providers can be best trained in a practical setting, when trainees are
enabled to practice with real patients, under guidance of a highly skilled
professional. Psychological components such as addressing emotions and
exploring the values and beliefs of providers should be incorporated in
separate training modules.
Keywords: Health psychology; Informed choices
C MacArthur, HR Winter, DE Bick, H Knowles, R Lilford, C Henderson, RJ

Lancashire, DA Braunholtz, H Gee, Effects of redesigned community postnatal
care on womens' health 4 months after birth: a cluster randomised
controlled trial, The Lancet, Volume 359, Issue 9304, 2 February 2002,
Pages 378-385, ISSN 0140-6736, 10.1016/S0140-6736(02)07596-7.
Much postpartum physical and psychological morbidity is not addressed by
present care, which tends to focus on routine examinations. We undertook a
cluster randomised controlled trial to assess community postnatal care that
has been redesigned to identify and manage individual needs.
Methods
We randomly allocated 36 general practice clusters from the West Midlands
health region of the UK to intervention (n=17) or control (19) care.
Midwives from the practices recruited women and provided care. 1087 (53%)
of 2064 women were in practices randomly assigned to the intervention
group, with 977 (47%) women in practices assigned to the control group.
Care was led by midwives, with no routine contact with general
practitioners, and was extended to 3 months. Midwives used symptom
checklists and the Edinburgh postnatal depression scale (EPDS) to identify
health needs and guidelines for the management of these needs. Primary
outcomes at 4 months were obtained by postal questionnaire and included the
women's short form 36 physical (PCS) and mental (MCS) component summary
scores and the EPDS. Secondary outcomes were women's views about care.
Multilevel analysis accounted for possible cluster effects.
Findings
801 (77%) of 1087 women in the intervention group and 702 (76%) of 977
controls responded at 4 months. Women's mental health measures were
significantly better in the intervention group (MCS, 303 [95% CI 153
452]; EPDS 192 [255 to 129]; EPDS 13+ odds ratio 057 [043076])
than in controls, but the physical health score did not differ.
Interpretation
Redesign of care so that it is midwife-led, flexible, and tailored to
needs, could help to improve women's mental health and reduce probable
depression at 4 months' postpartum.
, References, Sex Differences, Academic Press, San Diego, 2000, Pages 379-
462, ISBN 9780124874602, 10.1016/B978-012487460-2/50013-1.
SUSAN M GROSS, LAURA E CAULFIELD, MARGARET E BENTLEY, YVONNE BRONNER, LISA

KESSLER, JOAN JENSEN, DAVID M PAIGE, Counseling and Motivational Videotapes
Increase Duration of Breast-Feeding in African-American WIC Participants
Who Initiate Breast-Feeding, Journal of the American Dietetic Association,
Volume 98, Issue 2, February 1998, Pages 143-148, ISSN 0002-8223,
10.1016/S0002-8223(98)00037-6.
Abstract: Objective To evaluate the relative effects introducing
motivational videotapes and/or peer counseling in Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) clinics serving
African-American women have on breast-feeding duration.
Design Experimental intervention study. Pregnant women were enrolled at or

before 24 weeks gestation and were followed up until postpartum week 16.
Women were interviewed at enrollment, 7 to 10 days, 8 weeks, and 16 weeks
postpartum.
Subjects/setting One hundred fifteen African-American WIC participants who

initiated breast-feeding and who had been enrolled in 1 of 4 clinics.
Intervention Two-by-two factorial design, in which 4 clinics were randomly

assigned to receive either no intervention, a motivational video package
intervention, a peer-counseling intervention, or both interventions.
Main outcome measures Breast-feeding duration in weeks and relative risk

ratios for breast-feeding cessation before 16 weeks postpartum.
Statistical analysis performed Contingency table analysis, including 2

tests and log-rank tests; multivariate analysis using Cox proportional
hazards regression analysis.
Results A higher proportion of women were breast-feeding at 8 and 16 weeks

postpartum in the intervention clinics than in the control clinic. The
proportion of women reporting breast-feeding declined at 8 and 16 weeks
postpartum, but the rate of decline was slower in the 3 intervention
clinics than in the control clinic. Being younger than 19 years of age or
older than 25 years of age, having a male infant, and returning to work or
school all negatively affected breast-feeding duration, whereas previous
breast-feeding experience positively influenced breast-feeding duration.
Applications/conclusions WIC-based peer counselor support and motivational

videos can positively affect the duration of breast-feeding among African-
American women. WIC nutritionists and other health professionals in contact
with this population should expand their efforts toward promoting increased
duration of breast-feeding. J Am Diet Assoc. 1998;98:143-148.
Paul Ramchandani, Lamprini Psychogiou, Paternal psychiatric disorders and

children's psychosocial development, The Lancet, Volume 374, Issue 9690,
2228 August 2009, Pages 646-653, ISSN 0140-6736, 10.1016/S0140-
6736(09)60238-5.
Abstract: Summary
Psychiatric disorders of parents are associated with an increased risk of
psychological and developmental difficulties in their children. Most
research has focused on mothers, neglecting psychiatric disorders affecting
fathers. We review findings on paternal psychiatric disorders and their
effect on children's psychosocial development. Most psychiatric disorders
that affect fathers are associated with an increased risk of behavioural
and emotional difficulties in their children, similar in magnitude to that
due to maternal psychiatric disorders. Some findings indicate that boys are
at greater risk than girls, and that paternal disorders, compared with
maternal disorders, might be associated with an increased risk of
behavioural rather than emotional problems. Improved paternal mental health
is likely to improve children's wellbeing and life course.
Kathleen Fahy, Carolyn Hastie, Andrew Bisits, Christine Marsh, Lurena

Smith, Anne Saxton, Holistic physiological care compared with active
management of the third stage of labour for women at low risk of postpartum
haemorrhage: A cohort study, Women and Birth, Volume 23, Issue 4, December
Abstract: SummaryQuestion
Is holistic psychophysiological care in the third stage of labour safe
for women at low risk of postpartum haemorrhage?.
Background
Although there have been four randomised trials and a Cochrane Review on
the safety and effectiveness of care during the third stage labour, no
previous study has focussed only on women at low risk of postpartum
haemorrhage and no previous study has tested a form of physiological third
stage care that is provided by skilled midwives in an appropriate setting.
Design
Retrospective cohort study involving a maternity unit at a tertiary
referral hospital and a freestanding, midwifery-led birthing unit.
Participants
All low risk women who gave birth at either unit in the period July 2005
August 2008.
Interventions
Active management of the third stage of labour compared with holistic
psychophysiological third stage care.
Results
At the tertiary unit, 344 of 3075 low risk women (11.2%) experienced
postpartum haemorrhages (PPH). At the midwifery-led unit, PPH occurred for
10 of 361 women (2.8%), OR = 4.4, 95% CI [2.3, 8.4]. Treatment
received analysis showed that active management (n = 3016) was
associated with 347 postpartum haemorrhages (11.5%) compared with receiving
holistic psychophysiological care (n = 420) which was associated
with 7 (1.7%) PPH OR = 7.7, 95% CI [3.6, 16.3].
Conclusion
This study suggests that holistic psychophysiological care in the third
stage labour is safe for women at low risk of postpartum haemorrhage.
Active management was associated with a seven to eight fold increase in
postpartum haemorrhage rates for this group of women. Further prospective
observational evaluation would be helpful in testing this association.
Keywords: Labour, third stage; Physiological third stage care; Midwifery
models; Birth centre care; Labour
John Kattwinkel, Lynn J Cook, George Nowacek, Carey Bailey, Warren M

Crosby, Hallam Hurt, Jerry Short, Regionalized perinatal education,
Seminars in Neonatology, Volume 9, Issue 2, April 2004, Pages 155-165, ISSN
1084-2756, 10.1016/j.siny.2003.08.005.
Abstract: Despite changes in the organization and financing of healthcare
delivery, and dramatic increases in the number and distribution of
perinatal facilities and professionals over the past three decades, there
remains a continuing need for effective and efficient regionalized
perinatal outreach education programmes. Both the organizers and the
participants should be multidisciplinary and include both inpatient and
outpatient providers. Content should be restricted to issues relevant to
participants' practice, and include topics ranging from preconception to
postpartum and early infant care. There are various effective formats, but
consideration should be given to reaching as many providers as possible
simultaneously within a given facility, minimizing expense and economizing
on participants' time. Evaluation strategies range from assessment of
immediate outcomes, which generally examine programme process, to ultimate
outcomes, which measure changes in patient care and patient health.
Keywords: Education; Continuing education; Education evaluation;
Neonatology; Obstetrics; Outreach education; Perinatal education;
Perinatology; Regionalization; Perinatal care; Neonatal care; Organization
Nancy F Krebs, Maureen A Murtaugh, Position of The American Dietetic

Association: Promotion of Breast-Feeding, Journal of the American Dietetic
Association, Volume 97, Issue 6, June 1997, Pages 662-666, ISSN 0002-8223,
10.1016/S0002-8223(97)00167-3.
Phillip N. Rauk, Educational intervention, revised instrument sterilization

methods, and comprehensive preoperative skin preparation protocol reduce
cesarean section surgical site infections, American Journal of Infection
Control, Volume 38, Issue 4, May 2010, Pages 319-323, ISSN 0196-6553,
10.1016/j.ajic.2009.10.004.
In 2005, of the approximately 4 million births in the United States, 30%
were by cesarean section (C-section) delivery, which translates to roughly
over 1 million C-sections in 2005 alone. C-section is associated with
higher morbidity than vaginal delivery. Women who undergo C-section are 5
times more likely to develop a postpartum infection after delivery than
women who undergo vaginal delivery.
Objective
Estimates of surgical site infection (SSI) after C-section range from 1.50
to 2.64. A quality improvement initiative was implemented at the University
of Minnesota Medical School to reduce rates of SSI using changes based on
recommended care initiatives.
Methods
The multidisciplinary team developed a comprehensive staff education and
training program, added a preoperative skin preparation protocol using
chlorhexidine gluconate (CHG) no-rinse cloths, added CHG with alcohol for
interoperative skin preparation, and modified instrument sterilization
techniques.
Results
Data analysis revealed a statistically significant reduction in the overall
SSI rate from 7.5% (33/441) in January-July 2006 to 1.2% (5/436) in
January-July 2007 (2 test statistic, 21.2; P < .001; relative reduction
of 84%).
Conclusion
Interventions, including staff education, use of CHG no-rinse cloths for
preoperative skin prep, CHG with alcohol for intraoperative skin prep, and
appropriate instrument sterilization management led to reductions in SSI
rates in patients undergoing C-section at our institution. Rates of
endometritis were also noted to be lower after implementation of the
interventions.
Keywords: Surgical site infections; obstetrical surgical site infections;
C-section surgical site infections; chlorhexidine gluconate skin
preparation
Sue Barton, Chapter 7 - The postnatal period, In: Jill Mantle, BA FCSP
DIPTP, Jeanette Haslam, MPHIL GRADDIPPHYS MCSP SRP, and Sue Barton, MSC
DIPED MCSP DIPTP DIPRG&RT DIPTHRF SRP, Editor(s), Physiotherapy in
Obstetrics and Gynaecology (Second Edition), Butterworth-Heinemann, Oxford,
2004, Pages 205-247, ISBN 9780750622653, 10.1016/B978-0-7506-2265-3.50015-
0.
Jean-Pierre Unger, Patrick Van Dessel, Kasturi Sen, Pierre De Paepe,

International health policy and stagnating maternal mortality: is there a
causal link?, Reproductive Health Matters, Volume 17, Issue 33, May 2009,
Pages 91-104, ISSN 0968-8080, 10.1016/S0968-8080(09)33460-6.
Abstract: This paper examines why progress towards Millennium Development
Goal 5 on maternal health appears to have stagnated in much of the global
south. We contend that besides the widely recognised existence of weak
health systems, including weak services, low staffing levels, managerial
weaknesses, and lack of infrastructure and information, this stagnation
relates to the inability of most countries to meet two essential
conditions: to develop access to publicly funded, comprehensive health
care, and to provide the not-for-profit sector with needed political,
technical and financial support. This paper offers a critical perspective
on the past 15 years of international health policies as a possible
cofactor of high maternal mortality, because of their emphasis on disease
control in public health services at the expense of access to comprehensive
health care, and failures of contracting out and publicprivate
partnerships in health care. Health care delivery cannot be an issue both
of trade and of right. Without policies to make health systems in the
global south more publicly-oriented and accountable, the current standards
of maternal and child health care are likely to remain poor, and maternal
deaths will continue to affect women and their families at an intolerably
high level.
Keywords: health policy and programmes; health systems; privatisation;
neoliberal economics; maternal mortality and morbidity
Susan P Walker, Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff, Gail A
Wasserman, Ernesto Pollitt, Julie A Carter, the International Child
Development Steering Group, Child development: risk factors for adverse
outcomes in developing countries, The Lancet, Volume 369, Issue 9556, 1319
January 2007, Pages 145-157, ISSN 0140-6736, 10.1016/S0140-6736(07)60076-2.
Abstract: Summary
Poverty and associated health, nutrition, and social factors prevent at
least 200 million children in developing countries from attaining their
developmental potential. We review the evidence linking compromised
development with modifiable biological and psychosocial risks encountered
by children from birth to 5 years of age. We identify four key risk factors
where the need for intervention is urgent: stunting, inadequate cognitive
stimulation, iodine deficiency, and iron deficiency anaemia. The evidence
is also sufficient to warrant interventions for malaria, intrauterine
growth restriction, maternal depression, exposure to violence, and exposure
to heavy metals. We discuss the research needed to clarify the effect of
other potential risk factors on child development. The prevalence of the
risk factors and their effect on development and human potential are
substantial. Furthermore, risks often occur together or cumulatively, with
concomitant increased adverse effects on the development of the world's
poorest children.
Bernard Guyer, Sai Ma, Holly Grason, Kevin D. Frick, Deborah F. Perry,
Alyssa Sharkey, Jennifer McIntosh, Early Childhood Health Promotion and Its
Life Course Health Consequences, Academic Pediatrics, Volume 9, Issue 3,
MayJune 2009, Pages 142-149.e71, ISSN 1876-2859,
10.1016/j.acap.2008.12.007.
Abstract: Objective
To explore whether health promotion efforts targeted at preschool-age
children can improve health across the life span and improve future
economic returns to society.
Methods
We selected 4 health topics to reviewtobacco exposure, unintentional
injury, obesity, and mental healthbecause they are clinically and
epidemiologically significant, and represent the complex nature of health
problems in this early period of life. The peer-reviewed literature was
searched to assess the level of evidence for short- and long-term health
impacts of health promotion and disease prevention interventions for
children from before birth to age 5. This review sought to document the
monetary burden of poor child health, the cost implications of preventing
and treating child health problems, and the net benefit of the
interventions.
Results
The evidence is compelling that these 4 topicstobacco exposure,
unintentional injury, obesity, and mental healthconstitute a significant
burden on the health of children and are the early antecedents of
significant health problems across the life span. The evidence for the cost
consequences of these problems is strong, although more uneven than the
epidemiological data. The available evidence for the effectiveness of
interventions in this age group was strongest in the case of preventing
tobacco exposure and injuries, was limited to smaller-scale clinical
interventions in the case of mental health, and was least available for
efforts to prevent obesity among preschoolers.
Conclusions
Currently available research justifies the implementation of health
interventions in the prenatal to preschool periodespecially to reduce
tobacco exposure and prevent injuries. There is an urgent need for
carefully targeted, rigorous research to examine the longitudinal causal
relationships and provide stronger economic data to help policy makers make
the case that the entire society will benefit from wise investment in
improving the health of preschool-age children and their families.
Keywords: child health; early intervention; investing in children; life
course; mental health; obesity; tobacco exposure; unintentional injury
Beatrice K.M. Hung, Lydia Ling, S.G. Ong, Sources of influence on infant
feeding practices in Hong Kong, Social Science & Medicine, Volume 20,
Issue 11, 1985, Pages 1143-1150, ISSN 0277-9536, 10.1016/0277-
9536(85)90191-1.
Abstract: The breastfeeding rate in Hong Kong is low compared to the rates
in Western countries. To understand the relative importance of different
sources of influence on infant feeding practices, 714 Chinese mothers with
infants aged 4 weeks to 6 months were studied. It was found that the
bottlefeeding mothers were influenced more by the medical professionals who
did not support breastfeeding. This influence was further reinforced by the
mass media and particularly television advertisements on infant formulae.
The successful breastfeeding mothers, on the other hand, were influenced
more by their social networks through which they were told of the dangers
of bottlefeeding. The failed breastfeeding mothers differed from the other
groups in the lack of support they experienced from friends and relatives.
Although they received professional encouragement to breastfeed, they were
more sheltered from the influence of mass media and social networks. From
these findings, it is suggested that different sources of influence are
related to different feeding practices. However, to be able to continue
with the practice that one has chosen, the availability of social support
is essential. Implications of these findings are discussed and several
recommendations to promote breastfeeding are made.
Bibhuti K. Sar, Becky F. Antle, Linda K. Bledsoe, Anita P. Barbee, Michiel

A. Van Zyl, The importance of expanding home visitation services to include
strengthening family relationships for the benefit of children, Children
and Youth Services Review, Volume 32, Issue 2, February 2010, Pages 198-
205, ISSN 0190-7409, 10.1016/j.childyouth.2009.08.016.
Abstract: Although home visiting programs effectively address risks of
maltreatment related to the mother and infant through providing services
such as medical care, education/vocational support, and training on
positive infant parenting practices, little programmatic attention has been
paid to couple relationships, father involvement, and parenting
interactions in the context of new parenthood. These relationships within
the family system, if not nurtured, can heighten the risks for
maltreatment. Therefore, the research on the impact of these relationships
for children's wellbeing are reviewed, examples of evidence-based programs
to strengthen these relationships are provided, and changes to existing
home visiting policies and programs to include strengthening family
relationships for the benefit of children are recommended.
Keywords: Home visitation services; Economically disadvantaged families;
Evidence-based practices (EBP); Relationship strengthening programs
Barthlmy Kuate Defo, Effects of socioeconomic disadvantage and women's

status on women's health in Cameroon, Social Science & Medicine, Volume
44, Issue 7, April 1997, Pages 1023-1042, ISSN 0277-9536, 10.1016/S0277-
9536(96)00228-6.
Abstract: Research on the effects of socioeconomic disadvantage and women's
status on women's health is important for policy makers in developing
countries, where limited resources make it crucial to use existing maternal
and child health care resources to the best advantage. Using a community-
based data set collected prospectively in Cameroon, this study attempts to
understand the extent to which socioeconomic factors and women's status
have influences on women's health. The most important finding is that the
burden of illness rests disproportionately on the economically
disadvantaged women and on those with low social status. The long-term
effects of social disadvantage are apparent in the excesses of morbidity
among women who are not employed at the time of their children's birth,
women living in poor neighborhoods, and those living in households without
modern amenities. The maternal morbidity patterns during the postpartum
period indicate that the women's reports of their recovery and health
status from childbirth extend far beyond the first few weeks that previous
studies have focused on. From a theoretical perspective, this study has
demonstrated the importance of the intermediate framework for the study
of women's health: the operations of effects of a number of background
characteristics are mediated by more proximate determinants of women's
health. These results remain robust even after controlling for other
measured factors and after correcting for unmeasured heterogeneity and
sample selection; this helps to dismiss the potential influence of some
artifacts. While this study suggests that there are opportunities within
the existing health care system for meeting many of the health care needs
of the socially disadvantaged, further biobehavioral and psychosocial
research is needed to determine how women's status and social disadvantage
influence the demand for health care services, in order to ensure equitable
as well as a more effective delivery of health care services and to break
the vicious circle of disadvantage.
Keywords: women's health; women's status; socioeconomic status; prospective
study; Cameroon
Shirley Russ, Nicole Garro, Neal Halfon, Meeting children's basic health
needs: From patchwork to tapestry, Children and Youth Services Review,
10.1016/j.childyouth.2010.03.007.
Abstract: Few would deny that if a system were to be designed de novo to
meet children's basic health needs, it would be radically different from
the confusing and fragmented patchwork of programs in place today. While
Medicaid and the Children's Health Insurance Program (CHIP), have improved
access to care, increased use of health care services, and reduced unmet
health needs for low-income children, the impact of these programs on the
quality of health care, and on children's health outcomes is less certain.
At the same time, the prevalence of childhood chronic illness is
increasing, there is an epidemic of obesity, and sizeable increases in
reported developmental and behavioral problems and mental health issues.
Our existing system of care appears ill-equipped to respond to this
changing epidemiology. Unmet needs for care in childhood represent time-
bombs, likely to result in an explosion of chronic illness in mid-life. We
propose a new approach to child health policy, based on the life course
health development model in which health in childhood is regarded as a
foundation for lifelong well-being. A new tapestry of comprehensive
children's services, integrated across sectors, which fully address
children's health needs and promote positive health, could set children on
optimal health trajectories for life. This system could be a major
component of the transformative change the nation is seeking to reduce
health care costs and improve quality of life across the lifespan.
Keywords: Child health; Child welfare; Health insurance; Child policy;
Child health outcomes
Kristina M. Deligiannidis, Marlene P. Freeman, Complementary and

Alternative Medicine for the Treatment of Depressive Disorders in Women,
Psychiatric Clinics of North America, Volume 33, Issue 2, June 2010, Pages
441-463, ISSN 0193-953X, 10.1016/j.psc.2010.01.002.
Keywords: Complementary/alternative treatment; S-Adenosylmethionine; Omega-3 fatty acids; St John's wort;
Acupuncture; Depression; Women
Luc R.C.W. van Lonkhuijzen, Jos van Roosmalen, Gerda Zeeman, Implementing
safe motherhood: Free resources for training in maternal and neonatal care,
June 2010, Page 189, ISSN 0020-7292, 10.1016/j.ijgo.2010.01.017.
Keywords: Millennium Development Goals; Obstetric emergency; Online
training resources; Safe motherhood
Robert Halpern, Parent support and education programs, Children and Youth
Services Review, Volume 12, Issue 4, 1990, Pages 285-308, ISSN 0190-7409,
10.1016/0190-7409(90)90004-H.
(http://www.sciencedirect.com/science/article/pii/019074099090004H)
Abstract: Parent support and education programs are receiving renewed
attention as a vehicle for strengthening parenting and addressing other
support needs in low-income families. In this paper the author reviews the
theoretical rationale, situational context and empirical basis for these
programs.
Jonathan B. Kotch, Dorothy C. Browne, Christopher L. Ringwalt, Paul W.

Stewart, Ellen Ruina, Kathleen Holt, Betsy Lowman, Jin-Whan Jung, Risk of
child abuse or neglect in a cohort of low-income children, Child Abuse
& Neglect, Volume 19, Issue 9, September 1995, Pages 1115-1130, ISSN
0145-2134, 10.1016/0145-2134(95)00072-G.
Abstract: The purposes of this research were to identify risk factors for
reported child abuse or neglect and to examine the roles of stress and
social support in the etiology of child maltreatment. Mothers of newborn
infants with biomedical and sociodemographic risk factors were recruited
from community and regional hospitals and local health departments in 42
counties of North and South Carolina selected for geographic distribution
and for large numbers of such newborns. For every four such mothers, the
next mother to deliver an otherwise normal newborn was sought. Mothers were
interviewed shortly after giving birth, and state Central Registries of
Child Abuse and Neglect were reviewed when each infant was 1 year of age.
Eight hundred forty-two of 1,111 recruited mothers were successfully
interviewed in their homes between March 1986 and June 1987. Seven hundred
forty-nine North Carolina births who resided in the state more than 6
months were eligible for inclusion in the analysis. Logistic regression
with backward elimination procedures was used in the analysis. Maternal
education (p < .01), number of other dependent children in the home (p
< .01), receipt of Medicaid (p < .01), maternal depression (p < .
05), and whether the maternal subject lived with her own mother at age 14
years (p < .05) were the best predictors of a maltreatment report.
Further examination revealed an interaction effect between stressful life
events, as measured by life event scores, and social well-being (p < .
01). For children born at risk for social and/or medical problems, extreme
low income (participation in public income support programs), low maternal
education, maternal depression, the presence of any other young children in
the home, and a mother's separation at age 14 years from her own mother
significantly predict child maltreatment reports in the first year of life.
In addition, stressful life events, even if perceived positively, may
increase or decrease the risk of maltreatment reports, depending upon the
presence of social support.
Keywords: Child abuse; Child neglect; Poverty; Psychological stress; Social
support
Douglas Vanderbilt, Mary Margaret Gleason, Mental Health Concerns of the

Premature Infant Through the Lifespan, Child and Adolescent Psychiatric
Clinics of North America, Volume 19, Issue 2, April 2010, Pages 211-228,
ISSN 1056-4993, 10.1016/j.chc.2010.02.003.
Keywords: Preterm birth; Parent child interactions; Mental health;
Neurodevelopment
Douglas Vanderbilt, Mary Margaret Gleason, Mental Health Concerns of the

Premature Infant Through the Lifespan, Pediatric Clinics of North America,
Volume 58, Issue 4, August 2011, Pages 815-832, ISSN 0031-3955,
10.1016/j.pcl.2011.06.012.
Keywords: Preterm birth; Parent child interactions; Mental health;
Neurodevelopment
A. Stoebner-Delbarre, F. Letourmy, Conduite tenir pour aider les femmes

enceintes arrter de fumer : rles des professionnels de sant, Journal
de Gyncologie Obsttrique et Biologie de la Reproduction, Volume 34,
Supplement 1, April 2005, Pages 326-335, ISSN 0368-2315, 10.1016/S0368-
2315(05)83005-4.
Abstract: Rsum
Lexposition au tabagisme actif et passif pendant la grossesse est la cause
vitable la plus importante des complications gynco-obsttricales et
pdiatriques en France. Les bnfices cliniques et conomiques de larrt
du tabac sont bien documents. Lobjectif de ce travail est deffectuer une
revue des connaissances actuelles en matire daide larrt du tabac pour
les femmes enceintes. Cet article dcrit en dtail les actions efficaces
raliser en cabinet libral ou lhpital pour aider les femmes enceintes
arrter de fumer et les accompagner dans leur dmarche : mesure du
monoxyde de carbone expir, aide larrt selon la mthode des 5 A,
distribution de brochure daide larrt du tabac, prvention des
rechutes, formation des professionnels, participation et soutien des
actions collectives et aux mesures nationales.
Summary
Active and passive exposure to tobacco smoke during pregnancy is the most
serious and preventable cause of adverse maternal, fetal, and infant
outcomes in France. The clinical and economic benefits of cessation have
been documented. The objective of this article is to review the evidence
base addressing smoking cessation in pregnant women. The article describes
how best to assist the pregnant smoker in clinical practice or hospital to
quit during pregnancy. The following low intensity interventions designed
to be integrated into routine prenatal care are detailed: expired air CO
measures, practice of the evidence-based 5 A's smoking cessation
intervention for pregnant women, use of pregnant woman's self-help guide to
quit smoking, relapse prevention, health professionals training,
participation to community program.
Keywords: Grossesse; Tabac; Mdecins; Aide larrt; Professionnels de
sant; Pregnancy; Tobacco; Smoking cessation; Health professionals;
Interventions
Robert Li Kitts, Stuart J. Goldman, Education and Depression, Child and

Adolescent Psychiatric Clinics of North America, Volume 21, Issue 2, April
2012, Pages 421-446, ISSN 1056-4993, 10.1016/j.chc.2012.01.007.
Keywords: Depression; Education; Children; Adolescents
V.D Tsu, B Shane, New and underutilized technologies to reduce maternal

mortality: call to action from a Bellagio workshop, International Journal
of Gynecology & Obstetrics, Volume 85, Supplement 1, June 2004, Pages
S83-S93, ISSN 0020-7292, 10.1016/j.ijgo.2004.02.011.
Abstract: Little progress has been made in preventing the more than
500 000 maternal deaths that occur each year. Many new and
underutilized technologies can be used to reduce these deaths. In July
2003, maternal health experts from around the world gathered in Bellagio,
Italy, to develop a set of priority actions for reducing maternal mortality
using proven and promising technologies. To reduce maternal mortality,
immediate efforts are needed to accelerate the appropriate use of
technologies and to reduce their inequitable distribution. Organizations
are called on to commit the necessary human and financial resources to
evaluate and document the effectiveness of promising technologies and to
scale up and put proven technologies into widespread use to save women's
lives.
Keywords: Maternal morbidity and mortality; Technologies; Developing
countries
Marie-Paule Austin, Jana Colton, Susan Priest, Nicole Reilly, Dusan Hadzi-
Pavlovic, The Antenatal Risk Questionnaire (ANRQ): Acceptability and use
for psychosocial risk assessment in the maternity setting, Women and Birth,
Available online 20 July 2011, ISSN 1871-5192, 10.1016/j.wombi.2011.06.002.
Abstract: SummaryObjectives
To assess the value of the Antenatal Risk Questionnaire (ANRQ) as a
predictor of postnatal depression, to evaluate its acceptability to
pregnant women and midwives, and to consider its use as part of a model for
integrated psychosocial risk assessment in the antenatal setting.
Method
This paper further analysed published data from the Pregnancy Risk
Questionnaire in a sample of 1196 women. We extracted 12 items from the
original 23 item Pregnancy Risk Questionnaire to assess how the shorter
ANRQ would perform, and undertook the analysis in the subset who were
administered the Composite International Diagnostic Interview (CIDI) at 2
or 4 months postpartum to assess for major depression (N = 276).
We also sampled a subset of pregnant participants (N = 378) and
midwives (N = 44) to assess the tool's acceptability to these
groups respectively.
Findings
ROC curve analysis for the ANRQ yielded an acceptable area under the curve
of 0.69. The most clinically useful cut off on the ANRQ was a score of 23
or more, yielding a sensitivity of 0.62 and specificity of 0.64 with
positive predictive value of 0.3. The odds that a woman scoring 23 or more
on the ANRQ is also a case was 6.3 times greater than for a woman scoring
less than 23. Acceptability of the ANRQ was high among both women and
midwives.
Conclusion
The ANRQ is a highly acceptable self-report psychosocial assessment tool
which aids in the prediction of women who go on to develop postnatal
depression. In combination with a symptom based screening measure (e.g.,
the Edinburgh Postnatal Depression Scale) and routine questions relating to
drug and alcohol use and domestic violence, the ANRQ becomes most useful as
a key element of a screening intervention aimed at the early
identification of mental health risk and morbidity across the perinatal
period. Evaluation of this model in terms of clinical outcomes remains to
be undertaken.
Keywords: Pregnancy; Postnatal; Depression; Screening; Psychosocial
assessment
Kees De Meer, Roland Bergman, John S. Kusner, Socio-cultural determinants

of child mortality in Southern Peru: Including some methodological
considerations, Social Science & Medicine, Volume 36, Issue 3, February
1993, Pages 317-331, ISSN 0277-9536, 10.1016/0277-9536(93)90016-W.
(http://www.sciencedirect.com/science/article/pii/027795369390016W)
Abstract: Among Amerindian children living at high altitude in the Andes in
southern Peru, high child mortality rates have been reported in the
literature, especially in the perinatal and neonatal period. We compared
mortality rates in children calculated from retrospective survey data in 86
rural families from 2 Aymara and 3 Quechua peasant communities living at
the same level of altitude (3825m) in southern Peru. Relations between land
tenure, socio-cultural factors and child mortality were studied, and
methodological considerations in this field of interest are discussed.
Checks on consistency of empirical data showed evidence for underreporting

of neonatal female deaths with birth order 3 and more. Perinatal (124 vs 34
per 1000 births) and infant mortality (223 vs 111 per 1000 live births) was
significantly higher in Aymara compared with Quechua children, but no
difference was found after the first year of life. A short pregnancy
interval was associated with an elevated perinatal and infant mortality
rate, and a similar albeit insignificant association was found with
increased maternal age. Amount of land owned and birth order were not
related with child mortality. Although levels of maternal education are
generally low in both cultures, a consistent decline in infant and child
mortality was found with the amount of years mothers had attended school.
However, the results suggest a U-shaped relationship between the amount of
years of parental education and perinatal mortality in offspring. Late
fetal and early neonatal mortality were particularly high in one Aymara
community where mothers were found to have more years of education.
Infanticide, a known phenomenon in the highlands of the Andes, is discussed
in relation with the findings of the study. Although maternal and child
health services are utilized by the majority of families in 4 of 5 study
communities, 43 of 51 mothers under the age of 45 years reported that they
delivered their last baby in the absence of traditional midwives or
official medical supervision.
Keywords: perinatal mortality; child mortality; neonatal mortality;
altitude; land tenure; Aymara Indians; Quechua Indians; Peru
William D. Fraser, Michael S. Kramer, 15 - Labor and Delivery, In: Marlene

B. Goldman and Maureen C. Hatch, Editor(s), Women and Health, Academic
Press, San Diego, 2000, Pages 182-195, ISBN 9780122881459, 10.1016/B978-
012288145-9/50018-8.
Abstract: No other physiological event, with the possible exception of her
own birth, has as great a potential to benefit or to harm a woman's life as
labor and delivery. Consequently, health care planners, educators, and
providers hold the responsibility to ensure that the risk of mishap during
this period is minimized. They must regularly assess relevant indicators of
maternal and perinatal health to identify problems. Using this information,
they must develop and implement training, policies, and programs to ensure
effective approaches to prevention and to care. These programs must be
based on the best available scientific evidence.
Patricia C. Devine, Obstetric Hemorrhage, Seminars in Perinatology, Volume

33, Issue 2, April 2009, Pages 76-81, ISSN 0146-0005,
10.1053/j.semperi.2008.12.004.
Abstract: Despite advances is medical and surgical therapy, obstetric
hemorrhage remains a significant medical problem for both the developing
and developed world. Depending on the definition that is used, postpartum
hemorrhage complicates up to 18% of all deliveries. It is the single most
important cause of maternal mortality worldwide, accounting for 25% to 30%
of all maternal deaths, and it is the most common maternal morbidity in the
developed world. Most cases of hemorrhage are related to uterine atony and
abnormal placentation; however, many patients have no identifiable risk
factors. Implementation of the active management of labor has resulted in a
significant reduction in the incidence postpartum hemorrhage. However, a
large number of cases still involve suboptimal care, with delays in
diagnosis and treatment identified as common deficiencies.
Keywords: hemorrhage; risk factors; morbidity; quality
A.K. Mbonye, J.B. Asimwe, J. Kabarangira, G. Nanda, V. Orinda, Emergency

obstetric care as the priority intervention to reduce maternal mortality in
Uganda, International Journal of Gynecology & Obstetrics, Volume 96,
Issue 3, March 2007, Pages 220-225, ISSN 0020-7292,
10.1016/j.ijgo.2006.12.017.
Abstract: Purpose
We conducted a survey to determine availability of emergency obstetric care
(EmOC) to provide baseline data for monitoring provision of obstetric care
services in Uganda.
Methods
The survey, covering 54 districts and 553 health facilities, assessed
availability of EmOC signal functions. Following this, performance
improvement process was implemented in 20 district hospitals to scale-up
EmOC services.
Findings
A maternal mortality ratio (MMR) of 671/100,000 live births was recorded.
Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and
malaria accounted for 65.5% of the indirect causes. Among the obstetric
complications, abortion accounted for 38.9% of direct and malaria 87.4% of
indirect causes. Removal of retained products (OR 3.3,
P < 0.002), assisted vaginal delivery (OR 3.3,
P < 0.001) and blood transfusion (OR 13.7,
P < 0.001) were the missing signal functions contributing to
maternal deaths. Most health facilities expected to offer basic EmOC, 349
(97.2%) were not offering them. Using the performance improvement process,
availability of EmOC in the 20 hospitals improved significantly.
Conclusion
An integrated programming approach aiming at increasing access to EmOC,
malaria treatment and prevention services could reduce maternal mortality
in Uganda.
Keywords: Emergency obstetric care; Performance improvement process; Uganda
Deborah Maine, Therese McGinn, 31 - Maternal Mortality and Morbidity, In:

Marlene B. Goldman and Maureen C. Hatch, Editor(s), Women and Health,
Academic Press, San Diego, 2000, Pages 395-403, ISBN 9780122881459,
10.1016/B978-012288145-9/50036-X.
(http://www.sciencedirect.com/science/article/pii/B978012288145950036X)
Jeanne Pfeiffer, Melissa D. Avery, Mary Benbenek, Robbie Prepas, Lisa

Summers, Cecilia M. Wachdorf, Carol O'Boyle, Maternal and Newborn Care
During Disasters: Thinking Outside the Hospital Paradigm, Nursing Clinics
of North America, Volume 43, Issue 3, September 2008, Pages 449-467, ISSN
0029-6465, 10.1016/j.cnur.2008.04.008.
Abstract: Emergencies that challenge the infrastructure of the current
health care system require a shift in the standard of usual practice.
Pregnant women and their newborns are intimately linked special populations
that require continued care despite the community circumstances. Pre-event
planning with community partners can generate a safer alternative for
providing care during a public health emergency. Lessons learned from
international and United States public health emergencies have resulted in
a better understanding of the essentials of care and the development of
resources to guide planning for these populations.
Jocelyn DeJong, Chaza Akik, Faysal El Kak, Hibah Osman, Fadi El-Jardali,
The safety and quality of childbirth in the context of health systems:
mapping maternal health provision in Lebanon, Midwifery, Volume 26, Issue
Abstract: Objective
to provide basic information on the distribution (public/private and
geographically) and the nature of maternity health provision in Lebanon,
including relevant health outcome data at the hospital level in order to
compare key features of provision with maternal/neonatal health outcomes.
Design
a self-completion questionnaire was sent to private hospitals by the
Syndicate of Private Hospitals in collaboration with the study team and to
all public hospitals in Lebanon with a functioning maternity ward by the
study team in cooperation with the Ministry of Public Health.
Setting
childbirth in an institutional setting by a trained attendant is almost
universal in Lebanon and the predominant model of care is obstetrician-led
rather than midwife-led. Yet due to a 15-year-old civil war and a highly
privatised health sector, Lebanon lacks systematic or publically available
data on the organisation, distribution and quality of maternal health
services. An accreditation system for private hospitals was recently
initiated to regulate the quality of hospital care in Lebanon.
Participants
in total, 58 (out of 125 eligible) hospitals responded to the survey (46%
total response rate). Only hospital-level aggregate data were collected.
Measurements
the survey addressed the volume of services, mode of payment for
deliveries, number of health providers, number of labour and childbirth
units, availability of neonatal intensive care units, fetal monitors and
infusion rate regulation pumps for oxytocin, as well as health outcome data
related to childbirth care and stillbirths for the year 2008.
Findings
the study provides the first data on maternal health provision from a
survey of all eligible hospitals in Lebanon. More than three-quarters of
deliveries occur in private hospitals, but the Ministry of Public Health is
the single most important source of payment for childbirth. The reported
hospital caesarean section rate is high at 40.8%. Essential equipment for
safe maternal and newborn health care is widely available in Lebanon, but
over half of the hospitals that responded lack a neonatal intensive care
unit. The ratio of reported numbers of midwives to deliveries is three
times that of obstetricians to deliveries.
there is a need for greater interaction between maternal/neonatal health,
health system specialists and policy makers on how the health system can
support both the adoption of evidence-based interventions and, ultimately,
better maternal and perinatal health outcomes.
Keywords: Maternal health; Safety; Health system
Linda J. Harrison, Leanne Clarke, Judy A. Ungerer, Children's drawings

provide a new perspective on teacherchild relationship quality and school
adjustment, Early Childhood Research Quarterly, Volume 22, Issue 1, 1st
Quarter 2007, Pages 55-71, ISSN 0885-2006, 10.1016/j.ecresq.2006.10.003.
Abstract: A growing literature points to the importance of children's
relationships with their teachers as a factor influencing attitudinal,
cognitive, and behavioral aspects of school adjustment. However, such data
may be confounded when the same teacher rates school adjustment as well as
relationship quality. The present study sought to address this problem by
investigating direct (self-reported feelings about the teacher) and
indirect (representations through drawings) procedures to assess children's
perspectives on the relationship. Self-report questions were adapted from
measures of school liking and maternal acceptance. Drawings applied Fury's
system for describing relational negativity in childfamily drawings.
Results, based on a sample of 125 six-year-olds, showed significant
associations between children's reports/drawings and teacher-rated
relationship quality and school adjustment. Negativity in childteacher
drawings was a particularly salient correlate, suggesting that children's
representations of relationships can provide a useful independent means of
identifying relationship or adjustment difficulties at school.
Keywords: Teacherchild relationship; School adjustment; Children's
perspectives
EEVA T. ARONEN, SIRPA A. KURKELA, Long-Term Effects of an Early Home-Based

Intervention, Journal of the American Academy of Child & Adolescent
Psychiatry, Volume 35, Issue 12, December 1996, Pages 1665-1672, ISSN 0890-
8567, 10.1097/00004583-199612000-00019.
To evaluate the long-term effects of an early home-based intervention on
the quantity and quality of psychiatric symptoms in adolescents.
Method
The material consisted of 160 families with a baby born in 1975-1976.
First, the families were classified with a weighted risk index into low-
and high-risk families. Eighty families attended a 5-year-long family
counseling program (10 times/year). The other half of the families served
as a control group for the effects of counseling. The mental state of the
adolescents was assessed at age 14 to 15 years by the Child Behavior
Checklist and the Youth Self-Report.
Results
The adolescents in the counseling families scored significantly fewer total
symptoms on both the parent and the youth reports. The counseling reduced
more effectively internalizing than externalizing symptoms. The counseling
predicted better mental health in adolescence in both low- and high-risk
families.
Conclusions
Home-based early intervention can have positive long-term effects on the
mental state of adolescents. These results can be used when programs for
primary prevention in families with small children are planned.
Keywords: primary prevention; home-based intervention; follow-up
Paulo A. Graziano, Daniel M. Bagner, Stephen J. Sheinkopf, Betty R. Vohr,

Barry M. Lester, Evidence-based intervention for young children born
premature: Preliminary evidence for associated changes in physiological
regulation, Infant Behavior and Development, Volume 35, Issue 3, June 2012,
Pages 417-428, ISSN 0163-6383, 10.1016/j.infbeh.2012.04.001.
Abstract: The current study examined whether changes in maternal behaviors
following an evidence-based treatmentParentChild Interaction Therapy
(PCIT)was associated with improvements in cardiac vagal regulation in
young children born premature. Participants included 28 young children
(mean age = 37.79 months) that were born premature and presented
with elevated externalizing behavior problems. To assess cardiac vagal
regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA
change (withdrawal or suppression) to a clean-up task were derived pre and
post-treatment. Results indicated that an increase in behaviors mothers are
taught to use during treatment (i.e., do skillspraise, reflection, and
behavioral descriptions) was associated with an improvement in children's
post-treatment RSA suppression levels. The current study illustrates the
important role of caregiver behavior in promoting physiological regulation
in children born premature.
Keywords: Cardiac vagal regulation; RSA suppression; Emotion regulation;
Prematurity; Child; Parent training
Jennifer Prah Ruger, Milton C. Weinstein, S. Katherine Hammond, Margaret H.

Kearney, Karen M. Emmons, Cost-Effectiveness of Motivational Interviewing
for Smoking Cessation and Relapse Prevention among Low-Income Pregnant
Women: A Randomized Controlled Trial, Value in Health, Volume 11, Issue 2,
MarchApril 2008, Pages 191-198, ISSN 1098-3015, 10.1111/j.1524-
4733.2007.00240.x.
Abstract: AbstractObjectives
Low-income women have high rates of smoking during pregnancy, but little is
known about the costs, benefits, and cost-effectiveness of motivational
interviewing (MI), focused on the medical and psychosocial needs of this
population, as an intervention for smoking cessation and relapse
prevention.
Methods
A sample of 302 low-income pregnant women was recruited from multiple
obstetrical sites in the Boston metropolitan area into a randomized
controlled trial of a motivational intervention for smoking cessation and
relapse prevention versus usual care (UC). The findings of this clinical
trial were used to estimate the costs, benefits, and cost-effectiveness of
the intervention from a societal perspective, incorporating published
quality-adjusted life-year (QALY) and life-year (LY) estimates. Outcomes
included smoking cessation and relapse, maternal and infant outcomes,
economic costs, LYs and QALYs saved, and incremental cost-effectiveness
ratios.
Results
The cost-effectiveness of MI for relapse prevention compared to UC was
estimated to be $851/LY saved and $628/QALY saved. Including savings in
maternal medical costs in sensitivity analyses resulted in cost savings for
MI for relapse prevention compared to UC. For smoking cessation, MI cost
more but did not provide additional benefit compared to UC. In one-way
sensitivity analyses, the incremental cost-effectiveness of MI versus UC
would have been $117,100/LY saved and $86,300/QALY saved if 8% of smokers
had quit. In two-way sensitivity analyses, MI was still relatively cost-
effective for relapse prevention ($17,300/QALY saved) even if it cost as
much as $2000/participant and was less effective. For smoking cessation,
however, a higher level of effectiveness (9/110) and higher cost
($400/participant) resulted in higher incremental cost-effectiveness ratios
($112,000/QALY).
Conclusions
Among low-income pregnant women, MI helps prevent relapse at relatively low
cost, and may be cost-saving when net medical cost savings are considered.
For smoking cessation, MI cost more but provided no additional benefit
compared to UC, but might offer benefits at costs comparable to other
clinical preventive interventions if 810% of smokers are induced to quit.
Keywords: cost-effectiveness; low-income; pregnant women; relapse
prevention; smoking cessation
Dawn Flandermeyer, Cynthia Stanton, Deborah Armbruster, Uterotonic use at

home births in low-income countries: A literature review, International
Journal of Gynecology & Obstetrics, Volume 108, Issue 3, March 2010,
Pages 269-275, ISSN 0020-7292, 10.1016/j.ijgo.2009.12.001.
This literature review compiles data on rates of use, indications, types of
provider, mode of administration, and dose of uterotonics used for home
births in low-income countries, and identifies gaps meriting further
research.
Methods
Published and unpublished English language articles from 1995 through 2008
pertaining to home use of uterotonics were identified via electronic
searches of medical and social science databases. In addition,
bibliographies of articles were examined for eligible studies. Data were
abstracted and analyzed by the objectives outlined for this review.
Results
Twenty-three articles met the inclusion/exclusion criteria. Use rates of
uterotonics at home births ranged widely from 1% to 69%, with the large
majority of observations from South Asia. Descriptive studies suggest that
home use of uterotonics before delivery of the baby are predominantly
administered by nonprofessionals to accelerate labor, and are not perceived
as unsafe.
Conclusions
To achieve maximum benefit and minimal harm, programs that increase access
to uterotonics for postpartum hemorrhage prevention must take into account
existing practices among pregnant women. Further research regarding access
to uterotonics and intervention studies for provider behavior change
regarding uterotonic use is warranted.
Keywords: Home birth; Labor augmentation; Misoprostol; Oxytocin; Postpartum
hemorrhage; Uterotonics
Jeanne McDermott, Diana Beck, Sandra Tebben Buffington, Janne Annas,

Gunawan Supratikto, Darwin Prenggono, Dra.M.F.Sri Ekonomi, Endang Achadi,
Two models of in-service training to improve midwifery skills: how well do
they work?, Journal of Midwifery & Women's Health, Volume 46, Issue 4,
JulyAugust 2001, Pages 217-225, ISSN 1526-9523, 10.1016/S1526-
9523(01)00137-4.
Abstract: This program evaluation compared the knowledge, confidence, and
skills of Indonesian village midwives who attended an intensive in-service
training with midwives who received an internship program and midwives who
attended no program. The five key skills compared were prevention of
infection, use of the partograph, manual removal of placenta, bimanual
uterine compression, and neonatal resuscitation. Midwives from the
intensive in-service that combined competency-based skill training with
peer review and continuing education scored higher on the knowledge test
and demonstration of the five key skills and reported managing
complications better than midwives who attended no training program.
Midwives from the internship program scored intermediate between the
intensively trained and the untrained midwives. Overall, skill scores were
71% for midwives in the intensive program, 62% for the interns, and 51% for
midwives with no in-service training. Village midwives from the intensive
program scored significantly higher in the practical demonstration of
manual removal of placenta, bimanual compression, and neonatal
resuscitation than the interns, but the scores on infection prevention and
use of the partograph were not different between the two groups.
Differences in the volume of training opportunities between the two
programs could be responsible for the different outcomes.
Oona Campbell, M. Koblinsky, P. Taylor, Off to a rapid start: appraising

maternal mortality and services, International Journal of Gynecology &
Obstetrics, Volume 48, Supplement, June 1995, Pages S33-S52, ISSN 0020-
7292, 10.1016/0020-7292(95)02319-8.
Abstract: Enthusiasm for doing something about Safe Motherhood has been
expressed in many developing countries, but priorities for action cannot be
identified without adequately assessing a country's maternal mortality
situation. It is also important, however, to avoid embarking on time-
consuming research measuring indicators which are not essential to
developing programs. After presenting an overview of ideal Safe Motherhood
program components, the paper lists a series of questions which serve as an
assessment tool for collecting useful information and for identifying data
sources on maternal mortality and health. The framework for these questions
centers around the following steps: (1) gaining an overview of health
policy relevant to maternal mortality and morbidities; (2) assessing the
magnitude and causes of maternal mortality and morbidity, and the
characteristics of groups at particular risk; and (3) assessing the
available inputs in terms of services (access, quality, providers, what is
provided at various tiers, etc.) and in terms of the culture and existing
resources and groups.
Keywords: Maternal mortality; Maternal morbidity; Safe motherhood
Kathryn M. Andolsek, Gaylen M. Kelton, RISK ASSESSMENT, Primary Care:

Clinics in Office Practice, Volume 27, Issue 1, 1 March 2000, Pages 71-103,
ISSN 0095-4543, 10.1016/S0095-4543(05)70149-4.
Oona MR Campbell, Wendy J Graham, on behalf of The Lancet Maternal Survival

Series steering group, Strategies for reducing maternal mortality: getting
on with what works, The Lancet, Volume 368, Issue 9543, 713 October 2006,
Pages 1284-1299, ISSN 0140-6736, 10.1016/S0140-6736(06)69381-1.
Abstract: Summary
The concept of knowing what works in terms of reducing maternal mortality
is complicated by a huge diversity of country contexts and of determinants
of maternal health. Here we aim to show that, despite this complexity, only
a few strategic choices need to be made to reduce maternal mortality. We
begin by presenting the logic that informs our strategic choices. This
logic suggests that implementation of an effective intrapartum-care
strategy is an overwhelming priority. We also discuss the alternative
configurations of such a strategy and, using the best available evidence,
prioritise one strategy based on delivery in primary-level institutions
(health centres), backed up by access to referral-level facilities. We then
go on to discuss strategies that complement intrapartum care. We conclude
by discussing the inexplicable hesitation in decision-making after nearly
20 years of safe motherhood programming: if the fifth Millennium
Development Goal is to be achieved, then what needs to be prioritised is
obvious. Further delays in getting on with what works begs questions about
the commitment of decision-makers to this goal.
Bruce Rabin, Chapter 33 - Stress: A System of the Whole, In: Robert Ader,
Editor(s), Psychoneuroimmunology (Fourth Edition), Academic Press,
012088576-3/50040-X.
Abstract: Psychoneuroimmunologists direct their attention to understanding
the mechanisms of stressor-induced alterations of immune system function
and subsequent health alterations. However, stressor-induced health
alterations involve many components of health and affect many tissues of
the body that are independent of immune system alterations. Although the
theme of this book is directed to the immune system, this chapter will
consider stress as a system that alters the function of other systems that
are not part of the immune system, an area of particular interest to the
chapter author.
J. Chamberlain, R. McDonagh, A. Lalonde, S. Arulkumaran, The role of

professional associations in reducing maternal mortality worldwide,
October 2003, Pages 94-102, ISSN 0020-7292, 10.1016/S0020-7292(03)00185-1.
Abstract: The death of hundreds of thousands of women due to pregnancy-
related complications casts a shadow over the modern obstetrical world.
This paper examines the potential roles and responsibilities of
professional obstetrical and midwifery associations in addressing this
tolerated tragedy of maternal deaths. We examine the successes and
challenges of obstetrical and midwifery associations and encourage the
growth and development of active associations to address maternal mortality
within their own borders. Professional associations can play a vital role
in the reduction of maternal mortality worldwide. Their roles include
lobbying for women's health and rights, setting standards of practice,
raising awareness and team building. Associations from developed countries
can influence and strengthen their colleagues within developing countries;
for example, the FIGO Save the Mothers initiative. Professional
associations should be encouraged to play an active role in reducing
maternal mortality within their own country and abroad.
Keywords: Maternal mortality; Professional associations; Human rights
Penny E Clarke, Harriet Gross, Women's behaviour, beliefs and information

sources about physical exercise in pregnancy, Midwifery, Volume 20, Issue
2, June 2004, Pages 133-141, ISSN 0266-6138, 10.1016/j.midw.2003.11.003.
to examine the potential effect of low-risk pregnancy on women's
recreational activity patterns and to explore pregnant women's beliefs and
information sources regarding physical exercise participation.
Design:
preliminary, prospective survey
Setting:
participants homes in the East Midlands, UK.
Participants:
fifty-seven nulliparous, pregnant women.
Measurements:
levels of maternal physical activity participation were assessed by semi-
structured interview at 16, 25, 34 and 38 weeks gestation. The modified
Baecke questionnaire provided a measure of women's habitual sport and
leisure activities in the 12 months prior to pregnancy. A 10-item scale
assessed maternal beliefs regarding the importance of physical activity in
pregnancy. The fetal health locus of control scale measured the extent to
which women believed their own behaviour, the behaviour of others and/or
chance would influence fetal health. Open-ended questions assessed women's
information sources.
Findings:
fourteen of the 36 (39%) women who reported participating in some form of
weekly exercise before pregnancy did not report pursuing any similar
activities during pregnancy. Rest and relaxation were perceived as being
significantly more important during pregnancy than was regular exercise or
the maintenance of an active lifestyle. Fifty-five respondents (96%)
indicated that they had received advice about physical activity at least
once during pregnancy. At 16 weeks gestation, women obtained most of their
information from books and magazines. Between 25 and 38 weeks gestation,
most advice came from family and friends. Participants who reported
receiving this advice were significantly older, more educated and of a
higher activity level pre-pregnancy.
Key conclusions:
levels of maternal exercise may decline during pregnancy both as a result
of the physical changes of pregnancy and from a combination of social and
psychological factors. Present health education may be failing to correct
inaccurate perceptions of the risks associated with physical exercise in
pregnancy.
Implications for practice:
improving the quantity and quality of information related to physical
exercise has the potential to correct inaccurate perceptions and confer
several benefits on maternal and fetal health. Effective intervention
strategies should focus not only on the pregnant woman but also extend to
her family, friends and exercise provider.
Sahar Hassan-Bitar, Sheila Narrainen, Shedding light on the challenges

faced by Palestinian maternal health-care providers, Midwifery, Volume 27,
Issue 2, April 2011, Pages 154-159, ISSN 0266-6138,
10.1016/j.midw.2009.05.007.
Abstract: Objective
to explore the challenges and barriers faced by Palestinian maternal
health-care providers (HCPs) to the provision of quality maternal health-
care services through a case study of a Palestinian public referral
hospital in the Occupied Palestinian Territory.
Design and method
descriptive qualitative study. The data are from a broader study, conducted
in 2005 at the same hospital as part of a baseline assessment of maternal
health services.
Participants
31 maternal HCPs; nine midwives and 14 nurses and eight doctors.
Findings
the quality of care provided for women and infants at this Palestinian
public hospital is substandard. The maternal HCPs work within a difficult
and resource-constrained environment.
Issues include
high workload, poor compensation, humiliation in the workplace, suboptimal
supervision and the absence of professional support and guidance. Midwives
are perceived to be at the bottom of the health professional hierarchy.
Conclusions
there is a need for managers and policy makers to enable maternal HCPs to
provide better quality care for women and infants during childbirth,
through facilitating the roles of midwives and nurses and creating a more
positive and resourceful environment.
Palestinian midwives need to increase their knowledge and use evidence-
based practices during childbirth. They need to unite and create their own
circle of professional support in the form of a Palestinian midwifery
professional body.
Keywords: Midwife; Maternal human resources; Working conditions; Occupied
Palestinian territory
Anna LaRocco-Cockburn, Jennifer Melville, Michelle Bell, Wayne Katon,

Depression screening attitudes and practices among obstetrician
gynecologists, Obstetrics & Gynecology, Volume 101, Issue 5, Part 1,
May 2003, Pages 892-898, ISSN 0029-7844, 10.1016/S0029-7844(03)00171-6.
Abstract: Objective
To assess obstetriciangynecologists attitudes and practices related to
depression screening.
Methods
A total of 282 obstetriciangynecologists completed a 36-question mail
survey that assessed attitudes regarding depression screening, training to
treat depression, psychosocial concern, professional influence, and ease of
screening.
Results
Depression screening (employed regardless of signs or symptoms) was
reported by 44% of physicians. Positive attitudes toward depression
screening, high psychosocial concern, high ease of screening, and adequate
training to treat depression were significant independent predictors of
depression screening practices.
Conclusion
The majority of obstetriciangynecologists are concerned about depression,
believe depression screening is effective, and perform some degree of
depression screening with their patients. However, they perceive depression
screening as difficult to carry out in everyday practice, and some question
whether screening improves outcomes.
Harriet L MacMillan, C Nadine Wathen, Jane Barlow, David M Fergusson, John

M Leventhal, Heather N Taussig, Interventions to prevent child maltreatment
and associated impairment, The Lancet, Volume 373, Issue 9659, 1723
January 2009, Pages 250-266, ISSN 0140-6736, 10.1016/S0140-6736(08)61708-0.
Abstract: Summary
Although a broad range of programmes for prevention of child maltreatment
exist, the effectiveness of most of the programmes is unknown. Two specific
home-visiting programmesthe NurseFamily Partnership (best evidence) and
Early Starthave been shown to prevent child maltreatment and associated
outcomes such as injuries. One population-level parenting programme has
shown benefits, but requires further assessment and replication. Additional
in-hospital and clinic strategies show promise in preventing physical abuse
and neglect. However, whether school-based educational programmes prevent
child sexual abuse is unknown, and there are currently no known approaches
to prevent emotional abuse or exposure to intimate-partner violence. A
specific parent-training programme has shown benefits in preventing
recurrence of physical abuse; no intervention has yet been shown to be
effective in preventing recurrence of neglect. A few interventions for
neglected children and motherchild therapy for families with intimate-
partner violence show promise in improving behavioural outcomes. Cognitive-
behavioural therapy for sexually abused children with symptoms of post-
traumatic stress shows the best evidence for reduction in mental-health
conditions. For maltreated children, foster care placement can lead to
benefits compared with young people who remain at home or those who reunify
from foster care; enhanced foster care shows benefits for children. Future
research should ensure that interventions are assessed in controlled
trials, using actual outcomes of maltreatment and associated health
measures.
Mira M. Grice, Patricia M. McGovern, Bruce H. Alexander, Laurie Ukestad,

Wendy Hellerstedt, Balancing Work and Family After Childbirth: A
Longitudinal Analysis, Women's Health Issues, Volume 21, Issue 1, January
February 2011, Pages 19-27, ISSN 1049-3867, 10.1016/j.whi.2010.08.003.
In the United States, women with young children have dramatically increased
their participation in the workforce, resulting in greater potential
conflict between work and family roles. However, few studies have examined
postpartum workfamily conflict. This study examined associations between
workfamily conflict and womens health after childbirth.
Methods
Employed women, 18 years of age and older, were recruited while
hospitalized for childbirth and followed for 18 months (n = 541; 66%
response rate). Health outcomes were measured using the Short Form 12,
version 2. Longitudinal fixed-effects models estimated the associations
between workfamily conflict (modeled as job and home spillover) and
health.
Results
Women who reported high levels of job spillover to home had mental health
scores slightly, but significantly, worse than women who reported low
levels of spillover ( = 1.26; SE = 0.47). Women with medium and high
levels of home spillover to job also reported worse mental health ( =
0.81, SE = 0.30; and = 1.52, SE = 0.78) relative to those with low
spillover. Women who reported medium (versus low) levels of home spillover
reported slightly improved physical health ( = 0.64, SE = 0.30). There was
no significant association between job spillover and physical health.
Conclusion
This study focused exclusively on employed postpartum women. Results
illustrate that job and home spillover are associated with maternal mental
and physical health. Findings also revealed that flexible work arrangements
were associated with poorer postpartum mental health scores, which may
reflect unintended consequences, such as increasing the amount of work
brought home.
Nirbhay N. Singh, Subhashni D. Singh, Chapter 2 - Developmental

Considerations in Treatment, In: Helen Orvaschel, Jan Faust and Michel
Hersen, Editor(s), Handbook of Conceptualization and Treatment of Child
Psychopathology, Pergamon, Oxford, 2001, Pages 9-38, ISBN 9780080433622,
10.1016/B978-008043362-2/50003-2.
Abstract: A developmental perspective provides a framework for
understanding the nature and course of specific childhood disorders, an
essential basis for case conceptualization and long-term treatment.
Knowledge of the developmental course of childhood disorders provides
information about how symptoms of specific disorders vary across the life
span, and how children's individual differences affect not only their
developmental pathways but also their psychopathological pathways.
Hadiza Galadanci, Wolfgang Knzel, Oladapo Shittu, Robert Zinser, Manfred
Gruhl, Stefanie Adams, Obstetric quality assurance to reduce maternal and
fetal mortality in Kano and Kaduna State hospitals in Nigeria,
July 2011, Pages 23-28, ISSN 0020-7292, 10.1016/j.ijgo.2011.02.005.
Abstract: Objective
To achieve Millennium Development Goals 4 and 5 in Nigeria, a quality
assurance project in obstetrics in 10 hospitals in northern Nigeria was
established to improve maternal and fetal outcome.
Methods
The project commenced in January 2008 with assessment and improvement of
the structure of the 10 hospitals. Continuous maternal and fetal data
collection and analysis were conducted from 2008 to 2009 by means of a
maternity record book and structured monthly summary form. The quality of
hospital infrastructure and equipment was also assessed.
Results
The mean maternal mortality ratio (MMR) was reduced from 1790 per
100 000 births in the first half of 2008 to 940 per 100 000
births in the second half of 2009. The average fetal mortality ratio (FMR)
decreased slightly from 84.9 to 83.5 per 1000 births. There was an
inversely proportional relationship between the total number of deliveries
in a hospital and MMR and FMR. There was a close correlation between the
MMR and the equipment status and hygiene conditions of the hospitals.
Conclusion
Continuous monitoring of quality assurance in maternity units raised the
awareness of the quality of obstetric performance and improved the quality
of care provided, thereby improving MMR.
Keywords: Maternal mortality ratio; Millennium Development Goal 5;
Obstetrics; Quality Assurance
Elaine Germano, Judith Bernstein, Home birth and short-stay delivery:

Lessons in health care financing for providers of health care for women,
Journal of Nurse-Midwifery, Volume 42, Issue 6, NovemberDecember 1997,
Pages 489-498, ISSN 0091-2182, 10.1016/S0091-2182(97)00080-3.
Abstract: The current restructuring of the U.S. health care delivery system
is driven primarily by economic forces. Although primary care providers may
understand the roles of technology and advocacy in fostering fundamental
change, they may not be familiar with the issues related to financing of
health care and, thus, may not fully appreciate the extent to which
economic factors influence the character of their professional lives and
the services they provide. Analysis of the loss of the home birth option in
the 1950s provides a method for understanding and influencing the factors
driving health care restructuring today. In examining short-stay delivery
in the 1990s, this article also addresses ways in which managed health care
systems may improve or restrict women's access to a variety of primary care
services.
Afshan B. Hameed, Mark S. Sklansky, Pregnancy: Maternal and Fetal Heart

Disease, Current Problems in Cardiology, Volume 32, Issue 8, August 2007,
Pages 419-494, ISSN 0146-2806, 10.1016/j.cpcardiol.2007.04.004.
Abstract: Cardiac disorders complicate less than 1% of all pregnancies.
Physiologic changes in pregnancy may mimic heart disease. In order to
differentiate these adaptations from pathologic conditions, an in-depth
knowledge of cardiovascular physiology is mandatory. A comprehensive
history, physical examination, electrocardiogram, chest radiograph, and
echocardiogram are sufficient in most cases to confirm the diagnosis. Care
of women with cardiac disease begins with preconception counseling. Severe
lesions should be taken care of prior to contemplating pregnancy.
Management principles for pregnant women are similar to those for the non-
pregnant state. A team approach comprised of a maternal fetal medicine
specialist, cardiologist, neonatologist, and anesthesiologist is essential
to assure optimal outcome for both the mother and the fetus.
Although fetal heart disease complicates only a small percentage of

pregnancies, congenital heart disease causes more neonatal morbidity and
mortality than any other congenital malformation. Unfortunately, screening
approaches for fetal heart disease continue to miss a large percentage of
cases. This weakness in fetal screening has important clinical
implications, because the prenatal detection and diagnosis of congenital
heart disease may improve the outcome for many of these fetal patients. In
fact, simply the detection of major heart disease prenatally can improve
neonatal outcome by avoiding discharge to home of neonates with ductal-
dependent congenital heart disease. Fortunately, recent advances in
screening techniques, an increased ability to change the prenatal natural
history of many forms of fetal heart disease, and an increasing recognition
of the importance of a multidisciplinary, team approach to the management
of pregnancies complicated with fetal heart disease, together promise to
improve the outcome of the fetus with congenital heart disease.
Judith E.B. van der Waerden, Cees Hoefnagels, Clemens M.H. Hosman,
Psychosocial preventive interventions to reduce depressive symptoms in low-
SES women at risk: A meta-analysis, Journal of Affective Disorders, Volume
128, Issues 12, January 2011, Pages 10-23, ISSN 0165-0327,
10.1016/j.jad.2010.02.137.
Women who have low socioeconomic status (SES) or live in disadvantaged
circumstances are a vulnerable group at risk for depression. Little is
known about the efficacy of preventive interventions to reduce depressive
symptoms in low-SES women. The aim of this study is to provide an overview
of controlled outcome studies and to investigate the overall efficacy and
moderators of interventions targeted at reducing depressive symptoms in
this population.
Methods
A systematic review and meta-analysis were conducted for 14 studies
(N = 1396). The effect size of the studies was computed for
outcomes assessing changes in depressive symptom levels using the
standardized mean difference effect size. Study, target population, and
intervention descriptors expected to influence effect size were analyzed
using univariate subgroup and metaregression techniques with mixed-effects
statistical models.
Results
The estimated overall effect size of 0.31 was significant; study sample
characteristics, intervention characteristics and the research design of
the studies did not moderate intervention effects.
Limitations
Limitations to this study are the relatively limited number of well
controlled studies that could be included in the analyses.
Conclusions
A number of promising programs have been developed specifically for low-SES
women, a population at high risk for developing major depression. On
average these programs were found to reduce the level of depressive
symptoms, with more than half of the studies showing medium to large effect
sizes. This indicates that considerable mental health benefits can be
gained among disadvantaged women.
Keywords: Meta-analysis; Low SES; Women; Depressive symptoms; Prevention
April Ann Benasich, Jeanne Brooks-Gunn, Beatriz Chu Clewell, How do mothers
benefit from early intervention programs?, Journal of Applied Developmental
Psychology, Volume 13, Issue 3, JulySeptember 1992, Pages 311-362, ISSN
0193-3973, 10.1016/0193-3973(92)90035-G.
Abstract: Extant reviews of early childhood intervention programs for the
disadvantaged focus on the benefits that accrue to the children. Programs
also may influence the parents (typically the mother), as most programs
provide services to the mother as well as the child. In this article, the
efficacy of a particular set of programs is reviewed. Early interventions
that are educationally oriented, that are at least six months in duration,
that begin prior to age 3, and that serve disadvantaged families were
reviewed. Of the 27 programs, 11 offered regular, substantive, center-based
programming (mode = 40 hr/week; M = 25.7 hr/week), and 16 offered home
visits and/or center-based programs on a less frequent basis. Maternal
benefits are reviewed for maternal employment and education, fertility,
mother-infant interaction, home environment, maternal mental health and
self-esteem, and maternal attitudes and knowledge about childrearing. The
programs had the most impact on maternal employment and education, on
subsequent fertility, and on mother-infant interaction. Implications of
these findings for programs for poor families are considered.
Kathie Records, A Critical Review of Maternal Abuse and Infant Outcomes:

Implications for Newborn Nurses, Newborn and Infant Nursing Reviews, Volume
7, Issue 1, March 2007, Pages 7-13, ISSN 1527-3369,
10.1053/j.nainr.2006.12.005.
Abstract: Abuse of women is endemic in the United States, with most
violence occurring during childhood or the childbearing years. This article
presents a summary of the physical and psychological adaptations that occur
in women subsequent to abuse experience and the key physiologic changes
that affect pregnancy for these women. Outlining these physiologic changes
provides the basis for understanding and discussing the available evidence
of newborn outcomes when the mother has been abused. The maternal-newborn
relationship is explored in the context of abuse experiences. Long-term
alterations in childhood growth and development are noted. Recommendations
for nursing interventions to improve newborn outcomes when the mother has
been abused are provided. Areas needing additional research include
comparative descriptive designs exploring early maternal newborn
relationships for abused as compared with nonabused mother-infant dyads and
testing of interventions to decrease the stress response.
Keywords: Abuse; Domestic violence; Maternal; Infant; Newborn; Health;
Maternal-infant relationship
, References, Introduction to Forensic Psychology (Second Edition),

Academic Press, Burlington, 2005, Pages 495-550, ISBN 9780120643516,
10.1016/B978-012064351-6/50015-6.
Violet Q. Habwe, Posttransplantation Quality of Life: More Than Graft

Function, American Journal of Kidney Diseases, Volume 47, Issue 4,
Supplement 2, April 2006, Pages S98-S110, ISSN 0272-6386,
10.1053/j.ajkd.2005.12.041.
Abstract: Whereas newer immunosuppressive therapies have increased patient
and graft survival, long-term treatment with these drugs has been linked to
medical and physical complications that may impact on posttransplantation
quality of life. Immunosuppression-related physical side effects that can
alter appearanceincluding hirsutism, gingival hyperplasia, weight gain,
cushingoid facies, hand tremors, alopecia, and skin disordersare among the
most bothersome to patients and may have serious psychosocial implications.
In addition, physical side effects may influence patient adherence to their
prescribed treatment regimens and result in more serious complications,
such as acute rejection, graft loss, rehospitalization, and even mortality.
Therefore, strategies for minimizing side effects of immunosuppressive
therapy and improving medication adherence are integral to better long-term
transplant recipient management.
Keywords: Adherence; kidney transplantation; physical side effects; quality
of life; corticosteroids; cyclosporine; tacrolimus
Marcia A. Ellison, Selen Hotamisligil, Hang Lee, Janet W. Rich-Edwards,

Samuel C. Pang, Janet E. Hall, Psychosocial risks associated with multiple
births resulting from assisted reproduction, Fertility and Sterility,
10.1016/j.fertnstert.2004.11.053.
Abstract: Objective
To determine if increased psychosocial risks are associated with each
increase in birth multiplicity (i.e., singleton, twin, triplet) resulting
from assisted reproduction.
Design
Stratified random sample (n = 249).
Setting
An academic teaching hospital and private practice infertility center.
Patient(s)
Mothers raising 1- to 4-year-old children (n = 128 singletons, n = 111
twins, and n = 10 triplets) conceived through assisted reproduction.
Intervention(s)
Self-administered, mailed survey.
Main Outcome Measure(s)
Scales measuring material needs, quality of life, social stigma,
depression, stress, and marital satisfaction.
Result(s)
Using multivariate logistic regression models, for each additional multiple
birth child, the odds of having difficulty meeting basic material needs
more than tripled and the odds of lower quality of life and increased
social stigma more than doubled. Each increase in multiplicity was also
associated with increased risks of maternal depression.
Conclusion(s)
To increase patients' informed decision-making, assisted reproduction
providers might consider incorporating a discussion of these risks with all
patients before they begin fertility treatment, and holding the discussion
again if the treatment results in a multiple gestation. These data may also
help providers to identify appropriate counseling, depression screening,
and supports for patients with multiple births.
Keywords: Multiple births; fertility treatment outcomes; depression;
quality of life; iatrogenic; twins; triplets
Sam Rowlands, Social predictors of repeat adolescent pregnancy and focussed

strategies, Best Practice & Research Clinical Obstetrics &
Gynaecology, Volume 24, Issue 5, October 2010, Pages 605-616, ISSN 1521-
6934, 10.1016/j.bpobgyn.2010.02.016.
Abstract: This article begins with an overview of teenage pregnancy within
a social context. Data are then presented on conceptions and repeat
conceptions in teenagers. Social predictors of repeat teenage pregnancy are
grouped according to social ecological theory. A brief summary of
prevention of teenage pregnancy in general is followed by a detailed
analysis of studies of interventions designed to prevent repeat pregnancy
that reached specific quality criteria. The results of some systematic
reviews show no significant overall effect on repeat pregnancy, whereas
others show an overall significant reduction. Youth development programmes
are shown in some cases to lower pregnancy rates but in other cases to have
no effect or even to increase them. Features of secondary prevention
programmes more likely to be successful are highlighted.
Keywords: repeat; adolescent; teenage; pregnancy; predictor; strategy;
prevention; intervention
Wendy Simonds, Watching the clock: keeping time during pregnancy, birth,
and postpartum experiences, Social Science & Medicine, Volume 55, Issue
4, August 2002, Pages 559-570, ISSN 0277-9536, 10.1016/S0277-9536(01)00196-
4.
Abstract: In this paper, I analyze how different didactic discourses
surrounding pregnancy, birth, and postpartum care portray time in
procreative events. I investigate advice regarding procreative experiences
offered to women by a variety of experts, and offered by experts to each
other, examining literature which demonstrates the wide range of didactic
approaches to procreative events that are accessible in US culture, from
masculinist medical orthodoxythe dominant perspectiveto the
naturalist/feminist midwifery model, with self-help literature reflecting
the influence of both ends of this spectrum as well as of consumer-oriented
health activism. I explore how the conceptualization of time in the medical
discourse contributes to the overpowering or disempowering of procreating
women, and how the self-help and midwifery approaches respond to the
medical modelranging on a continuum from reification to refutation.
Obstetrics works on women's bodies to make them stay on time and on course;
this quest becomes more obsessively time-focused over time. In contrast,
the midwifery discourse centers on women active in time, rather than
against it. Self-help book authors line up somewhere in the middle, mostly
taking medical management of procreative time for granted and occasionally
try to show women ways in which we can buy time or bide our time against
medicine.
Keywords: Procreative discourses; Childbirth; Midwifery; Obstetrics;
Pregnancy; Procreation
Jeannette Milgrom, Charlene Schembri, Jennifer Ericksen, Jessica Ross, Alan

W. Gemmill, Towards parenthood: An antenatal intervention to reduce
depression, anxiety and parenting difficulties, Journal of Affective
Disorders, Volume 130, Issue 3, May 2011, Pages 385-394, ISSN 0165-0327,
10.1016/j.jad.2010.10.045.
There have been few antenatal interventions aimed at preparing women for
the transition to parenthood and previous attempts to intervene antenatally
to prevent postnatal depression and anxiety have had limited impact.
Methods
We evaluated the effectiveness of an antenatal intervention which targeted
risk factors for poor postnatal adjustment, with the dual aim of reducing
both postnatal symptoms of depression/anxiety and parenting difficulties (a
nine-unit self-guided workbook with weekly telephone support). Based on an
initial feasibility study (n = 200) which confirmed a low level
of help-seeking among distressed women during pregnancy, an additional
community networking component was developed aimed at increasing social
support and access to health professionals to facilitate treatment of
current antenatal depression/anxiety, if present. In the evaluation of a
second version of the intervention, pregnant women (n = 143) were
randomly allocated to receive either the intervention or routine care.
Results
Following the antenatal intervention there were significantly fewer cases
scoring above threshold for mild-to-severe depression/anxiety symptoms
postnatally compared to routine care, along with a trend towards reduced
parenting stress. The community networking component appeared helpful and
women with higher baseline depression scores showed higher levels of help-
seeking in both intervention and routine care groups.
Limitations
It was not possible to evaluate the efficacy of individual program
components separately.
Conclusions
The findings provide support for the effectiveness of the Towards
Parenthood intervention both as a preparation for parenthood program and in
reducing symptoms of postnatal depression/anxiety.
Keywords: Postnatal depression; Antenatal depression; Anxiety; Early
intervention; Parenting preparation; Randomised controlled trial
S. Darius Tandon, Fallon Cluxton-Keller, Julie Leis, Huynh-Nhu Le, Deborah

F. Perry, A comparison of three screening tools to identify perinatal
depression among low-income African American women, Journal of Affective
Disorders, Volume 136, Issues 12, January 2012, Pages 155-162, ISSN 0165-
0327, 10.1016/j.jad.2011.07.014.
The purpose of the current study was to determine the sensitivity,
specificity, and positive predictive value of three depression screening
tools among a low-income African American population of pregnant and
recently delivered women enrolled in home visitation programs in a low-
income urban community.
Methods
Ninety-five women enrolled in home visitation programs32 who were pregnant
and 63 with a child < 6 months comprise the study sample. Each
woman completed a structured clinical interview and three depression
screening toolsthe Edinburgh Postnatal Depression Scale (EPDS), Center for
Epidemiologic Studies Depression Scale (CES-D), and Beck Depression
Inventory II (BDI-II).
Results
Over a quarter of women (28.4%) were experiencing major depression. Each
screening tool was highly accurate in detecting major depression and major
or minor depression among prenatal and postpartum women, with areas under
the curve (AUCs) > 0.90. Sensitivities of all screening tools were
improved when using cutoffs lower than those considered standard by
instrument developers.
Limitations
Participants were recruited from home visitation programs in an urban
context which may limit generalizability to other populations of low-income
African American women. Given that no women during pregnancy met criteria
for minor depression, it was not possible to determine optimal prenatal
cutoff scores.
Conclusions
Three depression screening toolsthe EPDS, CES-D, and BDI-IIappear to be
reliable and brief assessments of major and minor depression among low-
income African American perinatal women. Providers using these tools should
consider using lower cutoff scores to most effectively identify women in
need of depression treatment.
Keywords: Postpartum depression; Screening; African American; Home visiting
Thomas F. Baskett, Epidemiology of obstetric critical care, Best Practice

October 2008, Pages 763-774, ISSN 1521-6934, 10.1016/j.bpobgyn.2008.06.002.
Abstract: In the last 20 years, in developed countries, maternal mortality
rates have fallen such that analysis of cases of severe maternal morbidity
is necessary to provide sufficient numbers to give a clinically relevant
assessment of the standard of maternal care. Different approaches to the
audit of severe maternal morbidity exist, and include need for intensive
care, organ system dysfunction and clinically defined morbidities. In both
developed and developing countries, the dominant causes of severe morbidity
are obstetric haemorrhage and hypertensive disorders. In some low-resource
regions, obstructed labour and sepsis remain significant causes of severe
maternal morbidity. The death to severe morbidity ratio may reflect the
standard of maternal care. Audits of severe maternal morbidity should be
complementary to maternal mortality reviews.
Keywords: maternal mortality; severe maternal morbidity; obstetric
intensive care; postpartum haemorrhage; eclampsia
Ming Wai Wan, Kathryn M. Abel, Jonathan Green, The transmission of risk to
children from mothers with schizophrenia: A developmental psychopathology
model, Clinical Psychology Review, Volume 28, Issue 4, April 2008, Pages
613-637, ISSN 0272-7358, 10.1016/j.cpr.2007.09.001.
Abstract: Research in children of mothers with schizophrenia (HRsz
children) has focused on identifying the early antecedents of adult illness
to understand its intergenerational (primarily genetic) transmission. From
a developmental psychopathology perspective, the vulnerability of HRsz
children may result from multiple environmental factors interacting with
ongoing developmental processes. The objectives were: (1) to understand the
extent to which having a mother with schizophrenia impacts on developmental
and clinical trajectories; (2) to review whether research supports a
proposed model for the non-genetic transmission of risk in HRsz offspring;
(3) to discuss the implications of the model for early intervention. HRsz
children show vulnerability in a range of areas throughout childhood, but
the findings are not unanimous in any single domain, and poor developmental
functioning in any given domain does not necessarily predict morbidity.
Broad support for a developmental psychopathology model is provided by
studies suggesting a generalised vulnerability and studies on the impact of
psychosocial factors. However, little empirical research has elucidated
specific proximal social environmental influences through development. Gaps
in the literature are identified where studies in depressed mothers and
other groups are potentially informative, and which suggest that
conventional psychological therapies may not be sufficient to enhance
offspring outcomes. Future research could inform our understanding of
developmental psychopathology and the development of preventative
interventions.
Keywords: Maternal schizophrenia; High risk; Developmental outcome; Gene
environment interaction
Noreen Goldman, Dana A. Glei, Evaluation of midwifery care: results from a

survey in rural Guatemala, Social Science & Medicine, Volume 56, Issue
4, February 2003, Pages 685-700, ISSN 0277-9536, 10.1016/S0277-
9536(02)00065-5.
Abstract: In an effort to reduce infant and maternal morbidity and
mortality in developing countries, the World Health Organization has
promoted the training of traditional birth attendants (midwives) and their
incorporation into the formal health care system. In this paper, we examine
several aspects of the integration of traditional and biomedical maternity
care that are likely to reflect the quality of care received by Guatemalan
women. Specifically, we examine the extent to which women combine
traditional and biomedical pregnancy care, the frequency with which
midwives refer women to biomedical providers, the content and quality of
care offered by midwives, and the effects of midwife training programs on
referral practices and quality of care. The analysis is based on data from
the 1995 Guatemalan Survey of Family Health. The results offer a mixed
assessment of the efficacy of midwife training programs. For example,
although trained midwives are much more likely than other midwives to refer
their clients to biomedical providers, most pregnant women do not see a
biomedical provider, and the quality of midwife care, as defined and
measured in this study, is similar between trained and untrained midwives.
Keywords: Pregnancy; Prenatal care; Birth; Midwifery; Traditional birth
attendant; Guatemala
T.G. Rana, B.D. Chataut, G. Shakya, G. Nanda, A. Pratt, S. Sakai,

Strengthening emergency obstetric care in Nepal: The Women's Right to Life
and Health Project (WRLHP), International Journal of Gynecology &
Obstetrics, Volume 98, Issue 3, September 2007, Pages 271-277, ISSN 0020-
7292, 10.1016/j.ijgo.2007.05.017.
The Women's Right to Life and Health Project contributes to Nepal's
National Safe Motherhood Program and maternal mortality reduction efforts
by working to improve the availability, quality and utilization of
emergency obstetric care services in public health facilities.
Methods
The project upgraded 8 existing public health facilities through
infrastructure, equipment, training, data collection, policy advocacy, and
community information activities. The total cost of the project was
approximately US$1.6 million.
Results
In 5 years, 3 comprehensive and 4 basic emergency obstetric care (EmOC)
facilities were established in an area where adequate EmOC services were
previously lacking. From 2000 to 2004, met need for EmOC improved from 1.9
to 16.9%; the proportion of births in EmOC project facilities increased
from 3.8 to 8.3%; and the case fatality rate declined from 2.7 to 0.3%.
Discussion
While the use of maternity services is still low in Nepal, improving
availability and quality of EmOC together with community empowerment can
increase utilization by women with complications, even in low-resource
settings. Partnerships with government and donors were key to the project's
success. Similar efforts should be replicated throughout Nepal to expand
the availability of essential life-saving services for pregnant women.
Keywords: Nepal; Emergency obstetric care; Maternal mortality; Utilization
J McCarthy, The conceptual framework of the PMM Network, International

Journal of Gynecology & Obstetrics, Volume 59, Supplement 2, 1 November
1997, Pages S15-S21, ISSN 0020-7292, 10.1016/S0020-7292(97)00143-4.
Abstract: Understanding the determinants of maternal mortality is a complex
task, in part because maternal deaths are influenced by many different
categories of events or conditions. Biology, economics, culture, demography
and the distribution and effectiveness of health services all contribute.
Conceptual frameworks have made important contributions to our
understanding of the determinants of other, equally complex events, such as
fertility and child survival. Also referred to as `proximate determinants
frameworks', such models are useful because they identify the specific
mechanisms through which social, economic and cultural factors lead to the
event of interest. Our model identifies the precise sequence of events that
lead to maternal death (pregnancy, complication and death) and specifies
categories of intermediate factors and distant factors that directly affect
one or more of these events. When the world literature on maternal
mortality was analyzed in light of the causal pathways laid out in the
conceptual framework, it became clear that some pathways are more amenable
to intervention and change than others. Implications for strategies,
programs and monitoring and evaluation are discussed. 1997
International Journal of Gynecology and Obstetrics
Keywords: Maternal mortality; International; Obstetric complications;
Determinants; Model; Education
Tzu-ting Huang, Chieh-Ying Yeh, Yc-Chen Tsai, A diet and physical activity
intervention for preventing weight retention among Taiwanese childbearing
women: a randomised controlled trial, Midwifery, Volume 27, Issue 2, April
2011, Pages 257-264, ISSN 0266-6138, 10.1016/j.midw.2009.06.009.
Abstract: Objective
to examine the effect of individual counselling on diet and physical
activity from pregnancy to six months post partum, or from birth to six
months post partum, on weight retention among Taiwanese women.
Design
a randomised controlled trial assigned participants to two experimental
groups [from pregnancy to six months post partum (EP) and from birth to six
months post partum (EPP)] and one comparison group.
Setting
a 3900-bed medical centre in northern Taiwan with around 3000 births
annually.
Participants
a sample of 189 women who had regular check-ups during pregnancy and gave
birth at the medical centre.
Interventions
the comparison group received the routine outpatient department obstetric
educational programme. The EP group attended regularly scheduled clinic
visits with individualised dietary and physical activity education plans
from 16 gestational weeks to six months post partum, and received on
brochure. The EPP group received the same educational intervention as the
EP group from 2448 hours after birth to six months post partum.
Measurements
body weight, body mass index, health-promoting behaviour and psycho-social
variables (self-efficacy, body image, depression and social support).
Findings
average gestational weight gain was 14.02, 15.27 and 16.22 kg in the
three EP, EPP and comparison groups respectively, and average weight
retention at six months post partum was 2.34, 4.06 and 5.08 kg in the
three groups, respectively.
Key conclusions
a diet and physical activity intervention from pregnancy is effective for
reducing post-pregnancy weight retention.
the findings of the present study should be taken into consideration when
incorporating significant others and weight-loss maintenance strategies
with interventions for a healthier family lifestyle.
Keywords: Weight retention; Intervention; Pregnancy; Post partum
Richard Hirschman, Edward S. Katkin, Psychophysiological Functioning,

Arousal, Attention, and Learning during the First Year of Life, In: Hayne
W. Reese, Editor(s), Advances in Child Development and Behavior, JAI, 1974,
Volume 9, Pages 115-150, ISSN 0065-2407, ISBN 9780120097098, 10.1016/S0065-
2407(08)60316-X.
Elizabeth R. Moore, Gene Cranston Anderson, Randomized Controlled Trial of

Very Early MotherInfant Skin-to-Skin Contact and Breastfeeding Status,
Journal of Midwifery & Women's Health, Volume 52, Issue 2, MarchApril
2007, Pages 116-125, ISSN 1526-9523, 10.1016/j.jmwh.2006.12.002.
Abstract: This study was done to evaluate effects of maternalinfant skin-
to-skin contact during the first 2 hours postbirth compared to standard
care (holding the infant swaddled in blankets) on breastfeeding outcomes
through 1 month follow-up. Healthy primiparous motherinfant dyads were
randomly assigned by computerized minimization to skin-to-skin contact (n =
10) or standard care (n = 10). The Infant Breastfeeding Assessment Tool was
used to measure success of first breastfeeding and time to effective
breastfeeding (time of the first of three consecutive scores of 1012).
Intervention dyads experienced a mean of 1.66 hours of skin-to-skin
contact. These infants, compared to swaddled infants, had higher mean
sucking competency during the first breastfeeding (8.7 2.1 vs 6.3 2.6;
P < .02) and achieved effective breastfeeding sooner (935 721 minutes
vs 1737 1001; P < .04). No significant differences were found in
number of breastfeeding problems encountered during follow-up (30.9 5.51
vs 32.7 5.84; P < .25) or in breastfeeding exclusivity (1.50 1.1 vs
2.10 2.2; P < .45). Sucking competency was also related to maternal
nipple protractility (r = .48; P < .03). Very early skin-to-skin contact
enhanced breastfeeding success during the early postpartum period. No
significant differences were found at 1 month.
Keywords: breastfeeding; breastfeeding exclusivity; early postpartum;
newborn suckling; skin-to-skin contact
M.H. Peters, Midwives and the achievement of safer motherhood,

International Journal of Gynecology & Obstetrics, Volume 50, Supplement
2, October 1995, Pages S89-S92, ISSN 0020-7292, 10.1016/0020-7292(95)02493-
V.
(http://www.sciencedirect.com/science/article/pii/002072929502493V)
Abstract: The root problem of unsafe motherhood in developing countries is
lack of access to a competent care-giver throughout pregnancy, childbirth
and the postpartum period. These resources, trained midwives, with or
without prior nursing training, should be recruited from the communities
they are to serve. Community midwives must be involved in any realistic
strategic plan to provide this needed midwifery care.
Keywords: Safe motherhood; Midwives; Maternity care
Dawn P. Misra, Holly Grason, Achieving safe motherhood: Applying a life

course and multiple determinants perinatal health framework in public
health, Women's Health Issues, Volume 16, Issue 4, JulyAugust 2006, Pages
159-175, ISSN 1049-3867, 10.1016/j.whi.2006.02.006.
Abstract: Safe motherhood has begun to be identified as a priority for the
health of American women. We argue that safe motherhood can be achieved
through application of a life course and multiple determinants framework.
This framework, with its focus on the preconception period, poses a dilemma
in that it links together periods of life and domains of activities that
have traditionally not been linked with maternal health. The interests of
women and children have often been juxtaposed in the making of policy.
Further, the domains of womens health, maternal and child health, and
family planning have often clashed over policy priorities and funds. This
framework shows that the research literature now links them inextricably to
better health outcomes, albeit indirectly; there are no intervention
studies that have demonstrated the empirical efficacy of this approach.
Thus, although this framework creates a strong rationale for the linkages
described, it also demands attention to a set of implementation strategies
that will overcome existing barriers. Through a focus on one maternal
factor, obesity, we discuss how a range of strategies grounded in the
framework can be undertaken to address maternal morbidity and mortality. We
then examine selected strategies at each level of the multiple determinants
life course framework and emphasize how public policies and public and
private sector professional practice can be reexamined to improve outcomes
for women in all time periods and aspects of reproductive potential, which
in turn might enhance outcomes for their offspring, both at birth and
beyond. Our intent is to influence how policy makers, public health
professionals, clinicians, and researchers approach safe motherhood.
Gary L. Darmstadt, Anita K.M. Zaidi, Barbara J. Stoll, CHAPTER 2 - Neonatal

Infections: A Global Perspective, Infectious Diseases of the Fetus and
Newborn (Seventh Edition), W.B. Saunders, Philadelphia, 2011, Pages 24-51,
ISBN 9781416064008, 10.1016/B978-1-4160-6400-8.00002-X.
Gary L. Darmstadt, Anne CC Lee, Simon Cousens, Lynn Sibley, Zulfiqar A.

Bhutta, France Donnay, Dave Osrin, Abhay Bang, Vishwajeet Kumar, Steven N.
Wall, Abdullah Baqui, Joy E. Lawn, 60 million non-facility births: Who
can deliver in community settings to reduce intrapartum-related deaths?,
International Journal of Gynecology & Obstetrics, Volume 107,
Supplement, October 2009, Pages S89-S112, ISSN 0020-7292,
10.1016/j.ijgo.2009.07.010.
For the world's 60 million non-facility births, addressing who is
currently attending these births and what effect they have on birth
outcomes is a key starting point toward improving care during childbirth.
Objective
We present a systematic review of evidence for the effect of community-
based cadrescommunity-based skilled birth attendants (SBAs), trained
traditional birth attendants (TBAs), and community health workers (CHWs)in
improving perinatal and intrapartum-related outcomes.
Results
The evidence for providing skilled birth attendance in the community is low
quality, consisting of primarily before-and-after and quasi-experimental
studies, with a pooled 12% reduction in all cause perinatal mortality (PMR)
and a 22%47% reduction in intrapartum-related neonatal mortality (IPR-
NMR). Low/moderate quality evidence suggests that TBA training may improve
linkages with facilities and improve perinatal outcomes. A randomized
controlled trial (RCT) of TBA training showed a 30% reduction in PMR, and a
meta-analysis demonstrated an 11% reduction in IPR-NMR. There is moderate
evidence that CHWs have a positive impact on perinatal-neonatal outcomes.
Meta-analysis of CHW packages (2 cluster randomized controlled trials, 2
quasi-experimental studies) showed a 28% reduction in PMR and a 36%
reduction in early neonatal mortality rate; one quasi-experimental study
showed a 42% reduction in IPR-NMR.
Conclusion
Skilled childbirth care is recommended for all pregnant women, and
community strategies need to be linked to prompt, high-quality emergency
obstetric care. CHWs may play a promising role in providing pregnancy and
childbirth care, mobilizing communities, and improving perinatal outcomes
in low-income settings. While the role of the TBA is still controversial,
strategies emphasizing partnerships with the health system should be
further considered. Innovative community-based strategies combined with
health systems strengthening may improve childbirth care for the rural
poor, help reduce gross inequities in maternal and newborn survival and
stillbirth rates, and provide an effective transition to higher coverage
for facility births.
Keywords: Birth asphyxia; Community health worker; Community midwife;
Hypoxia; Intrapartum; Neonatal mortality; Stillbirth; Traditional birth
attendant
L. Say, R.C. Pattinson, Maternal Mortality and Morbidity, In: Editor-in-

Chief: Kris Heggenhougen, Editor(s)-in-Chief, International Encyclopedia
of Public Health, Academic Press, Oxford, 2008, Pages 222-236, ISBN
9780123739605, 10.1016/B978-012373960-5.00466-4.
Abstract: Pregnancy, childbirth, and the postpartum period may have
negative outcomes ranging from minor conditions to more serious morbidities
and even death. Among all maternal deaths, 99% occur in developing parts of
the world, where maternal morbidities are also more prevalent. The patterns
of complications of pregnancy and childbirth reflect the capacity and
functioning of the health system in a population. Understanding the causes
of maternal deaths, the patterns of morbidities, the characteristics of the
groups affected most, and health system failures is essential to determine
where to concentrate efforts to provide improvements. Such information is
also an indicator of the broader issues of social inclusion, women's status
and rights, and socioeconomic development in the society.
Keywords: Eclampsia; Maternal morbidity; Maternal mortality; Maternal
mortality measurement; Maternal mortality ratio; Near miss; Obstetric
embolism; Obstetric hemorrhage; Obstetric morbidity; Obstructed labor;
Preeclampsia; Sepsis; Severe acute maternal morbidity
Monica S. Paz, Lynne M. Smith, Linda L. LaGasse, Chris Derauf, Penny Grant,
Rizwan Shah, Amelia Arria, Marilyn Huestis, William Haning, Arthur Strauss,
Sheri Della Grotta, Jing Liu, Barry M. Lester, Maternal depression and
neurobehavior in newborns prenatally exposed to methamphetamine,
Neurotoxicology and Teratology, Volume 31, Issue 3, MayJune 2009, Pages
177-182, ISSN 0892-0362, 10.1016/j.ntt.2008.11.004.
The effects of maternal depression on neonatal neurodevelopment in MA
exposed neonates have not been well characterized.
Objective
To determine the neurobehavioral effects of maternal depressive symptoms on
neonates exposed and not exposed to methamphetamine (MA) using the NICU
Network Neurobehavioral Scale (NNNS).
Design
The purpose of the IDEAL study is to determine the effects of prenatal MA
exposure on child outcome. IDEAL screened 13,808 subjects, 1632 were
eligible and consented and 176 mothers were enrolled. Only biological
mothers with custody of their child at the one-month visit
(n = 50 MA; n = 86 comparison) had the Addiction
Severity Index (ASI) administered. The NNNS was administered to the neonate
by an examiner blinded to MA exposure within the first five days of life.
General Linear Models tested the effects of maternal depression and
prenatal MA exposure on NNNS outcomes, with and without covariates.
Significance was accepted at p < .05.
Results
After adjusting for covariates, regardless of exposure status, maternal
depressive symptoms were associated with lower handling and arousal scores,
elevated physiological stress scores and an increased incidence of
hypotonicity. When adjusting for covariates, MA exposure was associated
with lower arousal and higher lethargy scores.
Conclusions
Maternal depressive symptoms are associated with neurodevelopmental
patterns of decreased arousal and increased stress. Prenatal MA exposure
combined with maternal depression was not associated with any additional
neonatal neurodevelopmental differences.
Keywords: Prenatal exposure; Neurodevelopment; Drugs; Depression
Bernadette Mazurek Melnyk, Holly E Brown, Dolores C Jones, Richard Kreipe,

Julie Novak, Improving the mental/psychosocial health of US children and
adolescents: Outcomes and implementation strategies from the national KySS
summit, Journal of Pediatric Health Care, Volume 17, Issue 6, Supplement,
November 2003, Pages S1-S24, ISSN 0891-5245, 10.1016/j.pedhc.2003.08.002.
Zahra Ghodsi, Maryam Asltoghiri, Does exercise training during pregnancy

affect gestational age and gestational weight gain?, Procedia - Social and
Behavioral Sciences, Volume 31, 2012, Pages 418-422, ISSN 1877-0428,
10.1016/j.sbspro.2011.12.077.
Abstract: Some controversies exist over the possibility that exercise
during pregnancy might increase the risk of preterm delivery. At the same
time excessive gestational weight gain is increasing in prevalence and
associated with a number of adverse pregnancy outcomes for both mother and
child. This study aimed to determine the possible relationship between
regular exercise of pregnancy and gestational weight gain and gestational
age at the moment of delivery. This was a case-control survey. By using a
continued method, performed on 250 women with one or two gestation were
assigned to either a training (n = 125) or a comparison
(n = 125) group. The supervised training was included three days
a week, 3045 min, from 2026th weeks to 3839th weeks of pregnancy.
Pregnancy outcomes include of gestational weight gain and gestational age
was recorded for two groups. Statistical analysis was performed using
Students t-test, man-Whitney, and chi-squared test where appropriate.
According finding of this study, No significant differences were found
(p > 0.05) between 2 groups for gestational age and exercise.
The mean gestational age did not differ between the training (39 weeks 1
day) and the comparison group (39 weeks, 4 days 1.23 day). There were
meaningful statistical evidences for exercise training and gestational
weight gain at the time of delivery.
According the findings of the present study, healthy gravid with one or two
gestation can safely engage in moderate, supervised exercise programmed
until the end of gestation as this would not affect gestational age. Also
the program proved effective in reducing gestational weight gain at the
time of delivery. Such programs should be considered as part of routine
pregnancy care for pregnant women especially obese ones.
Keywords: exercise training; pregnancy; gestational age; gestational weight
gain
Jennifer L. Williams, Brian McCarthy, Observations From a Maternal and

Infant Hospital in Kabul, Afghanistan2003, Journal of Midwifery &
Women's Health, Volume 50, Issue 4, JulyAugust 2005, Pages e31-e35, ISSN
1526-9523, 10.1016/j.jmwh.2005.02.009.
Abstract: Afghanistan is believed to have one of the highest infant and
maternal mortality rates in the world. As a result of decades of war and
civil unrest, Afghan women and children suffer from poor access to health
services, harsh living conditions, and insufficient food and micronutrient
security. To address the disproportionately high infant and maternal
mortality rates in Afghanistan, the US Department of Health and Human
Services pledged support to establish a maternal health facility and
training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected
because this hospital admits approximately 36,000 patients and delivers
more than 14,000 babies annually. This article reports the initial
observations at Rabia Balkhi Hospital and describes factors that influenced
womens access, the quality of care, and the evaluation health care
services. This observational investigation examined areas of obstetric,
laboratory and pharmacy, and ancillary services. The investigators
concluded that profound changes were needed in the hospitals health care
delivery system to make the hospital a safe and effective health care
facility for Afghan women and children and an appropriate facility in which
to establish an Afghan provider training program for updating obstetric
skills and knowledge.
Keywords: Afghanistan; maternal mortality; infant mortality; pregnant
women; health services; accessibility
Carol Sakala, Midwifery care and out-of-hospital birth settings: How do

they reduce unnecessary cesarean section births?, Social Science &
Medicine, Volume 37, Issue 10, November 1993, Pages 1233-1250, ISSN 0277-
9536, 10.1016/0277-9536(93)90335-2.
Abstract: In studies using matched or adjusted cohorts, U.S. women
beginning labor with midwives and/or in out-of-hospital settings have
attained cesarean section rates that are considerably lower than similar
women using prevailing forms of carephysicians in hospitals. This cesarean
reduction involved no compromise in mortality and morbidity outcome
measures. Moreover, groups of women at elevated risk for adverse perinatal
outcomes have attained excellent outcomes and cesarean rates well below the
general population rate with these care arrangements.
How do midwives and out-of-hospital birth settings so effectively help

women to avoid unnecessary cesareans? This paper explores this question by
presenting data from interviews with midwives who work in home settings.
The midwives' understanding of and approaches to major medical indications
for cesarean birth contrast strikingly with prevailing medical knowledge
and practice. From the midwives' perspective, many women receive cesareans
due to pseudo-problems, to problems that might easily be prevented, or to
problems that might be addressed through less drastic measures.
Policy reports addressing the problem of unnecessary cesarean births in the

U.S. have failed to highlight the substantial reduction in such births that
may be expected to accompany greatly expanded use of midwives and out-of-
hospital birth settings. The present studytogether with cohort studies
documenting such a reduction, studies showing other benefits of such forms
of care, and the increasing reluctance of physicians to provide obstetrical
servicessuggests that childbearing families would realize many benefits
from greatly expanded use of midwives and out-of-hospital birth settings.
Keywords: midwifery care; out-of-hospital birth; cesarean prevention;
maternity care policy
Ling-ling Gao, Sally Wai-chi Chan, Xiaomao Li, Shaoxian Chen, Yuantao Hao,
Evaluation of an interpersonal-psychotherapy-oriented childbirth education
programme for Chinese first-time childbearing women: A randomised
controlled trial, International Journal of Nursing Studies, Volume 47,
Issue 10, October 2010, Pages 1208-1216, ISSN 0020-7489,
10.1016/j.ijnurstu.2010.03.002.
Abstract: Objective
This study investigated the effects of an interpersonal-psychotherapy-
oriented childbirth psychoeducation programme on postnatal depression,
psychological well-being and satisfaction with interpersonal relationships
in Chinese first-time childbearing women.
Method
A randomised, controlled trial was conducted in the maternity clinic of a
regional hospital in China. The intervention was based on the principles of
interpersonal psychotherapy, and consisted of two 90-min antenatal classes
and a telephone follow-up within 2 weeks after delivery. One hundred and
ninety-four first-time pregnant women were randomly assigned to the
intervention group (n = 96) or a control group
(n = 98). Outcomes of the study included symptoms of postnatal
depression, psychological well-being and satisfaction with interpersonal
relationships, which were measured by the Edinburgh Postnatal Depression
Scale (EPDS), General Health Questionnaire (GHQ) and Satisfaction with
Interpersonal Relationships Scale (SWIRS), respectively.
Results
Women receiving the childbirth psychoeducation programme had significantly
better psychological well-being (t = 3.33, p = 0.001),
fewer depressive symptoms (t = 3.76, p = 0.000) and
better interpersonal relationships (t = 3.25,
p = 0.001) at 6 weeks postpartum as compared with those who
received only routine childbirth education.
Conclusion
An interpersonal-psychotherapy-oriented childbirth psychoeducation
programme could be implemented as routine childbirth education with ongoing
evaluation. Replication of this study with more diverse study groups, such
as mothers with high risks to depression, those with multiple, complicated
or multiparas pregnancies, would provide further information about the
effects of the programme.
Keywords: Evaluation; Interpersonal psychotherapy; Childbirth
psychoeducation; First-time childbearing women
Yookyong Lee, Neil B. Guterman, Young motherfather dyads and maternal

harsh parenting behavior, Child Abuse & Neglect, Volume 34, Issue 11,
November 2010, Pages 874-885, ISSN 0145-2134, 10.1016/j.chiabu.2010.06.001.
Abstract: Objective
This study examined whether the age of parents predicted maternal harsh
parenting behavior, specifically whether younger mothers might be at higher
risk than older mothers, and which paternal characteristics might be
associated with maternal parenting behavior.
Methodology
This study used data from the Fragile Families and Child Wellbeing (FFCW)
study. In the present study, the authors examined a subsample of families
for which complete data were available on all variables that were used in
the analyses (n = 1,597). Based on the parents age at the time
of the child's birth, motherfather age-dyad types were classified, and
selected paternal factors were used to examine their association with
maternal harsh parenting behavior. Psychological aggression, physical
aggression, and self-reports of spanking were used as proxies for maternal
harsh parenting behavior.
Results
Multivariate analyses indicated that adolescent mothers, regardless of how
old their partners were, were at higher risk for harsh parenting behavior
than older adult mothers. Regarding paternal factors, paternal coercion
against mother and the fathers use of spanking were significantly
associated with all three proxies for maternal harsh parenting behavior.
Fathers employment was a risk factor for maternal physical aggression.
Conclusion
This study supported findings from previous studies that younger mothers
may indeed be at greater risk for harsh parenting behavior. It is critical,
therefore, that they acquire appropriate parenting behavior and develop a
healthy relationship with their children. Additional studies, both cross-
sectional and longitudinal, are needed to involve their partners (i.e.,
their child's father) in order to shed light on ways of preventing harsh
parenting behavior and examining the role of fathers in maternal parenting
behavior.
The present study calls for more attention to sex education and
intervention programs in school and health care settings as important
components of prevention services. Practitioners need to better understand
the concept of harsh parenting behavior in order to work with young parents
and prevent future physical child abuse. Policy makers should support these
efforts and research should be done that engages both mothers and fathers
and seeks to enhance and modify existing programs for youths.
Keywords: Motherfather dyads; Maternal harsh parenting behavior; Fragile
families and child; Wellbeing study
Ambreen Kazi, Zafar Fatmi, Juanita Hatcher, Muhammad Masood Kadir, Unaiza
Niaz, Gail A. Wasserman, Social environment and depression among pregnant
women in urban areas of Pakistan: Importance of social relations, Social
Science & Medicine, Volume 63, Issue 6, September 2006, Pages 1466-
1476, ISSN 0277-9536, 10.1016/j.socscimed.2006.05.019.
Abstract: Aspects of the social environment, including social conditions
(socio-economic status, household situations, chronic illnesses) and social
relations (attitude and behaviors of relations) are major determinants of
depression among women. This study evaluates the relative power of social
relations and social conditions in predicting depression among pregnant
women in Pakistan. In the qualitative phase of the study, social
environmental determinants were identified through literature search, and
experts opinions from psychologists, psychiatrists, gynecologists,
sociologists and researchers. Along with this, 79 in-depth interviews were
conducted with pregnant women drawn from six hospitals (public and private)
and two communities in Karachi, Pakistan. Identified determinants of
depression were grouped into themes of social conditions and social
relations and pregnancy-related concerns. In the study's quantitative
phase, the relative power of the identified themes and categories, based on
their scores for predicting depression (determined by the Center for
Epidemiological StudiesDepression Scale (CES-D scale)), was determined
through multivariate linear regression. Social environmental determinants
of pregnant women were described under the themes and categories of (1)
social relations: involving husband, in-laws and children; (2) social
conditions: involving the economy, illness, life events, household work,
environmental circumstances and social problems; and (3) pregnancy-related
concerns i.e. symptoms of pregnancy, changes during pregnancy, dependency
and concern for unborn baby. Multivariate analysis found that among these
themes, social relations and pregnancy-related concerns were significantly
associated with total CES-D scores. Among the categories besides increasing
age and less education, husband, in-laws, household work and pregnancy
symptoms were significantly associated with total CES-D scores. The study
highlights the importance of social relations compared to social conditions
for determining depression in pregnant women.
Keywords: Pakistan; Social environment; Pregnancy; Social conditions;
Social relations; Urban area
Lynn T. Singer, - Methodological Considerations in Longitudinal Studies of

Infant Risk, In: John Dobbing, Editor(s), Developing Brain Behaviour,
Academic Press, London, 1997, Pages 209-251, ISBN 9780122188701,
10.1016/B978-012218870-1/50007-5.
Abstract: Visual and cognitive developmental advantages have been reported
for term and preterm infants fed human breast milk or formula fortified
with docosahexaenoic acid (DHA) and arachidonic acid (AA) in comparison to
infants fed formula without these long-chain polyunsaturated fatty acids
(LCPUFAs), but these findings remain unclear, controversial, and
contradictory (112). These studies raise the possibility that
specification of, and delivery of, optimal nutrition in the later states of
fetal development or in early postnatal life, can have significant,
positive, long-term impact on brain development, manifest in enhanced
intellectual competence. Further studies, however, are necessary to
establish rigorously if there are long-term benefits of the addition of
LCPUFAs to infant formulas, substances which occur naturally in human
breast milk.
Monica Oxford, Susan Spieker, Preschool language development among children

of adolescent mothers, Journal of Applied Developmental Psychology, Volume
27, Issue 2, MarchApril 2006, Pages 165-182, ISSN 0193-3973,
10.1016/j.appdev.2005.12.013.
Abstract: This longitudinal study examined a comprehensive set of
predictors of preschool language performance in a sample of children of
adolescent mothers. Six domains of risk (low maternal verbal ability,
intergenerational risk, contextual risk, relational risk, home
environmental risk, and child characteristics) for poor preschool language
development, measured throughout early childhood, were examined in a sample
of 154 children born to adolescent mothers. Logistic regression revealed
that having a poor language-learning home environment was associated with
children's low language scores even after accounting for mothers' below-
average verbal ability. More importantly, however, was the exploration of
the dual risk hypothesis that evaluated the effects of combined risk
factors. Being reared by a mother with low verbal ability amplified the
risk of a poor quality home linguistic environment, whereas having a poor
home linguistic environment did not adversely affect the language
development of children with mothers of average verbal ability.
Implications for intervention are discussed with regard to specificity of
intervention efforts within sub-populations of risk identified in this
paper.
Keywords: Preschool language; Adolescent mothers; Risk factors; Home
environment; Latent profile analysis
Mickey Chopra, Emmanuelle Daviaud, Robert Pattinson, Sharon Fonn, Joy E

Lawn, Saving the lives of South Africa's mothers, babies, and children: can
the health system deliver?, The Lancet, Volume 374, Issue 9692, 511
September 2009, Pages 835-846, ISSN 0140-6736, 10.1016/S0140-6736(09)61123-
5.
Abstract: Summary
South Africa is one of only 12 countries in which mortality rates for
children have increased since the baseline for the Millennium Development
Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are
important factors. Additionally, suboptimum implementation of high-impact
interventions limits programme effectiveness; between a quarter and half of
maternal, neonatal, and child deaths in national audits have an avoidable
health-system factor contributing to the death. Using the LiST model, we
estimate that 11500 infants' lives could be saved by effective
implementation of basic neonatal care at 95% coverage. Similar coverage of
dual-therapy prevention of mother-to-child transmission with appropriate
feeding choices could save 37200 children's lives in South Africa per year
in 2015 compared with 2008. These interventions would also avert many
maternal deaths and stillbirths. The total cost of such a target package is
US$15 billion per year, 24% of the public-sector health expenditure; the
incremental cost is $220 million per year. Such progress would put South
Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs
are affordable and the key gap is leadership and effective implementation
at every level of the health system, including national and local
accountability for service provision.
Kirti Iyengar, Sharad D Iyengar, Emergency obstetric care and referral:

experience of two midwife-led health centres in rural Rajasthan, India,
Reproductive Health Matters, Volume 17, Issue 33, May 2009, Pages 9-20,
ISSN 0968-8080, 10.1016/S0968-8080(09)33459-X.
Abstract: This paper documents the experience of two health centres in a
primary health service located in interior rural areas of southern
Rajasthan, northern India, where trained nurse-midwives are providing
skilled maternal and newborn care round the clock daily. The nurse-midwives
independently detect and manage complications and decide when to refer
women to the nearest hospital for emergency care, in telephonic
consultation with a doctor if required. From 2000-2008, 2,771 women in
labour and 202 women with maternal emergencies who were not in labour were
attended by nurse-midwives. Of women in labour, 21% had a life-threatening
complication or its antecedent condition and 16% were advised referral, of
which two-thirds complied. Compliance with referral was higher for maternal
conditions than fetal conditions. Among the 202 women who came with
complications antenatally, post-abortion or post-partum, referral was
advised for 70%, of whom 72% complied. The referral system included
counselling, arranging transport, accompanying women, facilitating
admission and supporting inpatient care, and led to higher referral
compliance rates. There was only one maternal death in nine years. We
conclude that trained nurse-midwives can significantly improve access to
skilled maternal and neonatal care in rural areas, and manage maternal
complications with and without the need for referral. Protocols must
acknowledge that some families might not comply with referral advice, and
also that initial care by nurse-midwives can reverse progression of certain
complications and thereby avert the need for referral.
Keywords: delivery care; obstetric complications; emergency obstetric care;
referral; nurse-midwives
Embry M. Howell, Nancy Heiser, Mary Harrington, A Review of Recent Findings

on Substance Abuse Treatment for Pregnant Women, Journal of Substance Abuse
Treatment, Volume 16, Issue 3, April 1999, Pages 195-219, ISSN 0740-5472,
10.1016/S0740-5472(98)00032-4.
Abstract: Recent years have brought an increased interest in the treatment
needs of pregnant substance abusers. This article reviews the literature on
this subject, providing an overview of what is known about the prevalence
of substance abuse during pregnancy; the factors in womens lives,
especially pregnant women, that lead to substance abuse and that facilitate
and impede treatment success; and the components of successful treatment
programs. The prevalence of prenatal illicit drug use is known to be about
5% of all pregnant women nationwide, with higher rates for selected
subgroups. Local studies have shown much higher rates. Substance abuse is
associated with poverty, with the substance abuse of significant others,
and with family violence. Perinatal substance abusers experience poorer
birth outcomes. The negative consequences for babies do not stop at birth;
home environments may be chaotic and often children are removed from their
mothers care if substance abuse continues after birth. While the
literature on prevalence, correlates, and outcomes of perinatal substance
abuse is plentiful, there continues to be sparse information on successful
treatment approaches. Sample sizes are small and there are few studies with
adequate comparison groups. The small number of outcome studies we review
suggest that, as with the broader treatment literature for other
populations, success (as measured by abstinence) is associated with
retention. Retention is facilitated by the provision of support services,
such as child care, parenting classes, and vocational training. There is no
clear empirical basis for concluding that one type of treatment (for
example, residential treatment) is more effective than another. Published
by Elsevier Science Inc.
Keywords: substance abuse; pregnancy; Medicaid substance abuse treatment
Dinesh Khanna, Erin L. Arnold, James N. Pencharz, Jennifer M. Grossman,

Shana B. Traina, Anand Lal, Catherine H. MacLean, Measuring Process of
Arthritis Care: The Arthritis Foundations Quality Indicator Set for
Rheumatoid Arthritis, Seminars in Arthritis and Rheumatism, Volume 35,
10.1016/j.semarthrit.2005.08.004.
Abstract: Objective
To describe the scientific evidence that supports each of the explicit
process measures in the Arthritis Foundations Quality Indicator Set for
Rheumatoid Arthritis.
Methods
For each of the 27 measures in the Arthritis Foundations Quality Indicator
set, a comprehensive literature review was performed for evidence that
linked the process of care defined in the indicator with relevant clinical
outcomes and to summarize practice guidelines relevant to the indicators.
Results
Over 7500 titles were identified and reviewed. For each of the indicators
the scientific evidence to support or refute the quality indicator was
summarized. We found direct evidence that supported a processoutcome link
for 15 of the indicators, an indirect link for 7 of the indicators, and no
evidence to support or refute a link for 5. The processes of care described
in the indicators for which no supporting/refuting data were found have
been assumed to be so essential to care that clinical trails assessing
their importance have not, and probably never will be, performed. The
process of care described in all but 2 of the indicators is recommended in
1 or more practice guidelines.
Conclusion
There are sufficient scientific evidence and expert consensus to support
the Arthritis Foundations Quality Indicator Set for Rheumatoid Arthritis,
which defines a minimal standard of care that can be used to assess health
care quality for patients with rheumatoid arthritis.
Keywords: rheumatoid arthritis; quality of care; quality measures; process
of care
Peter von Dadelszen, Beth Payne, Jing Li, J Mark Ansermino, Fiona Broughton
Pipkin, Anne-Marie Ct, M Joanne Douglas, Andre Gruslin, Jennifer A
Hutcheon, KS Joseph, Phillipa M Kyle, Tang Lee, Pamela Loughna, Jennifer M
Menzies, Mario Merialdi, Alexandra L Millman, M Peter Moore, Jean-Marie
Moutquin, Annie B Ouellet, Graeme N Smith, James J Walker, Keith R Walley,
Barry N Walters, Mariana Widmer, Shoo K Lee, James A Russell, Laura A
Magee, for the PIERS Study Group, Prediction of adverse maternal outcomes
in pre-eclampsia: development and validation of the fullPIERS model, The
Lancet, Volume 377, Issue 9761, 1521 January 2011, Pages 219-227, ISSN
0140-6736, 10.1016/S0140-6736(10)61351-7.
Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly
result from eclampsia, uncontrolled hypertension, or systemic inflammation.
We developed and validated the fullPIERS model with the aim of identifying
the risk of fatal or life-threatening complications in women with pre-
eclampsia within 48 h of hospital admission for the disorder.
Methods
We developed and internally validated the fullPIERS model in a prospective,
multicentre study in women who were admitted to tertiary obstetric centres
with pre-eclampsia or who developed pre-eclampsia after admission. The
outcome of interest was maternal mortality or other serious complications
of pre-eclampsia. Routinely reported and informative variables were
included in a stepwise backward elimination regression model to predict the
adverse maternal outcome. We assessed performance using the area under the
curve (AUC) of the receiver operating characteristic (ROC). Standard
bootstrapping techniques were used to assess potential overfitting.
Findings
261 of 2023 women with pre-eclampsia had adverse outcomes at any time after
hospital admission (106 [5%] within 48 h of admission). Predictors of
adverse maternal outcome included gestational age, chest pain or dyspnoea,
oxygen saturation, platelet count, and creatinine and aspartate
transaminase concentrations. The fullPIERS model predicted adverse maternal
outcomes within 48 h of study eligibility (AUC ROC 088, 95% CI 084092).
There was no significant overfitting. fullPIERS performed well (AUC ROC
>07) up to 7 days after eligibility.
Interpretation
The fullPIERS model identifies women at increased risk of adverse outcomes
up to 7 days before complications arise and can thereby modify direct
patient care (eg, timing of delivery, place of care), improve the design of
clinical trials, and inform biomedical investigations related to pre-
eclampsia.
Funding
Canadian Institutes of Health Research; UNDP/UNFPA/WHO/World Bank Special
Programme of Research, Development, and Research Training in Human
Reproduction; Preeclampsia Foundation; International Federation of
Obstetricians and Gynecologists; Michael Smith Foundation for Health
Research; and Child and Family Research Institute.
Susan J. Crockett, Laura S. Sims, Environmental influences on children's

eating, Journal of Nutrition Education, Volume 27, Issue 5, September
Abstract: Executive Summary
Dramatic changes in lifestyles and the environment have brought about
significant alterations in children's eating patterns and food choices.
Understanding these changes is pivotal if we are to help today's children
establish healthy eating patterns, which contribute to the prevention and
delay of chronic disease later in life.
This paper describes the most salient environmental factors affecting

children's eating patterns and identifies those that appear most amenable
to influence through public policy initiatives. A myriad of sociocultural
and demographic factors that characterize the U.S. population today have
combined to affect what children eat, where children eat, and with whom
they eat. What was once mainly in the purview of family decision making is
now increasingly in the realm of caregivers and peers, and many eating
encounters occur away from home.
Equally important is the plethora of societal and cultural factors that

influence children's food intake in the home, schools, institutions, child
care settings, health care programs, and the marketplace. American children
are given more and more responsibility for making their own food decisions
and are constantly exposed to advertising messages about food. Federally
sponsored food assistance programs, such as Food Stamps, Child Nutrition
Programs, Head Start, and the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC), make positive contributions to the
kinds and amounts of food made available to many children.
This paper makes a number of policy recommendations that have the potential
to positively influence children's eating patterns and nutritional status.
These include:1.
Provide tools to families so that they can provide healthful food choices
and facilitate the teaching of sound eating practices to children, by means
of (a) promoting partnerships and coordination among government programs,
the private sector, and schools to support the family structure, which is
pivotal for teaching decision making and self-management of health and
nutrition; (b) developing family-school partnerships for teenagers to
combat negative peer influences and help parents and adolescents adopt
positive health and eating behaviors; (c) reform the welfare system to
reward work, bolster parents' academic and job skills, and ensure a decent
standard of living that will enable families to provide adequate food and
foster healthful eating patterns.
2.
Reduce fragmentation and lack of coordination among food assistance, public
health, social service, and education programs that serve the same target
populations.
3.
Form partnerships with the media to help children improve their eating
habits by promoting food choices consistent with recommendations made in
Dietary Guidelines for Americans.
An ample supply of healthful foods must be made available to children from
which they can choose, and the information base on which these food choices
are made must be relevant and sound. By working together in partnerships
between public and private sector enterprises, we can make the eating
environment more healthful, thus enabling America's children to enjoy
better health and well-being.
Anne Buist, Promoting positive parenthood: emotional health in pregnancy,

Australian Midwifery, Volume 16, Issue 1, March 2003, Pages 10-14, ISSN
1448-8272, 10.1016/S1031-170X(03)80010-7.
Abstract: Depression is a common problem in the general population and is
projected to be one of the major health issues facing the world in 2020
(WHO). Serious consequences exist for the sufferer, and the family.
Given that women are twice as likely to suffer from depression, and are at
particular risk in the child bearing years, children from infancy may be
affected, with long term ramifications.
Postnatal depression (PND) occurs in 14% of women, and there may be a

similar number affected antenatally. The perinatal period thus is a crucial
time to identify depression, and offers an excellent opportunity to screen
women due to their increased contact with health services.
Carol A. Eades, Christopher Brace, Lawrence Osei, Katherine D. LaGuardia,

Traditional birth attendants and maternal mortality in Ghana, Social
Science & Medicine, Volume 36, Issue 11, June 1993, Pages 1503-1507,
ISSN 0277-9536, 10.1016/0277-9536(93)90392-H.
Abstract: Maternal mortality is high in most African countries,
particularly in rural areas where access to formal health care is limited.
The sociopolitical and economic environment complicates the medical factors
directly responsible for this high rate. Since the 1970s many African
countries have addressed this problem by training traditional birth
attendants (TBAs) in health promotion and in the basics of safe delivery
and referral. The Danfa Rural Health Project in Ghana has trained and
supervised TBAs since 1973. It is located relatively close to the health
services of the capital city of Accra, providing an ideal environment for
the practice of trained TBAs. Thirty-seven trained TBAs currently practice
in the area. Most provide patient education and encourage women to go to
the health center for preventive services. However, many report routinely
performing the high risk deliveries that they have been taught to refer to
higher level care and that when they do refer, their patients may not go.
Reasons for referral refusal frequently cited by TBAs include financial
limitation or lack of transportation and the patients fear of disrespectful
or painful treatment from medical personnel. In the rural environment, the
trained TBA's greatest contribution to lower maternal mortality rates may
lie in the area of health promotion rather than disease intervention.
Keywords: maternal mortality; traditional birth attendant; rural health
care
Alison James, Ruth Endacott, Elizabeth Stenhouse, Identifying women

requiring maternity high dependency care, Midwifery, Volume 27, Issue 1,
February 2011, Pages 60-66, ISSN 0266-6138, 10.1016/j.midw.2009.09.001.
Abstract: The prompt identification of clinical deterioration and referral
for appropriate care are key issues in the management of women who become
critically ill during pregnancy, labour and the postpartum period. The
Intensive Care Society has developed designated levels of care in relation
to adult patient care, which may not be appropriate for use in midwifery.
Therefore, exploring the midwifery, nursing and medical literature related
to levels of care and detection of clinical deterioration may highlight the
need for these to be modified and adapted for the development of midwifery-
specific levels of care that are appropriate for this cohort.
Keywords: Clinical deterioration; Levels of care; Maternity high dependency
care
E.J. Waterson, Iain M. Murray-Lyon, Preventing alcohol related birth

damage: A review, Social Science & Medicine, Volume 30, Issue 3, 1990,
Pages 349-364, ISSN 0277-9536, 10.1016/0277-9536(90)90190-4.
Abstract: Since 1974 numerous clinical studies have made it clear that
heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units
daily) can result in a child being born with a specific combination of
physical and mental disabilities known as the Fetal Alcohol Syndrome. More
moderate levels of intake (as little as 10 g of 1 unit daily) are
associated with other fetal problems known as Fetal Alcohol Effects. The
most common of these is growth retardation. Reduction of alcohol
consumption is beneficial to pregnancy outcome. However, despite this great
clinical and research interest within the field there has been
comparatively little attention paid to researching possible preventative
strategies and appropriate policy development.
This paper first describes the size of the problem posed by drinking in
pregnancy in the U.S.A. and the U.K., detailing the contrasting policy
response on either side of the Atlantic. It examines the difficulties of
formulating appropriate advice and then assesses the available research
reports on preventative measures. The strategies described include general
publicity and counselling for pregnant women. In addition, attention has
been paid to the problems of dissemination by emphasising professional
education.
One major shortcoming is that most of these studies appear to have been
carried out with little reference to existing knowledge on health education
and promotion, or educational work in the antenatal or alcohol fields. In
addition, little attention appears to have been paid to the characteristics
of the groups at whom intervention might be targeted or the underlying
social or psychological factors which maintain drinking in these groups.
The second part of this paper, therefore, attempts to suggest appropriate

avenues for developing preventative strategies by presenting a wide-ranging
review with special reference to British experience. Particular attention
is given to the issues of form and content of appropriate messages,
targeting of risk populations, the venue for intervention, and media and
the actual mechanisms involved in implementing the programme.
We conclude that women should be advised to limit their alcohol consumption

to no more than one unit a day when they are either pregnant or planning a
pregnancy. We recommend that pregnant women should be asked about their
alcohol and given appropriate advice during routine antenatal clinic
visits. We suggest that the form of advice should be designed with the
characteristics of the risk population in mind. Information about
appropriate levels of alcohol intake and further professional help for
those in need should be widely available and form an integral part of the
primary health service, as well as the antenatal and family planning
clinics in addition to the more specialist alcohol treatment and prevention
services already available.
Keywords: alcohol; prevention; Fetal Alcohol Syndrome; Fetal Alcohol
Effects
A. Paxton, D. Maine, L. Freedman, D. Fry, S. Lobis, The evidence for
emergency obstetric care, International Journal of Gynecology &
Obstetrics, Volume 88, Issue 2, February 2005, Pages 181-193, ISSN 0020-
7292, 10.1016/j.ijgo.2004.11.026.
Abstract: Purpose
We searched for evidence for the effectiveness of emergency obstetric care
(EmOC) interventions in reducing maternal mortality primarily in developing
countries.
Methods
We reviewed population-based studies with maternal mortality as the outcome
variable and ranked them according to the system for ranking the quality of
evidence and strength of recommendations developed by the US Preventive
Services Task Force. A systematic search of published literature was
conducted for this review, including searches of Medline, PubMed, Cochrane
Database of Systematic Reviews, the Cochrane Pregnancy and Childbirth
Database and the Cochrane Controlled Trials Register.
Results
The strength of the evidence is high in several studies with a design that
places them in the second and third tier in the quality of evidence ranking
system. No studies were found that are experimental in design that would
give them a top ranking, due to the measurement challenges associated with
maternal mortality, although many of the specific individual clinical
interventions that comprise EmOC have been evaluated through experimental
design. There is strong evidence based on studies, using quasi-
experimental, observational and ecological designs, to support the
contention that EmOC must be a critical component of any program to reduce
maternal mortality.
Keywords: Evidence; Maternal mortality; Emergency obstetric care
Monica L. Oxford, Jungeun Olivia Lee, The effect of family processes on

school achievement as moderated by socioeconomic context, Journal of School
Psychology, Volume 49, Issue 5, October 2011, Pages 597-612, ISSN 0022-
4405, 10.1016/j.jsp.2011.06.001.
Abstract: This longitudinal study examined a model of early school
achievement in reading and math, as it varies by socioeconomic context,
using data from the NICHD Study of Early Child Care and Youth Development.
A conceptual model was tested that included features of family stress,
early parenting, and school readiness, through both a single-group analysis
and also a multiple-group analysis. Latent profile analysis was used to
identify subgroups of more advantaged and less advantaged families. Family
stress and parenting were shown to operate differently depending on the
socioeconomic context, whereas child-based school readiness characteristics
were shown to operate similarly across socieodemographic contexts.
Implications for intervention are discussed.
Keywords: Academic achievement; Parenting; Sensitivity; Stress;
Socioeconomic disadvantage; Latent profile analysis
Audrey Prost, Rashmi Lakshminarayana, Nirmala Nair, Prasanta Tripathy,

Andrew Copas, Rajendra Mahapatra, Shibanand Rath, Raj Kumar Gope, Suchitra
Rath, Aparna Bajpai, Vikram Patel, Anthony Costello, Predictors of maternal
psychological distress in rural India: A cross-sectional community-based
study, Journal of Affective Disorders, Volume 138, Issue 3, May 2012, Pages
277-286, ISSN 0165-0327, 10.1016/j.jad.2012.01.029.
Maternal common mental disorders are prevalent in low-resource settings and
have far-reaching consequences for maternal and child health. We assessed
the prevalence and predictors of psychological distress as a proxy for
common mental disorders among mothers in rural Jharkhand and Orissa,
eastern India, where over 40% of the population live below the poverty line
and access to reproductive and mental health services is low.
Method
We screened 5801 mothers around 6 weeks after delivery using the
Kessler-10 item scale, and identified predictors of distress using multiple
hierarchical logistic regression.
Results
11.5% (95% CI: 10.712.3) of mothers had symptoms of distress (K10 score
> 15). High maternal age, low asset ownership, health problems in
the antepartum, delivery or postpartum periods, caesarean section, an
unwanted pregnancy for the mother, small perceived infant size and a
stillbirth or neonatal death were all independently associated with an
increased risk of distress. The loss of an infant or an unwanted pregnancy
increased the risk of distress considerably (AORs: 7.06 95% CI: 5.519.04
and 1.49, 95% CI: 1.121.97, respectively).
Limitations
We did not collect data on antepartum depression, domestic violence or a
mother's past birth history, and were therefore unable to examine the
importance of these factors as predictors of psychological distress.
Conclusions
Mothers living in underserved areas of India who experience infant loss, an
unwanted pregnancy, health problems in the perinatal and postpartum periods
and socio-economic disadvantage are at increased risk of distress and
require access to reproductive healthcare with integrated mental health
interventions.
Keywords: Common mental disorder; Maternal depression; India; Rural health
Cynthia T Zembo, Breastfeeding, Obstetrics and Gynecology Clinics of North

America, Volume 29, Issue 1, March 2002, Pages 51-76, ISSN 0889-8545,
10.1016/S0889-8545(03)00052-4.
W.H. Hui Choi, Gabriel K.H. Hui, Angel C.K. Lee, Maureen M.L. Chui, Student
nurses experiences and challenges in providing health education in Hong
Kong, Nurse Education Today, Volume 30, Issue 4, May 2010, Pages 355-359,
ISSN 0260-6917, 10.1016/j.nedt.2009.09.005.
Abstract: Summary
Despite a call for increased emphasis on health education within the Hong
Kong acute healthcare setting, in reality nurses conduct only minimal
health education and do not model good educational practice for students.
At the baccalaureate level, nursing education programmes aim to provide
students with practical experience of best practice and international
standards of care. This study describes the experiences of nursing students
in providing health education to in-patients at an obstetric unit in Hong
Kong. A qualitative research study using a phenomenological approach was
conducted at a major public hospital. Data were collected using participant
observation, debriefing notes, students reflective journals and semi-
structured interviews. Four themes emerged from the data: (a) effective
knowledge building, (b) being a professional nurse, (c) refining learned
skills, and (d) greater cultural awareness. The student experiences were
further influenced by the patients responses, the expectations of both
patients and nurses concerning the health educators role, and the role of
the clinical teacher. Study findings highlight the experience of the
students in conducting health education, something which has not been
adequately examined previously, and demonstrates the benefits of
independent clinical learning.
Keywords: Health education; Influential factor; Nursing student; Acute
J.C. Bhatia, Levels and determinants of maternal morbidity: results from a

community-based study in southern India, International Journal of
Gynecology & Obstetrics, Volume 50, Supplement 2, October 1995, Pages
S153-S163, ISSN 0020-7292, 10.1016/0020-7292(95)02504-6.
Abstract: This analysis is based on detailed interviews with 3600 rural and
urban women in southern India. They were younger than 35 and had at least
one child less than 5 years of age. Each woman was questioned by a trained
female interviewer and asked about problems she had encountered during the
last pregnancy. Approximately two-fifths (41%) reported at least one morbid
condition associated with that event. About one-fifth (18%) had had at
least one problem during the antenatal period and delivery and another 23%
indicated problems during the postpartum. Surgical interventions were made
in 13.1% of all deliveries. However, if we consider only those taking place
in hospital, more than one-third (34.2%) were delivered surgically. The
relationship between socioeconomic and demographic factors and reported
maternal morbidity has been examined by using multivariate statistical
techniques. The policy implications of the study are discussed.
Keywords: Maternal; Obstetric; Reproductive; Morbidity; Determinant
, Chapter 9 - Pelvic floor dysfunction and evidence-based physical therapy,

In: Kari B, PT, MSc, PhD, Bary Berghmans, PT, MSc, PhD, Siv Mrkved, PT,
MSc, PhD, and Marijke Van Kampen, PT, MSc, PhD, Editor(s), Evidence-Based
Physical Therapy for the Pelvic Floor, Churchill Livingstone, Edinburgh,
2007, Pages 161-315, ISBN 9780443101465, 10.1016/B978-0-443-10146-5.50015-
0.
, Subject Index, Journal of the American Dietetic Association, Volume 105,

8223(05)02065-1.
S. Russ, M. Regalado, N. Halfon, Healthcare, In: Editors-in-

Chief: Marshall M. Haith and Janette B. Benson, Editor(s)-in-Chief,
Encyclopedia of Infant and Early Childhood Development, Academic Press, San
Diego, 2008, Pages 73-89, ISBN 9780123708779, 10.1016/B978-012370877-
9.00076-1.
Abstract: Healthcare in early childhood is no longer focused solely on the
treatment of acute illness and the management of chronic conditions but
also on health promotion and illness prevention. Child health is defined
broadly across physical, cognitive, social, and emotional domains, and is
increasingly understood as occurring not in isolation but in the context of
the childs family and community. Child health providers must integrate
their services with those offered by early care and education and social
services to address family needs effectively and to optimize childrens
health and development. A responsive, high-quality childrens healthcare
system could have major benefits for health not just in childhood, but
throughout the life course.
Keywords: Child development; Health; Healthcare; Healthcare systems;
Medicine; Prenatal; Public health; Screening; Surveillance
Cade Fields-Gardner, Position of the American Dietetic Association:

Nutrition Intervention and Human Immunodeficiency Virus Infection, Journal
of the American Dietetic Association, Volume 110, Issue 7, July 2010, Pages
1105-1119, ISSN 0002-8223, 10.1016/j.jada.2010.05.020.
efforts to optimize nutritional status through individualized medical
nutrition therapy, assurance of food and nutrition security, and nutrition
education are essential to the total system of health care available to
people with human immunodeficiency virus (HIV) infection throughout the
continuum of care. Broad-based efforts to improve health care access and
treatment have stabilized HIV prevalence levels in many parts of the world
and led to longer survival for people living with HIV infection.
Confounding clinical and social issues, such as medication interactions,
comorbidities, wasting, lipodystrophy, food insecurity, aging, and other
related conditions further complicate disease management. With greater
understanding of the mechanisms of HIV disease and its impact on body
function, development of new treatments, and wider ranges of populations
affected, the management of chronic HIV infection continues to become more
complex and demanding. Achievement of food and nutrition security and
management of nutrition-related complications of HIV infection remain
significant challenges for clients with HIV infection and health care
professionals. Registered dietitians and dietetic technicians, registered,
should integrate their efforts into the overall health care strategies to
optimize their clinical and social influence for people living with HIV
infection.
Jennifer Prah Ruger, Christina M. Lazar, Economic evaluation of drug abuse

treatment and HIV prevention programs in pregnant women: A systematic
review, Addictive Behaviors, Volume 37, Issue 1, January 2012, Pages 1-10,
ISSN 0306-4603, 10.1016/j.addbeh.2011.07.042.
Abstract: Drug abuse and transmission of HIV during pregnancy are public
health problems that adversely affect pregnant women, their children and
surrounding communities. Programs that address this vulnerable population
have the ability to be cost-effective due to resulting cost savings for
mother, child and society. Economic evaluations of programs that address
these issues are an important tool to better understand the costs of
services and create sustainable healthcare systems. This study critically
examined economic evaluations of drug abuse treatment and HIV prevention
programs in pregnant women. A systematic review was conducted using the
criteria recommended by the Panel on Cost-Effectiveness in Health and
Medicine and the British Medical Journal (BMJ) checklist for economic
evaluations. The search identified 6 economic studies assessing drug abuse
treatment for pregnant women, and 12 economic studies assessing programs
that focus on prevention of mother-to-child transmission (PMTCT) of HIV.
Results show that many programs for drug abuse treatment and PMTCT among
pregnant women are cost-effective or even cost-saving. This study
identified several shortcomings in methodology and lack of standardization
of current economic evaluations. Efforts to address methodological
challenges will help make future studies more comparable and have more
influence on policy makers, clinicians and the public.
Keywords: Systematic review; Economic evaluation; Drug abuse treatment;
Prevention of mother-to-child transmission (PMTCT); HIV prevention;
Pregnant women
Sara K. Head, Kathryn M. Yount, Lynn M. Sibley, Delays in recognition of

and Care-seeking response to prolonged labor in Bangladesh, Social Science
& Medicine, Volume 72, Issue 7, April 2011, Pages 1157-1168, ISSN 0277-
9536, 10.1016/j.socscimed.2011.01.030.
Abstract: Maternal death, in which prolonged labor is the third leading
cause, accounts for 20% of deaths among women in Bangladesh. This study
describes the process of recognition and response to symptoms during
potential prolonged labor among 17 women in three sites in Bangladesh. In
OctoberDecember 2008, integrated illness history interviews were conducted
with women and confirmed and/or supplemented by family and/or birth
attendants present during labor. Interviews elicited participants
recognition of symptoms and care-seeking reactions and recorded responses
in time-by-event matrices. Interviews were conducted in Bangla, recorded,
transcribed, and translated into English. The most frequent and usually
first action was to seek care from untrained attendants at home, then from
professional attendants outside the home. Care-seeking outside the home
occurred a median of 19 h after perceived labor onset. Delays in care-
seeking arose for reasons related to: (1) confusion over the onset of
labor, (2) power processes inhibiting womens disclosure of labor symptoms,
(3) the practice of waiting for delivery, and (4) preferences for home
delivery. Strategies to encourage lay recognition of and response to
prolonged labor should consider womens misinterpretation and non-
disclosure of labor pain, health beliefs surrounding the labor process, and
fears of medical intervention.
Keywords: Bangladesh; Maternal health; Labor complications; Prolonged
labor; Care-seeking; Gender
Kymberlee Montgomery, Catherine Morse, Mary Ellen Smith-Glasgow, Bobbie

Posmontier, Michele Follen, Promoting Quality and Safety in Women's Health
Through the Use of Transdisciplinary Clinical Simulation Educational
Modules: Methodology and a Pilot Trial, Gender Medicine, Volume 9, Issue 1,
Supplement, February 2012, Pages S48-S54, ISSN 1550-8579,
10.1016/j.genm.2011.11.001.
Abstract: This manuscript presents the methodology used to assess the
impact of a clinical simulation module used for training providers
specializing in women's health. The methodology presented here will be used
for a quantitative study in the future.
Yvonne Lafayette Bronner, David Martin Paige, Current concepts in infant

nutrition, Journal of Nurse-Midwifery, Volume 37, Issue 2, Supplement,
MarchApril 1992, Pages S43-S58, ISSN 0091-2182, 10.1016/0091-
2182(92)90008-Q.
(http://www.sciencedirect.com/science/article/pii/009121829290008Q)
Abstract: Nutritional needs vary during the first year of life according to
the infant's individualized pattern of growth and amount of physical
activity. After delivery, the infant must make many physiologic
adjustments, develop immunologic defenses, and take in adequate nutrients
for survival. The type and consistency of foods change as the
gastrointestinal system matures and becomes able to metabolize the
components and excrete the needed metabolites of increasingly complex
foods. The recommended dietary allowance for infancy is based on the amount
of nutrients provided to healthy infants in human milk during the first six
months of life and on the consumption of formula and increasing amounts of
solid food during the second six months. The introduction of solid foods
should parallel the developmental changes that occur within the central
nervous system throughout the first year, these provide a level of
readiness for the infant to manage foods of various textures from full
liquid to soft.
Even though significant technologic advances have led to changes in the way
infants can be fed, human milk is still the optimal choice. Most women can
be encouraged to breast-feed regardless of their own nutritional status or
dietary intake. Contraindications can be managed on an individual basis. If
women do not elect to breast-feed, suitable commercial formulas are
available. The important issue in feeding is that of providing a variety of
appropriately prepared foods offered in a nonjudgmental atmosphere so that
the foundation is laid for the development of good food habits.
Emma Pitchforth, Richard J. Lilford, Yigzaw Kebede, Getahun Asres,

Charlotte Stanford, Jodie Frost, Assessing and understanding quality of
care in a labour ward: A pilot study combining clinical and social science
perspectives in Gondar, Ethiopia, Social Science & Medicine, Volume 71,
10.1016/j.socscimed.2010.08.001.
Abstract: Ensuring high quality intrapartum care in developing countries is
a crucial component of efforts to reduce maternal and neonatal mortality
and morbidity. Conceptual frameworks for understanding quality of care have
broadened to reflect the complexity of factors affecting quality of health
care provision. Yet, the role of social sciences within the assessment and
understanding of quality of care in this field has focused primarily on
seeking to understand the views and experiences of service users and
providers. In this pilot study we aimed to combine clinical and social
science perspectives and methods to best assess and understand issues
affecting quality of clinical care and to identify priorities for change.
Based in one referral hospital in Ethiopia, data collection took place in
three phases using a combination of structured and unstructured
observations, interviews and a modified nominal group process. This
resulted in a thorough and pragmatic methodology. Our results showed high
levels of knowledge and compliance with most aspects of good clinical
practice, and non-compliance was affected by different, inter-linked,
resource constraints. Considering possible changes in terms of resource
implications, local stakeholders prioritised five areas for change. Some of
these changes would have considerable resources implications whilst others
could be made within existing resources.
The discussion focuses on implications for informing quality improvement

interventions. Improvements will need to address health systems issues,
such as supply of key drugs, as well as changes in professional practice to
promote the rational use of drugs. Furthermore, the study considers the
need to understand broader organizational factors and inter-professional
relationships. The potential for greater integration of social science
perspectives as part of currently increasing monitoring and evaluation
activity around intrapartum care is highlighted.
Keywords: Quality of care; Maternal health; Ethiopia; Mixed methods;
Intrapartum care
Joy E. Lawn, Kate Kerber, Christabel Enweronu-Laryea, Simon Cousens, 3.6

Million Neonatal DeathsWhat Is Progressing and What Is Not?, Seminars in
Perinatology, Volume 34, Issue 6, December 2010, Pages 371-386, ISSN 0146-
0005, 10.1053/j.semperi.2010.09.011.
Abstract: Each year 3.6 million infants are estimated to die in the first 4
weeks of life (neonatal period)but the majority continue to die at home,
uncounted. This article reviews progress for newborn health globally, with
a focus on the countries in which most deaths occurwhat data do we have to
guide accelerated efforts? All regions are advancing, but the level of
decrease in neonatal mortality differs by region, country, and within
countries. Progress also differs by the main causes of neonatal death.
Three major causes of neonatal deaths (infections, complications of preterm
birth, and intrapartum-related neonatal deaths or birth asphyxia) account
for more than 80% of all neonatal deaths globally. The most rapid
reductions have been made in reducing neonatal tetanus, and there has been
apparent progress towards reducing neonatal infections. Limited, if any,
reduction has been made in reducing global deaths from preterm birth and
for intrapartum-related neonatal deaths. High-impact, feasible
interventions to address these 3 causes are summarized in this article,
along with estimates of potential for lives saved. A major gap is reaching
mothers and babies at birth and in the early postnatal period. There are
promising community-based service delivery models that have been tested
mainly in research studies in Asia that are now being adapted and evaluated
at scale and also being tested through a network of African implementation
research trials. To meet Millennium Development Goal 4, more can and must
be done to address neonatal deaths. A critical step is improving the
quantity, quality and use of data to select and implement the most
effective interventions and strengthen existing programs, especially at
district level.
Keywords: Neonatal; perinatal; epidemiology; MDGs; neonatal causes of
death; neonatal infection; intrapartum-related; preterm; low-income
countries
Judy Reid, Rebecca OReilly, Barbara Beale, Donna Gillies, Tanya Connell,
Research priorities of NSW midwives, Women and Birth, Volume 20, Issue 2,
June 2007, Pages 57-63, ISSN 1871-5192, 10.1016/j.wombi.2007.03.001.
Abstract: SummaryPurpose
Research is vital to achieve optimum health outcomes for pregnant women,
children and families. Recently, the benefit of setting research priorities
to effectively utilize limited resources has been identified. Currently
there is a lack of published Australian research data relevant to the
practice of midwifery. Consultation with current practitioners is important
to fulfill the National Health and Medical Research Council (NHMRC) key
priority for a healthy start to life, ensure limited resources are expended
appropriately and promote evidence-based midwifery practice. The aim of
this study was to ascertain the perceived research priorities and the
research experience of midwives in NSW, Australia.
Procedures
Postal questionnaire sent to the 1000 subscribers of Australian Midwifery,
of whom 90% (900) are midwives, in March 2005 with key open-ended questions
to ascertain midwifery research priorities and research experience of
participants.
Findings
Respondents were all midwives with 95% indicating they were currently
practising as a midwife. They identified six priority areas: professional
practice; clinical issues; education and support; breastfeeding;
psychosocial factors; rural/indigenous issues.
Principle conclusions
Priorities for research were identified and the need for a link between
research and professional midwifery practice was highlighted. Midwives were
positive about the possibility of becoming more actively involved in
research and/or advocates for evidence based practice. The opportunity
exists to take the broad priority areas from this study and develop
research questions of relevance for the midwifery profession.
Keywords: Midwifery research; Research priorities; Evidence-based practice
Ruth A. Lawrence, Robert M. Lawrence, Chapter 1 - Breastfeeding in Modern

Medicine, Breastfeeding (Seventh Edition), W.B. Saunders, Philadelphia,
2011, Pages 1-39, ISBN 9781437707885, 10.1016/B978-1-4377-0788-5.10001-X.
Maureen M. Black, Sarah E. Oberlander, 51 - Psychological Impact and

Treatment of Neglect of Children, In: Carole Jenny, MD, MBA, Editor,
Editor(s), Child Abuse and Neglect, W.B. Saunders, Philadelphia, 2011,
Pages 490-500, ISBN 9781416063933, 10.1016/B978-1-4160-6393-3.00051-8.
Michele Perry, Prenatal educationHow effective is it?, Australian College

of Midwives Incorporated Journal, Volume 5, Issue 1, March 1992, Pages 15-
20, ISSN 1031-170X, 10.1016/S1031-170X(05)80199-0.
Abstract: Are provision of knowledge and skills the major factors to
influence behaviour changes that will in turn affect psychological and
physiological outcomes in pregnancy and childbirth?
This paper argues that courses for expectant parents must not be considered
or promoted in isolation. Rather, they should be viewed as part of a
complex, interrelated structure of variables that serve to create,
influence, modify, support and reinforce factors considered to be
indicators of favourable birth outcomes. The potential for health promotion
activities is highlighted and problems of marketing, access, and
restrictive obstetric management practises emphasised. Relevant research is
discussed and areas for urgent action and further research are identified.
Carol A. Miller, Thomas B. Newman, Chapter 26 - Routine Newborn Care, In:

H. William Taeusch, M.D., Roberta A. Ballard, M.D., and Christine A.
Gleason, M.D., Editor(s), Avery's Diseases of the Newborn (Eighth Edition),
W.B. Saunders, Philadelphia, 2005, Pages 323-337, ISBN 9780721693477,
10.1016/B978-072169347-7.50028-7.
D.Kay Taylor, Carole Beauchamp, Hospital-based primary prevention strategy

in child abuse: a multi-level needs addressment, Child Abuse & Neglect,
Volume 12, Issue 3, 1988, Pages 343-354, ISSN 0145-2134, 10.1016/0145-
2134(88)90047-6.
Abstract: The purpose of this study was to evaluate a primary prevention
effort in child maltreatment, the focus of which was a community-wide
endeavor (i.e., subjects were not prescreened for risk potential). Specific
components of the planned intervention addressed four causal levels of
maltreatment: individual, family, community, and cultural factors. That
addressment was intended to build strengths in those parenting areas which
are predictive of abusive or neglectful outcomes. Target areas included
knowledge of child development, child-rearing attitudes, mother-infant
interaction patterns, and parenting skills. A posttest-only control group
design was employed. The control postpartum mothers received traditional or
routine hospital services; experimental mothers received special in-
hospital and aftercare services by trained student nurse volunteers. These
volunteers functioned in a dual educative/supportive role. Experimental
mothers reported more realistic expectations of behavior, embraced more
democratic child-rearing principles, provided more verbal stimulation to
their infants (reflecting an increased sensitivity), and displayed
increased problem-solving abilities.
Ingrid Helen Ravn, Lars Smith, Nina Aarhus Smeby, Nina Margrethe Kynoe,
Leiv Sandvik, Eli Haugen Bunch, Rolf Lindemann, Effects of early mother
infant intervention on outcomes in mothers and moderately and late preterm
infants at age 1 year: A randomized controlled trial, Infant Behavior and
Development, Volume 35, Issue 1, February 2012, Pages 36-47, ISSN 0163-
6383, 10.1016/j.infbeh.2011.09.006.
Abstract: Objective
There is a dearth of knowledge about the effects of early interaction-based
interventions on parenting and infant communication skills in moderately
and late preterm infants.
Aims
Assess in a RCT the effects of the MotherInfant Transaction program (MITP)
on maternal depression and stress, breastfeeding and mothers perception of
infant temperament; and MITP's impact on preterm infant communication
skills at 12 months.
Methods
Mothers/preterm infants (3036 weeks) were randomly assigned to MITP
(intervention group) or standard care (control group). Mean gestational age
in the intervention group was 33.3 1.5 (n = 56) and
in the control group (n = 50) 33.0 1.6. Outcomes were
assessed by CES-D, Parenting Stress Index; WHO breast-feeding categories,
Infant Behavior Questionnaire and The Pictorial Infant Communication
Scales.
Results
Intervention mothers reported significantly less postpartum depression one
month after discharge (p = .04) and more breastfeeding at 9
months (p = .02). No significant group differences in favour of
the intervention group were found on total parenting stress at 6
(p = .08) and 12 months (p = .46) or on perceived
infant communication skills at 12 months (p = .86). The
intervention mothers reported significantly less infant smile and laughter
at 6 (p = .02) and 12 (p = .006) months and less motor
activity at 12 months (p = .04).
Conclusions
The results suggest that MITP reduced postpartum depression and extended
the period of breastfeeding, but did not support any positive effects of
the intervention on self-reported maternal stress and perceived infant
communication.
Keywords: Infants; Depression; Maternal stress; Breastfeeding; Temperament;
Motherinfant communication
Elizabeth G. Damato, Parenting Multiple Infants, Newborn and Infant Nursing

Reviews, Volume 5, Issue 4, December 2005, Pages 208-214, ISSN 1527-3369,
10.1053/j.nainr.2005.08.003.
Abstract: The number of multiple-birth families has increased dramatically
in the last several decades. Raising more than one infant of the same age
presents unique challenges to parents, many of whom have endured a period
of infertility to conceive and take home fragile premature infants who
require vigilant care. Stress, depression, and exhaustion are increased for
these parents; recent evidence links these conditions to infant
developmental outcomes. This paper reviews the parenting experience for
families with multiple infants and presents strategies for assisting their
adjustment to parenting.
Joel G. Breman, Kenneth Bridbord, Linda E. Kupfer, Roger I. Glass, Global

Health: The Fogarty International Center, National Institutes of Health:
Vision and Mission, Programs, and Accomplishments, Infectious Disease
Clinics of North America, Volume 25, Issue 3, September 2011, Pages 511-
536, ISSN 0891-5520, 10.1016/j.idc.2011.06.003.
Keywords: Fogarty International Center; NIH; Research training in poor
countries; Infectious and noninfectious diseases training
James A. Taylor, Jeffrey A. Wright, David Woodrum, Chapter 26 - Routine

Newborn Care, Avery's Diseases of the Newborn (Ninth Edition), W.B.
Saunders, Philadelpia, 2012, Pages 300-315, ISBN 9781437701340,
10.1016/B978-1-4377-0134-0.10026-5.
Holly Powell Kennedy, Trisha Farrell, Regina Paden, Shannon Hill, Rima
Jolivet, Jacqueline Willetts, Sharon Schindler Rising, I Wasn't AloneA
Study of Group Prenatal Care in the Military, Journal of Midwifery &
Women's Health, Volume 54, Issue 3, MayJune 2009, Pages 176-183, ISSN
1526-9523, 10.1016/j.jmwh.2008.11.004.
Abstract: The military has recognized that health and quality of life for
service members are closely tied to the resources for their families,
including how they are cared for during pregnancy and childbirth. However,
there has been little examination of women's experience with different
models of prenatal care (PNC) in military settings. The purpose of this
article is to describe the results of a qualitative study of women's
experiences with the CenteringPregnancy model of group PNC compared to
individual PNC in two military health care settings. This clinical trial
enrolled 322 women who were randomized into group or individual PNC at two
military treatment facilities. Qualitative interviews were completed with
234 women during the postpartum period. Interpretative narrative and
thematic analysis was used to identify three themes: 1) I wasn't alone
the experience with group PNC; 2) I liked it butrecommendations to
improve group PNC; and 3) They really need to listengeneral concerns
across the sample about PNC. Greatest concerns of women in individual PNC
included lack of continuity and time with the provider. Our military
families must be assured that their health care system meets their needs
through personal and family-centered care. Group PNC offers the potential
for continuity of provider while also offering community with other women.
In the process, women gain knowledge and power as a health care consumer.
Keywords: CenteringPregnancy; group health care; military pregnancy;
prenatal care; qualitative research
Wendy J. Graham, Outcomes and effectiveness in reproductive health, Social

Science & Medicine, Volume 47, Issue 12, December 1998, Pages 1925-
1936, ISSN 0277-9536, 10.1016/S0277-9536(98)00334-7.
Abstract: Measuring reproductive health is problematic. Awareness of the
problems needs to be raised both among those collecting and those using
data on reproductive health. This paper discusses two major measurement
questions one related to ascertainment and the other to attribution. The
first question is to what extent the observed levels and patterns of
reproductive health outcomes in women are valid as opposed to artefacts of
the data sources and the data collection methods? The second question is
can lack of evidence of effectiveness for any reproductive health
intervention ever confidently be separated into no effects vs an inability
to measure effects? Determining the effectiveness of health interventions
is notoriously difficult. Reproductive health may not be a case for special
pleading in the competition for scarce resources, but equally it should not
be a case for special standards of proof of the effectiveness of
interventions standards which have not indeed been met by many other, and
yet unquestioned, health care priorities. What works in reproductive
health should in fact be judged from at least four different perspectives:
from that of women and their families, health professionals, the scientific
community, and national and international policy-makers.
Keywords: Reproductive health; Measurement; Effectiveness; Evidence;
Outcomes
Matthew Jowett, Safe motherhood interventions in low-income countries: an

economic justification and evidence of cost effectiveness, Health Policy,
Volume 53, Issue 3, 1 October 2000, Pages 201-228, ISSN 0168-8510,
10.1016/S0168-8510(00)00089-0.
Abstract: It is estimated that 1600 women die world-wide each day as a
result of problems during pregnancy or childbirth. A large proportion of
these deaths is preventable. This article examines the economic case for
investing in safe motherhood interventions, and reviews key evidence of the
cost effectiveness of safe motherhood interventions. According to one
study, antenatal and maternal services comprise two of the six most cost
effective sets of health interventions in low-income countries. However,
little detailed evidence exists regarding the relative cost effectiveness
of antenatal care, post-abortion care and essential obstetric care. Despite
this there is clear evidence that interventions such as substituting manual
vacuum aspiration for dilatation and curettage can result in significant
savings both for health facilities and patients. The paper estimates first
that 26% of maternal deaths are avoidable through antenatal/community-based
interventions, costing around 30% of the WHO Mother Baby Package; and
secondly that access to quality essential obstetric care can prevent a
further 48% of maternal deaths, consuming 24% of total Mother Baby Package
costs. Further work on the cost effectiveness of safe motherhood
interventions would provide useful information for policy makers concerned
with reducing maternal mortality in the most efficient manner possible.
Keywords: Safe motherhood; Maternal mortality; Cost effectiveness;
Efficiency; Cost
Peter S. Kaplan, Christina M. Danko, Christina J. Kalinka, Anna M. Cejka, A

developmental decline in the learning-promoting effects of infant-directed
speech for infants of mothers with chronically elevated symptoms of
depression, Infant Behavior and Development, Volume 35, Issue 3, June 2012,
Pages 369-379, ISSN 0163-6383, 10.1016/j.infbeh.2012.02.009.
Abstract: Infants of mothers who varied in symptoms of depression were
tested at 4 and 12 months of age for their ability to associate a segment
of an unfamiliar non-depressed mother's infant-directed speech (IDS) with a
face. At 4 months, all infants learned the voice-face association. At 12
months, despite the fact that none of the mothers were still clinically
depressed, infants of mothers with chronically elevated self-reported
depressive symptoms, and infants of mothers with elevated self-reported
depressive symptoms at 4 months but not 12 months, on average did not learn
the association. For infants of mothers diagnosed with depression in
remission, learning at 12 months was negatively correlated with the
postpartum duration of the mother's depressive episode. At neither age did
extent of pitch modulation in the IDS segments correlate with infant
learning. However, learning scores at 12 months correlated significantly
with concurrent maternal reports of infant receptive language development.
The roles of the duration and timing of maternal depressive symptoms are
discussed.
Keywords: Postpartum depression; Infant-directed speech; Infant associative
learning; Depression duration; Depression timing
George R. Heninger, Chapter 12 - Neuroscience, Molecular Medicine, and New

Approaches to the Treatment of Depression and Anxiety, In: MD, PhD Stephen
Waxman, Editor(s), From Neuroscience To Neurology, Academic Press,
012738903-5/50013-8.
Sylvia Murphy Tighe, An exploration of the attitudes of attenders and non-

attenders towards antenatal education, Midwifery, Volume 26, Issue 3, June
2010, Pages 294-303, ISSN 0266-6138, 10.1016/j.midw.2008.06.005.
Abstract: Objective
to explore the attitudes of first-time mothers towards antenatal education
from the perspective of attenders and non-attenders.
Design
a qualitative approach was utilised using focus group interviews to collect
the data.
Setting
the study was conducted in one local health office area of the Health
Service ExecutiveSouth East, Ireland.
Participants
a purposive sample of first-time mothers was interviewed to explore the
area of antenatal education. These women included both attenders and non-
attenders at antenatal education.
Key conclusions
the findings suggest there are many strengths, weaknesses, opportunities
and barriers to antenatal education. Strengths of antenatal education
included the facilitator of antenatal classes, the information and
preparation received, and the social aspect of meeting other expectant
mothers. Barriers to attendance at antenatal education included working
night shifts, no interest, transport difficulties, inflexible employer, and
partner not attending. A move away from didactic teaching methods and
greater participation and involvement of parents was identified as
necessary.
fundamental issues related to the provision and of antenatal education were
identified. A need for promotion and advertising of antenatal education was
identified by the participants. Mothers identified specific needs such as
the provision of postnatal classes and peer mentoring, flexible
availability of classes, and facilitators utilising the principles of adult
learning to guide classes. The mothers alluded to the importance of
father's attendance and inclusion at classes. In view of the poor uptake of
antenatal classes in Ireland, it is imperative that an approach to
antenatal education is parent centred and needs driven.
Keywords: Attitudes; Attenders; Non-attenders; Antenatal education;
Prenatal
Eisquel Herrera, Nadja Reissland, John Shepherd, Maternal touch and

maternal child-directed speech: effects of depressed mood in the postnatal
period, Journal of Affective Disorders, Volume 81, Issue 1, July 2004,
Pages 29-39, ISSN 0165-0327, 10.1016/j.jad.2003.07.001.
Abstract: Background: Postnatal depression affects the emotional state of
mothers and the quality of motherinfant interaction. Method: Touch
behaviour and content of child-directed speech were analysed for 72 mothers
and their infants during pleasurable play. Infants (18) of mothers with
depressed mood and 18 controls were seen when they were 6 months old; and
18 infants of mothers with depressed mood and 18 controls were seen when
they were 10 months old. Results: Depressed mothers in comparison with non-
depressed mothers lifted their infants more, restraining their behaviours.
Infants of depressed mothers in contrast to infants of non-depressed
mothers spent greater periods of time in touching self rather than mother
or toy, compensating for the lack of positive touch from their mothers.
Mothers with depressed mood of 6-month-old infants included fewer affective
and informative features in their speech than their controls. Non-depressed
mothers of younger babies showed a higher use of affective features when
compared with non-depressed mothers of older infants. In contrast,
depressed mothers of 6- and 10-month-old babies showed similar frequencies
of affect-salient speech during interactions in spite of their infants'
changing developmental demands. Limitations: Mothers in this study were
only mildly depressed, as assessed by the Edinburgh Postnatal Depression
Scale (EPDS). Nevertheless, the findings indicate that mothers with
depressive symptoms differ from non-depressed mothers in relation to touch
and content of speech when interacting with their infants. Conclusions:
These results suggest that postnatal depression may influence touch
behaviour as well as the affective and informative content of maternal
speech. The effect is that mothers with depressed mood in comparison with
non-depressed mothers touch their infants more negatively and their speech
is less well adjusted concerning the amount of emotional vs. information-
related content thereby preventing depressed mothers from responding
effectively to their infants' developmental needs.
Keywords: Depressed mood; Touch; Maternal child-directed speech; Infant
emotional response
Gemma K.S. Cass, Joanna F. Crofts, Timothy J. Draycott, The Use of

Simulation to Teach Clinical Skills in Obstetrics, Seminars in
Perinatology, Volume 35, Issue 2, April 2011, Pages 68-73, ISSN 0146-0005,
10.1053/j.semperi.2011.01.005.
Abstract: Obstetrical practice demands sensitivity, clinical skill, and
acumen. Obstetrical emergencies are rare occurrences and are most
appropriately dealt with by experienced staff. Simulation provides an
opportunity to gain this experience without patient risk and furthermore
builds confidence and satisfaction amongst learners. There is an abundance
of evidence to show the effectiveness of simulation training. Simulation
has been demonstrated to reduce errors, increase knowledge, skills,
communication and team working, and improve perinatal outcomes. Further
research to measure the effect of training to identify what works, where
and at what cost is needed. We explore the evidence for the use of
simulation-based training across a broad range of obstetrical emergencies,
promote collaboration amongst disciplines and discuss the formal
introduction of simulation training into a curriculum. Reducing preventable
harm in obstetrics is a priority for families and society at large and this
article endeavors to highlight the role that simulation has to play.
Keywords: medical simulation; training; obstetric emergencies; clinical
skills; teamwork
Pamela J. Surkan, Louise M. Ryan, Lina M. Carvalho Vieira, Lisa F. Berkman,

Karen E. Peterson, Maternal social and pyschological conditions and
physical growth in low-income children in Piau, Northeast Brazil, Social
Science & Medicine, Volume 64, Issue 2, January 2007, Pages 375-388,
ISSN 0277-9536, 10.1016/j.socscimed.2006.09.021.
Abstract: Prevalence of child undernutrition remains high in many
developing countries. In settings with scarce resources, modifiable
maternal social conditions may influence feeding and parenting practices,
in turn affecting child growth. This study aims to quantify the association
between maternal social support and depression to children's physical
growth outcomes in Teresina, Piau, northeast Brazil. Interviews were
conducted with a random sample of 595 mothers of children 624 months old
in four low-income sections of Teresina, Piau. We collected data on
sociodemographic factors, mothers social support, mothers depressive
symptomatology, and child's weight and recumbent length. Weight-for-height
z-scores (WHZ), height-for-age z-scores (HAZ) and weight-for-age z-scores
(WAZ) were calculated using the National Center for Chronic Disease
Prevention and Health Promotion Center SAS program based on the 2000
Centers for Disease Control reference growth curves. Multivariable linear
regression was used to model the association between maternal social
support and depression to child growth, adjusting for biological and socio-
demographic variables. Interviewer and neighborhood variation was accounted
for through the inclusion of random effects. In adjusted models, material
support, measured by number of friends or family members available to
mothers when needing food or milk, was related to 0.3 higher average WHZ
and 0.2 higher average WAZ in their children. Maternal positive social
interaction, which reflects engagement in leisure-time activities with
others, was associated with 0.3 higher average WHZ. Mothers affectionate
support was related to 0.2 higher average children's WHZ and WAZ, whereas
social support for resolving a conflict was associated with 0.2 lower
average HAZ. Maternal depression was not associated with child growth. It
is concluded that inadequate growth in children may be sensitive to
maternal social support.
Keywords: Social support; Childhood growth; Depression; Brazil; Nutrition;
Mothers
Jonathan M. Samet, Eugene M. Lewit, Kenneth E. Warner, Involuntary smoking

and children's health, Current Problems in Pediatrics, Volume 25, Issue 6,
July 1995, Pages 189-204, ISSN 0045-9380, 10.1016/S0045-9380(06)80033-2.
Katharine K. ODell, Lisa C. Labin, Common Problems of Urination in

Nonpregnant Women: Causes, Current Management, and Prevention Strategies,
Journal of Midwifery & Women's Health, Volume 51, Issue 3, MayJune
2006, Pages 159-173, ISSN 1526-9523, 10.1016/j.jmwh.2006.01.003.
Abstract: This article uses a case-based approach to review common problems
of urination in nonpregnant women, including overactive bladder; stress,
urge, and mixed incontinence; and retention and prolapse. Up-to-date
clinical issues related to assessment, diagnosis, treatment, and follow-up
are reviewed, with a discussion of underlying pathophysiology and
prevention strategies. Suggestions are made for relevant curriculum content
at both the basic and advanced levels of advanced practice education.
Keywords: urinary incontinence; prolapse; overactive bladder; stress
incontinence; urge incontinence
Suzanne Yates, CHAPTER 11 - Practical bodywork in the postpartum, Pregnancy

and Childbirth, Churchill Livingstone, Edinburgh, 2010, Pages 313-338, ISBN
9780702030550, 10.1016/B978-0-7020-3055-0.00011-X.
Naheed Bano, Rizwana Chaudhri, Lubna Yasmeen, Faiza Shafi, Lubna Ejaz, A
study of maternal mortality in 8 principal hospitals in Pakistan in 2009,
September 2011, Pages 255-259, ISSN 0020-7292, 10.1016/j.ijgo.2011.03.018.
To determine maternal mortality to assess the achievement of Millennium
Development Goal 5 in Pakistan and suggest remedial measures.
Methods
Throughout 2009, maternal deaths occurring in obstetrics and gynecology
departments in 8 hospitals in Rawalpindi and Islamabad, Pakistan, were
recorded. A data form was filled in by the duty registrar at the time of
death. Data were analyzed via SPSS.
Results
During the study period, there were 47 209 live births and 108
maternal deaths (age 1745 years). Among those who died, 30% were
primigravidas, 50% had a parity of 14, and 20% had a parity of 5 or more;
20.4% had not delivered, 40.7% had vaginal delivery, and 36.1% had cesarean
delivery; 67.6% were unbooked and 32.4% were booked (14 under care of a
consultant and 21 under care of a medical officer); 73%, 22%, and 5% died
in the first, second, and third trimesters, respectively; 17.5% died
prenatally, 4.6% during labor, and 78% postpartum; 73% were in a critical
condition and 8% were dead on arrival. Eclampsia, postpartum hemorrhage,
and sepsis caused 23, 13, and 13 deaths, respectively.
Conclusion
Maternal death can be effectively managed by skilled care during pregnancy,
childbirth, and the postnatal period.
Keywords: Maternal Mortality; Maternal Mortality Ratio; Millennium
Development Goal 5
Barbara J. Myers, Motherinfant bonding: The status of this critical-period

hypothesis, Developmental Review, Volume 4, Issue 3, September 1984, Pages
240-274, ISSN 0273-2297, 10.1016/S0273-2297(84)80007-6.
Abstract: Bonding is the process which occurs soon after birth in which a
mother forms an affectionate attachment to her infant. Early research
suggested that separation of mother from the infant in the first postpartum
hours and days damages the formation of that bond with deleterious
consequences for maternal behavior and child development. Much of the more
recent research refutes these findings. The research both favoring and not
favoring the bonding hypothesis is critically reviewed, with the evidence
generally not supporting the notion that early and extended contact is
crucial to the motherinfant bond.
Ellen M. Szwajcer, Gerrit J. Hiddink, Maria A. Koelen, Cees M.J. van
Woerkum, Nutrition awareness and pregnancy: Implications for the life
course perspective, European Journal of Obstetrics & Gynecology and
Reproductive Biology, Volume 135, Issue 1, November 2007, Pages 58-64, ISSN
0301-2115, 10.1016/j.ejogrb.2006.11.012.
Abstract: Objective
To explore the influence of a life event (pregnancy) on nutrition awareness
and the motivations for nutrition behaviour.
Study design
In-depth, face-to-face interviews with five groups of 12 women: women
wishing to conceive a child, women in the first, second, and third
trimesters of their first pregnancy, and women in the first trimester of
their second pregnancy. As is common in qualitative research, participants
were selected on the basis of diversity together with maximum
representativeness within normal populations with respect to socio-
demographic characteristics.
Results
With respect to nutrition awareness, three groups of women can be
distinguished: (1) those who are going all the way; these women try to
live precisely by the book, (2) those who are taking the flexible way;
these women are more aware of their nutrition, but are more flexible in
handling it, and (3) women who continue the same way; these women have a
no-nonsense mentality and do not experience essential shifts in their
nutrition awareness. The extent and fluctuations in nutrition awareness
throughout preconception and pregnancy are based on three types of
motivations, the interest of (1) the child, (2) the mother, and (3) the
social environment.
Conclusions
This study provides indications that preconception and pregnancy could
indeed be a life event leading to increased general nutrition awareness
that might influence women's future nutrition-related behaviours.
Keywords: Nutrition; Awareness; Motivation; Preconception; Pregnancy
John G. Borkowski, Thomas L. Whitman, Anne Wurtz Passion, Elizabeth A.

Rellinger, Kristen Sommer, Deborah Keogh, Keri Weed, Unraveling the New
Morbidity: Adolescent parenting and Developmental Delays, In: Norman W.
Bray, Editor(s), International Review of Research in Mental Retardation,
9780123662187, 10.1016/S0074-7750(08)60119-6.
Suniya S. Luthar, Katy G. Walsh, Treatment needs of drug-addicted mothers:

Integrated parenting psychotherapy interventions, Journal of Substance
Abuse Treatment, Volume 12, Issue 5, SeptemberOctober 1995, Pages 341-348,
ISSN 0740-5472, 10.1016/0740-5472(95)02010-1.
Abstract: Substance abuse among women is associated with several negative
maternal as well as child outcomes. This article reviews the theoretical
and empirical literature on salient domains of risk and vulnerability among
addicted mothers, with a view toward identifying critical components of
effective intervention programs.
Keywords: addicted mothers; parenting psychotherapy
Lucia DAmbruoso, Endang Achadi, Asri Adisasmita, Yulia Izati, Krystyna

Makowiecka, Julia Hussein, Assessing quality of care provided by Indonesian
village midwives with a confidential enquiry, Midwifery, Volume 25, Issue
Abstract: Objective
to conduct a confidential enquiry to assess the quality of care provided by
Indonesian village midwives and to identify opportunities for improvement.
Methods
local health-care practitioners assessed village-based care in obstetric
emergencies in 13 cases of maternal death and near-miss from rural villages
in West Java. The study focused on clinical quality of care, but also
investigated the influence of the health system and social factors. The
reviews were based on transcripts of interviews with health-care providers,
family and community members involved in the cases. Both favourable and
adverse factors were identified in order to recognise positive
contributions, where they occurred. At the end of a series of case reviews,
recommendations for practice were generated and disseminated.
Findings
in the cases reviewed, midwives facilitated referral effectively, reducing
delays in reaching health facilities. Midwives emergency diagnostic skills
were accurate but they were less capable in the clinical management of
complications. Coverage was poor; in some locations, midwives were
responsible for up to five villages. Village midwives were also perceived
as unacceptable to women and their families. Families and communities did
not prepare for emergencies with finances or transport, partly due to a
poorly understood health insurance system. The enquiry had learning effects
for those involved.
Key conclusions
village midwives should: receive appropriate support for the management of
obstetric emergencies; engage with communities to promote birth
preparedness; and work in partnership with formal and informal providers in
the community. The enquiry was a diagnostic tool to identify opportunities
for improving care. Practitioners had a unique insight into factors that
contribute to quality care and how feasible interventions might be made.
Keywords: Confidential enquiry; Emergency obstetric care; Quality of care;
Village midwife; Indonesia
Robert A. Dyer, Anthony R. Reed, Michael F. James, Obstetric anaesthesia in

low-resource settings, Best Practice & Research Clinical Obstetrics
& Gynaecology, Volume 24, Issue 3, June 2010, Pages 401-412, ISSN 1521-
6934, 10.1016/j.bpobgyn.2009.11.005.
Abstract: Close co-operation between obstetricians and obstetric
anaesthesia providers is crucial for the safety and comfort of parturients,
particularly in low-resource environments. Maternal and foetal mortality is
unacceptably high, and the practice of obstetric anaesthesia has an
important influence on outcome. Well-conducted national audits have
identified the contributing factors to anaesthesia-related deaths. Spinal
anaesthesia for caesarean section is the method of choice in the absence of
contraindications, but is associated with significant morbidity and
mortality. Minimum requirements for safe practice are adequate skills,
anaesthesia monitors, disposables and drugs and relevant management
protocols for each level of care. The importance of current outreach
initiatives is emphasised, and educational resources and the available
financial sources discussed. The difficulties of efficient procurement of
equipment and drugs are outlined. Guiding principles for the practice of
analgesia for labour, anaesthesia for caesarean section and the management
of obstetric emergencies, where the anaesthetist also has a central role,
are suggested.
Keywords: anaesthesia; obstetrics; low resources
C. Jane Morrell, Review of interventions to prevent or treat postnatal

depression, Clinical Effectiveness in Nursing, Volume 9, Supplement 2,
2006, Pages e135-e161, ISSN 1361-9004, 10.1016/j.cein.2006.11.006.
The objective of this study was to examine evidence of the effectiveness of
interventions, particularly by midwives, to prevent postnatal depression,
or by Health Visitors to treat postnatal depression.
Methods
A literature search from 1966 to July 2005 covered health databases
MEDLINE, CINAHL, EMBASE, and PsycINFO, and Evidence-Based databases in The
Cochrane Library, covering the Cochrane Database of Systematic Reviews and
the Cochrane Controlled Trials Register. Studies that evaluated maternal
mood up to one year after delivery were reviewed.
Results
From the 37 published studies that involved an intervention to prevent
postnatal depression, there was little evidence of effectiveness. Of 20
reviewed trials aiming to treat PND, there were encouraging outcomes, but
many of the studies had methodological or reporting limitations. Of all the
trials reviewed, The PoNDER Trial, a pragmatic cluster randomised trial
(commissioned and funded by the NHS R&D Health Technology Assessment
programme) was the largest, with the longest follow-up (to 18 months). This
trial reported the cost-effectiveness of Health Visitors role in the
detection of PND and offering a psychological intervention.
Conclusion
Among all the trials reviewed here, The PoNDER Trial has provided evidence
of the cost-effectiveness of the HVs role in detecting PND and offering a
psychological intervention.
Keywords: Treatment; Depression; Postnatal women; Review; Health visitor;
Primary care
Robert T. Ammerman, Frank W. Putnam, Mekibib Altaye, Liang Chen, Lauren J.

Holleb, Jack Stevens, Jodie A. Short, Judith B. Van Ginkel, Changes in
depressive symptoms in first time mothers in home visitation, Child Abuse
& Neglect, Volume 33, Issue 3, March 2009, Pages 127-138, ISSN 0145-
2134, 10.1016/j.chiabu.2008.09.005.
Abstract: Objective
The expansion of Home Visitation Programs for at-risk, first-time mothers
and their young children has drawn attention to the potential impact of
depression on program outcomes, yet little research has examined depression
in the context of home visitation. The purpose of this study was to
determine the prevalence of and changes in depressive symptoms in mothers
enrolled in home visitation and identify predictors of change in symptoms
over the first 9 months of service.
Methods
Subjects consisted of 806 at-risk, first-time mothers enrolled in a Home
Visitation Program. Self-reported depression was measured at enrollment and
again 9 months later. Established clinical cutoffs were used to identify
clinically elevated levels of depression. Additional measures were taken of
interpersonal trauma history, concurrent intimate partner violence, and
social support.
Results
Results indicated that: (1) 45.3% of mothers had clinically elevated
symptoms of depression at some point during the first 9 months of service,
(2) 25.9% of mothers had elevated symptoms at both time points or at the 9-
month assessment, and (3) 74.1% experienced an interpersonal trauma prior
to enrollment. Lack of improvement or worsening of depressive symptoms from
enrollment to 9 months was best predicted by pre-enrollment interpersonal
trauma history, young maternal age, being African American, and symptoms
severe enough to have led to mental health treatment.
Conclusions
Findings suggest that maternal depressive symptoms are a significant
problem in home visitation. The role of interpersonal trauma in depressive
symptoms, and how to best address these clinical issues in home visitation,
warrants further examination.
Maternal depression is prevalent in Home Visitation Programs, and many
mothers exhibit elevated symptoms at multiple time points over the first
year of service. Interpersonal trauma history is also prevalent, and is
predictive of increased depressive symptoms over time. Home Visitation
Programs should note that mothers with interpersonal trauma history, young
maternal age, and being African American have an increased likelihood of
persistent depressive symptoms, which may in turn pose significant
challenges to providing services.
Keywords: Maternal depression; Home visitation; Child abuse prevention
Barbara J. Stoll, Chapter 2 - Neonatal Infections: A Global Perspective,

Infectious Diseases of the Fetus and Newborn Infant (Sixth Edition), W.B.
Saunders, Philadelphia, 2006, Pages 27-57, ISBN 9780721605371, 10.1016/B0-
72-160537-0/50004-9.
Abstract: One of the greatest challenges to global public health is to
eliminate the gaps between rich and poor countries in health care
resources, in access to preventive and curative services, and in health
outcomes. Although infant mortality has declined by more than 50% since
1955,1 neonatal mortality has changed little in some of the worlds poorest
countries. Worldwide, neonatal mortality accounts for a substantial
proportion of deaths of both infants and children younger than 5
years.1,2,3 The World Health Organization (WHO) estimates that more than 4
million neonates die each year and that 98% of these deaths occur in
developing countries.2,3 Causes of neonatal mortality, especially in
developing countries, are difficult to ascertain, partly because many of
these deaths occur at home, unattended by medical personnel, and partly
because critically ill neonates often present with nondiagnostic signs and
symptoms of disease. Infectious diseases, birth asphyxia, and complications
of prematurity are thought to be the major causes of neonatal death
worldwide.2,3,4,5
Although access to sophisticated technology is limited in developing

countries, neonatal mortality related to infection could be substantially
reduced by simple, known interventions before and during pregnancy, labor,
and delivery; in the immediate postpartum period; and in the early days of
life.2,3,5,6 The global burden of infectious diseases in the newborn,
direct and indirect causes of neonatal mortality attributed to infection,
specific infections of relevance in developing countries, and strategies to
reduce both the incidence of neonatal infection and morbidity and mortality
in infants who do become infected are reviewed in this chapter.
Diane L. Langkamp, Rebecca G. Girardet, Primary Care for Twins and Higher
Order Multiples, Current Problems in Pediatric and Adolescent Health Care,
10.1016/j.cppeds.2005.10.005.
Francois Feillet, Anita MacDonald, Danielle Hartung (Perron), Barbara

Burton, Outcomes beyond phenylalanine: An international perspective,
Molecular Genetics and Metabolism, Volume 99, Supplement, 2010, Pages S79-
S85, ISSN 1096-7192, 10.1016/j.ymgme.2009.09.015.
Abstract: Control of blood phenylalanine (Phe) levels throughout the life
of a person diagnosed with phenylketonuria (PKU) is the biochemical
management strategy necessary to provide the best potential for optimal
outcome. Psychosocial support mechanisms comprise the other aspects of PKU
management that are necessary to overcome the hurdles of living with this
chronic disease and to adhere to the rigors of its management. Additional
psychosocial support may be required, in light of increasing evidence that
control of blood Phe levels in PKU can still lead to subtle but measurable
cognitive function deficits as well as a predisposition to certain
psychiatric symptoms and disorders. An all encompassing PKU management
strategy that goes beyond simply treating blood Phe levels can empower and
enable people born with PKU to achieve similar life goals as those born
without PKU. This review looks at PKU management strategies that go beyond
treating Phe levels, specifically (1) the roles psychologists play in
managing PKU from infancy through adulthood and how they help PKU families
and caregivers deal with the disease and the burden of its management; (2)
understanding the challenges of transitioning into adulthood as an
individual with PKU and addressing unmet needs in this population; (3) how
non-traditional practices can be utilized in PKU. The objective is to
emphasize that management of PKU goes well beyond addressing the
biochemical nature of this disease in order to achieve optimal patient
outcomes.
Keywords: Phenylketonuria; ADHD
Dorothy Scott, Early identification of maternal depression as a strategy in

the prevention of child abuse, Child Abuse & Neglect, Volume 16, Issue
3, 1992, Pages 345-358, ISSN 0145-2134, 10.1016/0145-2134(92)90044-R.
(http://www.sciencedirect.com/science/article/pii/014521349290044R)
Abstract: Maternal suicide and infanticide are merely the extreme tip of
the iceberg of psychological and social morbidity associated with post-
partum depression. Despite research indicating an association between
maternal depression and disturbed parent-child interaction, maternal
depression has been largely ignored in the literature on child maltreatment
and in child protection practice. Practitioners should be alert to the
potential risks to the child associated with maternal depression. In cases
where child abuse has occurred, they should consider the possibility that
the mother is depressed and that this needs to be treated as a problem in
its own right. In terms of prevention of child maltreatment, early
identification of maternal depression is an important strategy in which
primary health workers have an important role. This study investigates the
feasibility of broadening the traditional infant health focus of the role
of the Australian Maternal and Child Health Nurse or Public Health Nurse to
encompass maternal emotional and social well-being. Using quantitative and
qualitative methods, the conditions under which mothers would find this
acceptable, and the factors that facilitate or constrain such role
redefinition are analyzed.
Keywords: Maternal depression; Post-partum depression; Early intervention;
Prevention; Child abuse
Kelly G. Lambert, The parental brain: Transformations and adaptations,

Physiology & Behavior, Available online 27 March 2012, ISSN 0031-9384,
10.1016/j.physbeh.2012.03.018.
Abstract: Few evolutionary transformations rival the complex
neurobiological modifications accompanying the mammalian transition to
parenthood. Research conducted primarily in maternal rodents highlights the
engagement of multiple areas of the brain to initiate and maintain interest
in resource-depleting vulnerable pups throughout lactation. Interestingly,
many modifications marking the transition to motherhood result in adaptive
response options that persist well beyond the weaning of pups;
specifically, adaptations such as cognitive flexibility, emotional
regulation and enhanced social attentiveness coincide with the parenthood
transition and have emerged as defining characteristics of the most
adaptive mammalian species. The paternal brain also results in interesting
modifications that, in some biparental species, mimic the effects observed
in females. Taken together, research suggests that the designation of
parent is less of a categorical variable and more of a continuous
variable, with the quality of nurturing responses directed toward offspring
influenced by many factors such as predisposed sensitivity to reproductive
hormones, nature and duration of exposure to offspring, number of
reproductive experiences, adequate resources, and composition of the social
environment. Indeed, the transition from an animal focused on self-
preservation to one that is responsive to the needs of other animals, and
the accompanying increases in reproductive fitness, represent a significant
evolutionary transition, or upgrade of sorts, leading to a more diverse
array of response options to meet the challenging demands of changing
environmental and social terrains.
Keywords: Maternal; Paternal; Parental; Nurturing responses;
Neuroplasticity; Adaptive responses; Mammalian brain
Heidi Falter Olson, Janice D. Nunnelee, Incidence of thrombosis in

pregnancy and postpartum: A retrospective review in a large private
hospital, Journal of Vascular Nursing, Volume 16, Issue 4, December 1998,
Pages 84-86, ISSN 1062-0303, 10.1016/S1062-0303(98)90012-7.
Abstract: This article addresses a 10-year retrospective chart review that
was conducted at St John's Mercy Medical Center in St Louis, Mo, to
investigate the incidence and prevalence of deep vein thrombosis in
pregnancy and during the postpartum period. A total of 65, 912 deliveries
occurred between 1985 and 1995, and 105 (0.2%) patients were diagnosed with
a deep vein thrombosis or superficial vein thrombosis during pregnancy or
during the postpartum period. The study compared specific demographic data
of the patients, and the differences in diagnostic testing, obstetric and
medical history, methods of treatment, and sequela of patients, as well as
the nursing implications.
Kathryn E. Phillips, Georgette Flood, Employer Approaches To Preconception

Care, Women's Health Issues, Volume 18, Issue 6, Supplement, November
December 2008, Pages S36-S40, ISSN 1049-3867, 10.1016/j.whi.2008.07.006.
Abstract: In recent years, the idea of preconception careeducation,
counseling, and interventions delivered to women before they become
pregnanthas gained traction as a critically important health promotion
opportunity for women and their families. Employers, as purchasers of
health care and as providers of wellness services, have an important role
to play in the promotion of preconception care. Large, self-insured
employers can craft their medical benefit plans to include evidence-
informed preventive health benefits such as preconception care. Employers
can also design and implement worksite health promotion programs that
address preconception, pregnancy, and postpartum health. And employers of
all sizes can educate women and their partners on pregnancy health through
tailored communication. This article provides an overview of the business
case for preconception care and concrete steps employers can take to
support and incent preconception care among their beneficiaries. The
article also includes suggestions on ways providers and health
professionals support employers in these efforts.
Tracy L. Jones, Ronald J. Prinz, Potential roles of parental self-efficacy

in parent and child adjustment: A review, Clinical Psychology Review,
10.1016/j.cpr.2004.12.004.
Abstract: This review examines the potential roles of parental self-
efficacy (PSE) in parent and child adjustment and the role of parental
cognitions in understanding behaviors and emotions within families. The
areas in this review include parental competence and psychological
functioning, as well as child behaviors, socio-emotional adjustment, school
achievement, and maltreatment. There is strong evidence linking PSE to
parental competence, and more modest linkage to parental psychological
functioning. Some findings suggest that PSE impacts child adjustment
directly but also indirectly via parenting practices and behaviors.
Although the role of PSE likely varies across parents, children, and
culturalcontextual factors, its influence cannot be overlooked as a
possible predictor of parental competence and child functioning, or perhaps
an indicator of risk. PSE may also be an appropriate target for prevention
and intervention efforts. Limitations in the literature include measurement
problems, variability in conceptualizations and definitions of the
construct, and the lack of research exploring causality. Future research
should focus on clarifying the measurement of PSE, studying potential bias
in self-report of PSE, and utilizing experimental and longitudinal designs
to untangle the issues of causal direction and potential transactional
processes.
Keywords: Parental self-efficacy; Parenting; Parental competence; Child
adjustment
Jane Fisher, Thach Duc Tran, Trang Thu Nguyen, Tuan Tran, Common perinatal
mental disorders and alcohol dependence in men in northern Viet Nam,
Journal of Affective Disorders, Volume 140, Issue 1, September 2012, Pages
97-101, ISSN 0165-0327, 10.1016/j.jad.2012.03.029.
To establish the prevalence and correlates of the perinatal common mental
disorders of depression and anxiety (PCMD) and alcohol dependence (AD) in
men in northern Viet Nam.
Methods
A cross-sectional study of men whose wives were > 28 weeks
pregnant or mothers of newborns recruited from randomly-selected rural and
urban communes. Data sources were Structured Clinical Interviews for DSM
IV; CAGE assessment of alcohol use and study-specific questionnaires. Odds
ratios and 95% CIs were calculated by multiple logistic regressions.
Results
Overall, 231/360 eligible men were recruited, of whom 17.7% [95% CI, 12.8
22.7] were diagnosed with a PCMD; 33.8% [95% CI, 27.940.1] with AD (CAGE
score 2) and 6.9% [95% CI, 4.311.0] with co-morbid PCMD and
AD. PCMD were associated with experiences of coincidental life adversity,
intimate partner violence, age > 30; an unwelcome pregnancy
and primiparity. AD was more common among men with low education, living in
the poorest households and in unskilled work.
Conclusions
Common mental disorders and AD are prevalent, but currently unrecognised
among men in northern Viet Nam whose wives are pregnant or have recently
given birth.
Keywords: Common mental disorders; Alcohol dependence; Men; Developing
countries
Guido G. Urizar Jr., Ricardo F. Muoz, Impact of a prenatal cognitive-

behavioral stress management intervention on salivary cortisol levels in
low-income mothers and their infants, Psychoneuroendocrinology, Volume 36,
10.1016/j.psyneuen.2011.04.002.
Abstract: Summary
Recent findings suggest that elevated stress levels during the pre- and
postpartum period are related to poor maternal and infant health outcomes;
yet, few studies have prospectively examined the efficacy of stress
management interventions on regulating stress levels among mothers and
their infants. The current study examined whether a prenatal cognitive
behavioral stress management (CBSM) intervention would be effective in
regulating salivary cortisol (a biological marker of stress) and self-
reported stress levels among mothers and their infants at six and 18 months
postpartum, relative to two control groups. Our sample was comprised of
predominantly Spanish-speaking, low-income women (80%; mean
age = 25 5 years) who were screened for depression
during their second trimester of pregnancy (M = 16 5
weeks of gestation). Women at high risk for depression [i.e., having either
a past history of major depression or current elevated symptoms of
depression (16 on CES-D)] were randomized to either a CBSM group
(n = 24) or a usual care (UC) group (n = 33), while a
low risk comparison (LRC) group (n = 29) was comprised of women
not meeting either depression criteria. ANCOVA analyses demonstrated that:
(1) infants of women in the CBSM and LRC groups had significantly lower
cortisol levels than infants of women in the UC group at six months
postpartum (p < .001); and (2) women in the CBSM group had
lower cortisol levels than women in the UC group at 18 months postpartum
(p < .01). These results suggest that prenatal CBSM
interventions may be efficacious in regulating biological markers of stress
among mothers and their infants, thereby decreasing their risk for
developing health complications over time.
Keywords: Stress; Cortisol; Pregnancy; Mothers; Infants; Stress management
Amy M Windham, Leon Rosenberg, Loretta Fuddy, Elizabeth McFarlane, Calvin

Sia, Anne K Duggan, Risk of mother-reported child abuse in the first 3
years of life, Child Abuse & Neglect, Volume 28, Issue 6, June 2004,
Pages 645-667, ISSN 0145-2134, 10.1016/j.chiabu.2004.01.003.
Abstract: Objective: The purpose of this research was to investigate,
within an at-risk population, parent and child characteristics associated
with a mothers self-reports of severe physical assault and assault on the
self-esteem of the child in the first 3 years of life.
Design: The study population consisted of a community-based sample of

mothers of newborns identified as at-risk for child maltreatment (n=595).
Families were assessed annually from the childs birth through age 3 using
instruments with established psychometric properties. Independent variables
investigated included: family socio-demographics, parity, mothers social
support, maternal depression, maternal problem drug or alcohol use, partner
violence, childs age, childs sex, low birth weight/small for gestational
age (SGA), and mothers perception of childs demand level. Associations
with maltreatment were examined using multivariable methods for
longitudinal data.
Results: Child severe physical assault was significantly associated with

parent characteristics (maternal depression and partner violence); and
child characteristics (SGA). Assault to the childs self-esteem was
significantly associated with maternal depression, maternal illicit drug
use, partner violence and mothers perception of childs demand level.
Controlling for family sociodemographic characteristics did not change the
associations. Likewise, while mothers perception of child demand level had
an independent association with self-esteem assault, the associations
described above persisted while demand level was held constant. In this
high-risk sample, abuse was not associated with mothers age, education,
race, parity, or household income level.
Conclusions: While characteristics such as SGA can serve as markers for

increased abuse risk, they are not amenable to intervention after the child
is born. However, certain other risk factors, such as maternal depression
and domestic violence are malleable and should be targeted for intervention
with the goal of preventing child maltreatment.
Keywords: Child abuse; Psychological abuse; Depression; Family violence;
Temperament
Emre Yanikkerem, Rahime Tuncer, Kezban Yilmaz, Meryem Aslan, Glten
Karadeniz, Breast-feeding knowledge and practices among mothers in Manisa,
Turkey, Midwifery, Volume 25, Issue 6, December 2009, Pages e19-e32, ISSN
0266-6138, 10.1016/j.midw.2007.10.012.
Abstract: Objective
to determine breast-feeding knowledge and practices among mothers before
and after an educational intervention on breast feeding.
Design
cross-sectional, descriptive study using a face-to-face questionnaire.
Setting
Manisa Maternity and Children's Hospital, which has Baby Friendly status.
Participants
158 women in the early postpartum period.
Measurements and findings
10.8% of women were not aware that they should offer colostrum to their
babies. Only 43.7% of women commenced breast feeding within the first 30
minutes of giving birth. Prior to receiving the educational intervention,
55.7% of mothers knew how often they should feed their baby, 48.7% knew
that they should breast feed their baby for two years together with
additional food, although 55.1% of women did not know how to hold their
breast during a feed. The mean pre-test score was 9.9 (SD 2.4; range 313),
and the mean post-test score was 12.6 (SD 0.8; range 913). The difference
between the mean pre- and post-test scores was statistically significant
(paired t=15.3, df=157, P<0.001).
Conclusion and implications for practice
given the integral role of breast feeding in improving overall community
health, regular breast-feeding counselling should be offered, particularly
during the pregnancy and early postpartum period.
Keywords: Breast feeding; Breast-feeding education; Baby; Newborn baby;
Baby nutrition
Chamarrita Farkas, Nelson Valds, Maternal stress and perceptions of self-

efficacy in socioeconomically disadvantaged mothers: An explicative model,
Infant Behavior and Development, Volume 33, Issue 4, December 2010, Pages
654-662, ISSN 0163-6383, 10.1016/j.infbeh.2010.09.001.
Abstract: Studies have demonstrated that maternal stress and perceptions of
self-efficacy influence a mother's performance, affecting her ability to
interact with her child and to understand and answer his needs. The purpose
of this study was to evaluate maternal stress and the perception of self-
efficacy in the mothers of infants who are cared for in child-care centers
and belong to the poorest segment of the Chilean population. To this end,
these aspects were studied in 121 low-income, high-social-risk mothers with
children between the ages of 4 and 9 months. The final goal was to generate
an explicative model of self-efficacy and maternal stress that considered
characteristics of the family and the child. The results revealed that
family characteristics especially household size, per capita incomes and
mother age are more relevant for explaining maternal self-efficacy and
stress. The findings and implications for practice are discussed.
Keywords: Early infancy; Contextual liabilities; Maternal self-efficacy;
Maternal stress
Debora Barnes-Josiah, Cynthia Myntti, Antoine Augustin, The three delays

as a framework for examining maternal mortality in Haiti, Social Science
& Medicine, Volume 46, Issue 8, 15 April 1998, Pages 981-993, ISSN
0277-9536, 10.1016/S0277-9536(97)10018-1.
Abstract: Haiti has one of the highest rates of maternal mortality in the
Caribbean. The Three Delays model proposes that pregnancy-related
mortality is overwhelmingly due to delays in: (1) deciding to seek
appropriate medical help for an obstetric emergency; (2) reaching an
appropriate obstetric facility; and (3) receiving adequate care when a
facility is reached. This framework was used to analyze a sample of 12
maternal deaths that occurred in a longitudinal cohort of pregnant Haitian
women. Because of political upheavals in Haiti during the survey, these
deaths are an underestimate of all deaths that occurred in the cohort.
Family and friend interviews were used to obtain details about the medical
and social circumstances surrounding each death. A delayed decision to see
medical care was noted in eight of the 12 cases, whereas delays in
transportation only appeared to be significant in two. Inadequate care at a
medical facility was a factor in seven cases. Multiple delays were relevant
in the deaths of three women. Family and friend interviews suggest that a
lack of confidence in available medical options was a crucial factor in
delayed or never made decisions to seek care. Expanding the coverage of
existing referral networks, improving community recognition of obstetric
emergencies, and improving the ability of existing medical institutions to
deliver quality obstetric care, are all necessary. However, services will
continue to be under-utilized if they are perceived negatively by pregnant
women and their families. The current data thus suggest that improvements
to Haitis maternity care system which focus on reducing the third delay
that is, improving the quality and scope of care available at existing
medical facilitieswill have the greatest impact in reducing needless
maternal deaths.
Keywords: Haiti; maternal mortality; verbal autopsies; maternity care
Judith Fullerton, Richard Severino, Kelly Brogan, Joyce Thompson, The

International Confederation of Midwives study of essential competencies of
midwifery practice, Midwifery, Volume 19, Issue 3, September 2003, Pages
174-190, ISSN 0266-6138, 10.1016/S0266-6138(03)00032-9.
Abstract: Objective: to delineate the knowledge, skills, and behaviours
that would characterise the domain of competencies of the midwife who is
educated according to the international definition of the profession.
Design: Phase I: a qualitative Delphi study; Phase II: a descriptive survey

research process.
Participants: a stratified random sample of member organisations of the

International Confederation of Midwives (ICM) and regulatory
representatives from these same countries.
Findings: a list of basic (essential) and additional competencies for

midwives who have been educated in keeping with the ICM/WHO/FIGO
international definition of the midwife was developed through an interative
Delphi process, and then affirmed, using a survey research method. The
final list includes 214 individual task statements within six domains of
midwifery practice.
Implications for practice: this list of competencies can serve as a basis

for educational curriculum design, as a guideline for regulatory policy
development, as a reference document for individual practitioners in an
assessment of their initial and continued competency and by the ICM and its
member associations as a resource for advocating for the role of midwifery
within health-care systems world-wide.
Linda L. Wright, Chapter 4 - Global Neonatal Health, Avery's Diseases of

the Newborn (Ninth Edition), W.B. Saunders, Philadelpia, 2012, Pages 23-36,
ISBN 9781437701340, 10.1016/B978-1-4377-0134-0.10004-6.
Pisake Lumbiganon, Malinee Laopaiboon, A Metin Glmezoglu, Joo Paulo
Souza, Surasak Taneepanichskul, Pang Ruyan, Deepika Eranjanie Attygalle,
Naveen Shrestha, Rintaro Mori, Nguyen Duc Hinh, Hoang Thi Bang, Tung
Rathavy, Kang Chuyun, Kannitha Cheang, Mario Festin, Venus Udomprasertgul,
Maria Julieta V Germar, Gao Yanqiu, Malabika Roy, Guillermo Carroli,
Katherine Ba-Thike, Ekaterina Filatova, Jos Villar, for the World Health
Organization Global Survey on Maternal and Perinatal Health Research Group,
Method of delivery and pregnancy outcomes in Asia: the WHO global survey on
maternal and perinatal health 200708, The Lancet, Volume 375, Issue 9713,
612 February 2010, Pages 490-499, ISSN 0140-6736, 10.1016/S0140-
6736(09)61870-5.
There has been concern about rising rates of caesarean section worldwide.
This Article reports the third phase of the WHO global survey, which aimed
to estimate the rate of different methods of delivery and to examine the
relation between method of delivery and maternal and perinatal outcomes in
selected facilities in Africa and Latin America in 200405, and in Asia in
200708.
Methods
Nine countries participated in the Asia global survey: Cambodia, China,
India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each
country, the capital city and two other regions or provinces were randomly
selected. We studied all women admitted for delivery during 3 months in
institutions with 6000 or fewer expected deliveries per year and during 2
months in those with more than 6000 deliveries. We gathered data for
institutions to obtain a detailed description of the health facility and
its resources for obstetric care. We obtained data from women's medical
records to summarise obstetric and perinatal events.
Findings
We obtained data for 109101 of 112152 deliveries reported in 122 recruited
facilities (97% coverage), and analysed 107950 deliveries. The overall
rate of caesarean section was 273% (n=29428) and of operative vaginal
delivery was 32% (n=3465). Risk of maternal mortality and morbidity index
(at least one of: maternal mortality, admission to intensive care unit
[ICU], blood transfusion, hysterectomy, or internal iliac artery ligation)
was increased for operative vaginal delivery (adjusted odds ratio 21, 95%
CI 1726) and all types of caesarean section (antepartum without
indication 27, 1455; antepartum with indication 106, 93120;
intrapartum without indication 142, 98207; intrapartum with indication
145, 132160). For breech presentation, caesarean section, either
antepartum (02, 0103) or intrapartum (03, 0204), was associated
with improved perinatal outcomes, but also with increased risk of stay in
neonatal ICU (20, 1136; and 21, 1237, respectively).
Interpretation
To improve maternal and perinatal outcomes, caesarean section should be
done only when there is a medical indication.
Funding
US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank
Special Programme of Research, Development and Research Training in Human
Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and
Welfare of Japan; Ministry of Public Health, China; and Indian Council of
Medical Research.
, Neuroleptic drugs, In: Editor: J.K. Aronson, Editor(s)-in-Chief,

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse
Drug Reactions and Interactions (Fifteenth Edition), Elsevier, Amsterdam,
2006, Pages 2438-2489, ISBN 9780444510051, 10.1016/B0-44-451005-2/00134-0.
Deborah Bender, Ana Santander, Aurora Balderrama, Alfredo Arce, Rosario
Medina, Transforming the process of service delivery to reduce maternal
mortality in Cochabamba, Bolivia, Reproductive Health Matters, Volume 3,
Issue 6, November 1995, Pages 52-59, ISSN 0968-8080, 10.1016/0968-
8080(95)90159-0.
Abstract: Maternal mortality is a problem of considerable magnitude yet it
still receives inadequate attention in developing countries. Recently,
increased attention has been given to preventing maternal mortality through
innovative programmes of service delivery, in which success is usually
measured by outcomes such as changes in the ratio of maternal
mortality/morbidity or an increase in use of health services, without
looking at the actual process of service delivery. This paper presents a
model of participative management as a means of changing the process of
maternal health care delivery. It was developed as part of Proyecto MADRE,
a community-based reproductive health project in Cochabamba, Bolivia.
Julia S. Seng, Mickey Sperlich, Lisa Kane Low, Mental Health, Demographic,
and Risk Behavior Profiles of Pregnant Survivors of Childhood and Adult
Abuse, Journal of Midwifery & Women's Health, Volume 53, Issue 6,
NovemberDecember 2008, Pages 511-521, ISSN 1526-9523,
10.1016/j.jmwh.2008.04.013.
Abstract: Our objective was to address the gap in knowledge about the
extent to which perinatal mental health and risk behaviors are associated
with childhood and adult experiences of abuse that arises because of
barriers to screening and disclosure about past and current abuse. Survey
data from an ongoing study of the effects of posttraumatic stress on
childbearing were used to describe four groups of nulliparous women: those
with no abuse history, adult abuse only, childhood abuse only, and abuse
that occurred during both periods. The rates of abuse history disclosure
were higher in the research context than in the clinical settings. Mental
health morbidity and risk behaviors occurred in a dose-response pattern
with cumulative abuse exposure. Rates of current posttraumatic stress
disorder ranged from 4.1% among those never abused to 11.4% (adult only),
16.0% (childhood only), and 39.2% (both periods). Women abused during both
periods also were more likely to be using tobacco (21.5%) and drugs (16.5%)
during pregnancy. We conclude that mental health and behavioral risk
sequelae affect a significant portion of both childhood and adult abuse
survivors in prenatal care. The integration into the maternity setting of
existing evidence-based interventions for the mental health and behavioral
sequelae of abuse is needed.
Keywords: intimate partner violence; childhood abuse; perinatal mental
health; posttraumatic stress; screening
M.A. Koblinsky, Beyond maternal mortality magnitude, interrelationship

and consequences of women's health, pregnancy-related complications and
nutritional status on pregnancy outcomes, International Journal of
Gynecology & Obstetrics, Volume 48, Supplement, June 1995, Pages S21-
S32, ISSN 0020-7292, 10.1016/0020-7292(95)02322-4.
Abstract: The magnitude of maternal morality in developing countries and
its disparity with similar statistics from the developed world has touched
a responsive chord among policy makers and health services program
officials. What is not well appreciated, however, is that maternal
mortality is only the tip of the iceberg for every one maternal death,
acute obstetrical complications cause suffering in nearly 100 women, 250
women contract a sexually transmitted disease, and 1000 women suffer
stunting and/or anemia. All of these problems impact on the pregnancy
outcome, both for the woman as well as for the newborn. Through a review of
the literature, the magnitude, interrelationships and consequences of these
various problems are described. The woman and the newborn are a dyad, a
unit; what affects the woman typically affects the fetus and is manifest in
the newborn. Safe motherhood programs need to pay attention to both,
realizing that interventions aimed at the woman can benefit the next
generation.
Keywords: Maternal mortality; Maternal morbidity; Perinatal mortality;
Newborn
Rachel G. Lucas-Thompson, Wendy A. Goldberg, Chapter 7 - Family

Relationships and Children's Stress Responses, In: Janette B. Benson,
Editor(s), Advances in Child Development and Behavior, JAI, 2011, Volume
40, Pages 243-299, ISSN 0065-2407, ISBN 9780123864918, 10.1016/B978-0-12-
386491-8.00007-4.
Abstract: Abstract
In this chapter, the theoretical and empirical associations between family
relationships and children's responses to stressors are reviewed. Family
relationships explored are primarily dyadic, representing the emphasis of
past empirical research; these include parentparent, parentchild, and
sibling relationships. However, in recognition of the more complicated and
interconnected nature of family relationships, also reviewed are
associations between the broader family context and children's stress
responses. Multiple measures of stress responses are considered, including
both physiological and emotional responses to and recovery from stressful
experiences. Overall, the studies reviewed suggest that poor-quality family
environments, including those characterized by low emotional support or
high conflict, are associated with dysregulated stress responses throughout
childhood and adolescence. In contrast, children and adolescents in
families with high emotional support or low conflict seem to be protected
from developing stress regulatory problems. Limitations in this body of
research as well as directions for future research are discussed.
Keywords: Family relationships; Stress physiology; Childhood; Adolescence;
Family environment
Susan G. Devine, Simone L. Harrison, Petra G. Buettner, Building capacity

of maternity staff to discourage the use of sunlight therapy in the post-
partum period and infancy, Women and Birth, Volume 21, Issue 3, September
To describe the development, implementation and evaluation of an
educational intervention that addresses risky beliefs held by midwives and
nurses working in maternity areas and new mothers about therapeutic sun
exposure.
Procedure
In 20022003, 59 midwives and nurses from a hospital in northern Queensland
participated in an educational intervention to discourage mothers from
exposing themselves and their infants to sunlight for therapeutic reasons.
Intervention staff attended an educational workshop and/or received
educational resources. Resources (posters, pamphlets and bookmarks) were
developed for the staff to use for educating mothers. Process evaluation of
the quality and usefulness of the workshop and resources was conducted
immediately after the workshop and 12 months later.
Findings
Intervention staff indicated that the workshop was relevant to their work,
and increased their knowledge and confidence in talking to mothers about
sunlight exposure. Ninety percent of the 59 participants indicated they had
used the workshop information in their interactions with post-partum
mothers. Of the resources, pamphlets and bookmarks were used most often.
Conclusions and implications for practice
The educational intervention was successful in developing the knowledge of
midwives and nurses to provide sound advice to new mothers about
therapeutic sun exposure and in developing resources to support them in
their education. Although workshops and resources are useful in the short
term, they are impractical to sustain. To improve sustainability, content
on this topic needs to be incorporated into midwifery and nursing curricula
across Australia.
Keywords: Sun exposure; Maternity staff; Education; Infancy; Post-partum
period
Jo Borghi, Tim Ensor, Aparnaa Somanathan, Craig Lissner, Anne Mills, on

behalf of The Lancet Maternal Survival Series steering group, Mobilising
financial resources for maternal health, The Lancet, Volume 368, Issue
9545, 2127 October 2006, Pages 1457-1465, ISSN 0140-6736, 10.1016/S0140-
6736(06)69383-5.
Abstract: Summary
Coverage of cost-effective maternal health services remains poor due to
insufficient supply and inadequate demand for these services among the
poorest groups. Households pay too great a share of the costs of maternal
health services, or do not seek care because they cannot afford the costs.
Available evidence creates a strong case for removal of user fees and
provision of universal coverage for pregnant women, particularly for
delivery care. To be successful, governments must also replenish the income
lost through the abolition of user fees. Where insurance schemes exist,
maternal health care needs to be included in the benefits package, and
careful design is needed to ensure uptake by the poorest people. Voucher
schemes should be tested in low-income settings, and their costs and
relative cost-effectiveness assessed. Further research is needed on methods
to target financial assistance for transport and time costs. Current
investment in maternal health is insufficient to meet the fifth Millennium
Development Goal (MDG), and much greater resources are needed to scale up
coverage of maternal health services and create demand. Existing global
estimates are too crude to be of use for domestic planning, since resource
requirements will vary; budgets need first to be developed at country-
level. Donors need to increase financial contributions for maternal health
in low-income countries to help fill the resource gap. Resource tracking at
country and donor levels will help hold countries and donors to account for
their commitments to achieving the maternal health MDG.
Carole A. Warnes, Roberta G. Williams, Thomas M. Bashore, John S. Child,

Heidi M. Connolly, Joseph A. Dearani, Pedro del Nido, James W. Fasules,
Thomas P. Graham Jr, Ziyad M. Hijazi, Sharon A. Hunt, Mary Etta King,
Michael J. Landzberg, Pamela D. Miner, Martha J. Radford, Edward P. Walsh,
Gary D. Webb, ACC/AHA 2008 Guidelines for the Management of Adults With
Congenital Heart Disease: A Report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing Committee to Develop Guidelines on the Management of Adults With
Congenital Heart Disease) Developed in Collaboration With the American
Society of Echocardiography, Heart Rhythm Society, International Society
for Adult Congenital Heart Disease, Society for Cardiovascular Angiography
and Interventions, and Society of Thoracic Surgeons, Journal of the
American College of Cardiology, Volume 52, Issue 23, 2 December 2008, Pages
e143-e263, ISSN 0735-1097, 10.1016/j.jacc.2008.10.001.
Keywords: ACC/AHA Practice Guidelines; congenital heart disease; cardiac
defects; congenital heart surgery; unoperated/repaired heart defects;
medical therapy; cardiac catheterization
Deborah Koniak-Griffin, Nancy L.R Anderson, Mary-Lynn Brecht, Inese

Verzemnieks, Janna Lesser, Sue Kim, Public health nursing care for
adolescent mothers: impact on infant health and selected maternal outcomes
at 1 year postbirth, Journal of Adolescent Health, Volume 30, Issue 1,
January 2002, Pages 44-54, ISSN 1054-139X, 10.1016/S1054-139X(01)00330-5.
Abstract: Purpose: To compare effects of an early intervention program
(EIP) of intense home visitation by public health nurses (PHNs) with
effects of traditional public health nursing care (TPHN) on infant health
and selected maternal outcomes of adolescent mothers.
Methods: EIP adolescents (N = 102) received preparation-for-motherhood

classes and individual home visits (from pregnancy through 1 year
postpartum) from PHNs employed in a county health department. Participants
were predominantly Latina (64%) and African-American (11%) and from
impoverished backgrounds. Infant health outcomes were determined based on
medical record data; interviews and standardized questionnaires evaluated
other program effects (e.g., maternal educational achievement and
psychological status). Data were analyzed using Chi-square and repeated
measures ANOVA.
Results: Infants of EIP mothers experienced significantly fewer total days

(n = 74) and actual episodes (n = 14) of hospitalization during the first
year of life than those receiving TPHN (n = 154, n = 24, respectively).
Similarly, positive program effects were found for immunization rates.
There were no group differences in emergency room visits or repeat
pregnancy rates. Alcohol, tobacco, and marijuana use significantly
increased from pregnancy through 1 year postpartum in both groups but
remained markedly lower than rates prior to pregnancy (lifetime rates).
Conclusions: These findings demonstrate the positive effects of a PHN home

visitation program on health outcomes for children of adolescent mothers.
Days of infant hospitalization were substantially reduced and immunization
rates increased during the first year of life for children of EIP mothers.
Greater efforts need to be directed toward preventing repeat pregnancy and
return to substance use following childbirth in at-risk adolescent mothers.
Keywords: Adolescents; Adolescent mothers; Nurse home visitation; Infant
hospitalization
Mary Carolan, Cheryl Steele, Heather Margetts, Knowledge of gestational

diabetes among a multi-ethnic cohort in Australia, Midwifery, Volume 26,
10.1016/j.midw.2009.01.006.
Abstract: Objective
to explore knowledge about gestational diabetes (GDM) among a multi-ethnic
sample of women who were receiving antenatal care in Melbourne, Australia.
Design
cross-sectional comparative survey.
Setting
diabetes clinic located in a public hospital in Melbourne's Western
suburbs.
Participants
143 pregnant women with GDM from Vietnamese, Indian, Filipino and Caucasian
backgrounds.
Findings
200 questionnaires were distributed and 143 were returned (response rate
71.5%). There were statistically significant differences between ethnic
groups in terms of educational level (p=0.001) and fluency in English
(p=0.001). Educational levels, measured in completed years of schooling,
were lowest among Vietnamese [mean 8.5 years, standard deviation (SD) 1.0],
Filipino (mean 8.9 years, SD 1.5) and Caucasian [mean 10.2 years, SD 0.9]
women. Indian women had a higher mean level of education (11.6 years, SD
0.9). Fluency in English was reported by 100% of Caucasian, Indian and
Filipino women, but 53.3% of Vietnamese women required interpreter
services. The women's answers varied with ethnicity and educational status.
Vietnamese and Filipino women displayed the least knowledge about GDM and
food values. Caucasian women also scored poorly on general knowledge about
GDM. Indian women scored highest across all areas of interest.
Key conclusions
Vietnamese women had the poorest English skills and lowest educational
levels, and were identified as the group at greatest risk of
misunderstanding GDM. English language proficiency alone, however, was not
associated with better comprehension of GDM in this study. Higher
educational level was the only factor linked to increased comprehension. It
is, therefore, important that new educational strategies are developed to
address lower health literacy as well as cultural factors when caring for
multi-ethnic populations with GDM. This approach may also serve to address
lower levels of comprehension among Caucasian populations.
Keywords: Gestational diabetes; Multi-ethnic; Knowledge; Antenatal care
Susan R. Fawcus, Maternal mortality and unsafe abortion, Best Practice

June 2008, Pages 533-548, ISSN 1521-6934, 10.1016/j.bpobgyn.2007.10.006.
Abstract: Unsafe abortions refer to terminations of unintended pregnancies
by persons lacking the necessary skills, or in an environment lacking the
minimum medical standards, or both. Globally, unsafe abortions account for
67,900 maternal deaths annually (13% of total maternal mortality) and
contribute to significant morbidity among women, especially in under-
resourced settings. The determinants of unsafe abortion include restrictive
abortion legislation, lack of female empowerment, poor social support,
inadequate contraceptive services and poor health-service infrastructure.
Deaths from unsafe abortion are preventable by addressing the above
determinants and by the provision of safe, accessible abortion care. This
includes safe medical or surgical methods for termination of pregnancy and
management of incomplete abortion by skilled personnel. The service must
also include provision of emergency medical or surgical care in women with
severe abortion complications. Developing appropriate services at the
primary level of care with a functioning referral system and the inclusion
of post abortion contraceptive care with counseling are essential facets of
abortion care.
Keywords: abortion legislation; contraception; manual vacuum aspiration;
maternal mortality; postabortion care; unintended pregnancy; unsafe
abortion
S.A. Otchere, H.T. Binh, Strengthening emergency obstetric care in Thanh

Hoa and Quang Tri provinces in Vietnam, International Journal of Gynecology
& Obstetrics, Volume 99, Issue 2, November 2007, Pages 165-172, ISSN
0020-7292, 10.1016/j.ijgo.2007.07.005.
Abstract: Objective
Save the Children/USA and the Ministry of Health of Vietnam undertook a
project between 2001 and 2004 to improve the availability of, access to,
quality and utilization of emergency obstetric care (EmOC) services at
district and provincial hospitals in two provinces in Vietnam.
Methods
The project improved the functional capacity of 3 provincial and 1 district
hospitals providing comprehensive EmOC services, and upgraded 1 district
hospital providing basic EmOC into a comprehensive EmOC facility through
training, infrastructure and quality improvement.
Results
Data presented in this paper focus on only the 2 district hospitals even
though the UN process indicators showed increases in utilization of EmOC in
all 5 hospitals. In the case of Hai Lang, the proportion of births
increased from 13% at baseline to 31% at the end of 2004, and met need
increased significantly from 16% to 87% largely due to increased capacity
of the hospital and staff. Met need in Hoang Hoa hospital more than doubled
(17% at baseline versus 54% in 2004) and the proportion of births increased
slightly from 19% in 2001 to 22% in 2004. Case fatality rates for the two
hospitals remarkably remained at zero. Lessons from this project have been
incorporated into national policy and guidelines.
Conclusion
Improvements in the capacity of existing health facilities to treat
complications in pregnancy and childbirth can be realized in a relatively
short period of time and is an essential element in reducing maternal
mortality.
Keywords: Vietnam; Emergency obstetric care; Quality of care; Maternal
mortality
M. Sharan, D. Strobino, S. Ahmed, Intrapartum oxytocin use for labor

acceleration in rural India, International Journal of Gynecology &
Obstetrics, Volume 90, Issue 3, September 2005, Pages 251-257, ISSN 0020-
7292, 10.1016/j.ijgo.2005.05.008.
Abstract: Objective: To examine factors associated with the use of oxytocin
for acceleration of labor in women delivered at home in rural India.
Method: Quantitative data were collected from 527 women who were delivered
at home and qualitative interviews were carried out with 21 mothers and 9
birth attendants. Results: Oxytocin use was associated with higher
education and socioeconomic status, primigravidity, and delivery by a
traditional birth attendant. Conclusion: Labor acceleration with oxytocin
occurs indiscriminately In India. Oxytocin use should be regulated, and
training for birth attendants should be provided as well as health
education for pregnant women.
Keywords: Oxytocin; Home deliveries; India; Traditional birth attendants
Patrice Johnelle Sparks, Racial/Ethnic Differences in Breastfeeding

Duration among WIC-Eligible Families, Women's Health Issues, Volume 21,
Issue 5, SeptemberOctober 2011, Pages 374-382, ISSN 1049-3867,
10.1016/j.whi.2011.03.002.
Abstract: Purpose
This research documented racial/ethnic differences in breastfeeding
duration among mothers from seven diverse racial/ethnic groups in rural and
urban areas of the United States that initiated breastfeeding among income
and categorically eligible WIC participants.
Methods
Using data from the Longitudinal 9-MonthPreschool Restricted-Use data file
of the Early Childhood Longitudinal StudyBirth Cohort, this research first
assessed racial/ethnic differences in breastfeeding initiation and
duration, maternal and child health characteristics, social service usage,
and sociodemographic characteristics. Next, breastfeeding survivorship and
Cox proportional hazards models were estimated to assess potential
racial/ethnic disparities in breastfeeding duration once these control
variables were accounted for in multiple variable models.
Findings
Breastfeeding initiation rates and breastfeeding durations of 6 months were
lower among WIC-eligible mothers compared with all mothers. WIC-eligible,
foreign-born Mexican-Origin Hispanic (FBMOH) mothers were most likely to
breastfeed for 6 months. Breastfeeding duration rates dropped quickly after
4 months of duration among WIC-eligible mothers that initiated. Two
crossover patterns in breastfeeding durations were noted among 1) FBMOH and
non-Hispanic Black mothers and 2) Asian and Native American mothers. A
FBMOH breastfeeding duration advantage was noted compared with non-Hispanic
White mothers once all control variables were included in the Cox
proportional hazard models. No other racial/ethnic disparities in
breastfeeding duration were noted.
Conclusion
More attention to educational programs and broad forms of support as part
of WIC are needed to help reach the breastfeeding duration goals of Healthy
People 2010 and continued support of the Loving Support Peer Counseling
Program may serve as an ideal policy for local WIC offices.
Ruchi Puri, Stephen Rulisa, Shahrzad Joharifard, Jeffrey Wilkinson, Patrick

Kyamanywa, Nathan Thielman, Knowledge, attitudes, and practices in safe
motherhood care among obstetric providers in Bugesera, Rwanda,
February 2012, Pages 124-127, ISSN 0020-7292, 10.1016/j.ijgo.2011.09.025.
Abstract: Objective
To determine the knowledge, attitudes, and practices of obstetric care
providers (OCPs) in Bugesera District, Rwanda, crucial to the delivery of
safe motherhood services.
Methods
A quantitative descriptive survey in Kinyarwanda targeting all OCPs in the
district was implemented in November 2010 to determine demographic
characteristics, safe motherhood knowledge, obstetric practices, and
attitudes toward additional training.
Results
The study captured 87% of OCPs, of whom 137 of 168 (82%) were A2 level
nurses. Most expressed a need to improve their knowledge (60.6%) and skills
confidence (72.2%) in safe motherhood. The mean percentage of correct
answers of 50 questions assessing overall knowledge was 46.4%; sections on
normal labor (39.3% correct) and obstetric complications (37.1% correct)
were the weakest. Fundal pressure during vaginal delivery was practiced by
60.8%, and only 15.9% of providers practiced active management of the third
stage of labor for all deliveries. Providers supported additional training,
and 89.3% expressed willingness to participate in a 2-day workshop even if
it were their day off.
Conclusion
The study has identified a need to improve safe motherhood knowledge and
practices of OCPs in the Bugesera District of Rwanda. OCPs support
additional training as an intervention to reduce maternal mortality.
Keywords: Emergency obstetric care; Health provider competency; Knowledge,
attitudes, and practice survey; Maternal mortality; Safe motherhood; Sub-
Saharan Africa
Jane Svensson, Lesley Barclay, Margaret Cooke, Randomised-controlled trial

of two antenatal education programmes, Midwifery, Volume 25, Issue 2, April
2009, Pages 114-125, ISSN 0266-6138, 10.1016/j.midw.2006.12.012.
Abstract: Objective
to determine whether a new antenatal education programme with increased
parenting content could improve parenting outcomes for women compared with
a regular antenatal education programme.
Design
a randomised-controlled trial. Data were collected through self-report
surveys.
Setting
specialist referral maternity hospital in Sydney, Australia.
Participants
170 women birthing at the hospital. Ninety-one women attended the new
programme and 79 the regular programme.
Intervention
a new antenatal education programme (Having a Baby programme) developed
from needs assessment data collected from expectant and new parents. One
important feature of the programme was the recognition that pregnancy,
labour, birth and early parenting were a microcosm of the childbearing
experience, rather than separate topics.
Measures
the primary outcome measure was perceived maternal parenting self-efficacy.
Worry about the baby, and perceived parenting knowledge, were secondary
outcome measures. They were measured before the programme and after birth.
Birth outcomes were also recorded.
Findings
the postnatal perceived maternal parenting self-efficacy scores of women
who attended the Having a Baby programme were significantly higher than
those who attended the regular programme. Perceived parenting knowledge
scores of women who attended the Having a Baby programme were also
significantly higher than those who attended the regular programme. Worry
scores were lower but they did not reach statistical significant. Birth
outcomes were similar.
the Having a Baby programme improved maternal self-efficacy and parenting
knowledge. Parenting programmes that continue in the early postnatal period
may be beneficial.
Keywords: Childbirth education; Pregnancy; Randomised control trial;
Programme evaluation
Sherryl H. Goodman, Lauren B. Adamson, Joann Riniti, Steven Cole, Mothers'

Expressed Attitudes: Associations with Maternal Depression and Children's
Self-Esteem and Psychopathology, Journal of the American Academy of Child
& Adolescent Psychiatry, Volume 33, Issue 9, NovemberDecember 1994,
Pages 1265-1274, ISSN 0890-8567, 10.1097/00004583-199411000-00007.
Mothers' expressed attitudes about their children were examined to discern
whether the associations between maternal depression and children's
psychopathology and self-esteem might be modified by the mother's
expression of critical attitudes.
Method
Motherchild dyads with mothers who had a history of at least one episode
of unipolar major depression during the child's lifetime (N = 20) were
compared to dyads with well parents (N = 19). Children's ages ranged from 8
to 10 years. Mothers' attitudes toward their children were derived from
semistructured interviews. The affect expressed in each maternal statement
was coded as neutral, positive, descriptive negative, or affectively
charged negative.
Results
Affectively charged negative statements were found to be associated with
mothers with a history of depressive episodes. A tendency was noted for the
highest rates of psychopathology to be among children of depressed mothers
who used affective-negative statements. Mothers' use of affectively charged
negatives was found to modify the association between maternal depression
and children's lower global self-worth.
Conclusions
Clinicians attuned to mothers' expression of critical attitudes toward
their children might detect children at risk for lowered self-esteem and
the development of psychopathology.
Keywords: expressed attitudes; maternal depression
Mary C Blehar, Public health context of women's mental health research,

Psychiatric Clinics of North America, Volume 26, Issue 3, September 2003,
Pages 781-799, ISSN 0193-953X, 10.1016/S0193-953X(03)00039-X.
(http://www.sciencedirect.com/science/article/pii/S0193953X0300039X)
Heather L. Colleran, Cheryl A. Lovelady, Use of MyPyramid Menu Planner for
Moms in a Weight-Loss Intervention during Lactation, Journal of the Academy
of Nutrition and Dietetics, Volume 112, Issue 4, April 2012, Pages 553-558,
ISSN 2212-2672, 10.1016/j.jand.2011.12.004.
Abstract: The Internet offers a valuable resource for promotion of healthy
eating and Web-based communication between the dietetics practitioner and
client. In a 16-week intervention examining the effects of energy
restriction (500 kcal/day) and exercise on body composition in
overweight/obese lactating women, MyPyramid Menu Planner for Moms was used
to support dietary counseling. Random assignment occurred at 4 weeks
postpartum to either an Intervention group (n=14) or Minimal Care group
(n=13) from 2008 through 2010. Three 24-hour dietary recalls were obtained
using the Nutrition Data System at 4 and 20 weeks postpartum. Individual
MyPyramid Menu Planner accounts were created for the Intervention group and
used in face-to-face dietary counseling. Repeated measures analysis of
variance was used to test for differences between groups for change in
dietary intake and weight. Changes in energy, saturated fat, and percent of
energy from added sugars were significantly different between Intervention
group and Minimal Care group (613 [521] kcal vs 171 [435] kcal; P=0.03;
14.9 [14.0] g vs +0.9 [13.4] g; P<0.01; and 3.5% [5.3%] vs +2.2%
[4.8%]; P<0.01, respectively). The Intervention group significantly
increased their whole fruit servings and decreased their total grain and
milk servings compared with the Minimal Care group (P<0.05). The
Intervention group lost significantly more weight (5.8 [3.5] kg) than the
Minimal Care group (1.6 [5.4] kg) (P=0.03). Although participants must
have access to an Internet-based computer and possess basic food knowledge,
these results suggest MyPyramid Menu Planner might prove to be an effective
dietary counseling support tool for improving dietary intake and promoting
weight loss during lactation.
Keywords: MyPyramid; Counseling; Weight loss; Diet; Postpartum
David P Hopkins, Peter A Briss, Connie J Ricard, Corinne G Husten, Vilma G

Carande-Kulis, Jonathan E Fielding, Mary O Alao, Jeffrey W McKenna, Donald
J Sharp, Jeffrey R Harris, Trevor A Woollery, Kate W Harris, The Task Force
on Community Preventive Services, Reviews of evidence regarding
interventions to reduce tobacco use and exposure to environmental tobacco
smoke, American Journal of Preventive Medicine, Volume 20, Issue 2,
Supplement 1, February 2001, Pages 16-66, ISSN 0749-3797, 10.1016/S0749-
3797(00)00297-X.
Abstract: Overview: This report presents the results of systematic reviews
of effectiveness, applicability, other effects, economic evaluations, and
barriers to use of selected population-based interventions intended to
reduce tobacco use and exposure to environmental tobacco smoke. The related
systematic reviews are linked by a common conceptual approach. These
reviews form the basis of recommendations by the Task Force on Community
Preventive Services (TFCPS) regarding the use of these selected
interventions. The TFCPS recommendations are presented on page 67 of this
supplement.
Keywords: smoking cessation; tobacco use cessation; tobacco smoke
pollution; community health services; decision-making; evidence-based
medicine; meta-analysis; review literature; practice guidelines; preventive
health services; public health practice
, April 2011 New in Review, Journal of the American Dietetic Association,

10.1016/j.jada.2011.02.028.
Martha Morrison Dore, Joan M. Doris, Pearl Wright, Identifying substance
abuse in maltreating families: A child welfare challenge, Child Abuse &
Neglect, Volume 19, Issue 5, May 1995, Pages 531-543, ISSN 0145-2134,
10.1016/0145-2134(95)00013-X.
(http://www.sciencedirect.com/science/article/pii/014521349500013X)
Abstract: Studies of the link between parental substance abuse and child
maltreatment suggest that chemical dependence is present in at least half
of the families who come to the attention of child welfare authorities for
child abuse and neglect. Parental substance abuse is thought to be a
primary factor in greatly increased rates of children entering foster care
over the past decade. It is also a clear risk factor for child mental
health problems and poor developmental outcomes in children. At the same
time, however, minimal attention is often given to training child
protective services workers and other child welfare personnel in
identifying and confronting substance abuse in families on their caseloads.
The authors explore standardized methods developed for screening for
substance abuse among various populations and suggest ways of adapting
these screening devices for families reported for child maltreatment. They
identify assessment and treatment considerations in substance abusing
families as well.
Keywords: Child; Abuse; Maltreatment; Drugs; Family
Bishara S. Atiyeh, S. William A. Gunn, Shady N. Hayek, Provision of

essential surgery in remote and rural areas of developed as well as low and
middle income countries, International Journal of Surgery, Volume 8, Issue
8, 2010, Pages 581-585, ISSN 1743-9191, 10.1016/j.ijsu.2010.07.291.
Surgery is increasingly becoming an integral part of public health and
health systems development worldwide. Such surgical care should be provided
at the same type and level in both urban and rural settings. However,
provision of essential surgery in remote and rural areas of developed as
well as low and middle income countries remains totally inadequate and
poses great challenges.
Methods
Though not intended to be a systematic review, several aspects of primary
health care and its surgical aspects in remote and rural areas were
reviewed. Search tools included Medline, PubMed and Scopius. Health
concerns such as quality health care and limitations, as well as
infrastructures, surgical workforce as well as implications for planning,
teaching and training for surgical care in remote areas were searched.
Results
The dire shortage of surgeons and anesthesiologists in most low and middle
income countries means task shifting and training of non-physician
clinicians (NPCs) is the only option particularly in most developing poor
countries.
Conclusion
The best means of bringing surgical care to rural dwellers is yet to be
clearly determined. However, modern surgical techniques integrated with the
strategy as outlined by the World Health Organization can be brought to
rural areas through specially organized camps. Sophisticated surgery can
thus be performed in a high-volume and cost-effective manner, even in
temporary settings. However, provision of essential surgery to rural and
remote areas can only partly be met both in developed and in low and middle
income countries and it will take years to solve the problem of unmet
surgical needs in these areas.
Keywords: Essential surgery; Rural area; Primary health care
Catherine StevensSimon, Donna Nelligan, Lisa Kelly, Adolescents at risk

for mistreating their children: Part II: a home- and clinic-based
prevention program, Child Abuse & Neglect, Volume 25, Issue 6, June
2001, Pages 753-769, ISSN 0145-2134, 10.1016/S0145-2134(01)00237-X.
Abstract: Objective: To determine if adding an intensive home visitation
component to a comprehensive adolescent-oriented maternity program prevents
child abuse and neglect.
Methods: We studied 171 participants in a comprehensive, adolescent-

oriented maternity program who were deemed to be at high risk for child
abuse and neglect. Half were randomly assigned to receive in-home parenting
instruction. Major disruptions of primary care-giving by the adolescent
mother were classified hierarchically as abuse, neglect, and abandonment.
Results: Compliance with home visits varied in relation to the support the
teenage mothers received from their families and the fathers of their
babies (p < .0001). There were no significant treatment group
differences in the pattern of health care utilization, the rate of
postpartum school return, repeat pregnancies, or child abuse and neglect.
The incidence of maltreatment rose in tandem with the predicted risk status
of the mother. Ultimately, 19% of the children were removed from their
mothers custody.
Conclusions: Prediction efforts were effective in identifying at-risk

infants, but this intensive home-and clinic-based intervention did not
alter the incidence of child maltreatment or maternal life course
development. A parenting program that was more inclusive of the support
network might be more popular with teenagers and therefore more effective.
Our findings also emphasize the importance of including counseling
specifically designed to prevent teenagers from abandoning their children.
Keywords: Child abuse; Adolescent pregnancy; Adolescent parenting
Katherine B. Saxton, Neha John-Henderson, Matthew W. Reid, Darlene D.

Francis, The social environment and IL-6 in rats and humans, Brain,
Behavior, and Immunity, Volume 25, Issue 8, November 2011, Pages 1617-1625,
ISSN 0889-1591, 10.1016/j.bbi.2011.05.010.
Abstract: Inflammatory cytokine levels predict a wide range of human
diseases including depression, cardiovascular disease, type 2 diabetes,
autoimmune disease, general morbidity, and mortality. Stress and social
experiences throughout the lifecourse have been associated with
inflammatory processes. We conducted studies in humans and laboratory rats
to examine the effect of early life experience and adult social position in
predicting IL-6 levels. Human participants reported family homeownership
during their childhood and current subjective social status. Interleukin-6
(IL-6) was measured from oral mucosal transudate. Rats were housed in
groups of three, matched for quality of maternal care received. Social
status was assessed via competition for resources, and plasma IL-6 was
assessed in adulthood. In both humans and rats, we identified an
interaction effect; early social experience moderated the effect of adult
social status on IL-6 levels. Rats that experienced low levels of maternal
care and people with low childhood socioeconomic status represented both
the highest and lowest levels of IL-6 in adulthood, depending on their
social status as young adults. The predicted interaction held for non-
Hispanic people, but did not occur among Hispanic individuals. Adversity
early in life may not have a monotonically negative effect on adult health,
but may alter biological sensitivity to later social experiences.
Keywords: Stress; Adversity; Socioeconomic status; Rat; Cytokine;
Lifecourse
Ruth A. Lawrence, Robert M. Lawrence, Chapter 8 - Practical Management of

the Mother-Infant Nursing Couple, Breastfeeding (Seventh Edition), W.B.
Saunders, Philadelphia, 2011, Pages 232-282, ISBN 9781437707885,
10.1016/B978-1-4377-0788-5.10008-2.
Sandi Dietrich, Ten steps in establishing a nurse-midwifery service/private

practice for the nurse-widwife who's looking for a job in the system,
Journal of Nurse-Midwifery, Volume 24, Issue 2, MarchApril 1979, Pages 9-
18, ISSN 0091-2182, 10.1016/0091-2182(79)90053-3.
Abstract: Most nurse-midwives find that getting an education is the most
important part of becoming a nurse-midwife. In actuality this represents
only about fifty percent of the effort required. the remaining fifty
percent involving the problems of seeking and securing employment that is
other than temporary in nature. The following is a look at the source of
the many common problems in establishing a nurse-midwifery service and a
discussion of some recommended solutions.
David J. Birnbach, Eduardo Salas, Can Medical Simulation and Team Training
Reduce Errors in Labor and Delivery?, Anesthesiology Clinics, Volume 26,
10.1016/j.anclin.2007.11.001.
Abstract: Patient safety is one of the most pressing challenges in health
care today, and there is no question that medical errors occur and that
patients are worried about them. Currently, there is a belief that the
availability of medical simulations and the knowledge gained from the
science of team training may improve patient outcomes, and there is a
paradigm shift occurring in many universities and training programs. This
article discusses two strategies that, when combined, may reduce medical
error in the labor and delivery suite: team training and medical
simulation.
Dawn Edge, Falling through the net Black and minority ethnic women and
perinatal mental healthcare: health professionals' views, General Hospital
Psychiatry, Volume 32, Issue 1, JanuaryFebruary 2010, Pages 17-25, ISSN
0163-8343, 10.1016/j.genhosppsych.2009.07.007.
The objective of this study was to investigate health professionals' views
about perinatal mental healthcare for Black and minority ethnic women.
Methods
Qualitative data were collected from a range of healthcare professionals
(n=42) via individual interviews and focus groups. Participants were
recruited from antenatal community clinics, a large teaching hospital,
general practice and a specialist voluntary sector agency in the north of
England, UK.
Results
Participants reported inadequacies in training and lack of confidence both
for identifying the specific needs of Black women and for managing
perinatal depression more generally, particularly in women with
mild/moderate and subthreshold depression. Inadequate perinatal
depression management was associated with failure to screen routinely,
confusion about professional roles and boundaries, and poorly defined care
pathways, which increased women's likelihood of falling through the net,
thus failing to receive appropriate care and treatment.
Conclusions
Suboptimal detection and treatment of perinatal depression among high-
risk women highlight gaps between UK policy and practice. This applies to
women from all ethnic groups. However, evidence suggests that Black women
might be particularly vulnerable to deficiencies in provision. Effective
management of perinatal depression requires a more robust implementation of
existing guidelines, more effective strategies to address the full spectrum
of need, improved professional training and a more coordinated multiagency
approach.
Keywords: Perinatal depression; Ethnicity; Healthcare; Minority women
M. Rosato, F. Malamba, B. Kunyenge, T. Phiri, C. Mwansambo, P. Kazembe, A.

Costello, S. Lewycka, Strategies developed and implemented by women's
groups to improve mother and infant health and reduce mortality in rural
Malawi, International Health, Available online 2 June 2012, ISSN 1876-3413,
10.1016/j.inhe.2012.03.007.
Abstract: We evaluated the strategies to tackle maternal and infant health
problems developed by women's groups in rural Malawi.
Quantitative data were analyzed on strategies developed by 184 groups at

two of the meetings in the community action cycle (attended by 3365 and
3047 women). Data on strategies implemented was collected through a survey
of the 197 groups active in January 2010. Qualitative data on the
identification and implementation of strategies was collected through 17
focus group discussions and 12 interviews with men and women.
To address the maternal and child health problems identified the five most
common strategies identified were: health education sessions, bicycle
ambulances, training of traditional birth attendants, wetland vegetable
garden (dimba garden) cultivation and distribution of insecticide treated
bednets (ITNs). The five most common strategies actually implemented were:
dimba garden cultivation, health education sessions, ITN distribution,
health programme radio listening clubs and clearing house surroundings. The
rationale behind the strategies and the factors facilitating and hindering
implementation are presented.
The potential impact of the strategies on health is discussed. Women's

groups help communities to take control of their health issues and have the
potential to reduce neonatal, infant and maternal mortality and morbidity
in the longer term.
Keywords: Community mobilization; Women's groups; Maternal mortality; Child
mortality; Community empowerment; Malawi
Erin J. Maher, Lyscha A. Marcynyszyn, Tyler W. Corwin, Rhenda Hodnett,

Dosage matters: The relationship between participation in the Nurturing
Parenting Program for infants, toddlers, and preschoolers and subsequent
child maltreatment, Children and Youth Services Review, Volume 33, Issue 8,
10.1016/j.childyouth.2011.04.014.
Abstract: This article uses statewide data on caregivers of young children
referred to the Nurturing Parenting Program (NPP) for allegations of abuse
and neglect to examine the relationship between program dosage and
subsequent maltreatment. At six months after participating in the program,
caregivers who attended more sessions were significantly less likely to be
reported for child maltreatment, holding other factors constant. At two
years after participating, caregivers attending more sessions were
significantly less likely to have a substantiated maltreatment incidence,
controlling for other characteristics of families associated with
maltreatment. These findings demonstrate the program is associated with
preventing short-term allegations and longer-term substantiated incidences
of maltreatment for a child welfare population. By demonstrating the
importance of participation in the NPP, we increase the evidence about
effective parent education programs for this population.
Keywords: Parent education; Maltreatment; Child welfare; Program evaluation
Carole A. Warnes, Roberta G. Williams, Thomas M. Bashore, John S. Child,
Heidi M. Connolly, Joseph A. Dearani, Pedro del Nido, James W. Fasules,
Thomas P. Graham Jr, Ziyad M. Hijazi, Sharon A. Hunt, Mary Etta King,
Michael J. Landzberg, Pamela D. Miner, Martha J. Radford, Edward P. Walsh,
Gary D. Webb, ACC/AHA 2008 Guidelines for the Management of Adults With
Congenital Heart Disease: Executive Summary: A Report of the American
College of Cardiology/American Heart Association Task Force on Practice
Guidelines (Writing Committee to Develop Guidelines for the Management of
Adults With Congenital Heart Disease) Developed in Collaboration With the
American Society of Echocardiography, Heart Rhythm Society, International
Society for Adult Congenital Heart Disease, Society for Cardiovascular
Angiography and Interventions, and Society of Thoracic Surgeons, Journal of
the American College of Cardiology, Volume 52, Issue 23, 2 December 2008,
Pages 1890-1947, ISSN 0735-1097, 10.1016/j.jacc.2008.10.002.
Keywords: ACC/AHA Practice Guidelines; congenital heart disease; cardiac
defects; congenital heart surgery; unoperated/repaired heart defects;
medical therapy; cardiac catheterization
Bimal Kanti Paul, Deborah J Rumsey, Utilization of health facilities and

trained birth attendants for childbirth in rural Bangladesh: an empirical
study, Social Science & Medicine, Volume 54, Issue 12, June 2002, Pages
1755-1765, ISSN 0277-9536, 10.1016/S0277-9536(01)00148-4.
Abstract: The majority of births in rural Bangladesh are carried out in
unhygienic conditions by relatives and traditional birth attendants (TBAs).
This results in a high incidence of maternal and infant mortality that
could be reduced if childbirth were to occur in health centers or under the
supervision of trained TBAs (TTBAs). In this paper, we examined factors
associated with utilization of modern health resources for childbirth in 39
villages of Bangladesh. We followed a retrospective survey research design
to collect relevant information from couples who experienced childbirth
during a two-year period from July 1, 1995 to June 1997. The data indicate
that slightly over 11% of the deliveries were performed by trained
personnel with the rest attended by TBAs. Multivariate analysis clearly
shows that delivery complications was the most significant factor
determining the use of modern health care resources for childbirth,
followed by parental education, and pre-natal care. We conclude that quick
response to delivery complications and improved access to hospitals and
TTBAs can reduce the risk of infant and maternal mortality and morbidity in
rural Bangladesh.
Keywords: Childbirth; Traditional birth attendants; Trained traditional
birth attendants; Rural Bangladesh
Shad Deering, Lindsay C. Johnston, Kathryn Colacchio, Multidisciplinary

Teamwork and Communication Training, Seminars in Perinatology, Volume 35,
Issue 2, April 2011, Pages 89-96, ISSN 0146-0005,
10.1053/j.semperi.2011.01.009.
Abstract: Every delivery is a multidisciplinary event, involving nursing,
obstetricians, anesthesiologists, and pediatricians. Patients are often in
labor across multiple provider shifts, necessitating numerous handoffs
between teams. Each handoff provides an opportunity for errors. Although a
traditional approach to improving patient outcomes has been to address
individual knowledge and skills, it is now recognized that a significant
number of complications result from team, rather than individual, failures.
In 2004, a Sentinel Alert issued by the Joint Commission revealed that most
cases of perinatal death and injury are caused by problems with an
organization's culture and communication failures. It was recommended that
hospitals implement teamwork training programs in an effort to improve
outcomes. Instituting a multidisciplinary teamwork training program that
uses simulation offers a risk-free environment to practice skills,
including communication, role clarification, and mutual support. This
experience should improve patient safety and outcomes, as well as enhance
employee morale.
Keywords: teamwork; patient safety; labor and delivery; communication;
simulation
Susan McClennan Reece, Stress and maternal adaptation in first-time mothers

more than 35 years old, Applied Nursing Research, Volume 8, Issue 2, May
1995, Pages 61-66, ISSN 0897-1897, 10.1016/S0897-1897(95)80490-0.
Abstract: This prospective longitudinal study assessed relationships among
variables of the early transition to parenthood and maternal stress and
adaptation 1 year after delivery in primiparas older than 35 years. Life
change scores at 1 month were associated with greater stress at 1 year.
Positive self-evaluations of parenting early in the transition to
parenthood were associated with greater confidence and support in mothering
at 1 year. Compared with normative data, stress scores of study
participants were found to be high. The importance of addressing early
perceptions of parenting with older first-time mothers was supported.
Farida M. Jeejeebhoy, Carolyn M. Zelop, Rory Windrim, Jose C.A. Carvalho,

Paul Dorian, Laurie J. Morrison, Management of cardiac arrest in pregnancy:
A systematic review, Resuscitation, Volume 82, Issue 7, July 2011, Pages
801-809, ISSN 0300-9572, 10.1016/j.resuscitation.2011.01.028.
Abstract: Objective
To describe the consensus on science pertaining to resuscitation of the
pregnant patient.
Design
Systematic review.
Data sources
EMBASE, Ovid MEDLINE, Evidence Based Reviews, American Heart Association
library and bibliographies of selected articles.
Review methods
The following inclusion criteria were used: pregnancy and cardiac arrest
out of hospital, pregnancy and cardiac arrest in hospital, cardiovascular,
respiratory, fetal survival, and pharmacology as they relate to cardiac
arrest and resuscitation. Non-English papers, case reports and reviews were
excluded. Studies were selected through an independent review of titles,
abstracts and full article. Two reviewers independently graded the
methodological quality of selected articles.
Results
1305 articles were identified and 5 were selected for further review. There
were no randomized trials and overall the quality of the selected studies
was good. Two studies examined chest compressions on a manikin in left
lateral tilt from the horizontal and concluded that although feasible with
increasing degrees of tilt forcefulness of the chest compressions
decreases. The third study observed the transthoracic impedance was not
altered during pregnancy. One case series and one retrospective cohort
study reviewed perimortem cesarean section. Both reports concluded that
perimortem cesarean section is rarely done within the recommended time
frame of 5 min after the onset of maternal cardiac arrest.
Conclusions
Usual defibrillation dosages are likely appropriate in pregnancy.
Perimortem cesarean section is an intervention which is rarely done within
5 min to optimize maternal salvage from cardiac arrest. Chest
compressions in left lateral tilt are less forceful compared to the supine
position.
Keywords: Cardiac arrest; Maternal resuscitation; Systematic review
Shannon K. de lEtoile, Responses to Infant-Directed Singing in Infants of
Mothers with Depressive Symptoms, The Arts in Psychotherapy, Available
online 19 May 2012, ISSN 0197-4556, 10.1016/j.aip.2012.05.003.
(http://www.sciencedirect.com/science/article/pii/S0197455612000937?v=s5)
Abstract: This study explored responses to infant-directed (ID) singing in
infants of mothers with and without depressive symptoms under two
conditions: mother sings to infant, and stranger sings to infant. Sixteen,
3 to 9-month-old infants of mothers with depression were matched by age and
gender to sixteen infants of mothers without depression. Infant gaze
responses toward each singer were coded from video and ranged from most
negative to most positive, in the order of roaming, averted, neutral,
intermittent and sustained. Mothers depression status had no effect on
infant gaze response toward ID singing from mother or stranger. During ID
singing from mother, infants displayed high levels of either neutral or
sustained gaze. In response to ID singing from stranger, infants
demonstrated sustained gaze more than any other gaze type. Infants also
showed significantly more roaming and neutral gaze toward mother than
stranger, and used significantly more averted and sustained gaze with
stranger than mother. Findings indicate that infants of depressed mothers
did not display a depressed interaction style with their mother or with a
stranger during ID singing. Additionally, infants in both groups appeared
capable of discriminating their mother from a stranger. ID singing appears
to enhance face-to-face interaction such that infants can experience self-
regulation, even when mothers have depression. Findings support the idea of
combining ID singing and interaction coaching as a therapeutic intervention
for mothers with depression and their infants.
Keywords: Infant-directed singing; Maternal depression; infant gaze; Infant
self-regulation
Matthews Mathai, Working with communities, governments and academic

institutions to make pregnancy safer, Best Practice & Research Clinical
Obstetrics & Gynaecology, Volume 22, Issue 3, June 2008, Pages 465-476,
ISSN 1521-6934, 10.1016/j.bpobgyn.2008.02.002.
Abstract: The major medical causes of maternal death and the effective
interventions to prevent maternal death due to these causes are known. Yet,
every year, an estimated 529,000 women die during and following pregnancy
and childbirth. Most of these deaths occur in developing countries where
other non-medical determinants of maternal health influence the
accessibility to these interventions. Improvements in maternal health can
be achieved through a health systems approach. Care should be provided as a
continuum throughout the life cycle and across health facilities through
the health system. Communities, professional organizations and academic
institutions should work actively with the government to: provide a package
of service, based on population health needs, that is close to home; ensure
availability of essential medicines and commodities; address financial
barriers to receiving care; strengthen the health workforce; and gather and
use information to improve maternal health.
Keywords: academic institutions; community; continuum of care; government;
health systems; making pregnancy safer; maternal mortality
Nancy Donelan-McCall, John Eckenrode, David L. Olds, Home Visiting for the
Prevention of Child Maltreatment: Lessons Learned During the Past 20 Years,
Pediatric Clinics of North America, Volume 56, Issue 2, April 2009, Pages
389-403, ISSN 0031-3955, 10.1016/j.pcl.2009.01.002.
Abstract: For nearly two decades, home visitation has been promoted as a
promising strategy to prevent child maltreatment, but reviews of the
literature on home visiting programs have been mixed. This article examines
how home visitation for the prevention of child maltreatment has evolved
during the past 20 years. It reviews several home visitation programs
focused on preventing child maltreatment and highlights the Nurse-Family
Partnership home visitation program. It discusses how advocacy and public
policy for prevention of child maltreatment have shifted from a general
call to promote universal home visitation programs to a more refined
emphasis on promoting programs that are evidence-based, targeted to those
most at risk for maltreatment, and with infrastructure in place to ensure
implementation with fidelity to the model tested in trials. Finally, it
discusses how primary care providers may advocate to ensure that their
patients have access to evidence-based home visiting programs that meet
their needs.
Keywords: Home visiting; Child maltreatment; Prevention; Nurses; Policy;
Early childhood
Sachie Oshima, Kristi L. Kirschner, Allen Heinemann, Patrick Semik,

Assessing the knowledge of future internists and gynecologists in caring
for a woman with tetraplegia, Archives of Physical Medicine and
Rehabilitation, Volume 79, Issue 10, October 1998, Pages 1270-1276, ISSN
0003-9993, 10.1016/S0003-9993(98)90274-X.
Abstract: Objective: To assess the knowledge base and comfort level of
potential physician gatekeepers when treating women with spinal cord
injuries. Residents with at least 1 year of training in either internal
medicine (IM) or obstetrics and gynecology (Ob/Gyn) from a large academic
urban medical center were surveyed.
Study Design: This study used a written questionnaire that included a case
scenario of a young woman with C6 tetraplegia who presented to her primary
care physician for a routine visit. Information about the patient from her
history and physical and laboratory exams was presented in stages, followed
by open-ended queries to elicit information about the residents' problem-
solving processes and management strategies.
Results: Thirty-eight percent (30 of 79) of the IM residents and 64% (14 of
22) of the Ob/Gyn residents completed the questionnaire. Significant
deficits in knowledge about physical accessibility, spasticity management,
and potential disability-related medical complications in pregnancy were
found. More Ob/Gyn residents were aware of the risk of autonomic
hyperreflexia than IM residents, whereas the IM residents demonstrated
greater awareness of neurogenic bladder and skin problems. Both groups
indicated they were not very comfortable in managing the patient's care.
Conclusions: The results raise concern about the adequacy of the training
of primary care physicians to meet the needs of people with severe
disabilities.
Chaturaka Rodrigo, Senaka Rajapakse, HIV, poverty and women, International

Health, Volume 2, Issue 1, March 2010, Pages 9-16, ISSN 1876-3413,
10.1016/j.inhe.2009.12.003.
Abstract: Summary
This review examines the interactions of financial status and HIV and its
implications for women. MEDLINE and Google scholar were searched using the
keywords women, poverty and HIV in any field of the article. The
search was limited to articles published in English over the last 10 years.
The first section of the article tries to establish whether poverty or
wealth is a risk factor for HIV. There is credible evidence for both
arguments. While wealth shows an increased risk for both sexes, poverty
places women at a special disadvantage. The second section explains how the
financial status interacts with other non biological factors to put women
at increased risk. While discrimination based on these factors disadvantage
women, there are some paradoxical observations that do not fit with the
traditional line of explanation (e.g. paradoxical impact of wealth and
education on HIV). The final section assesses the impact of HIV in driving
poverty and the role of women in interventional programmes. The specific
impact of poverty on females in families living with HIV is less explored.
Though microfinance initiatives to empower women are a good idea in theory,
the actual outcome of such a programme is less convincing.
Keywords: HIV; Poverty; Violence; Women; Gender norms; HAART
Shinya Ito, Amy Lee, Drug excretion into breast milkOverview, Advanced
Drug Delivery Reviews, Volume 55, Issue 5, 29 April 2003, Pages 617-627,
ISSN 0169-409X, 10.1016/S0169-409X(03)00034-6.
Abstract: Breastfeeding is the optimal form of infant feeding for the first
months of an infants life, and the majority of healthy women initiate
breastfeeding after the birth of their infant. However, women on medication
may default to formula feeding or not taking their drug therapy for fear of
exposing their infant to the medication through the breast milk. Although
the majority of medications are considered to be compatible with
breastfeeding, cases of significant infant toxicity exist, suggesting a
case by case risk assessment to be made before the mother initiates
breastfeeding or drug therapy. Unfortunately, current clinical risk
assessment is often compromised by the paucity of data, as studies in
breastfeeding women and their infants are ethically difficult to conduct.
Circumventing the ethical constraints, approaches have been proposed to
estimate drug excretion into milk from physicochemical characteristics of
the drug, which diffuses through the mammary gland epithelia. However, as
our understanding on drug transfer mechanisms increases, it has become
abundantly clear that carrier-mediated processes are involved with
excretion of a number of drugs into milk. This article provides an overview
of the benefits of breastfeeding, the effect of medication use during
breastfeeding on maternal decisions and infant health, and factors
determining infant exposure to medication through the breast milk.
Keywords: Adherence; Breastfeeding; Drug effect; Drug therapy; Drug
transfer; Human milk; Milk production; Neonate
Judith E Herwig, Markus Wirtz, Jrgen Bengel, Depression, partnership,

social support, and parenting: interaction of maternal factors with
behavioral problems of the child, Journal of Affective Disorders, Volume
80, Issues 23, June 2004, Pages 199-208, ISSN 0165-0327, 10.1016/S0165-
0327(03)00112-5.
Abstract: Background: Children of depressed mothers are at elevated risk to
develop behavioral problems. Besides maternal depression, other risk
factors like interpersonal functioning, are discussed. The object of this
study was to investigate the predictive value of the maternal variables
depression, partnership, social support, and parenting for internal and
external behavioral problems of the children. Methods: A total of 100
mothers and their children who participated in a German motherchild
rehabilitation program were interviewed by questionnaire. Structural
equation modeling was conducted in order to determine the predictive value
of the mentioned maternal variables on behavioral problems of the children.
Results: Behavioral problems of the children can be predicted by the
parenting and the partnership of the mothers. Mothers with more parenting
difficulties and with less containment with partnership report more
behavioral problems of their children. Depression and social support do
indirectly predict the childs problems. Limitations: The data is from a
cross-sectional sample. Therefore, path models do not demonstrate
causation. All information is based upon maternal report. Conclusions:
These findings suggest the need for intervention programs which focus on
the parenting and the partnership of the mothers. More research with
independent assessment is needed.
Keywords: Mother; Children; Rehabilitation; Depression; Parenting
Ruth A. Lawrence, Robert M. Lawrence, Chapter 23 - Educating and training

the medical professional, Breastfeeding (Sixth Edition), Mosby,
Philadelphia, 2005, Pages 809-823, ISBN 9780323028233, 10.1016/B978-0-323-
02823-3.50028-0.
B.E. Kwast, Building a community-based maternity program, International

Journal of Gynecology & Obstetrics, Volume 48, Supplement, June 1995,
Pages S67-S82, ISSN 0020-7292, 10.1016/0020-7292(95)02321-3.
Abstract: The MotherCare Project has as its goal the reduction of maternal
and neonatal mortality and related morbidities, and the promotion of the
health of women and newborns. To achieve these goals, maternal and family
planning programs were strengthened in both rural and urban settings
through three intervention strategies policy reform, affecting behaviors
and improving services. The fundamental premise in each project was to
strengthen the weakest part of the maternity care pyramid, ensuring
linkages among all levels of service from community through to the
referral hospital level. In rural Andean populations of Bolivia, knowledge
of danger signs and women's response to them improved, increasing in use of
prenatal and family planning services through a participatory problem-
solving and community-based strategy. In West Java, Indonesia, bringing
professional midwifery services and facilities closer to women together has
resulted in a positive response to their use. Augmenting this intervention
with a transport and intercommunication system together with improved
hospital practice through perinatal mortality meetings and in-service
training for doctors and midwives has reduced the maternal and perinatal
mortality over a four year period. Hospital practice has improved in Uganda
and in two states of Nigeria, maternal mortality and morbidity have been
reduced in the training facility where seminars for physicians, training of
midwives in life saving midwifery and interpersonal communication skills
have taken place, and equipment and supplies have been improved.
Furthermore, in rural Guatemala, implementation of norms and protocols,
expert supervision and sensitization of hospital staff to the needs of the
community has increased referral by traditional birth attendants (TBAs) to
the hospital and reduced perinatal mortality.
Keywords: Maternal and perinatal mortality; Risk scoring; Maternity
services; Midwifery training; Referral
Maria Marino, Roberta Masella, Pamela Bulzomi, Ilaria Campesi, Walter

Malorni, Flavia Franconi, Nutrition and human health from a sexgender
perspective, Molecular Aspects of Medicine, Volume 32, Issue 1, February
2011, Pages 1-70, ISSN 0098-2997, 10.1016/j.mam.2011.02.001.
Abstract: Nutrition exerts a life-long impact on human health, and the
interaction between nutrition and health has been known for centuries. The
recent literature has suggested that nutrition could differently influence
the health of male and female individuals. Until the last decade of the
20th century, research on women has been neglected, and the results
obtained in men have been directly translated to women in both the medicine
and nutrition fields. Consequently, most modern guidelines are based on
studies predominantly conducted on men. However, there are many sexgender
differences that are the result of multifactorial inputs, including gene
repertoires, sex steroid hormones, and environmental factors (e.g., food
components). The effects of these different inputs in male and female
physiology will be different in different periods of ontogenetic
development as well as during pregnancy and the ovarian cycle in females,
which are also age dependent. As a result, different strategies have
evolved to maintain male and female body homeostasis, which, in turn,
implies that there are important differences in the bioavailability,
metabolism, distribution, and elimination of foods and beverages in males
and females. This article will review some of these differences underlying
the impact of food components on the risk of developing diseases from a
sexgender perspective.
Keywords: Nutrition; Health; Sex; Gender; Food; Beverage
Abdul Wahed Al Serouri, Arwa Al Rabee, Mohammed Bin Afif, Abdullah Al

Rukeimi, Reducing maternal mortality in Yemen: Challenges and lessons
learned from baseline assessment, International Journal of Gynecology &
Obstetrics, Volume 105, Issue 1, April 2009, Pages 86-91, ISSN 0020-7292,
10.1016/j.ijgo.2008.12.020.
Abstract: Objective
The Yemen is a signatory of the Millennium Development Goals (MDGs) and one
of 10 countries chosen for the UN Millennium Project. However, recent MDG
progress reviews show that it is unlikely that the maternal health goal
will be reached by 2015 and Yemen still has an unacceptably high maternal
mortality of 365 per 100 000 live births. Because 82% of deaths happen
intrapartum, the purpose of this needs assessment was to identify and
prioritize constraints in delivery of emergency obstetric care (EmOC).
Methods
Four district hospitals and 16 health centers in 8 districts were assessed
for functional capacity in terms of infrastructure; availability of
essential equipment and drugs; EmOC technical competency and training
needs; and Health Management Information System.
Results
We found poor obstetric services in terms of structure (staffing pattern,
equipment, and supplies) and process (knowledge and management skills).
Conclusion
The data argue for strengthening the 4 interlinked health system elements
human resources, and access to, use, and quality of services. The
Government must address each of these elements to meet the Safe Motherhood
MDG.
Keywords: Emergency obstetric care; Baseline assessment; Maternal
mortality; Millennium Development Goals; World Bank; Yemen
Janine Schooley, Christine Mundt, Pascale Wagner, Judith Fullerton, Mark

ODonnell, Factors influencing health care-seeking behaviours among Mayan
women in Guatemala, Midwifery, Volume 25, Issue 4, August 2009, Pages 411-
421, ISSN 0266-6138, 10.1016/j.midw.2007.07.011.
Abstract: Objective
to identify and better understand factors that influence care-seeking
behaviour for women's health among indigenous Mayan populations in the
highlands of Guatemala.
Design
adaptation of qualitative anthropological methods involving observations,
key informant interviews and focus group discussions (FGDs).
Setting
Project Concern International's Casa Materna, Huehuetenango, Guatemala.
Participants
Interviews and FGDs were conducted among 21 clients (current or past) of
the Casa Materna and traditional birth attendants; 17 female
advocates/promoters of the Casa Materna and related services; and 12 male
advocates, including spouses, non-government organisation staff and
community health workers.
Findings
the following findings emerged from focus group data:
Women's support groups (WSGs) provided an enabling environment in which
women could form friendships, bond, discuss concerns about their
reproductive health, and identify concrete ways of addressing them;
Supportive friends, family members and advocates influenced women's
decisions to seek health care at the Casa Materna; Women's decisions to
seek care were often associated with their sense of self-worth and self-
esteem, and women's self-esteem was enhanced by their participation in the
WSGs; Women's decisions to seek care were influenced by the perception that
women would be able to access culturally appropriate, safe and secure
health care services at the Casa Materna; The learned behaviour of
negotiation with key decision-makers and/or opinion leaders was an
effective tool for convincing such individuals of the value of accessing
facility-based care; The proven track record, high quality of services and
cultural competence offered at the Casa Materna increased the confidence
and level of trust of clients and their family members about the care that
would be received; Couple-based education and health promotion were
effective techniques for achieving behaviour and attitude change among both
men and women.
Key conclusions
the Casa Materna and its community outreach strategy serve an essential
purpose in the provision of maternity care for the isolated and vulnerable
families of the Guatemalan highlands, by bridging traditional and Western
approaches to health care services. The Casa Materna service model plays a
critical role in improving women's self-efficacy and ultimately
strengthening the social fabric that characterises this high risk and
vulnerable population.
the Casa Materna model provides a foundation upon which to bridge and
strengthen the relationship between community advocates, traditional
community-based health care providers, and the government-funded system of
health care. The findings of this study should be incorporated into future
research to determine the potential for bringing the model to scale.
Keywords: Maternal mortality; Birth centers; Maternity waiting home;
Perinatal care
Christine Wekerle, David A. Wolfe, Prevention of child physical abuse and

neglect: Promising new directions, Clinical Psychology Review, Volume 13,
Issue 6, 1993, Pages 501-540, ISSN 0272-7358, 10.1016/0272-7358(93)90044-M.
(http://www.sciencedirect.com/science/article/pii/027273589390044M)
Abstract: Intervention studies targeting risk factors to child physical
abuse and neglect are reviewed. Programs that addressed parental competency
enhancement with a wide range of at-risk individuals, including new parents
and teen parents, formed the principal data base. Outcome evaluation
studies using an appropriate research methodology were identified from 1977
to 1990 (N = 34). Maternal global adjustment and child-rearing skills were
principal intervention targets, and significant gains were shown in these
areas across studies. The promotion of child cognitive development and
child behavioral competencies was a secondary target of intervention in
many studies. More modest gains in these child areas were found, especially
for behavioral competeneies. Programs that provided an individualized
approach were most successful, especially with parents considered to be at
greater risk of maltreatment. Base don these findings, specific strategies
to address identified needs of the parent, child, and family situation hold
the most promise for prevention, as opposed to nonspecific support and
assistance; however, evidence of long-term benefits is limited, and
indicators of actual maltreatment (e.g., child abuse reports) are rare and
unreliable. Theoretical constructs for consideration in the development and
evaluation of prevention strategies are discussed, as well as
methodological and applied issues.
Ian Norman, Two years into the job: An overview of published papers and
future directions, International Journal of Nursing Studies, Volume 44,
Issue 1, January 2007, Pages 1-8, ISSN 0020-7489,
10.1016/j.ijnurstu.2006.11.002.
Keywords: Review; Publication synthesis
Philip Blumenshine, Susan Egerter, Colleen J. Barclay, Catherine Cubbin,

Paula A. Braveman, Socioeconomic Disparities in Adverse Birth Outcomes: A
Systematic Review, American Journal of Preventive Medicine, Volume 39,
Issue 3, September 2010, Pages 263-272, ISSN 0749-3797,
10.1016/j.amepre.2010.05.012.
Abstract: Context
Adverse birth outcomes, such as preterm birth and low birth weight, have
serious health consequences across the life course. Socioeconomic
disparities in birth outcomes have not been the subject of a recent
systematic review. The aim of this study was to systematically review the
literature on the association of socioeconomic disadvantage with adverse
birth outcomes, with specific attention to the strength and consistency of
effects across socioeconomic measures, birth outcomes, and populations.
Evidence acquisition
Relevant articles published from 1999 to 2007 were obtained through
electronic database searches and manual searches of reference lists.
English-language studies from industrialized countries were included if (1)
study objectives included examination of a socioeconomic disparity in a
birth outcome and (2) results were presented on the association between a
socioeconomic predictor and a birth outcome related to birth weight,
gestational age, or intrauterine growth. Two reviewers extracted data and
independently rated study quality; data were analyzed in 20082009.
Evidence synthesis
Ninety-three of 106 studies reported a significant association, overall or
within a population subgroup, between a socioeconomic measure and a birth
outcome. Socioeconomic disadvantage was consistently associated with
increased risk across socioeconomic measures, birth outcomes, and
countries; many studies observed racial/ethnic differences in the effect of
socioeconomic measures.
Conclusions
Socioeconomic differences in birth outcomes remain pervasive, with
substantial variation by racial or ethnic subgroup, and are associated with
disadvantage measured at multiple levels (individual/family, neighborhood)
and time points (childhood, adulthood), and with adverse health behaviors
that are themselves socially patterned. Future reviews should focus on
identifying interventions to successfully reduce socioeconomic disparities
in birth outcomes.
P. Bailey, A. Paxton, S. Lobis, D. Fry, Measuring progress towards the MDG

for maternal health: Including a measure of the health system's capacity to
treat obstetric complications, International Journal of Gynecology &
Obstetrics, Volume 93, Issue 3, June 2006, Pages 292-299, ISSN 0020-7292,
10.1016/j.ijgo.2006.01.029.
Abstract: Objective
This paper argues for an additional indicator for measuring progress of the
Millennium Development Goal for maternal healththe availability of
emergency obstetric care.
Methods
MDG monitoring will be based on two indicators: the maternal mortality
ratio and the proportion of births attended by skilled personnel. Strengths
and weaknesses of a third indicator are discussed
Results
The availability of EmOC measures the capacity of the health system to
respond to direct obstetric complications. Benefits to using this
additional indicator are its usefulness in determining an adequate
distribution of services and showing management at all levels what life-
saving interventions are not being provided, and stimulate thought as to
why. It can reflect programmatic changes over a relatively short period of
time and data requirements are not onerous.
Conclusion
A measure of strength of the health system is important since many
interventions depend on the health system for their implementation.
Keywords: Indicator; MDG; Maternal mortality
Julia A. Snethen, Marion E. Broome, Susan E. Cashin, Effective Weight Loss

for Overweight Children: A Meta-Analysis of Intervention Studies, Journal
of Pediatric Nursing, Volume 21, Issue 1, February 2006, Pages 45-56, ISSN
0882-5963, 10.1016/j.pedn.2005.06.006.
Abstract: Childhood overweight has increased in the United States. Success
of weight-loss programs has been limited (Barlow, S.E., & Dietz, W.H.
(1998). Obesity evaluation and treatment: Expert committee recomendations.
Pediatrics, 102, e29.). The purpose of this investigation was to
systematically examine the effectiveness of weight-loss interventions for
children. For this meta-analysis, seven weight-loss intervention studies
were coded and quality index scores calculated. The interventions had a
significant positive effect on weight-loss average d = 0.95, with a 95%
confidence interval of 0.79 to 1.11. Limited interventional studies with
effective long-term maintenance of weight loss in children are available in
the literature. However, there are effective methods for weight loss in
children.
Siv Mrkved, Chapter 10 - Evidence for pelvic floor physical therapy for
urinary incontinence during pregnancy and after childbirth, In: Kari B,
PT, MSc, PhD, Bary Berghmans, PT, MSc, PhD, Siv Mrkved, PT, MSc, PhD, and
Marijke Van Kampen, PT, MSc, PhD, Editor(s), Evidence-Based Physical
Therapy for the Pelvic Floor, Churchill Livingstone, Edinburgh, 2007, Pages
317-336, ISBN 9780443101465, 10.1016/B978-0-443-10146-5.50016-2.
Peter J. Blizard, Undergraduate medical education in Indonesia and its

relevance for the needs of primary health care services, Health Policy,
10.1016/0168-8510(88)90089-9.
Abstract: As a cumulative result of efforts made over the last 15 years,
Indonesian medical school teachers have developed and are implementing a
common core curriculum of undergraduate medical education in 14
government medical schools. This curric-ulum is based on explicit learning
objectives. The Indonesian Government requires that all new doctors must
work for between 3 and 5 years in a Primary Health Care (PHC) centre
immediately after graduation. Indonesian medical school teachers and
administrators have deliberately tried to shape the core curriculum to the
needs of PHC in their country. This study provides a detailed content
analysis of the core curriculum in an effort to estimate the relevance
of the core curriculum to the func-tions and tasks doctors are expected to
undertake at the PHC level of the Indone-sian health system. It is shown
that the core curriculum is largely relevant both in terms of its
framework and in its details. Some omissions from the curriculum are
noted. It is contended that the development of the core curriculum is but
the cul-mination of the many efforts at educational innovation and change
which have been attempted in Indonesia over the last 15 years; it is
contended that Indonesia's ex-perience shows that it is possible, even in a
well-established system of medical schools, for teachers to plan and
implement programmes of Community-Oriented Medical Education (COME); and,
finally, it is contended that medical teachers in other developing
countries who may wish to reorient their programmes of medical edu-cation
towards the needs of Primary Health Care would benefit from a careful ex-
amination of the approaches to this task which have been adopted by their
col-leagues in Indonesia.
Keywords: Medical education; Curriculum planning; Competency-based
curriculum; Primary health care; Indonesia
Barbara J. Rawlins, Young-Mi Kim, Aleisha M. Rozario, Eva Bazant, Tambudzai

Rashidi, Sheila N. Bandazi, Fannie Kachale, Harshad Sanghvi, Jin Won Noh,
Reproductive health services in Malawi: An evaluation of a quality
improvement intervention, Midwifery, Available online 12 November 2011,
ISSN 0266-6138, 10.1016/j.midw.2011.10.005.
Abstract: Objective
this study was to evaluate the impact of a quality improvement initiative
in Malawi on reproductive health service quality and related outcomes.
Design
(1) post-only quasi-experimental design comparing observed service quality
at intervention and comparison health facilities, and (2) a time-series
analysis of service statistics.
Setting
sixteen of Malawi's 23 district hospitals, half of which had implemented
the Performance and Quality Improvement (PQI) intervention for reproductive
health at the time of the study.
Participants
a total of 98 reproductive health-care providers (mostly nursemidwives)
and 139 patients seeking family planning (FP), antenatal care (ANC), labour
and delivery (L&D), or postnatal care (PNC) services.
Intervention
health facility teams implemented a performance and quality improvement
(PQI) intervention over a 3-year period. Following an external
observational assessment of service quality at baseline, facility teams
analysed performance gaps, designed and implemented interventions to
address weaknesses, and conducted quarterly internal assessments to assess
progress. Facilities qualified for national recognition by complying with
at least 80% of reproductive health clinical standards during an external
verification assessment.
Measurements
key measures include facility readiness to provide quality care, observed
health-care provider adherence to clinical performance standards during
service delivery, and trends in service utilisation.
Findings
intervention facilities were more likely than comparison facilities to have
the needed infrastructure, equipment, supplies, and systems in place to
offer reproductive health services. Observed quality of care was
significantly higher at intervention than comparison facilities for PNC and
FP. Compared with other providers, those at intervention facilities scored
significantly higher on client assessment and diagnosis in three service
areas, on clinical management and procedures in two service areas, and on
counselling in one service area. Service statistics suggest that the PQI
intervention increased the number of Caesarean sections, but showed no
impact on other indicators of service utilisation and skilled care.
Conclusions
the PQI intervention showed a positive impact on the quality of
reproductive health services. The effects of the intervention on service
utilisation had likely not yet been fully realized, since none of the
facilities had achieved national recognition before the evaluation. Staff
turnover needs to be reduced to maximise the effectiveness of the
intervention.
the PQI intervention evaluated here offers an effective way to improve the
quality of health services in low-resource settings and should continue to
be scaled up in Malawi.
Keywords: Performance improvement; Reproductive health; Maternal and child
health; Impact evaluation
Ruth A. Lawrence, Robert M. Lawrence, Chapter 23 - Educating and Training

the Medical Professional, Breastfeeding (Seventh Edition), W.B. Saunders,
0788-5.10023-9.
Chao-Hua Chuang, Pei-Jen Chang, Yi-Chun Chen, Wu-Shiun Hsieh, Baai-Shyun

Hurng, Shio-Jean Lin, Pau-Chung Chen, Maternal return to work and
breastfeeding: A population-based cohort study, International Journal of
Nursing Studies, Volume 47, Issue 4, April 2010, Pages 461-474, ISSN 0020-
7489, 10.1016/j.ijnurstu.2009.09.003.
In recent decades there has been a marked rise in the participation of
women with infants in the labour market, while there has been a decline in
the prevalence rate of breastfeeding.
Objective
To explore the relationship between maternal return to work and
breastfeeding.
Design
An on-going prospective longitudinal study.
Setting and participants
Multistage stratified systematic sampling was designed to recruit 24,200
pairs, postpartum women and newborns, from the Taiwan national birth
register in 2005. Participating women underwent two home interviews at 6
and 18 months after giving birth, following structured questionnaires. A
total of 21,248 and 20,172 women were interviewed, and the completed
interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively.
All study participants provided informed consent as approved by the Ethics
Review Board of the National Taiwan College of Public Health.
Results
The overall prevalence of initial breastfeeding was 83.7%. Postpartum women
returning to work less than or equal to 1 month had the lowest initiation
of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding
duration less than or equal to 1 month (34.9%) than the overall population
(26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started
breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12
months, respectively. Women with maternal leave of less than or equal to 6
months ceased breastfeeding earlier than those with maternal leave beyond 6
months and those who did not return to work up to 18 months after birth.
After adjustment for potential confounders, odds ratios of initial
breastfeeding seemed no different, except those for postpartum women who
returned to work less than or equal to 1 month and those who did not return
to work. Mothers returning to work within 1 year after giving birth were
significantly earlier in weaning than those without return to work.
Conclusion
In our study, an early maternal return to work, especial within 6 months
after giving birth, was a barrier to the initiation and continuation of
breastfeeding. Thus, a comprehensive strategy is required to encourage the
practice of breastfeeding in working women from pregnancy to the return to
work, and nurses should work to promote breastfeeding in the different
occasion.
Keywords: Return to work; Maternity leave; Breastfeeding; Population-based
cohort study
A. Paxton, P. Bailey, S. Lobis, The United Nations Process Indicators for

emergency obstetric care: Reflections based on a decade of experience,
November 2006, Pages 192-208, ISSN 0020-7292, 10.1016/j.ijgo.2006.08.009.
Abstract: Objective
The paper reviews the experience with the EmOC process indicators, and
evaluates whether the indicators serve the purposes for which they were
originally created to gather and interpret relatively accessible data to
design and implement EmOC service programs.
Method
We review experience with each of the 6 process indicators individually,
and monitoring change over time, at the level of the facility and at the
level of a region or country. We identify problems encountered in the field
with data collection and interpretation.
Result
While they have strengths and weaknesses, the process indicators in general
serve the purposes for which they were developed. The data are easily
collected, but some data problems were identified. We recommend several
relatively minor modifications to improve data collection, interpretation
and utility.
Conclusions
The EmOC process indicators have been used successfully in a wide variety
of settings. They describe vital elements of the health system and how well
that system is functioning for women at risk of dying from major obstetric
complications.
Keywords: Emergency obstetric care; Process indicators; Program monitoring;
Maternal mortality
Marcia C Inhorn, Global infertility and the globalization of new

reproductive technologies: illustrations from Egypt, Social Science &
Medicine, Volume 56, Issue 9, May 2003, Pages 1837-1851, ISSN 0277-9536,
10.1016/S0277-9536(02)00208-3.
Abstract: Infertility is a problem of global proportions, affecting on
average 812 percent of couples worldwide. In some societies, however
particularly those in the infertility belt of sub-Saharan Africaas many
as one-third of all couples are unable to conceive. Factors causing high
rates of tubal infertility in parts of the developing world include
sexually transmitted, postpartum, and postabortion infections; however,
male infertility, which is rarely acknowledged, contributes to more than
half of all cases. Unfortunately, the new reproductive technologies (NRTs)
such as in vitro fertilization (IVF), which are prohibitively expensive and
difficult to implement in many parts of the developing world, represent the
only solution to most cases of tubal and male infertility. Not
surprisingly, these technologies are rapidly globalizing to pronatalist
developing societies, where children are highly desired, parenthood is
culturally mandatory, and childlessness socially unacceptable. Using Egypt
as an illustrative case study, this paper examines five of the major forces
fueling the global demand for NRTs; these include demographic and
epidemiological factors, the fertilityinfertility dialectic, problems in
health care seeking, gendered suffering, and adoption restrictions.
Following this overview, a detailed examination of the implications of the
rapid global spread of NRTs to the developing world will be offered. By
focusing on Egypt, where nearly 40 IVF centers are in operation, this
article will demonstrate the considerable constraints on the practice and
utilization of NRTs in a developing country on the receiving end of
global reproductive technology transfer. The article concludes by stressing
the need for primary prevention of infections leading to infertility,
thereby reducing global reliance on NRTs.
Keywords: Infertility; New reproductive technologies; Gender;
Globalization; Global health; Egypt
Beverly Rossman, Breastfeeding Peer Counselors in the United States:

Helping to Build a Culture and Tradition of Breastfeeding, Journal of
Midwifery & Women's Health, Volume 52, Issue 6, NovemberDecember 2007,
Pages 631-637, ISSN 1526-9523, 10.1016/j.jmwh.2007.05.006.
Abstract: Traditionally, women have relied upon the wisdom and experience
of other women to learn about mothering and breastfeeding. In the United
States, however, this once-standard mother-to-mother interaction was almost
nonexistent by the mid20th century. Recent advances in the understanding
of the benefits of breastfeeding for maternal and child health have led
most professional organizations to advocate breastfeeding as the norm of
infant feeding. Promotional breastfeeding efforts over the past 3 decades
include strategies to strengthen support for breastfeeding in the health
care system and in the community. Breastfeeding peer counseling represents
a model of mother-to-mother support which emerged in the 1980s as a
community-based resource to provide mothers with the support and assistance
needed to establish and maintain breastfeeding in the early weeks and
months postpartum. This article describes the role, training, and
effectiveness of breastfeeding peer counselors and discusses ways that
mothers and peer counselors might benefit from the connection and
relationship that develops between the breastfeeding mother and her peer
counselor. An exemplar of a breastfeeding peer counseling program is
presented.
Keywords: breastfeeding; mother-to-mother support; peer counseling; peer
support
Constance Williams, David Munson, John Zupancic, Haresh Kirpalani,

Supporting bereaved parents: practical steps in providing compassionate
perinatal and neonatal end-of-life care A North American perspective,
Seminars in Fetal and Neonatal Medicine, Volume 13, Issue 5, October 2008,
Pages 335-340, ISSN 1744-165X, 10.1016/j.siny.2008.03.005.
Abstract: Summary
Providing compassionate bereavement support challenges care-givers in
perinatal medicine. A practical and consistent approach tailored to
individual families may increase the care-giver's ability to relieve
parental grief. This approach includes: (1) clear and consistent
communication compassionately delivered; (2) shared decision-making; (3)
physical and emotional support; and (4) follow-up medical, psychological
and social care. Challenges to providing comprehensive end-of-life care
include care-giver comfort, consistency of care, cultural and legal
barriers, and lack of adequate training.
Keywords: Perinatal bereavement; End-of-life care; Neonatal intensive care;
Ethics; Parental involvement
Lauren B. Levy, Michael W. O'Hara, Psychotherapeutic interventions for

depressed, low-income women: A review of the literature, Clinical
Psychology Review, Volume 30, Issue 8, December 2010, Pages 934-950, ISSN
0272-7358, 10.1016/j.cpr.2010.06.006.
Abstract: Low-income women have very high rates of depression and also face
a number of unique barriers that can prevent them from seeking, accepting,
engaging in, or benefiting from psychotherapy treatment. Untreated
depression often leads to deleterious psychological consequences for these
women and their children, and may also diminish a woman's ability to
improve her economic circumstances. We reviewed the literature on
psychotherapeutic interventions for depressed, low-income women,
identifying a number of practical, psychological, and cultural barriers
that often prevent them from engaging in psychotherapy. Next, we assessed
the degree to which established intervention programs help women overcome
these barriers. The data suggest that it is quite difficult to engage
depressed, low-income women in psychotherapy, but that a number of standard
psychotherapy approaches do show promise. However, we found that many of
the currently available interventions fail to fully address the barriers
that prevent this population from engaging in treatment. Moreover, the
impact these interventions have on engagement and attrition rates or
clinical improvements is often inadequately reported. We provide
preliminary recommendations for clinicians who work with low-income women
as well as suggestions for bolstering the literature base.
Keywords: Low-income; Psychotherapy; Depression
Douglas Almond, Janet Currie, Chapter 15 - Human Capital Development before

Age Five, In: Orley Ashenfelter and David Card, Editor(s), Handbook of
Labor Economics, Elsevier, 2011, Volume 4, Part B, Pages 1315-1486, ISSN
1573-4463, ISBN 9780444534521, 10.1016/S0169-7218(11)02413-0.
Abstract: This chapter seeks to set out what economists have learned about
the effects of early childhood influences on later life outcomes, and about
ameliorating the effects of negative influences. We begin with a brief
overview of the theory which illustrates that evidence of a causal
relationship between a shock in early childhood and a future outcome says
little about whether the relationship in question is biological or
immutable. We then survey recent work which shows that events before five
years old can have large long term impacts on adult outcomes. Child and
family characteristics measured at school entry do as much to explain
future outcomes as factors that labor economists have more traditionally
focused on, such as years of education. Yet while children can be
permanently damaged at this age, an important message is that the damage
can often be remediated. We provide a brief overview of evidence regarding
the effectiveness of different types of policies to provide remediation. We
conclude with a list of some of the many outstanding questions for future
research.
Keywords: Human capital; Early childhood; Health; Fetal origins
Theresa O. Scholl, 8 - Puberty and Adolescent Pregnancy, In: Marlene B.

Goldman and Maureen C. Hatch, Editor(s), Women and Health, Academic Press,
San Diego, 2000, Pages 85-98, ISBN 9780122881459, 10.1016/B978-012288145-
9/50011-5.
Abstract: Puberty is a time of life that is characterized by maturation of
the hypothalamic-pituitary-gonadal axis, accelerated physical growth, and
the development of the secondary sexual characteristics. The underlying
mechanism that gives rise to these changes is not known. Physical
modifications, however, are part of the complex alteration that takes
place. The growth spurt modifies the size and shape of almost every bodily
dimensionthe face grows and markedly alters, the heart, lungs, viscera,
and reproductive tract all expand in size, weight, and volume. The skeleton
(long bones, vertebrae), musculature, and, in females, the fat mass also
increase. In the end, a girl will be transformed physically in a woman-
adult in the size, shape, and composition of her body, with mature
secondary sexual characteristics, and she is likely to be sexually active
and capable of reproduction. The ages at which the growth spurt commences,
breasts begin to bud (thelarche), pubic hair first appears (pubarche), and
menarche (first menstrual bleeding) starts vary by nearly a third of the
life span of a prepubertal girl.
Cynthia Farquhar, Lynn Sadler, Vicki Masson, Gillian Bohm, Alastair Haslam,
Beyond the numbers: classifying contributory factors and potentially
avoidable maternal deaths in New Zealand, 20062009, American Journal of
Obstetrics and Gynecology, Volume 205, Issue 4, October 2011, Pages 331.e1-
331.e8, ISSN 0002-9378, 10.1016/j.ajog.2011.07.044.
Abstract: Objective
We sought to describe a new classification system for contributory factors
in, and potential avoidability of, maternal deaths and to determine the
contributory factors and potential avoidability among 4 years of maternal
deaths in New Zealand.
Study Design
A new classification system for reporting contributory factors in all
maternal deaths was developed from previous tools and applied to all
maternal deaths in New Zealand from 2006 through 2009.
Results
There were 49 deaths and the maternal mortality ratio was 19.2/100,000
maternities. Contributory factors were identified in 55% of cases. An
expert panel identified 35% of maternal deaths as potentially avoidable. In
cases where potential avoidability was determined, there were nearly always
2 or 3 domains where contributory factors were identified.
Conclusion
Almost one third of maternal deaths in New Zealand can be considered to be
potentially avoidable. This methodology has the potential to identify areas
for improvement in the quality of maternity care.
Keywords: maternal death; mortality review; potentially avoidable factors;
quality improvement
Aluisio Cotrim Segurado, Vera Paiva, Rights of HIV Positive People to

Sexual and Reproductive Health: Parenthood, Reproductive Health Matters,
Volume 15, Issue 29, Supplement, May 2007, Pages 27-45, ISSN 0968-8080,
10.1016/S0968-8080(07)29032-9.
Abstract: In many areas of the globe most HIV infection is transmitted
sexually or in association with pregnancy, childbirth and breastfeeding,
raising the need for sexual and reproductive health and HIV/AIDS
initiatives to be mutually reinforcing. Many people with HIV, who are in
good health, will want to have children, and highly active antiretroviral
therapy provides women and men living with AIDS the possibility of
envisaging new life projects such as parenthood, because of a return to
health. However, there are still difficult choices to face concerning
sexuality, parenthood desires and family life. Structural, social and
cultural issues, as well as the lack of programmatic support, hinder the
fulfilment of the right to quality sexual and reproductive health care and
support for having a family. This paper addresses the continuum of care
involved in parenthood for people living with HIV, from pregnancy to infant
and child care, and provides evidence-based examples of policies and
programmes that integrate sexual and reproductive health interventions with
HIV/AIDS care in order to support parenthood. Focusing on parenthood for
people living with and affected by HIV, that is, focusing on the couple
rather than the woman as the unit of care, the individual or the set of
adults who are responsible for raising children, would be an innovative
programmatic advance. Going beyond maternal and child health care to
providing care and support for parents and others who are responsible for
raising children is especially relevant for those living with HIV
infection.
Keywords: HIV/AIDS; parenthood; antenatal care; delivery care; post-partum
care; infant care; infant feeding
Stephen Thielke, Steven Vannoy, Jrgen Untzer, Integrating Mental Health

and Primary Care, Primary Care: Clinics in Office Practice, Volume 34,
10.1016/j.pop.2007.05.007.
Abstract: Mental health and primary care delivery systems have evolved to
operate differently. For example, attention to multiple medical issues,
health maintenance, and structured diagnostic procedures are standard
elements of primary care rarely incorporated into mental health care. A
multidisciplinary treatment approach, group care, and case management are
common features of mental health treatment settings only rarely used in
primary care practices. Advances in treatments for mental health disorders
and increased knowledge of the integral link between mental health and
physical health encourage mental health disorder treatment in primary care
settings, which reach the most patients. Effective integration of mental
health care into primary care requires systematic and pragmatic change that
builds on the strengths of both mental health and primary care.
Clarissa Bonanno, Sreedhar Gaddipati, Mechanisms of Hemostasis at Cesarean

Delivery, Clinics in Perinatology, Volume 35, Issue 3, September 2008,
Pages 531-547, ISSN 0095-5108, 10.1016/j.clp.2008.07.007.
Abstract: Postpartum hemorrhage is an obstetric emergency that represents a
major cause of maternal morbidity and mortality. With the recent rise in
the cesarean delivery rate, prompt recognition and proper management at the
time of cesarean delivery are becoming increasingly important for providers
of obstetrics. Preparedness for hemorrhage can be achieved by recognition
of prior risk factors and implementation of specific hemorrhage protocols.
Medical and surgical therapies are available to treat obstetric hemorrhage
after cesarean delivery.
Keywords: Hemostasis; Hemorrhage; Cesarean delivery; Uterine atony; Medical
therapy; Uterotonic agents; Surgical therapy
M. Bellad, T. D, M. Ganachari, M. Mallapur, O110 Sublingual (SL) powdered

misoprostol (400 mcg) vs IM oxytocin (10 IU) for prevention of postpartum
blood loss a randomized controlled trial, International Journal of
Gynecology & Obstetrics, Volume 107, Supplement 2, October 2009, Pages
S124-S125, ISSN 0020-7292, 10.1016/S0020-7292(09)60482-3.
Shalini Bharat, Vaishali Sharma Mahendra, Meeting the Sexual and

Reproductive Health Needs of People Living with HIV: Challenges for Health
Care Providers, Reproductive Health Matters, Volume 15, Issue 29,
Supplement, May 2007, Pages 93-112, ISSN 0968-8080, 10.1016/S0968-
8080(07)29030-5.
Abstract: A trained health service workforce is critical to ensuring good
quality service delivery to people with HIV. There is only limited
documented information on the challenges and constraints facing health care
providers in meeting the sexual and reproductive health needs of HIV
positive women and men. This paper reviews information on providers'
attitudes, motivation and level of preparedness in addressing the sexual
and reproductive health needs of people living with HIV in the context of
the human resources crisis and emerging treatment and prevention
strategies. There is a need for significant investment in improving the
health infrastructure and providers' ability to take universal precautions
against infection in health care settings. Additionally, there is need for
comprehensive and appropriate training for health care providers to build
their capacity to meet the requirements and expectations of different sub-
populations of HIV positive people. This includes not only physicians but
also nurses and midwives, who are the primary caregivers for most of the
population in many resource-poor settings. Supportive and knowledgeable
providers are crucial for helping HIV positive people seek and adhere to
treatment, prevent sexually transmitted infections, unintended pregnancies
and vertical transmission of HIV and support positive living free from
stigma and discrimination. Providers, some of whom may themselves be HIV
positive, can make an important difference, especially if they are
supported in their working conditions, are knowledgeable about HIV and
sexual and reproductive health and have the skills to provide good quality
care.
Keywords: health care providers; sexual and reproductive health services;
HIV/AIDS; training of service providers; providerpatient relations
Carol Sakala, Medically unnecessary cesarean section births: Introduction

to a symposium, Social Science & Medicine, Volume 37, Issue 10,
November 1993, Pages 1177-1198, ISSN 0277-9536, 10.1016/0277-9536(93)90331-
W.
Abstract: Between 1965 and 1986, the United States cesarean section rate
increased from 4.5 to 24.1%. Increasingly, childbearing women and their
advocates, along with many others, have recognized that a large proportion
of cesareans confers a broad array of risks without providing any medical
benefit. A growing literature examines the diverse causes of medically
unnecessary cesareans and the diverse effects of surgical birth on women,
infants, and families. Various programs and policies have been proposed or
implemented to reduce cesarean rates.
In recent decades, many other nations have also experienced a sharply

escalating cesarean section rate. It is reasonable to conclude that a
largely uncontrolled international pandemic of medically unnecessary
cesarean births is occurring. The level of political, analytic, and
programmatic activity that has occurred in the U.S. regarding medically
unnecessary surgical births does not seem to be paralleled in other nations
with sharply escalating rates.
This symposium was organized with the objective of presenting the U.S.
experience with various dimensions of the problem of medically unnecessary
cesareans to an international audience. Although preliminary and
inadequate, it is hoped that this experience will encourage policy leaders
and investigators throughout the world to recognize and address the problem
of run-away cesarean section births.
The first section of this introduction summarizes the U.S. experience with
medically unnecessary cesareans from the perpective of trends, causes,
consequences, and solutions. The second section covers the same topics,
presenting selected material from various other nations throughout the
world. In the course of these overviews, I introduce the symposium's seven
contributions, most of which focus on circumstances in the U.S.
Keywords: cesarean section; U.S.; cesarean section international trends;
cesarean section medically unnecessary; cesarean section pandemic
Matthew P Longnecker, Howard J Hoffman, Mark A Klebanoff, John W Brock,

Haibo Zhou, Larry Needham, Tilahun Adera, Xuguang Guo, Kimberly A Gray, In
utero exposure to polychlorinated biphenyls and sensorineural hearing loss
in 8-year-old children, Neurotoxicology and Teratology, Volume 26, Issue 5,
SeptemberOctober 2004, Pages 629-637, ISSN 0892-0362,
10.1016/j.ntt.2004.04.007.
Abstract: Early-life exposure to polychlorinated biphenyls (PCBs), a
ubiquitous environmental contaminant, increases the hearing threshold at
selected frequencies in rats. Among humans from the Faroe Islands with
unusually high early-life PCB exposure, exposure was directly associated
with increased hearing thresholds at two frequencies, although the deficits
were present in the left ear but not the right. We examined PCB levels in
maternal pregnancy serum in relation with audiometrically determined
hearing thresholds among offspring when they were of school age. Complete
data were available for 195 children with sensorineural hearing loss (SNHL)
and 615 children selected at random, all of whom were born in 19591966 in
the Collaborative Perinatal Project (CPP) U.S. cohort. The median exposure
among those selected at random, as reflected by the mother's third
trimester serum total PCB concentration, was 2.8 g/l, about twofold higher
than recent background levels in the United States. Based on the average
hearing threshold across the frequencies essential for speech recognition
in the worst ear, the maternal serum PCB level was unrelated to the
adjusted odds of SNHL or to adjusted mean hearing threshold. Overall, an
adverse effect of early-life, background-level PCB exposure on SNHL was not
supported by these data.
Keywords: Polychlorinated biphenyls; Sensorineural hearing loss;
Audiometry; Children
T. Ostler, B. Ackerson, Parental Chronic Mental Illness, In: Editors-in-

Chief: Marshall M. Haith and Janette B. Benson, Editor(s)-in-Chief,
Encyclopedia of Infant and Early Childhood Development, Academic Press, San
Diego, 2008, Pages 479-490, ISBN 9780123708779, 10.1016/B978-012370877-
9.00116-X.
Abstract: This article provides an overview of the effects of parental
chronic mental illness on parenting and on the development and well-being
of infants and young children. The article describes various types of
chronic mental illness and discusses how illness symptoms can contribute to
parenting risk. A model for understanding how chronic parental mental
illness can effect child development is then presented followed by a
synthesis of findings on the outcomes of young children who are reared by a
parent with a chronic mental illness. Attention is given to maternal mental
illnesses in the peripartum period.
Keywords: Anxiety disorders; Child development; Chronic mental illness;
Infants; Parenting; Postpartum depression; Postpartum psychosis; Young
children
Ruth A. Lawrence, Robert M. Lawrence, Chapter 13 - Maternal employment,

Breastfeeding (Sixth Edition), Mosby, Philadelphia, 2005, Pages 461-477,
ISBN 9780323028233, 10.1016/B978-0-323-02823-3.50018-8.
Ying Lau, Yuqiong Wang, Lei Yin, Kin Sun Chan, Xiujing Guo, Validation of
the Mainland Chinese version of the Edinburgh Postnatal Depression Scale in
Chengdu mothers, International Journal of Nursing Studies, Volume 47, Issue
9, September 2010, Pages 1139-1151, ISSN 0020-7489,
10.1016/j.ijnurstu.2010.02.005.
The Mainland Chinese version of the Edinburgh Postnatal Depression Scale
(EPDS) has been validated among antenatal women, subsequent validation
among postnatal women is necessary.
Objectives
This study investigated the prevalence of postnatal depression and the
psychometric characteristics of the Mainland Chinese version of the EPDS
among postnatal women.
Design
Two studies were used for validating the EPDS with specific aims. Study I
established the psychometric properties of the EPDS by examining the
convergent, discriminant and construct validity, internal consistency and
stability of the scale. Study II established its sensitivity, specificity
and the optimal cut-off score of the EPDS according the DSM-IV-TR criteria
using the Structured Clinical Interview.
Setting
: Four regional public hospitals in Chengdu.
Participants
: A convenience sample was composed of 300 and 342 postnatal women in study
I and II, respectively.
Method
A receiver operating characteristic (ROC) analysis was carried out to
evaluate the global functioning of the scale. The Beck Depression Inventory
(BDI), Dyadic Adjustment Scale (DAS) and standard SF-12 Health Survey (SF-
12) were used to investigate the convergent, discriminant and construct
validity. An exploratory factor analysis was used to investigate the
structural validity of the scale. Confirmatory factor analysis (CFA) was
tested the proposed factor module by Linear Structural Relations (LISREL).
The Cronbach's alpha reliability coefficient, split-half reliability and
test-retest reliability were used to examine the internal consistency and
stability of the scale.
Results
The prevalence of postnatal depression was 4.7%. Structural validity
revealed a three-factor structure for the EPDS and the CFA showed a good
overall fit of this three-factor model. Convergent and construct validity
was supported and discriminant validity suggested that the EPDS
successfully discriminated among the nondepressed, mildly and clinically
depressed groups. The area under curve (AUC) was 89.6% and the logistic
estimate for the threshold score was 10.5 (sensitivity, 81.25%;
specificity, 80.67%) for clinical depression. The split-half reliability of
the EPDS was 0.74, Cronbach's alpha was 0.78 and test-retest reliability
was 0.90.
Conclusions
Our data confirm the validity of the Mainland Chinese version of EPDS in
identifying postnatal depression among postnatal women in Chengdu by using
>10 cut-off point. Because of its brevity and acceptability, it is
recommended that the EPDS be used in routine postnatal screening.
Keywords: Mainland Chinese version of the EPDS; Factor analysis; ROC
analysis; Sensitivity; Specificity
Debra S Penney, Jeanne Raisler, Meeting womens health needs in Yemen: a

midwifery perspective, Journal of Midwifery & Women's Health, Volume
45, Issue 1, JanuaryFebruary 2000, Pages 72-78, ISSN 1526-9523,
10.1016/S1526-9523(99)00005-7.
Abstract: Maternal mortality in Yemen is one of the highest in the world.
Reaching the rural majority of the population with primary health care
services has been a continual priority for the nation. Despite efforts to
expand health services, access to maternal and child health care remains
low. The training of community midwives nationwide has been undertaken
recently to address the need for maternal and child health services,
particularly in rural areas. Several lessons have been gained through this
initial training that will improve future efforts.
Ricky Finzi-Dottan, Yael Segal Triwitz, Pavel Golubchik, Predictors of

stress-related growth in parents of children with ADHD, Research in
Developmental Disabilities, Volume 32, Issue 2, MarchApril 2011, Pages
510-519, ISSN 0891-4222, 10.1016/j.ridd.2010.12.032.
Abstract: This study was designed to investigate stress-related growth in
71 parents of children with ADHD, compared with 80 parents of non-clinical
children. Adopting Tedeschi and Calhoun's (2004) theoretical framework for
predicting personal growth, the study investigated the contribution of
emotional intelligence (individual characteristics), social support
(environmental factors), parental self-efficacy and perceptions of
parenting as a challenge vs. a threat (cognitive processing). Results
indicated that emotional intelligence was the main predictor of stress-
related growth, particularly for parents of ADHD children, emphasizing that
this personal trait is especially relevant to coping with on-going parental
strain; whereas social support made a greater contribution to growth for
the control group than for parents of children with ADHD. Path analysis
confirmed our research model, suggesting that parents sense of competence
and of parenthood as a challenge vs. a threat mediates between emotional
intelligence and social support on the one hand, and growth on the other.
Keywords: Children with ADHD; Emotional intelligence; Perceiving
parenthood; Social support; Stress-related growth
Truls stbye, Katrina M. Krause, Marissa Stroo, Cheryl A. Lovelady,

Kelly R. Evenson, Bercedis L. Peterson, Lori A. Bastian, Geeta K. Swamy,
Deborah G. West, Rebecca J.N. Brouwer, Nancy L. Zucker, Parent-focused
change to prevent obesity in preschoolers: Results from the KAN-DO study,
Preventive Medicine, Available online 13 June 2012, ISSN 0091-7435,
10.1016/j.ypmed.2012.06.005.
Abstract: Objective
The study presents the immediate post-intervention results of Kids and
Adults Now Defeat Obesity!, a randomized controlled trial to enhance
healthy lifestyle behaviors in motherpreschooler (25 years
old) dyads in North Carolina (20072011). The outcomes include change
from baseline in the child's diet, physical activity and weight, and in the
mother's parenting behaviors, diet, physical activity, and weight.
Method
The intervention targeted parenting through maternal emotion regulation,
home environment, feeding practices, and modeling of healthy behaviors. 400
mother-child dyads were randomized.
Results
Mothers in the intervention arm, compared to the control arm, reduced
instrumental feeding ( 0.24 vs. 0.01, p < 0.001) and
TV snacks (.069 vs. 0.24, p = 0.001). There were
also improvements in emotional feeding (p = 0.03), mother's
sugary beverage (p = 0.03) and fruit/vegetable
(p = 0.04) intake, and dinners eaten in front of TV
(p = 0.01); these differences were not significant after
adjustment for multiple comparisons.
Conclusion
KAN-DO, designed to maximize the capacity of mothers as agents of change,
improved several channels of maternal influence. There were no group
differences in the primary outcomes, but differences were observed in the
parenting and maternal outcomes and there were trends toward improvement in
the preschoolers' diets. Long-term follow-up will address whether these
short-term trends ultimately improve weight status.
Keywords: Obesity; Randomized controlled trial; Parenting; Emotion
regulation; Physical activity; Dietary intake
Jennifer Hall, Effective community-based interventions to improve exclusive

breast feeding at four to six months in low- and lowmiddle-income
countries: a systematic review of randomised controlled trials, Midwifery,
10.1016/j.midw.2010.03.011.
only about 25% of babies are exclusively breast fed until six months of age
in developing countries and, given their greater risk of infection and
infant mortality, there is a need to investigate ways of increasing this.
The aim of this review is to assess the effectiveness of community-based
interventions to improve the rates of exclusive breast feeding at four to
six months in infants in low- and lowmiddle-income countries.
Methods
a systematic review of literature identified through searches of Medline,
Global Health and CINAHL databases to identify randomised controlled trials
of community-based interventions to improve the rate of exclusive breast
feeding in low- and lowmiddle-income countries.
Findings
four studies, from four different countries, were included in the final
review. Although they evaluated slightly different interventions, all
showed a significant improvement in the rate of exclusive breast feeding
with a pooled odds ratio of 5.90 (95% confidence interval 1.8118.6) on
random effects meta-analysis.
Conclusion
community-based interventions in low- and lowmiddle-income countries can
substantially increase the rates of exclusive breast feeding and are
therefore a viable option. The interventions included in the review varied,
indicating that there are a number of ways in which this might be achieved;
it is recommended that these are used as a starting point for determining
the most appropriate intervention with regard to the setting. Given the
importance of this issue, the lack of research in the area is surprising.
The studies in the review demonstrate that good-quality randomised
controlled trials of this area are possible and should encourage further
research.
Keywords: Systematic review; Exclusive breast feeding; Community-based
intervention; Developing countries
Monica Sarfi, Lars Smith, Helge Waal, Jon Martin Sundet, Risks and
realities: Dyadic interaction between 6-month-old infants and their mothers
in opioid maintenance treatment, Infant Behavior and Development, Volume
10.1016/j.infbeh.2011.06.006.
Abstract: A number of studies point to methadone exposure in utero as a
possible risk factor in the developing motherinfant relationship in the
first year of life. This study is part of a larger, national follow-up of
38 infants prenatally exposed to methadone or buprenorphine and 36
comparison, low-risk infants. The aim of the present paper is to assess the
quality of motherinfant relationship when the infants are 6 months old.
Videotaped motherinfant interactions were rated in a global scale (NICHD).
Maternal and infant contributions collapsed into the variables infant
style and maternal style showed that the only factor making significant
contribution to the outcome measure dyadic mutuality was maternal style.
The importance of group membership (exposed versus non-exposed), was
reduced when controlling for maternal drug use prior to opioid maintenance
treatment (OMT), maternal depression and parenting stress as well as
infants developmental status and sensory-integrative functions. This
suggests that prediction of dyadic mutuality should be based on individual
characteristics rather than group characteristics. These results support
previous research findings that methadone and buprenorphine use per se does
not have direct influence on the quality of early motherinfant
relationship, but tailored follow-up procedures targeting drug-free
pregnancies and parenting support are beneficial for women in OMT and their
children.
Keywords: Opioid maintenance treatment; Motherinfant relationship; Dyadic
mutuality
S.T. Truitt, A.B. Fraser, D.A. Grimes, M.F. Gallo, K.F. Schulz, Hormonal
contraception during lactation: systematic review of randomized controlled
trials, Contraception, Volume 68, Issue 4, October 2003, Pages 233-238,
ISSN 0010-7824, 10.1016/S0010-7824(03)00133-1.
Abstract: Contraception choices may be limited for lactating women due to
concerns about hormonal effects on quality and quantity of milk, passage of
hormones to the infant and infant growth. We conducted a systematic review
of randomized controlled trials to determine the effect of hormonal
contraception on lactation. We sought all randomized controlled trials,
reported in any language, that included any form of hormonal contraception
compared with another form of hormonal contraception, nonhormonal
contraception or placebo during lactation. Seven reports from five
randomized controlled trials met the inclusion criteria. Most of the five
trials did not specify their method used to generate a random sequence,
method of allocation concealment, blinding of treatments or use of an
intention-to-treat analysis. Additionally, high loss-to-follow-up rates
invalidated at least two trials. The findings from two trials comparing
oral contraceptives to placebo during lactation were conflicting. Another
trial found no inhibitory effects on lactation from progestin-only
contraceptives. Finally, the World Health Organization trial found a
statistically significant decline in breast milk volume in women using
combined oral contraceptives compared to women using progestin-only pills.
However, infant growth for the two groups did not differ. The limited
evidence from randomized controlled trials on the effect of hormonal
contraceptives during lactation is of poor quality and insufficient to
establish an effect of hormonal contraception, if any, on milk quality and
quantity. At least one properly conducted randomized controlled trial of
adequate size is urgently needed to make recommendations regarding hormonal
contraceptive use for lactating women.
Keywords: Oral contraceptives; Lactation; Systematic review
Wendy J. Graham, Oona M.R. Campbell, Maternal health and the measurement
trap, Social Science & Medicine, Volume 35, Issue 8, October 1992,
Pages 967-977, ISSN 0277-9536, 10.1016/0277-9536(92)90236-J.
(http://www.sciencedirect.com/science/article/pii/027795369290236J)
Abstract: This paper focuses on the contribution of measurement-related
factors to the neglect of maternal health in resource allocation for
programmes and in public health research. As the recent interest in
maternal health has now progressed beyond the need for information
primarily for the purpose of advocacy, measurement-related factors have
emerged as powerful constraints on programme action. Three outstanding
needs for information can be identified: first, to establish the levels and
trends of specific maternal health outcomes; secondly, to identify the
characteristics and determinants of health outcomes; and thirdly, to
monitor and evaluate the effectiveness of programmes designed to influence
health outcomes. In order to meet these needs, the emphasis placed on
operational research by the current major initiatives in maternal health
must be complemented by an equivalent emphasis on methodological studies.
The call for improved information by international and national agencies
should be made in unison with the call for action.
Inadequate information is a reality that has to be faced throughout the

world, but particularly in developing countries. The quality, quantity and
scope of health-related data are the elements of this inadequacy and may be
discussed in terms of four factors: the indicators, the data sources, the
measurement techniques, and the conceptual framework. In this paper, the
neglect of maternal health and the lack of information are shown to be
self-reinforcing and constitute a measurement trap sprung by these four
factors. Dismantling this trap has revealed a weak conceptual framework to
lie at the very centre. Maternal health has tended to be conceptualized as
a discrete, negative state, characterized by physical rather than social or
mental manifestations, and by a narrow time-perspective focusing on
pregnancy, delivery and the puerperium. The need to broaden this
perspective and to develop equally broad operational definitions represent
important steps forward that must be taken.
Keywords: maternal health; developing countries; information; measurement;
definition; conceptualization
Angela E. Wilson, Effectiveness of an educational programme in perineal

repair for midwives, Midwifery, Volume 28, Issue 2, April 2012, Pages 236-
246, ISSN 0266-6138, 10.1016/j.midw.2011.02.011.
Abstract: Objective
to evaluate the effectiveness of a work-based module and in-service
educational programme in perineal repair for midwives on their perceived
level of competency undertaking this skill in clinical practice.
Design
a quasi-experimental prepost intervention case study combining a non-
equivalent comparison group and evaluation action research.
Setting
six NHS consultant/midwifery led Trusts in South East England between
December 2002 and 2006.
Participants
145 midwives from six NHS Trusts.
Interventions
a post-registration work-based module in perineal repair for midwives and
alternative two hour in-service perineal repair workshops across five
intervention Trusts.
midwives' perceived level of competency and confidence undertaking perineal
repair.
Main findings
significantly greater numbers of midwives were able to practice perineal
repair at higher levels of competency following an educational intervention
in five intervention Trusts (P<.006). There was a non-significant
difference in the comparison Trust (P<.535). In addition, an educational
programme for midwives increased the numbers of senior student midwives who
were able to participate in perineal repair confidently under the direct
supervision of their mentor when they perceived that their mentor was
confident and competent undertaking the procedure.
Key conclusions
an educational programme in perineal repair can make a significant
difference to the midwives' perceived level of competency and confidence
when assessing and managing perineal trauma and repair.
competency and expertise are complex phenomena and the data has provided
greater insight into the complex nature of workplace learning alongside the
multiple factors influencing clinical decision-making such as staff
shortage, time constraints and inadequate numbers of midwives who are able
to instruct, supervise and assess competency in perineal repair. Funding
for training is fundamental for the sustainability of future practice
development.
Keywords: Perineal trauma; Training; Competency; Accountability
Kathleen Flynn Gaffney, New directions in maternal Attachment research,

Journal of Pediatric Health Care, Volume 2, Issue 4, JulyAugust 1988,
Pages 181-188, ISSN 0891-5245, 10.1016/0891-5245(88)90019-3.
Abstract: Early exchanges between a mother and her infant are the
foundation on which future human relationships are built. Maternal
attachment studies underscore the significance of this early interactional
phenomenon and suggest that the attachment process may have underpinnings
in the prenatal period. This article presents an overview of recent
findings in maternal attachment research. Special emphasis is placed on
measurement instruments and findings associated with prenatal maternal
attachment.
Joyce King, Contraception and Lactation, Journal of Midwifery & Women's

Health, Volume 52, Issue 6, NovemberDecember 2007, Pages 614-620, ISSN
1526-9523, 10.1016/j.jmwh.2007.08.012.
Abstract: The benefits of breastfeeding for both the infant and the mother
are undisputed. Longer intervals between births decrease fetal/infant and
maternal complications. Lactation is an effective contraceptive for the
first 6 months postpartum only if women breastfeed exclusively and at
regular intervals, including nighttime. Because a high percentage of women
in the United States supplement breastfeeding, it is important for these
women to choose a method of contraception to prevent unintended
pregnancies. Both the method of contraception and the timing of the
initiation of contraceptives are important decisions that a clinician must
help the breastfeeding woman make. Ideally, the chosen method of
contraception should not interfere with lactation. This article reviews the
research on the effect of contraceptives, including hormonal
contraceptives, on lactation.
Keywords: contraception; lactation
Maureen Raynor, Social and psychological context of childbearing, Women's

Health Medicine, Volume 3, Issue 2, MarchApril 2006, Pages 64-67, ISSN
1744-1870, 10.1383/wohm.2006.3.2.64.
Abstract: The transition to motherhood is an emotional watershed which is
punctuated by feelings of loss as well as gain. Not surprisingly, it is a
period that is associated with significant social and psychological changes
and upheavals that may give rise to feelings of uncertainty and self-doubt.
The National Services Framework for Children, Young People and Maternity
Services (Department of Health 2004) acknowledges the demands of parenthood
and identified clear standards for promoting health and wellbeing of women,
children, partners and families as a whole, placing emphasis on supporting
and helping parents prepare and adjust to their parenting role.
Furthermore, it outlines a number of vulnerability factors that may have
adverse consequences for maternal and neonatal outcomes. This, for example,
takes account of social deprivation/social exclusion, teenage pregnancy,
substance abuse, domestic violence and minority ethnic groups. To
comprehend the enormity of childbearing on womens lives this paper
considers the social and psychological context of motherhood as a major
life event.
Keywords: mental health; social context; domestic violence; child poverty;
teenage pregnancy; psychological context; depressive symptoms; postpartum
distress
SHARON MANNE, KATHERINE DUHAMEL, JAMIE OSTROFF, SUSAN PARSONS, D. RICHARD

MARTINI, SHARON E. WILLIAMS, LAURA MEE, SANDRA SEXSON, JANE AUSTIN, GARY
WINKEL, FARID BOULAD, WILLIAM H. REDD, Coping and the Course of Mother's
Depressive Symptoms During and After Pediatric Bone Marrow Transplantation,
Journal of the American Academy of Child & Adolescent Psychiatry,
10.1097/01.CHI.0000070248.24125.C0.
To evaluate the role of maternal coping strategies in depressive symptoms
experienced by mothers of children undergoing bone marrow transplantation
(BMT).
Method
A total of 207 mothers completed measures of coping and depressive symptoms
at the time of the child's BMT, 3 and 6 months post-BMT. The sample was
collected between 1998 and 2002. The acceptance rate was 73%. The
contribution of demographic, illness and treatment parameters, and mothers'
concerns about the child were also evaluated. Growth curve modeling was
used to evaluate the role of coping in the course of depressive symptoms.
Both main effects and interactions of coping strategies with time of
assessment were evaluated.
Results
Acceptance and humor were associated with reductions in maternal depressive
symptoms, and planning and alcohol/substance use were associated with
increases in maternal depressive symptoms. Positive reframing, use of
emotional support, and use of religion were associated with the course of
depressive symptoms, but the magnitude of associations differed depending
on the use of the coping strategies at the time of transplantation.
Mothers' fears about the child also predicted depressive symptoms.
Conclusions
Acceptance and humor may be targets for behavioral interventions to reduce
mothers' depressive symptoms during and after pediatric BMT
hospitalization.
Keywords: coping; pediatric bone marrow transplantation; maternal
adjustment; psychological distress
The Supplementation with Multiple Micronutrients Intervention Trial

(SUMMIT) Study Group, Effect of maternal multiple micronutrient
supplementation on fetal loss and infant death in Indonesia: a double-blind
cluster-randomised trial, The Lancet, Volume 371, Issue 9608, 1925 January
2008, Pages 215-227, ISSN 0140-6736, 10.1016/S0140-6736(08)60133-6.
Maternal nutrient supplementation in developing countries is generally
restricted to provision of iron and folic acid (IFA). Change in practice
toward supplementation with multiple micronutrients (MMN) has been hindered
by little evidence of the effects of MMN on fetal loss and infant death. We
assessed the effect of maternal supplementation with MMN, compared with
IFA, on fetal loss and infant death in the setting of routine prenatal care
services.
Methods
In a double-blind cluster-randomised trial in Lombok, Indonesia, we
randomly assigned 262 midwives to distribute IFA (n=15486) or MMN (n=15
804) supplements to 31290 pregnant women through government prenatal care
services that were strengthened by training and community-based advocacy.
Women obtained supplements, to be taken daily, every month from enrolment
to 90 days post partum. The primary outcome was early infant mortality
(deaths until 90 days post partum). Secondary outcomes were neonatal
mortality, fetal loss (abortions and stillbirths), and low birthweight.
Analysis was by intention to treat. The study is registered as an
International Standard Randomised Controlled Trial, number ISRCTN34151616.
Findings
Infants of women consuming MMN supplements had an 18% reduction in early
infant mortality compared with those of women given IFA (355 deaths per
1000 livebirths vs 43 per 1000; relative risk [RR] 082, 95% CI 070095,
p=0010). Infants whose mothers were undernourished (mid upper arm
circumference <235 cm) or anaemic (haemoglobin <110 g/L) at
enrolment had a reduction in early infant mortality of 25% (RR 075, 062
090, p=00021) and 38% (RR 062, 049078, p<00001), respectively.
Combined fetal loss and neonatal deaths were reduced by 11% (RR 089, 081
100, p=0045), with significant effects in undernourished (RR 085, 073
098, p=0022) or anaemic (RR 071, 058087, p=00010) women. A cohort of
11101 infants weighed within 1 h of birth showed a 14% (RR 086, 073
101, p=0060) decreased risk of low birthweight for those in the MMN
group, with a 33% (RR 067, 051089, p=00062) decrease for infants of
women anaemic at enrolment.
Interpretation
Maternal MMN supplementation, as compared with IFA, can reduce early infant
mortality, especially in undernourished and anaemic women. Maternal MMN
supplementation might therefore be an important part of overall
strengthening of prenatal-care programmes.
Deborah S. Walker, Joan M. Visger, Debra Rossie, Contemporary Childbirth

Education Models, Journal of Midwifery & Women's Health, Volume 54,
Issue 6, NovemberDecember 2009, Pages 469-476, ISSN 1526-9523,
10.1016/j.jmwh.2009.02.013.
Abstract: Since the 1960s, childbirth education advocates have attempted to
persuade pregnant women that educational preparation for labor and birth is
an essential component of the transition to motherhood. Initially, pregnant
women who were seeking unmedicated births as a refuge from the inhumane
childbirth treatments of the mid-20th century embraced this view. However,
with the changing childbirth climate, including a growing preference for
medicated birth, scheduled inductions, and cesarean sections, attendance
has diminished and childbirth education finds itself at a crossroads.
Commonly used childbirth education models/organizations and several new
emerging models along with the available research literature and
recommendations for clinical practice and research are presented.
Keywords: antepartum; childbirth education; intrapartum; pregnancy
Debra Elliott, Xiangping Li, Peimin Zhu, Emil Gaitour, 2 - Headache in

Pregnancy, In: Alireza Minagar, Editor(s), Neurological Disorders and
Pregnancy, Elsevier, London, 2011, Pages 13-54, ISBN 9780123849113,
10.1016/B978-0-12-384911-3.00002-6.
Abstract: Headache is a frequent complaint among women of childbearing age.
Although most experience an improvement in headache during pregnancy,
others have severe symptoms that cause suffering or dehydration, or
represent a more sinister health problem. Management of headaches in
pregnancy poses challenges for the health care team that can be overcome
with proper guidance and attention to the needs of the fetus and gravid
mother.
Josefina M. Contreras, Jean E. Rhodes, Sarah C. Mangelsdorf, Pregnant

African American teenagers' expectations of their infants' temperament:
Individual and social network influences, Journal of Applied Developmental
Psychology, Volume 16, Issue 2, AprilJune 1995, Pages 283-295, ISSN 0193-
3973, 10.1016/0193-3973(95)90036-5.
Abstract: Factors associated with pregnant teenagers' expectations of their
infants' temperament were examined. A total of 126 pregnant African
American teenagers were included in the study, all of whom were expecting
their first baby. The teenagers' expectations for their infants'
temperament was assessed using Mebert and Kalinowski's (1986) modified
version of the Infant Characteristics Questionnaire (ICQ). Pregnant
teenagers who were anxious and/or depressed tended to expect their infants
to have more difficult temperaments. In addition, those teenagers who were
more satisfied with current support resources and perceived their maternal
relationships as more warm and accepting tended to have more positive
expectations of their infants' temperament. Finally, expectant teens who
held more accurate beliefs and knowledge about infant development and
milestones had more positive expectations of their infants. Implications of
these findings for future research and intervention are discussed.
Sari Goldstein Ferber, Ruth Feldman, Imad R. Makhoul, The development of

maternal touch across the first year of life, Early Human Development,
Volume 84, Issue 6, June 2008, Pages 363-370, ISSN 0378-3782,
10.1016/j.earlhumdev.2007.09.019.
Abstract: The developmental trajectories of specific forms of maternal
touch during natural caregiving were examined across the first year in
relation to the development of motherinfant reciprocal communication. One
hundred and thirty-one mothers and infants in four groups aged 3, 6, 9, and
12 months were observed in a cross-sectional design at home during natural
caregiving and motherchild play sessions. Microanalytic coding of the
caregiving sessions considered nine forms of maternal touch, which were
aggregated into three global touch categories: affectionate, stimulating,
and instrumental. Play sessions were coded for maternal sensitivity and
dyadic reciprocity. Maternal affectionate and stimulating touch decreased
significantly during the second 6 months of life. In parallel, dyadic
reciprocity increased in the second half year. Dyadic reciprocity was
predicted by the frequency of affectionate touch but not by any other form
of touch. Results contribute to specifying the role of touch as it evolves
across the first year of life within the global motherinfant communication
system.
Keywords: Maternal touch; Crawling; 6 months; Separation individuation
Robert Klitzman, Paul S Appelbaum, Wendy Chung, Mark Sauer, Anticipating

issues related to increasing preimplantation genetic diagnosis use: a
research agenda, Reproductive BioMedicine Online, Volume 17, Supplement 1,
2008, Pages 33-42, ISSN 1472-6483, 10.1016/S1472-6483(10)60188-5.
Abstract: Increasing use of preimplantation genetic diagnosis (PGD) poses
numerous clinical, social, psychological, ethical, legal and policy
dilemmas, many of which have received little attention. Patients and
providers are now considering and using PGD for a widening array of genetic
disorders, and patients may increasingly seek designer babies. In the
USA, although governmental oversight policies have been discussed, few
specific guidelines exist. Hence, increasingly, patients and providers will
face challenging ethical and policy questions of when and for whom to use
PGD, and how it should be financed. These issues should be better clarified
and addressed through collection of data concerning the current use of PGD
in the USA, including factors involved in decision making about PGD use, as
well as the education of the various communities that are, and should be,
involved in its implementation. Improved understanding of these issues will
ultimately enhance the development and implementation of future clinical
guidelines and policies.
Keywords: assisted reproduction technology; decision making; ethics;
insurance; IVF; providerpatient communication
Justin C. Sherwin, Mark H. Reacher, William H. Dean, Jeremiah Ngondi,

Epidemiology of vitamin A deficiency and xerophthalmia in at-risk
populations, Transactions of the Royal Society of Tropical Medicine and
Hygiene, Volume 106, Issue 4, April 2012, Pages 205-214, ISSN 0035-9203,
10.1016/j.trstmh.2012.01.004.
Abstract: Summary
Vitamin A deficiency (VAD) is an important public health problem worldwide
that contributes significantly to the global burden of disease. Vitamin A
deficiency disorders include xerophthalmia and increased risk of infectious
diseases, both of which increase risk of mortality. Xerophthalmia is also a
leading cause of preventable blindness. Areas with highly prevalent VAD
often share common dietary and other environmental exposures, including
poverty, infectious diseases, limited development and poor availability of
vitamin A containing food. Globally, the prevalence of VAD has been
declining, which may be due to widespread vitamin A supplementation in
conjunction with measles immunisation in at-risk populations. Recent meta-
analyses confirm that provision of vitamin A to children aged between 6
months and 5 years confers a significant mortality benefit. Further
preventative measures for VAD comprise improving availability of vitamin A
containing food, including foods biofortified with vitamin A. Ensuring
vitamin A is available in any form in adequate quantities remains
problematic, especially in areas affected by environmental catastrophes and
conflict, and other areas where access to vitamin A containing foods and
healthcare interventions is limited. Hence, it remains essential that
maternal and child health workers remain vigilant for VAD in nutritionally
vulnerable populations.
Keywords: Vitamin A; Xerophthalmia; Epidemiology; Public health; Nutrition;
Blindness
P. Toledo, Whats new in obstetric anesthesia: the 2011 Gerard W. Ostheimer

lecture, International Journal of Obstetric Anesthesia, Volume 21, Issue 1,
January 2012, Pages 68-74, ISSN 0959-289X, 10.1016/j.ijoa.2011.11.003.
Abstract: The Gerard W. Ostheimer lecture is delivered at the Society for
Obstetric Anesthesia and Perinatology Annual Meeting. The lecture provides
a comprehensive review of the previous years literature in obstetric
anesthesia, obstetrics, perinatology, and health services research relevant
for obstetric anesthesiologists. This article covers several of the major
themes that emerged from the 2010 literature.
Keywords: Obesity; Gestational diabetes mellitus; Local anesthetic systemic
toxicity; Aspiration; Postdural puncture headache; Oxytocin; Patient safety
Ximena Ossa, Luis Bustos, Lilian Fernandez, Prenatal attachment and

associated factors during the third trimester of pregnancy in Temuco,
Chile, Midwifery, Available online 26 September 2011, ISSN 0266-6138,
10.1016/j.midw.2011.08.015.
Abstract: Objective
to estimate the prevalence of poorer prenatal attachment and its
association with psycho-affective factors in pregnant women during the
third trimester.
Design and setting
cross-sectional study in Temuco, La Araucana Region, Chile.
Measurements
data were collected by structured interview with closed questions for the
sociodemographic characterisation of the sample and measurement of six
aspects: prenatal attachment, perceived stress, depression, perception of
relationship with partner, subjective family support, and obstetric
information regarding current and previous pregnancies.
Participants
244 pregnant women selected by stratified random sampling in all centres
(n=5) of the public health system in Temuco, Chile, with proportional
allocation.
Findings
the prevalence of poorer prenatal attachment was 24.3% (95% confidence
interval 1930%), and this was found to be associated with discontent with
the pregnancy, unwanted pregnancy, higher levels of perceived stress,
depression and low family support. Religious activity and work were found
to modulate the association between poorer prenatal attachment and psycho-
affective aspects. The percentage of unplanned pregnancies was high in this
study (61.35), and although this does not have a direct influence on poorer
prenatal attachment, it is associated with discontent with the pregnancy
and unwanted pregnancy.
the high proportion of poorer prenatal attachment during the third
trimester of pregnancy associated with potentially detectable psychosocial
factors means that early diagnosis and timely intervention during prenatal
care are an essential challenge for midwives in their work. Any progress
that can be made during pregnancy will favour the development of the
bonding experience after birth, and thus the balanced development of the
child.
Keywords: Prenatal attachment; Pregnancy; Psychosocial factors
Sherry L. Farr, Rebecca H. Bitsko, Donald K. Hayes, Patricia M. Dietz,

Mental health and access to services among US women of reproductive age,
American Journal of Obstetrics and Gynecology, Volume 203, Issue 6,
December 2010, Pages 542.e1-542.e9, ISSN 0002-9378,
10.1016/j.ajog.2010.07.007.
Abstract: Objective
The objective of the study was to estimate prevalence of depression and
serious psychological distress (SPD) and mental health service receipt
among reproductive-age women.
Study Design
We used 2006-2007 nationally representative data to estimate the prevalence
of depression and SPD among nonpregnant women aged 18 to 44 years. Using
logistic regression, we individually examined predictors of depression and
SPD and characteristics associated with clinical diagnosis and current
treatment.
Results
More than 14% of women had current depression and 2.7% had current SPD.
Risk factors for major depression and SPD included older age, less
education, being unmarried, inability to work/unemployed, and low income.
Among depressed women, 18-24 year-olds, nonwhite women, those with
children, the employed, and urban women had lower odds of clinical
diagnosis. Among women with SPD, Hispanic, employed, and those without
health insurance had lower odds of receiving treatment.
Conclusion
Mental health conditions are prevalent among women of reproductive age and
a substantial proportion goes untreated.
Keywords: depression; depressive disorder; mental disorder; women
Peter J Winch, M Ashraful Alam, Afsana Akther, Dilara Afroz, Nabeel Ashraf
Ali, Amy A Ellis, Abdullah H Baqui, Gary L Darmstadt, Shams El Arifeen, M
Habibur Rahman Seraji, the Bangladesh PROJAHNMO Study Group, Local
understandings of vulnerability and protection during the neonatal period
in Sylhet district, Bangladesh: a qualitative study, The Lancet, Volume
366, Issue 9484, 612 August 2005, Pages 478-485, ISSN 0140-6736,
10.1016/S0140-6736(05)66836-5.
Understanding of local knowledge and practices relating to the newborn
period, as locally defined, is needed in the development of interventions
to reduce neonatal mortality. We describe the organisation of the neonatal
period in Sylhet District, Bangladesh, the perceived threats to the well-
being of neonates, and the ways in which families seek to protect them.
Methods
We did 39 in-depth, unstructured, qualitative interviews with mothers,
fathers, and grandmothers of neonates, and traditional birth attendants.
Data on neonatal knowledge and practices were also obtained from a
household survey of 6050 women who had recently given birth.
Findings
Interviewees defined the neonatal period as the first 40 days of life
(chollish din). Confinement of the mother and baby is most strongly
observed before the noai ceremony on day 7 or 9, and involves restriction
of movement outside the home, sleeping where the birth took place rather
than in the mother's bedroom, and sleeping on a mat on the floor. Newborns
are seen as vulnerable to cold air, cold food or drinks (either directly or
indirectly through the mother), and to malevolent spirits or evil eye.
Bathing, skin care, confinement, and dietary practices all aim to reduce
exposure to cold, but some of these practices might increase the risk of
hypothermia.
Interpretation
Although fatalism and cultural acceptance of high mortality have been cited
as reasons for high levels of neonatal mortality, Sylheti families seek to
protect newborns in several ways. These actions reflect a set of
assumptions about the newborn period that differ from those of neonatal
health specialists, and have implications for the design of interventions
for neonatal care.
Elaine McEwan Carty, Tali A. Conine, Lorraine Hall, Comprehensive health

promotion for the pregnant woman who is disabled: The role of the midwife,
Journal of Nurse-Midwifery, Volume 35, Issue 3, MayJune 1990, Pages 133-
142, ISSN 0091-2182, 10.1016/0091-2182(90)90163-Y.
(http://www.sciencedirect.com/science/article/pii/009121829090163Y)
Abstract: Increasing numbers of women with physical or sensory disabilities
are choosing to bear children. Research and experience seem to indicate
serious shortcomings in assisting disabled primiparas toward confident,
healthy, and safe childbearing and childcaring. Guidelines are suggested
for appropriate referral or direct provision of education and counselling
services for such clients during prepregnancy, pregnancy, labor and
delivery, and the postpartum period. Useful resources are identified to
assist the nursemidwife in her role.
Yu Gao, Lesley Barclay, Availability and quality of emergency obstetric

care in Shanxi Province, China, International Journal of Gynecology &
Obstetrics, Volume 110, Issue 2, August 2010, Pages 181-185, ISSN 0020-
7292, 10.1016/j.ijgo.2010.05.001.
Abstract: Objective
To investigate the availability and quality of emergency obstetric care
(EmOC) received by women in a rural Chinese province.
Methods
The study was conducted in 7 rural counties and townships in Shanxi
Province, China. Data sources included interviews with 7 hospital leaders,
5 maternal and child health workers, and 7 obstetricians; 118 records of
complicated delivery were audited, 21 Maternal and Child Health Annual
Reports analyzed, and observations conducted of facilities and advanced
labor care.
Results
The number of comprehensive EmOC facilities was adequate in all counties.
Three counties had fewer basic EmOC facilities than recommended and only 4
counties reached the recommended level. Most of the existing township
hospitals did not provide birthing services. All the county hospitals could
perform cesarean deliveries with rates from 6.8%40.8%. The management of
complications was not evidence-based. For example, women with pre-eclampsia
and eclampsia were given too little magnesium sulfate; women were not
closely monitored for hemorrhage after birth and the partograph was used
incorrectly with consequences for obstructed labor.
Conclusion
Basic EmOC facilities are not adequate and township hospitals should be
upgraded to provide birthing services. The quality of EmOC is poor and
needs improvement.
Keywords: China; Emergency obstetric care; Rural health
Robert L. Brent, Saving lives and changing family histories: appropriate

counseling of pregnant women and men and women of reproductive age,
concerning the risk of diagnostic radiation exposures during and before
pregnancy, American Journal of Obstetrics and Gynecology, Volume 200, Issue
1, January 2009, Pages 4-24, ISSN 0002-9378, 10.1016/j.ajog.2008.06.032.
Abstract: Over the past 50 years, our laboratory has provided consultations
dealing with the risks of various environmental toxicant exposures during
pregnancy. These contacts were primarily by telephone or written
communications. Since the year 2000, the primary source of consultations
has been via the internet. In 2007, the pregnancy website of the Health
Physics Society received 1,299,672 visits. The contacts who downloaded
information totaled 620,035. After reading the website information, 1442
individuals who were still concerned contacted me directly. Unfortunately,
we have learned that many physicians and other counselors are not prepared
to counsel patients concerning radiation risks. Approximately, 8% of the
website contacts, who had consulted a professional, were provided
inaccurate information that could have resulted in an unnecessary
interruption of a wanted pregnancy.
Research from our and other investigators' laboratories has provided

radiation risk data that are the basis for properly counseling contacts
with radiation exposures. Mammalian animal research has been an important
source of information that improves the quality and accuracy of estimating
the reproductive and developmental risks of ionizing radiation in humans.
What are the reproductive and developmental risks of in utero ionizing

radiation exposure?
1. Birth defects, mental retardation, and other neurobehavioral effects,

growth retardation, and embryonic death are deterministic effects
(threshold effects). This indicates that these effects have a no adverse
effect level (NOAEL). Almost all diagnostic radiological procedures provide
exposures that are below the NOAEL for these developmental effects.
2. For the embryo to be deleteriously affected by ionizing radiation when

the mother is exposed to a diagnostic study, the embryo has to be exposed
above the NOAEL to increase the risk of deterministic effects. This rarely
happens when the pregnant women have x-ray studies of the head, neck, chest
or extremities.
3. During the preimplantation and preorganogenesis stages of embryonic

development, the embryo is least likely to be malformed by the effects of
ionizing radiation because the cells of the very young embryo are
omnipotential and can replace adjacent cells that have been deleteriously
affected. This early period of development has been designated as the all-
or-none period.
4. Protraction and fractionation of exposures of ionizing radiation to the

embryo decrease the magnitude of the deleterious effects of deterministic
effects.
5. The increased risk of cancer following high exposures to ionizing

radiation exposure to adult populations has been demonstrated in the atomic
bomb survivor population. Radiation-induced carcinogenesis is assumed to be
a stochastic effect (nonthreshold effect) so that there is theoretically a
risk at low exposures. Whereas there is no question that high exposures of
ionizing radiation can increase the risk of cancer, the magnitude of the
risk of cancer from embryonic exposures following diagnostic radiological
procedures is very controversial. Recent publications and analyses indicate
that the risk is lower for the irradiated embryo than the irradiated child,
which surprised many scientists interested in this subject, and that there
may be no increased carcinogenic risk from diagnostic radiological studies.
Examples of appropriate and inappropriate counseling will be presented to
demonstrate how counseling can save lives and change family histories. The
reader is referred to the Health Physics Society website to obtain many
examples of the answers to questions posed by women and men who have been
exposed to radiation (www.hps.org). Then click on ATE (ask the expert).
Keywords: cancer; congenital malformations; ionizing radiation risk;
pregnancy risks
Janet Currie, Chapter 19 Child health in developed countries, In: Anthony

J. Culyer and Joseph P. Newhouse, Editor(s), Handbook of Health Economics,
Elsevier, 2000, Volume 1, Part B, Pages 1053-1090, ISSN 1574-0064, ISBN
9780444504715, 10.1016/S1574-0064(00)80032-3.
Abstract: This chapter provides an overview of the literature on child
health in developed countries. I first lay out a simple economic model of
the demand for child health inputs, and discuss whether the evidence is
consistent with that model. Next, two main causes of market failure in the
market for child health inputs lack of information and externalities
are analyzed. These failures may provide an economic rationale for
government intervention in the market for health care. Much of the
literature on child health has focused on one such intervention, the
provision of public health insurance. However, the utilization of health
care is only one input into the production of child health, and it is far
from the most important input for most children. Hence, the last section of
this chapter offers a brief review of what we know about the effects of
government interventions designed to address other threats to child health.
The chapter concludes with some opinions about useful direction for future
research and data collection efforts.
Keywords: children; infants; health
, New in review, Journal of the American Dietetic Association, Volume 94,

Issue 7, July 1994, Pages 785-786,788-796,799-803, ISSN 0002-8223,
10.1016/0002-8223(94)91952-6.
E. Diczfalusy, World Health Organization special programme of research,

development and research training in human reproduction: The first fifteen
years: A review, Contraception, Volume 34, Issue 1, July 1986, Pages 1-119,
ISSN 0010-7824, 10.1016/0010-7824(86)90003-X.
Kent D.W. Bream, Susan Gennaro, Ursula Kafulafula, Ellen Mbweza, David
Hehir, Barriers to and Facilitators for Newborn Resuscitation in Malawi,
Africa, Journal of Midwifery & Women's Health, Volume 50, Issue 4,
10.1016/j.jmwh.2005.04.006.
Abstract: Newborn resuscitation is a key component of efforts to reduce
neonatal morbidity and mortality. This article reports the findings of
focus groups conducted to explore the barriers and facilitators present for
obstetric nurse providers in a central urban hospital in Malawi regarding
the training and provision of neonatal resuscitation. All obstetric nurse
providers in this setting participated in focus groups; these groups
identified 4 themes: 1) confidence in their skills in assessing newborns
and recognizing the need for resuscitation, 2) a lack of resources, 3)
facilitators who would enable them to introduce resuscitation, and 4)
solutions to the current problems. Resource shortages and barriers to
providing care included availability of staff, equipment, and supplies;
labor ward geography; ethical dilemmas; and the lack of standard protocols
regarding newborn resuscitation. Facilitators were professional experience
and the critical load of deliveries performed. Solutions to barriers
included small resource additions as well as long-term policy changes. With
standard policy and protocols, experienced, confident nurses could overcome
the barriers to providing newborn resuscitation. This group identified ways
to change systems to decrease infant mortality, thereby improving the
health and quality of life of women receiving care in Malawi.
Keywords: resuscitation; asphyxia neonatorum; neonatal mortality; infant;
newborn; international health; health care use; nurse-midwives; access to
health care; delivery of health care
Heribert Hofer, Marion L. East, Biological Conservation and Stress, In:

Anders Pape Mller, Manfred Milinski and Peter J.B. Slater, Editor(s),
Advances in the Study of Behavior, Academic Press, 1998, Volume 27, Pages
405-525, ISSN 0065-3454, ISBN 9780120045273, 10.1016/S0065-3454(08)60370-8.
Shannon K. de lEtoile, Infant behavioral responses to infant-directed

singing and other maternal interactions, Infant Behavior and Development,
10.1016/j.infbeh.2006.03.002.
Abstract: Seventy, 69-month-old infants were videotaped during six
interactions: mother sings assigned song, stranger sings assigned song,
mother sings song of choice, mother reads book, mother plays with toy, and
mother and infant listen to recorded music. Infant-directed (ID) singing
conditions elicited moderately positive cognitive behavior, low levels of
positive physical behavior and minimal amounts of vocal behaviors, mostly
negative. Across all conditions, cognitive scores remained positive at low
to moderate levels. Physical responses were most positive during book and
toy, most negative during recorded music, and differed by gender,
especially during ID singing. Vocally, infants responded positively to toy,
and 8-month-old infants vocalized more than younger infants, particularly
during ID singing conditions. ID singing appears just as effective as book
reading or toy play in sustaining infant attention and far more effective
than listening to recorded music, while interactions involving objects may
provide opportunity for shared attention.
Keywords: Infant-directed singing; Attachment; Sustained attention; Affect
regulation
Erin Kate Dooley, Robert L. Ringler Jr., Prenatal Care: Touching the
Future, Primary Care: Clinics in Office Practice, Volume 39, Issue 1, March
2012, Pages 17-37, ISSN 0095-4543, 10.1016/j.pop.2011.11.002.
Keywords: Antenatal; Prenatal; Pregnancy; Preconception; Testing and
screening; Patient education
Peter S. Kaplan, Christina M. Danko, Andres Diaz, Christina J. Kalinka, An

associative learning deficit in 1-year-old infants of depressed mothers:
Role of depression duration, Infant Behavior and Development, Volume 34,
10.1016/j.infbeh.2010.07.014.
Abstract: The effectiveness of infant-directed speech (IDS) produced by
non-depressed mothers for promoting the acquisition of voice-face
associations was investigated in 1-year-old children of depressed mothers
in a conditioned-attention paradigm. Prior research suggested that infants
of mothers with comparatively longer-duration depressive episodes exhibit
poorer learning in response to non-depressed mothers IDS, but duration of
depression was confounded with infant age. In the current study, 1-year-old
infants of currently depressed mothers with relatively longer-duration
depressive episodes (i.e., perinatal onset) showed significantly poorer
learning than 1-year-olds of currently depressed mothers with relatively
shorter duration depressive episodes (non-perinatal onset). This was true
despite the fact that there were no measurable differences in the severity
of depression, level of social functioning, or antidepressant medication
use between the two groups. These findings add support to the hypothesis
that there is an experience-based change in responsiveness to female IDS in
infants of depressed mothers during the first year of life.
Keywords: Chronic depression; Infant-directed speech; Infant associative
learning
Karin Christiani, Women's health: effect on morbidity and mortality in

pregnancy and birth, Midwifery, Volume 12, Issue 3, September 1996, Pages
113-119, ISSN 0266-6138, 10.1016/S0266-6138(96)90054-6.
Jessica L. Young, Peter R. Martin, Treatment of Opioid Dependence in the

Setting of Pregnancy, Psychiatric Clinics of North America, Volume 35,
Issue 2, June 2012, Pages 441-460, ISSN 0193-953X,
10.1016/j.psc.2012.03.008.
Keywords: Opioid dependence; Pregnancy; Addiction; Methadone; Buprenorphine
Richard P. Barth, An experimental evaluation of in-home child abuse

prevention services, Child Abuse & Neglect, Volume 15, Issue 4, 1991,
Pages 363-375, ISSN 0145-2134, 10.1016/0145-2134(91)90021-5.
Abstract: Perinatal child abuse prevention projects are rarely rigorously
evaluated. Women were referred to the Child Parent Enrichment Project
(CPEP) project during or just after pregnancy if identified as at-risk of
engaging in child abuse by community professionals. Clients were randomly
assigned to CPEP services (n = 97) or traditional community services (n =
94). CPEP services are based on ecological theory and involve six months of
home visiting by paraprofessional women and linkage to other formal and
informal community resources. No advantages on self-report measures for the
CPEP group were measured at posttest, and follow-up reports of child abuse
were similar for both groups. Consumer satisfaction indicates that clients
highly valued the program. Some indication of greater success with families
with less serious problems was observed. The results argue for caution
regarding the capacities of perinatal child abuse prevention services to
serve the high-risk clientele they often receive.
Keywords: Child abuse; Prevention; Home visiting; Paraprofessionals;
Perinatal
Robert Pattinson, Kate Kerber, Eckhart Buchmann, Ingrid K Friberg, Maria

Belizan, Sonia Lansky, Eva Weissman, Matthews Mathai, Igor Rudan, Neff
Walker, Joy E Lawn, for The Lancet's Stillbirths Series steering committee,
Stillbirths: how can health systems deliver for mothers and babies?, The
Lancet, Volume 377, Issue 9777, 713 May 2011, Pages 1610-1623, ISSN 0140-
6736, 10.1016/S0140-6736(10)62306-9.
Abstract: Summary
The causes of stillbirths are inseparable from the causes of maternal and
neonatal deaths. This report focuses on prevention of stillbirths by scale-
up of care for mothers and babies at the health-system level, with
consideration for effects and cost. In countries with high mortality rates,
emergency obstetric care has the greatest effect on maternal and neonatal
deaths, and on stillbirths. Syphilis detection and treatment is of moderate
effect but of lower cost and is highly feasible. Advanced antenatal care,
including induction for post-term pregnancies, and detection and management
of hypertensive disease, fetal growth restriction, and gestational
diabetes, will further reduce mortality, but at higher cost. These
interventions are best packaged and provided through linked service
delivery methods tailored to suit existing health-care systems. If 99%
coverage is reached in 68 priority countries by 2015, up to 11 million
(45%) third-trimester stillbirths, 201000 (54%) maternal deaths, and 14
million (43%) neonatal deaths could be saved per year at an additional
total cost of US$109 billion or $232 per person, which is in the range of
$096232 for other ingredients-based intervention packages with only
recurrent costs.
Marilyn J Essex, Marjorie H Klein, Eunsuk Cho, Ned H Kalin, Maternal stress
beginning in infancy may sensitize children to later stress exposure:
effects on cortisol and behavior, Biological Psychiatry, Volume 52, Issue
3223(02)01553-6.
Preclinical studies demonstrate that the neonatal environment can
permanently alter an individuals responses to stress. To demonstrate a
similar phenomenon in humans, we prospectively examined the relationships
of maternal stress beginning in infancy and concurrent stress on
preschoolers hypothalamic-pituitary-adrenal activity and later mental
health symptoms.
Methods
Salivary cortisol levels were assessed in 282 4.5-year-old children and 154
of their siblings. Maternal reports of stress were obtained when the
children were ages 1, 4, and 12 months, and again at 4.5 years. Childrens
mental health symptoms were assessed in first grade.
Results
A cross-sectional analysis revealed that preschoolers exposed to high
levels of concurrent maternal stress had elevated cortisol levels; however,
a longitudinal analysis revealed that concurrently stressed children with
elevated cortisol also had a history of high maternal stress exposure in
infancy. Importantly, children exposed only to high levels of concurrent or
early stress had cortisol levels that did not significantly differ from
those never exposed to stress. Further analysis of the components of stress
indicated that maternal depression beginning in infancy was the most potent
predictor of childrens cortisol. We also found that preschoolers with high
cortisol levels exhibited greater mental health symptoms in first grade.
Conclusions
These results link the findings of preclinical studies to humans by showing
that exposure to early maternal stress may sensitize childrens pituitary-
adrenal responses to subsequent stress exposure.
Keywords: Children; cortisol; mental health symptoms; maternal stress;
maternal depression; longitudinal
, Office of Technology AssessmentThe role of Federal agencies in

adolescent health, Journal of Adolescent Health, Volume 13, Issue 3, May
1992, Pages 183-235, ISSN 1054-139X, 10.1016/1054-139X(92)90094-R.
(http://www.sciencedirect.com/science/article/pii/1054139X9290094R)
T. Paul Schultz, Chapter 52 Population Policies, Fertility, Women's Human

Capital, and Child Quality, In: T. Paul Schultz and John A. Strauss,
Editor(s), Handbook of Development Economics, Elsevier, 2007, Volume 4,
Pages 3249-3303, ISSN 1573-4471, ISBN 9780444531001, 10.1016/S1573-
4471(07)04052-1.
Abstract: Population policies are defined here as voluntary programs which
help people control their fertility and expect to improve their lives.
There are few studies of the long-run effects of policy-induced changes in
fertility on the welfare of women, such as policies that subsidize the
diffusion and use of best practice birth control technologies. Evaluation
of the consequences of such family planning programs almost never assess
their long-run consequences, such as on labor supply, savings, or
investment in the human capital of children, although they occasionally
estimate the short-run association with the adoption of contraception or
age-specific fertility. The dearth of long-run family planning experiments
has led economists to consider instrumental variables as a substitute for
policy interventions which not only determine variation in fertility but
are arguably independent of the reproductive preferences of parents or
unobserved constraints that might influence family life cycle behaviors.
Using these instrumental variables to estimate the effect of this exogenous
variation in fertility on family outcomes, economists discover these cross
effects of fertility on family welfare outcomes tend to be substantially
smaller in absolute magnitude than the OLS estimates of partial
correlations referred to in the literature as evidence of the beneficial
social externalities associated with the policies that reduce fertility.
The paper summarizes critically the empirical literature on fertility and
development and proposes an agenda for research on the topic.
Keywords: consequences of fertility decline; child quality; evaluation of
population policies
Ellen M. Szwajcer, Gerrit J. Hiddink, Maria A. Koelen, Cees M.J. van

Woerkum, Written nutrition communication in midwifery practice: What
purpose does it serve?, Midwifery, Volume 25, Issue 5, October 2009, Pages
509-517, ISSN 0266-6138, 10.1016/j.midw.2007.10.005.
Abstract: Objective
to obtain an in-depth understanding of verbal and written nutrition
communication in Dutch midwifery practice.
Design, setting and participants
data were collected by recording 12 initial antenatal consultations (12
weeks into the pregnancy) with primiparous women from four Dutch midwifery
practices spread over The Netherlands, followed by two semi-structured
qualitative interviews with the women. The interviews were undertaken on
the day after the consultation and two weeks later.
Findings
analysis of the recordings revealed that a nutrition brochure was offered
in an information pack, but it was not used or referred to by the midwives.
Verbally, clients were informed about healthy nutrition in general terms.
Specific, personally relevant nutrition-related questions and motivators of
nutrition behaviour were rarely clarified and addressed. Midwives tried to
create a good relationship with their clients by being friendly,
complimentary, confirmative and supportive. Women appreciated talking about
nutrition with the midwife because of her expertise. The subsequent
interviews with the women revealed, however, that nutrition communication
took place relatively late in pregnancy at a point when women were more
interested in hearing the baby's heart beat. Furthermore, clients seldom
looked through the nutrition brochure at home.
Key conclusion
the provision of a nutrition brochure does not serve any real purpose.
to reach optimal synergy between verbal and written nutrition communication
in midwifery practice, midwives should actively refer to a nutrition
brochure in addition to verbal communication. Moreover, health
organisations should realise that the provision of nutrition brochures to
midwives does not mean that these brochures will be used as an integral
part of midwives nutrition communication with clients.
Keywords: Midwife; Pregnancy; Nutrition communication; Brochures
Elias F. Melo Jr., Jos G. Cecatti, Rodolfo C. Pacagnella, Debora F.B.

Leite, Daniel E. Vulcani, Maria Y. Makuch, The prevalence of perinatal
depression and its associated factors in two different settings in Brazil,
Journal of Affective Disorders, Volume 136, Issue 3, February 2012, Pages
1204-1208, ISSN 0165-0327, 10.1016/j.jad.2011.11.023.
The prevalence of antepartum and postpartum depression (PPD) and its
association with certain risk factors was evaluated.
Method
The Edinburgh Postnatal Depression Scale (EPDS) was applied and
sociodemographic data was obtained at the beginning of the third trimester
of pregnancy and at 46 weeks postpartum.
Results
The prevalence of depression was 24.3% during pregnancy (n = 600
women) and 10.8% in the postpartum period (n = 555). The factors
independently associated with antepartum depression were the absence of a
partner (PRadj 1.93; 95%CI: 1.442.58), a lower socioeconomic class (1.75;
1.182.60), being non-white (1.48; 1.092.01) and multiparity (1.32; 1.01
1.74). For postpartum depression, the factors were the occurrence of
psychological violence (PRadj 3.31; 95%CI: 2.025.43), use of alcohol
during pregnancy (2.14; 1.333.45), being non-white (1.85; 1.113.08) and
physical violence (2.14; 1.134.08). The sensitivity of depression during
pregnancy as a predictor of PPD was 75%, while specificity was 81%. There
were no differences between the two settings.
Limitations
EDPS does not diagnose depression and as a screening instrument it could
overestimate the true prevalence of depression.
Conclusions
The use of the EPDS instrument during pregnancy would allow a screening for
identifying women at higher risk of developing PPD and then a proposal of
specific interventions to manage this condition. Postpartum depression was
prevalent in around 10% of the women and was associated with unfavorable
sociodemographic conditions including the use of alcohol and with the
occurrence of psychological and physical violence.
Keywords: Depression; High-risk pregnancy; Postpartum; Risk factors
Mona Sharan, Saifuddin Ahmed, Mismay Ghebrehiwet, Khama Rogo, The quality
of the maternal health system in Eritrea, International Journal of
Gynecology & Obstetrics, Volume 115, Issue 3, December 2011, Pages 244-
250, ISSN 0020-7292, 10.1016/j.ijgo.2011.07.025.
Abstract: AbstractObjective
To examine the quality of the maternal health system in Eritrea to
understand system deficiencies and its relevance to maternal mortality
within the context of Millennium Development Goal (MDG) 5.
Methods
A sample of 118 health facilities was surveyed. Data were collected on 5
dimensions of health system quality: availability; accessibility;
management; infrastructure; and process indicators. Data on the causes of
hospital admissions for obstetric patients and maternal deaths were
extracted from medical records.
Results
Eritrea has only 11 comprehensive emergency obstetric care (CEmOC)
facilities, all of which are grossly understaffed. There is considerable
pressure on the infrastructure and health providers at hospitals.
Compliance with clinical care standards and availability of supplies were
optimal. As a result, the case fatality rate of 0.65% was low. In total,
45.6% of obstetric admissions and 19.5% of maternal deaths were attributed
to abortion complications.
Conclusion
In Eritrea, critical gaps in the health systemespecially those related to
human resourceswill impede progress toward MDG 5, and it will not be
possible to reduce maternal mortality without addressing the high burden of
abortion.
Keywords: Eritrea; Health system; Obstetric care; Quality
MARTIN T. STEIN, CHAPTER 27 - Strategies to Enhance Developmental and

Behavioral Services in Primary Care, In: Mark L. Wolraich, MD, Dennis D.
Drotar, PhD, Paul H. Dworkin, MD, and Ellen C. Perrin, MA, MD, Editor(s),
Developmental-Behavioral Pediatrics, Mosby, Philadelphia, 2008, Pages 887-
903, ISBN 9780323040259, 10.1016/B978-0-323-04025-9.50030-1.
Walter L. Larimore, Matthew K. Cline, KEEPING NORMAL LABOR NORMAL, Primary

Care: Clinics in Office Practice, Volume 27, Issue 1, 1 March 2000, Pages
221-236, ISSN 0095-4543, 10.1016/S0095-4543(05)70157-3.
Miriam Stewart, Graham Reid, Colin Mangham, Fostering children's

resilience, Journal of Pediatric Nursing, Volume 12, Issue 1, February
1997, Pages 21-31, ISSN 0882-5963, 10.1016/S0882-5963(97)80018-8.
Abstract: Resilience is relevant to nurses because of its implications for
health. Research on the resilience of children and adolescents
hasproliferated over the past five years. However, the specific processes
underlying resilience and outcome variables require further study.
Furthermore, few intervention studies have been conducted. This article
describes resilience and factors that influence resilience of children,
examines the relationship between resilience and health, identifies
interventions that foster children's resilience and health, reviews
research focusing on children's resilience, and suggests the relevance of
resilience to nursing of children.
Vincenzo Berghella, Jason K. Baxter, Suneet P. Chauhan, Evidence-based

labor and delivery management, American Journal of Obstetrics and
Gynecology, Volume 199, Issue 5, November 2008, Pages 445-454, ISSN 0002-
9378, 10.1016/j.ajog.2008.06.093.
Abstract: Our objective was to provide evidence-based guidance for
managment decisions during labor and delivery. We performed MEDLINE,
PubMed, and COCHRANE searches with the terms labor, delivery, pregnancy,
randomized trials, plus each management aspect of labor and delivery (eg,
early admission). Each management step of labor and delivery was reviewed
separately. Evidence-based good quality data favor hospital births, delayed
admission, support by doula, training birth assistants in developing
countries, and upright position in the second stage. Home-like births,
enema, shaving, routine vaginal irrigation, early amniotomy, hands-on
method, fundal pressure, and episiotomy can be associated with
complications without sufficient benefits and should probably be avoided.
We conclude that labor and delivery interventions supported by good quality
data as just described should be routinely performed. All aspects with
lower data quality should be researched with adequately powered and
designed trials.
Keywords: delivery; evidence-based; labor
Robert N. Emde, Craig Brown, Adaptation to the Birth of a Down's Syndrome

Infant: Grieving and Maternal Attachment, Journal of the American Academy
of Child Psychiatry, Volume 17, Issue 2, Spring 1978, Pages 299-323, ISSN
0002-7138, 10.1016/S0002-7138(10)60094-5.
Abstract: Six cases, involving family adaptation to a Down's syndrome
birth, illustrate variations in the countermovement between processes of
parental grieving for a fantasied normal infant and attachment to a real
handicapped infant. After initial grieving, there is likely to be some
affective denial of disability, with a second wave of grieving inaugurated
by a social smile which is dampened and by eye-to-eye contact which is less
than expected. Implications for intervention are especially important in
the light of our changing attitudes toward home care of the retarded.
Muriel Walshe, Colm McDonald, Jane Boydell, Jing Hua Zhao, Eugenia
Kravariti, Timothea Touloupoulou, Paul Fearon, Elvira Bramon, Robin M.
Murray, Matthew Allin, Long-term maternal recall of obstetric complications
in schizophrenia research, Psychiatry Research, Volume 187, Issue 3, 30 May
2011, Pages 335-340, ISSN 0165-1781, 10.1016/j.psychres.2011.01.013.
Abstract: Obstetric complications (OCs) are consistently implicated in the
aetiology of schizophrenia. Information about OCs is often gathered
retrospectively, from maternal interview. It has been suggested that
mothers of people with schizophrenia may not be accurate in their
recollection of obstetric events. We assessed the validity of long term
maternal recall by comparing maternal ratings of OCs with those obtained
from medical records in a sample of mothers of offspring affected and
unaffected with psychotic illness. Obstetric records were retrieved for 30
subjects affected with psychosis and 40 of their unaffected relatives. The
Lewis-Murray scale of OCs was completed by maternal interview for each
subject blind to the obstetric records. There was substantial agreement
between maternal recall and birth records for the summary score of
definite OCs, birth weight, and most of the individual items rated, with
the exception of antepartum haemorrhage. There were no significant
differences in the validity of recall or in errors of commission by mothers
for affected and unaffected offspring. These findings indicate that several
complications of pregnancy and delivery are accurately recalled by mother's
decades after they occurred. Furthermore, there is no indication that
mothers are less accurate in recalling OCs for their affected offspring
than their unaffected offspring. When comparing women with and without
recall errors, we found those with recall errors to have significantly
worse verbal memory than women without such errors. Assessing the cognition
of participants in retrospective studies may allow future studies to
increase the reliability of their data.
Keywords: Obstetric complications; Maternal report; Medical records;
Schizophrenia
Sheila Hill Parker, 46 - Nutrition, Weight, and Body Image, In: Marlene B.
Goldman and Maureen C. Hatch, Editor(s), Women and Health, Academic Press,
San Diego, 2000, Pages 578-588, ISBN 9780122881459, 10.1016/B978-012288145-
9/50053-X.
Abstract: The 1990s have brought an explosion of health information and a
variety of products to the public, requiring greater awareness,
intelligence, and vigilance among the general public and health care
professionals to determine what is truly healthy and nutritious. The
health professions, manufacturers, food establishments, fitness centers,
and the media are all promoting their often conflicting and confusing
messages about what the terms healthy and nutritious mean. Along with
these messages come the images of the right size and shape of the healthy
American woman: the extremely thin woman whose food behavior and intake
often counters the accepted scientifically based recommendations for a
balanced dietary pattern [1]. Unfortunately, many American women are more
accepting of the social and media-generated image of the ideal American
woman rather than the ideal dietary pattern for health maintenance and the
prevention of chronic diseases.
Christopher T. Lang, Jeffrey C. King, Maternal mortality in the United

States, Best Practice & Research Clinical Obstetrics & Gynaecology,
10.1016/j.bpobgyn.2007.10.004.
Abstract: Despite a significant improvement in the US maternal mortality
ratio since the early 1900s, it still represents a substantial and
frustrating burden, particularly given the fact that essentially no
progress has been made in most US States since 1982. Additionally, the US
Centers for Disease Control and Prevention has stated that most cases are
probably preventable. Two disheartening issues within this topic include a
gross underestimation of the magnitude of maternal mortality particularly
before 1987, but which likely persists to a lesser degree today and the
continued significant racial disparity in maternal mortality. Explanations
for the plateau in maternal mortality include the recent trend of delayed
childbearing, with the potential accompanying complications associated with
older reproductive age (particularly over 35 years) and multiparity. The
impressive increase in multifetal pregnancies related to delayed
childbearing and assisted reproductive technology also plays a role.
Finally, peripartum cardiomyopathy has become an increasingly recognized
source of maternal mortality. Pregnancy-related mortality is largely
accounted for by thromboembolic disease, hemorrhage, hypertension and its
associated complications, and infection. However, since the inclusion of
maternal deaths occurring after 42 days post-delivery as pregnancy related,
traumatic injuries including homicides and suicides are an alarming
source of maternal mortality. An especially important contemporary issue to
consider within this topic is cesarean delivery on maternal request,
opponents of which cite concerns not only for immediate morbidity and
mortality increased over that associated with a vaginal birth, but also for
potential morbidity and mortality associated with future pregnancies. One
particularly appealing opportunity to reduce maternal mortality is to
recognize, examine, and learn from so-called near-miss cases.
Keywords: AfricanAmericans; cardiomyopathies; cesarean section; homicide;
maternal mortality; parity; pregnancy complications; suicide; twins; United
States
Lynn P Freedman, Wendy J Graham, Ellen Brazier, Jeffrey M Smith, Tim Ensor,
Vincent Fauveau, Ellen Themmen, Sheena Currie, Koki Agarwal, Practical
lessons from global safe motherhood initiatives: time for a new focus on
implementation, The Lancet, Volume 370, Issue 9595, 1319 October 2007,
Pages 1383-1391, ISSN 0140-6736, 10.1016/S0140-6736(07)61581-5.
Abstract: Summary
The time is right to shift the focus of the global maternal health
community to the challenges of effective implementation of services within
districts. 20 years after the launch of the Safe Motherhood Initiative, the
community has reached a broad consensus about priority interventions,
incorporated these interventions into national policy documents, and
organised globally in coalition with the newborn and child health
communities. With changes in policy processes to emphasise country
ownership, funding harmonisation, and results-based financing, the capacity
of countries to implement services urgently needs to be strengthened. In
this article, four global maternal health initiatives draw on their
complementary experiences to identify a set of the central lessons on which
to build a new, collaborative effort to implement equitable, sustainable
maternal health services at scale. This implementation effort should focus
on specific steps for strengthening the capacity of the district health
system to convert inputs into functioning services that are accessible to
and used by all segments of the population.
Susan Purdin, Tila Khan, Roxanne Saucier, Reducing maternal mortality among
Afghan refugees in Pakistan, International Journal of Gynecology &
Obstetrics, Volume 105, Issue 1, April 2009, Pages 82-85, ISSN 0020-7292,
10.1016/j.ijgo.2008.12.021.
Abstract: Objective
The International Rescue Committee (IRC) strove to reduce maternal
mortality among Afghan refugees in Hangu district of Pakistan by improving
access to emergency obstetric care (EmOC), community knowledge of danger
signs of pregnancy, and the use of health information.
Methods
IRC established EmOC centers, trained community members on safe motherhood,
linked primary health care with education on danger signs of pregnancy and
the importance of skilled attendance, and improved the health information
system.
Results
The maternal mortality ratio among Afghan refugees in the area improved
from 291 per 100 000 live births in 2000 to 102 per 100 000 live
births in 2004. The proportion of refugee births attended by skilled staff
increased from 5% in 1996 to 67% in 2007. Complete prenatal care coverage
increased from 49% in 2000 to 90% in 2006, and postnatal coverage more than
trebled from 27% in 2000 to 85% in 2006.
Conclusion
Improved services, community involvement and education, good coordination,
and effective systems succeeded in reducing maternal mortality in a
traditionally conservative environment.
Keywords: Emergency obstetric care; Community participation; Maternal
mortality; Pakistan; Refugee reproductive health
Christine Dehlendorf, Maria Isabel Rodriguez, Kira Levy, Sonya Borrero,

Jody Steinauer, Disparities in family planning, American Journal of
Obstetrics and Gynecology, Volume 202, Issue 3, March 2010, Pages 214-220,
ISSN 0002-9378, 10.1016/j.ajog.2009.08.022.
Abstract: Prominent racial/ethnic and socioeconomic disparities in rates of
unintended pregnancy, abortion, and unintended births exist in the United
States. These disparities can contribute to the cycle of disadvantage
experienced by specific demographic groups when women are unable to control
their fertility as desired. In this review we consider 3 factors that
contribute to disparities in family planning outcomes: patient preferences
and behaviors, health care system factors, and provider-related factors.
Through addressing barriers to access to family planning services,
including abortion and contraception, and working to ensure that all women
receive patient-centered reproductive health care, health care providers
and policy makers can substantially improve the ability of women from all
racial/ethnic and socioeconomic backgrounds to make informed decisions
about their fertility.
Keywords: abortion; contraception; family planning; health disparities;
unintended pregnancy
Benedict Weobong, Bright Akpalu, Victor Doku, Seth Owusu-Agyei, Lisa Hurt,
Betty Kirkwood, Martin Prince, The comparative validity of screening scales
for postnatal common mental disorder in Kintampo, Ghana, Journal of
Affective Disorders, Volume 113, Issues 12, February 2009, Pages 109-117,
ISSN 0165-0327, 10.1016/j.jad.2008.05.009.
There have been few attempts formally to validate screening measures for
postnatal common mental disorder in low income country settings. We have
investigated the comparative validity of three different screening
approaches in a community-based study in Kintampo, Ghana.
Method
160 women aged 1545 years, and 511 weeks postpartum were first screened
using the Self-Report Questionnaire (SRQ-20), with oversampling of higher
scorers. The other test assessments were the Edinburgh Postnatal Depression
Scale (EPDS) and the Patient Health Questionnaire (PHQ-9). Criterion
validity was measured against the Comprehensive Psychopathological Rating
Scale (CPRS), and concurrent validity against the WHO Disability Assessment
Schedule. A sub-sample (n = 40) was re-interviewed 2 weeks later
for testretest reliability.
Results
Internal consistency (Cronbach's Alpha) was equivalent across all three
test scales; EPDS (0.79), SRQ-20 (0.78) and PHQ-9 (0.79). Testretest
reliability was better for PHQ-9 (ICC 0.75) than for the EPDS (0.51). For
criterion validity the PHQ-9 (AUROC 0.90 (0.810.98)), was superior to the
SRQ-20 (0.74 (0.620.86)) and the EPDS ((0.84 (0.760.92). Youden's Index
was also superior for PHQ-9. Item analysis revealed that a mixture of
somatic and cognitive symptoms best discriminated between cases and non-
cases for all three scales.
Limitations
Inability to ascertain inter-rater reliability, order effects and possible
loss of technical equivalence due to item modifications.
Conclusions
The evidence for the validity, reliability, and superiority of the PHQ-9
over other screening assessments has been extended. The PHQ-9 is short,
easy to administer and acceptable to a largely illiterate population of
Ghanaian women, 5 to 11 weeks post partum.
Keywords: Postpartum depression; Common mental disorder; Validity;
Reliability; PHQ-9
Christina S. Meade, Jeannette R. Ickovics, Systematic review of sexual risk

among pregnant and mothering teens in the USA: pregnancy as an opportunity
for integrated prevention of STD and repeat pregnancy, Social Science &
Medicine, Volume 60, Issue 4, February 2005, Pages 661-678, ISSN 0277-9536,
10.1016/j.socscimed.2004.06.015.
Abstract: Behaviors that lead to teen pregnancy also place young women at
risk for STDs and repeat pregnancy. Compared to the broad literature on
adolescent sexual risk behavior, our understanding of sexual risk in
pregnant/mothering teens lags far behind. Primary objectives of this
systematic review (19812003) of pregnant/mothering teens were to: (1)
document rates of STD, repeat pregnancy, condom use, and contraception; (2)
identify correlates of these biological and behavioral outcomes; (3) review
sexual risk reduction interventions; and (4) discuss directions for future
research and implications for clinical care. Fifty-one studies met
inclusion criteria. Rates of STD and repeat pregnancy were high, with the
majority of teens engaging in unprotected sex during and after pregnancy.
An Ecological Model of Sexual Risk, based on Bronfenbrenner's (1989)
Ecological Systems Theory, was proposed to organize findings on correlates
of sexual risk. Improvements in research, including integration of outcomes
and risk factors, stronger methodologies, and standardized assessments, are
essential. Results suggest that teen pregnancy is a marker for future
sexual risk behavior and adverse outcomes, and that pregnant/mothering
teens need hybrid interventions promoting dual use of condoms and hormonal
contraception. Pregnancy may provide a critical window of opportunity for
sexual risk reduction.
Keywords: Teen mothers; Pregnant teens; Sexual risk behavior; STD; Repeat
pregnancy; Review; USA
Lynn Sibley, Sandra Tebben Buffington, Lelisse Tedessa Sr, Kathryn McNatt,
Home-Based Life Saving Skills in Ethiopia: An Update on the Second Phase of
Field Testing, Journal of Midwifery & Women's Health, Volume 51, Issue
10.1016/j.jmwh.2005.10.015.
Abstract: Home-Based Life Saving Skills (HBLSS) was integrated over 3 years
into a district-level child survival project coordinated through the
Ministry of Health and Save the Children Foundation/US in Liben Woreda,
Guji Zone, Oromia Region, southern Ethiopia. During late 2004, the second
phase of the program was reviewed for performance, home-based management,
learning transfer, and program coverage. The immediate posttraining
performance score for HBLSS guides for First Actions was 87% (a 78%
increase over the pretraining baseline) and 79% at 1 year (a 9% decrease
from the immediate posttraining score). The home-based management score of
women attended by HBLSS guides for First Actions was 89%, compared to 32%
for women assisted by other unskilled attendants. HBLSS guides teach women
and families in the community as they were taught, by using pictorial Take
Action Cards, role-play and demonstration, and a variety of venues.
Estimates of HBLSS coverage suggest that HBLSS guides attended 24% to 26%
of births, and 54% of women giving birth were exposed to HBLSS training.
The HBLSS field tests demonstrate a promising program that increases access
to basic care for poor, underserved, rural populations who carry the
greatest burden of maternal and neonatal mortality.
Keywords: emergency obstetric care; home-based care; maternal mortality;
neonatal mortality; Ethiopia
Hally McCrea, Marion E. Wright, Maurice Stringer, Psychosocial factors

influencing personal control in pain relief, International Journal of
Nursing Studies, Volume 37, Issue 6, 1 December 2000, Pages 493-503, ISSN
0020-7489, 10.1016/S0020-7489(00)00029-8.
Abstract: A questionnaire was administered to 100 women (50 primigravidae,
50 multigravidae) to investigate the influence of psychosocial factors on
personal control in pain relief. Personal control was measured using a 36-
item scale based on the concept of Rule. The women were asked to rate
each rule on a 7-point Likert scale. Measures of psychosocial factors
included assessment of the womens expectations of labour pain, maternal
confidence, pain intensity, antenatal training and partner support.
Demographic variables including parity were also recorded. The
questionnaires were completed prior to and within 48 h following the
womens delivery (whilst they were inpatients on the postnatal ward).
Two variables, antenatal training and pain intensity, emerged as predictors

of personal control in pain relief following stepwise multiple regression
analysis. These findings have implications for clinical practice
particularly in the area of antenatal care and planning care during labour.
Keywords: Labour pain; Personal control; Antenatal training; Pain intensity
Katherine J. Gold, Martha E. Boggs, Emeline Mugisha, Christie Lancaster

Palladino, Internet Message Boards for Pregnancy Loss: Whos On-Line and
Why?, Women's Health Issues, Volume 22, Issue 1, JanuaryFebruary 2012,
Pages e67-e72, ISSN 1049-3867, 10.1016/j.whi.2011.07.006.
Pregnancy loss is common, but its significance is often minimized by
family, friends, and the community, leaving bereaved parents with unmet
need for support. This study sought to describe demographics, usage
patterns, and perceived benefits for women participating in Internet
pregnancy loss support groups.
Methods
We requested permission to post an anonymous Internet survey on large and
active United States Internet message boards for women with miscarriages
and stillbirths. The study purposefully oversampled stillbirth sites and
included both closed- and open-ended questions. The University of Michigan
Institutional Review Board approved the study. Closed-ended questions were
summarized and evaluated with bivariate analysis. We performed a
qualitative analysis of open-ended data using an iterative coding process
to identify key themes.
Results
Of 62 sites queried, 15 granted permission to post the survey on 18
different message boards. We collected 1,039 surveys, of which 1,006 were
complete and eligible for analysis. Women were typically white, well
educated, and frequent users. They noted message boards helped them to feel
less isolated in their loss and grief and they appreciated unique aspects
of Internet communication such as convenience, access, anonymity, and
privacy. Pregnancy loss message boards are an important aspect of support
for many bereaved mothers. African-American women seem to be substantially
underrepresented on-line despite being at higher risk for stillbirth.
Conclusion
Internet message boards serve a unique function in providing support for
women with miscarriage and stillbirth. The benefits are often significantly
different from those encountered in traditional face-to-face bereavement
support.
Michael A Friedman, Alan R Spitzer, Discharge criteria for the term

newborn, Pediatric Clinics of North America, Volume 51, Issue 3, June 2004,
Pages 599-618, ISSN 0031-3955, 10.1016/j.pcl.2004.01.011.
Nelly Aguilera, Grecia M. Marrufo, Can better infrastructure and quality

reduce hospital infant mortality rates in Mexico?, Health Policy, Volume
80, Issue 2, February 2007, Pages 239-252, ISSN 0168-8510,
10.1016/j.healthpol.2006.03.003.
Abstract: Preliminary evidence from hospital discharges hints enormous
disparities in infant hospital mortality rates. At the same time, public
health agencies acknowledge severe deficiencies and variations in the
quality of medical services across public hospitals. Despite these
concerns, there is limited evidence of the contribution of hospital
infrastructure and quality in explaining variations in outcomes among those
who have access to medical services provided at public hospitals. This
paper provides evidence to address this question. We use probabilistic
econometric methods to estimate the impact of material and human resources
and hospital quality on the probability that an infant dies controlling for
socioeconomic, maternal and reproductive risk factors. As a measure of
quality, we calculate for the first time for Mexico patient safety
indicators developed by the AHRQ. We find that the probability to die is
affected by hospital infrastructure and by quality. In this last regard,
having been treated in a hospital with the worse quality incidence doubles
the probability to die. This paper also presents evidence on the
contribution of other risk factors on perinatal mortality rates. The
conclusions of this paper suggest that lower infant mortality rates can be
reached by implementing a set of coherent public policy actions including
an increase and reorganization of hospital infrastructure, quality
improvement, and increasing demand for health by poor families.
Keywords: Hospital infrastructure and quality; Infant mortality rates;
Mexico
Leslie B. Marshall, Jean A. Lakin, Antenatal health care policy, services

and clients in urban Papua New Guinea, International Journal of Nursing
Studies, Volume 21, Issue 1, 1984, Pages 19-34, ISSN 0020-7489,
10.1016/0020-7489(84)90004-X.
A. Alisjahbana, C. Williams, R. Dharmayanti, D. Hermawan, B.E. Kwast, M.
Koblinsky, An integrated village maternity service to improve referral
patterns in a rural area in West-Java, International Journal of Gynecology
& Obstetrics, Volume 48, Supplement, June 1995, Pages S83-S94, ISSN
0020-7292, 10.1016/0020-7292(95)02323-5.
Abstract: The Regionalization of Perinatal Care, an intervention study
carried out in Tanjungsari, a subdistrict in rural West Java, aimed to
develop a comprehensive maternal health program to improve maternal and
perinatal health outcomes. The main inputs included training at all levels
of the health care system (informal and formal) and the establishment of
birthing homes in villages to make services more accessible. Special
attention was given to referral, transportation, communication and
appropriate case management, A social marketing program was conducted to
inform people of the accessible birthing homes for clean delivery, located
near the women, and with better transportation and communications to
referral facilities should complications arise. The study design was
longitudinal, following all pregnant women from early pregnancy until 42
days postpartum in an intervention and a comparison area. The population
was 90 000 in the intervention area and 40 000 in the comparison area.
Inclusion criteria were all mother and infant units delivered between June
1st, 1992 and May 31st, 1993.
Analysis showed the following results:

Most women sought antenatal care (>95%). In Tanjungsari, nearly 90%
sought such care from professional providers as versus 75% in the control
area of Cisalak.
Most women with bleeding or bleeding and edema during pregnancy sought
professional assistance in both the study and control areas. However, fever
for more than 3 days received more attention in the study area versus
control area (93 vs. 69%).
Greater than 85% of deliveries in both areas were conducted by TBAs.

However, in the study area, nearly one-third of those with intrapartum
complications (17%) delivered in a health facility compared to one-tenth in
the control area. This meant a hospital delivery, primarily with assistance
of a doctor or doctor/midwife combination.
Overall referral rates by TBAs were low 13% of women with complications in
Tanjungsari and 6% in Cisalak. More women with intrapartum complications
were referred in the study area than in the control, and more complied when
referred.
Women who suffered intrapartum complications were more likely to have a

perinatal death. Perinatal deaths declined in Tanjungsari, but not
significantly. However, the trend over the period of the intervention shows
an improvement in the deliveries managed by TBAs with more deaths resulting
in the hands of professionals. Either
J. Kevin Nugent, Yvette Blanchard, Jane E. Stewart, Chapter 11 - Supporting

Parents of Premature Infants: An Infant-Focused, Family-Centered Approach,
In: Dara Brodsky, MD, and Mary Ann Ouellette, MS, APRIM, IBCLC, Editor(s),
Primary Care of the Premature Infant, W.B. Saunders, Philadelphia, 2008,
Pages 255-267, ISBN 9781416000396, 10.1016/B978-1-4160-0039-6.50035-5.
, September 2011 New in Review, Journal of the American Dietetic

Association, Volume 111, Issue 9, September 2011, Pages
1419,1420,1421,1423,1425,1427,1428, ISSN 0002-8223,
10.1016/j.jada.2011.07.028.
Judith S. Gooding, Liza G. Cooper, Arianna I. Blaine, Linda S. Franck,

Jennifer L. Howse, Scott D. Berns, Family Support and Family-Centered Care
in the Neonatal Intensive Care Unit: Origins, Advances, Impact, Seminars in
Perinatology, Volume 35, Issue 1, February 2011, Pages 20-28, ISSN 0146-
0005, 10.1053/j.semperi.2010.10.004.
Abstract: Family-centered care (FCC) has been increasingly emphasized as an
important and necessary element of neonatal intensive care. FCC is
conceptualized as a philosophy with a set of guiding principles, as well as
a cohort of programs, services, and practices that many hospitals have
embraced. Several factors drive the pressing need for family-centered care
and support of families of infants in NICUs, including the increase in the
number of infants in NICUs; growth in diversity of the population and their
concurrent needs; identification of parental and familial stress and lack
of parenting confidence; and gaps in support for families, as identified by
parents and NICU staff. We explore the origins of and advances in FCC in
the NICU and identify various delivery methods and aspects of FCC and
family support in the NICU. We examine the research and available evidence
supporting FCC in the NICU and offer recommendations for increased
dissemination and for future study.
Keywords: family-centered care; FCC; NICU; family support
Audrey M. Pottinger, Helen Trotman-Edwards, Novie Younger, Detecting

depression during pregnancy and associated lifestyle practices and concerns
among women in a hospital-based obstetric clinic in Jamaica, General
Hospital Psychiatry, Volume 31, Issue 3, MayJune 2009, Pages 254-261, ISSN
0163-8343, 10.1016/j.genhosppsych.2009.02.002.
Abstract: Objective
Antenatal depression, despite its association with increased maternal
morbidity risks, is understudied in the developing world. We determined the
rate and predictors of depression throughout pregnancy and the use of
medication in women attending an obstetric clinic.
Method
Prospective longitudinal study of 452 women newly registered at the
antenatal clinic at the University Hospital of the West Indies between
September 2005 and February 2006. Sociodemographic data, clinical
information and self reports of depression using Edinburgh Postnatal
Depression Scale (EPDS) were gathered over three trimesters.
Results
On average, 25% of women were identified as having a probable depressive
disorder over the three trimesters. Independent demographic predictors were
youth and unemployment (P<05). Planned pregnancy, exercising, not
smoking, being married and support from physician and family were
protective factors (P<.05). Using a multivariable model, prior history
of depression was the strongest predictor of depression during pregnancy.
Of those taking medication for depression prior to pregnancy, only 1.6%
remained on medication during the pregnancy.
Conclusions
Poverty-related factors and lifestyle are associated with higher EPDS
scores during pregnancy in Jamaican women. A protocol of psychosocial
management in obstetric care is discussed along with recommendations for
future research.
Keywords: Antenatal depression; Lifestyle practices; Medication use;
Psychosocial interventions; Jamaican women
Juliawati Untoro, Arnold Timmer, Werner Schultink, The challenges of iodine

supplementation: a public health programme perspective, Best Practice &
Research Clinical Endocrinology & Metabolism, Volume 24, Issue 1,
February 2010, Pages 89-99, ISSN 1521-690X, 10.1016/j.beem.2009.08.011.
Abstract: An adequate iodine intake during pregnancy, lactation and early
childhood is particularly critical for optimal brain development of the
foetus and of children 724 months of age. While the primary strategy for
sustainable elimination of iodine deficiency remains universal salt
iodisation, the World Health Organization and the United Nations Children's
Fund recommend a complementary strategy of iodine supplements as a
temporary measure when salt iodisation could not be implemented. This
article aims to review current evidence on efficacy and implications of
implementing iodine supplementation as a public health measure to address
iodine deficiency. Iodine supplementation seems unlikely to reach high
coverage in a rapid, equitable and sustained way. Implementing the
programme requires political commitment, effective and efficient supply,
distribution and targeting, continuous education and communication and a
robust monitoring system. Thus, universal salt iodisation should remain the
primary strategy to eliminate iodine deficiency.
Keywords: iodine deficiency disorders (IDDs); iodised oil supplementation;
iodine supplementation; universal salt iodisation (USI); iodised salt
Lisa J. Moran, Jodie Dodd, Victoria Nisenblat, Robert J. Norman, Obesity

and Reproductive Dysfunction in Women, Endocrinology & Metabolism
Clinics of North America, Volume 40, Issue 4, December 2011, Pages 895-906,
ISSN 0889-8529, 10.1016/j.ecl.2011.08.006.
Keywords: Obesity; Fertility; Pregnancy; Polycystic ovary syndrome
Jacqueline E. Monaco, Orthopedic considerations in pregnancy, Primary Care

Update for OB/GYNS, Volume 3, Issue 6, NovemberDecember 1996, Pages 197-
200, ISSN 1068-607X, 10.1016/S1068-607X(96)00027-3.
Abstract: Almost all pregnant women experience musculoskeletal discomfort
during pregnancy, with a good portion of them suffering from severe
disability. The purpose of this article is to review normal physiologic
musculoskeletal changes of pregnancy and distinguish them from pathological
conditions. This article also will offer solutions to reduce patient pain
or discomfort and call attention to some serious conditions that must not
be over-looked. A review of the literature was done using the MEDLINE
database from 19851995. Articles regarding low back pain, carpal tunnel
syndrome, DeQuervain's tenosynovitis, aseptic necrosis of the femoral head,
transient osteoporosis of the hip, and rupture of the symphysis pubis were
reviewed. From the data, the author provides information concerning these
conditions, identifies patients at risk, and advises obstetricians on how
to take a more active role in treatment, and thereby improve pregnant
patient's quality of life.
Dmitry M. Davydov, Robert Stewart, Karen Ritchie, Isabelle Chaudieu,

Resilience and mental health, Clinical Psychology Review, Volume 30, Issue
5, July 2010, Pages 479-495, ISSN 0272-7358, 10.1016/j.cpr.2010.03.003.
Abstract: The relationship between disease and good health has received
relatively little attention in mental health. Resilience can be viewed as a
defence mechanism, which enables people to thrive in the face of adversity
and improving resilience may be an important target for treatment and
prophylaxis. Though resilience is a widely-used concept, studies vary
substantially in their definition, and measurement. Above all, there is no
common underlying theoretical construct to this very heterogeneous research
which makes the evaluation and comparison of findings extremely difficult.
Furthermore, the varying multi-disciplinary approaches preclude meta-
analysis, so that clarification of research in this area must proceed
firstly by conceptual unification. We attempt to collate and classify the
available research around a multi-level biopsychosocial model,
theoretically and semiotically comparable to that used in describing the
complex chain of events related to host resistance in infectious disease.
Using this underlying construct we attempt to reorganize current knowledge
around a unitary concept in order to clarify and indicate potential
intervention points for increasing resilience and positive mental health.
Keywords: Psychological resilience; Mental health; Mental disorders;
Immunity model
A. Buist, J. Bilszta, J. Milgrom, B. Barnett, B. Hayes, M.-P. Austin,

Health professional's knowledge and awareness of perinatal depression:
Results of a national survey, Women and Birth, Volume 19, Issue 1, March
Abstract: SummaryIntroduction
Postnatal depression affects 14% of women, occurring also antenatally, with
potential long-term consequences, making it an important disorder to detect
and manage early. In this study we sought to examine knowledge and
awareness of perinatal depression in health professionals involved in
perinatal care throughout Australia prior to the implementation of a
comprehensive screening program, aimed at improving detection and access to
appropriate management.
Methods
A random sample of General Practitioners (GPs) and Maternal Child Health
Nurses (MCHNs) and Midwives, in regions throughout Australia to be
subsequently targeted by a screening and education program, were invited to
participate. Responses to a hypothetical vignette and a knowledge
questionnaire, as well as details of experience were completed.
Findings
Questionnaires were completed by 246 GPs, 338 MCHNs and 569 midwives, with
overall response rates; GP's 23%; MCHN's 55% and midwives 57%.
Although knowledge level was similar among professional groups, MCHNs had
higher levels of awareness of perinatal depression. Both GPs and MCHNs were
more likely than midwives to recognize the need for providing help to women
with emotional distress. Depression was more likely to be considered
postnatally than antenatally in all groups, with GPs most likely to provide
this diagnosis. GPs had a significant propensity to recommend
antidepressants, and midwives to select non-specific medications.
Conclusions
Health professionals responding to this survey had a high awareness and
similar knowledge base. Further education on antenatal depression and the
safety risks and alternatives to medication is important for all groups,
but particularly important for midwives and GPs. The latter is especially
relevant given the preference for women with perinatal depression not to
use pharmacological interventions to treat their emotional distress.
Keywords: Perinatal depression; Education; Knowledge; Awareness and health
professionals; Screening
Violet H. Barkauskas, Lisa Kane Low, Sheryl Pimlott, Health outcomes of

incarcerated pregnant women and their infants in a community-based program,
Journal of Midwifery & Women's Health, Volume 47, Issue 5, September
Abstract: An experimental, community-based, residential program, focused on
health promotion, was established in 1990 for incarcerated pregnant women
with short-term sentences and histories of drug abuse in a large,
midwestern metropolitan area in the United States. Infants resided with
mothers after birth. Prenatal care, delivery, postpartum, and family-
planning services were initiated and provided by a nurse-midwifery service.
Community-based health care, job training, and drug rehabilitation were
provided for women during pregnancy through the fourth postpartum month.
Program participants prenatal, delivery, postpartum, and neonatal health
outcomes are presented and compared with those of incarcerated women in the
same state prison system who experienced usual correctional facility care
and support. Program participants represented a group of obstetrically
high-risk women. Health outcomes for both groups of incarcerated women and
their infants were similar and more optimal than would have been expected
given their preexisting health conditions and risk factors.
Peter J. Marshall, Justin W. Kenney, Biological perspectives on the effects

of early psychosocial experience, Developmental Review, Volume 29, Issue 2,
June 2009, Pages 96-119, ISSN 0273-2297, 10.1016/j.dr.2009.05.001.
Abstract: There is much current interest in how adverse experiences early
in life might affect certain elements of physiological, behavioral, and
psychological functioning across the lifespan. Recent conceptual frameworks
for studying the effects of early experience have involved constructs such
as experience-expectant, experience-dependent, and experience-adaptive
plasticity. The latter construct is related to comparative models of
developmental programming which posit the persistence of biological
adjustments to the early caregiving environment. We briefly review such
models and their translational implications. We then turn to human
development and focus on the effects of large changes in childrens life
courses as tests of hypotheses related to early experience effects. In
particular, the effect of early institutionalization on childrens brain
and behavioral development after changes to adoptive families or foster
care is used as an example of a research area in which programming
hypotheses have been proposed.
Keywords: Early experience; Neuroscience; Institutionalization;
Development; Biology
Ruth A. Lawrence, Robert M. Lawrence, Chapter 8 - Management of the mother-

infant nursing couple, Breastfeeding (Sixth Edition), Mosby, Philadelphia,
2005, Pages 255-316, ISBN 9780323028233, 10.1016/B978-0-323-02823-3.50013-
9.
Joan Y. Meek, BREASTFEEDING IN THE WORKPLACE, Pediatric Clinics of North

America, Volume 48, Issue 2, April 2001, Pages 461-474, ISSN 0031-3955,
10.1016/S0031-3955(08)70038-5.
Timothy Wilkin, Mary Ann Chiasson, 90 - Sexually Transmitted Infections in

Men and Women, In: Marianne J. Legato, MD, Editor(s), Principles of Gender-
Specific Medicine, Academic Press, San Diego, 2004, Pages 966-977, ISBN
9780124409057, 10.1016/B978-012440905-7/50363-7.
Abstract: This chapter will discuss the current state of knowledge of the
association of biologic sex with the manifestations, complications, and
epidemiology of sexually transmitted infections (STIs), biologic and
behavioral factors for both men and women that modify susceptibility, and
considerations for STI prevention and control. Current recommendations for
treatment of common STIs including considerations for pregnancy are listed
in Table 90-1 [1]. Although the response to these treatments is similar in
men and women, the complications for certain STIs are very gender specific,
with women confronting the possibilities of infertility, ectopic pregnancy,
cancer, and neonatal transmission of pathogens. As a result, the Centers
for Disease Control and Prevention (CDC) recommend that sexually active
women, especially young women, be screened annually for STIs including
cervical cytology; men are tested for STIs only when they have symptomatic
infection.
Naveed Zafar Janjua, Elizabeth Delzell, Rodney R. Larson, Sreelatha Meleth,

Edmond K. Kabagambe, Sibylle Kristensen, Nalini Sathiakumar, Maternal
nutritional status during pregnancy and surma use determine cord lead
levels in Karachi, Pakistan, Environmental Research, Volume 108, Issue 1,
September 2008, Pages 69-79, ISSN 0013-9351, 10.1016/j.envres.2008.06.004.
To estimate the umbilical cord blood lead levels (BLLs) of Pakistani
neonates and to identify determinants for umbilical BLLs.
Methods
We conducted a cross-sectional study of mothers and infants at one of the
two obstetric units of two tertiary care hospitals in Karachi during
JanuaryAugust 2005. Information from 540 mothers selected randomly from
those registered for delivery was obtained about their pregnancy, diet, and
current and past lead exposures. We collected umbilical cord blood for lead
levels analyzed using graphite furnace atomic absorption spectrophotometry.
We computed geometric and arithmetic means. We performed multiple linear
regression analysis to identify factors associated with log-transformed
umbilical cord BLLs. We also performed logistic regression analysis to
identify determinants of high lead cord BLLs (10 g/dl).
Results
The geometric mean cord BLL of the neonates was 9.6 g/dl; arithmetic
mean (S.D.) was 10.8 g/dl (5.7) with a median of 9.7 g/dl and a
range of 1.848.9 g/dl. Women who reported intake of less than
58.5 mg of elemental iron supplement per day during pregnancy had cord
BLL of 10.0 g/dl; in comparison those women who had higher iron
intake had lower cord BLL (8.4 g/dl). Those who used surma (an eye
cosmetic) daily had higher cord BLL (11.5 g/dl) as compared to those
who used it less frequently (9.4 g/dl). In multivariable linear
regression model, higher iron intake, owning a car, and being in 2nd
quartile of mid-arm circumference were associated with low lead levels
while father's occupation in lead-based industry was associated with
significantly higher umbilical cord BLLs. There was interaction of daily
surma use and ethnicity. Geometric mean BLLs were varied among surma users
by ethnicity.
Conclusions
Umbilical cord BLLs are high in Karachi, Pakistan, in comparison to those
in developed countries such as United States. Measures are needed to reduce
fetal lead exposure to prevent adverse affect on neurocognitive
development. Association of low iron (below RDA of 60 mg per day) with
high umbilical cord has implications for strengthening iron supplement
intake during pregnancy. Umbilical cord BLLs differed among surma users by
ethnicity.
Keywords: Umbilical cord blood lead levels; Iron; Surma; Socioeconomic
status; Pakistan
Kate J Kerber, Joseph E de Graft-Johnson, Zulfiqar A Bhutta, Pius Okong,

Ann Starrs, Joy E Lawn, Continuum of care for maternal, newborn, and child
health: from slogan to service delivery, The Lancet, Volume 370, Issue
6736(07)61578-5.
Abstract: Summary
The continuum of care has become a rallying call to reduce the yearly toll
of half a million maternal deaths, 4 million neonatal deaths, and 6 million
child deaths. The continuum for maternal, newborn, and child health usually
refers to continuity of individual care. Continuity of care is necessary
throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal
period, and childhood) and also between places of caregiving (including
households and communities, outpatient and outreach services, and clinical-
care settings). We define a population-level or public-health framework
based on integrated service delivery throughout the lifecycle, and propose
eight packages to promote health for mothers, babies, and children. These
packages can be used to deliver more than 190 separate interventions, which
would be difficult to scale up one by one. The packages encompass three
which are delivered through clinical care (reproductive health, obstetric
care, and care of sick newborn babies and children); four through
outpatient and outreach services (reproductive health, antenatal care,
postnatal care and child health services); and one through integrated
family and community care throughout the lifecycle. Mothers and babies are
at high risk in the first days after birth, and the lack of a defined
postnatal care package is an important gap, which also contributes to
discontinuity between maternal and child health programmes. Similarly,
because the family and community package tends not to be regarded as part
of the health system, few countries have made systematic efforts to scale
it up or integrate it with other levels of care. Building the continuum of
care for maternal, newborn, and child health with these packages will need
effectiveness trials in various settings; policy support for integration;
investment to strengthen health systems; and results-based operational
management, especially at district level.
Brian P. Kurtz, Anna C. Muriel, Annah N. Abrams, 42 - Pediatric

Consultation, Massachusetts General Hospital Handbook of General Hospital
Psychiatry (Sixth Edition), W.B. Saunders, Saint Louis, 2010, Pages 565-
581, ISBN 9781437719277, 10.1016/B978-1-4377-1927-7.00042-X.
Andrew Carlin, Zarko Alfirevic, Physiological changes of pregnancy and

monitoring, Best Practice & Research Clinical Obstetrics &
6934, 10.1016/j.bpobgyn.2008.06.005.
Abstract: Advances in medical care have led to increasing numbers of
complex, high-risk obstetric patients. Specialist training and a sound
knowledge of normal maternal physiology are essential to optimize outcomes.
One of the earliest observed changes is peripheral vasodilatation; this
causes a fall in systemic vascular resistance and triggers physiological
changes in the cardiovascular and renal systems, with 4050% increases in
cardiac output and glomerular filtration rates. Safety concerns over Swan
Ganz catheters have driven the increasing interest in alternative
techniques, such as echocardiography, thoracic bioimpedance and pulse
contour analysis, although their exact roles in future obstetric high-
dependency care have yet to be established. Analysis of arterial blood
gases is fundamental to the management of sick patients, and correct
interpretation can be aided by a systematic approach. Observation charts
are almost ubiquitous in all aspects of medicine, but little evidence
exists to support their use in the high-dependency setting.
Keywords: maternal physiology; high-dependency care; monitoring;
observation charts
Esther M.F van Sluijs, Mireille N.M van Poppel, Willem van Mechelen, Stage-
based lifestyle interventions in primary care: Are they effective?,
American Journal of Preventive Medicine, Volume 26, Issue 4, May 2004,
Pages 330-343, ISSN 0749-3797, 10.1016/j.amepre.2003.12.010.
To systematically review the literature concerning the effect of stages-of-
changebased interventions in primary care on smoking, physical activity,
and dietary behavior.
Methods
An extensive search (until July 2002) was performed using the following
inclusion criteria: (1) (randomized) controlled trial (RCT/CT), (2)
intervention initiated in primary care, (3) and intervention aimed at
changing smoking, physical activity, or dietary behavior, and stages-of-
change-based outcomes, and (4) behavioral outcomes. Methodologic quality
was assessed, and conclusions on the effectiveness at short-, medium-, and
long-term follow-up were based on a rating system of five levels of
evidence. Odds ratios were calculated when methodologically appropriate.
Results
A total of 29 trials were selected for inclusion. Thirteen studies included
a physical activity intervention, 14 aimed at smoking cessation, and five
included a dietary intervention. Overall methodologic quality was good. No
evidence was found for an effect on stages of change and actual levels of
physical activity. Based on the strength of the evidence, limited to no
evidence was found for an effect on stages of change for smoking and
smoking quit rates. Odds ratios for quitting smoking showed a positive
trend. Strong evidence was found for an effect on fat intake at short- and
long-term follow-up. Limited evidence was found for an effect on stages of
change for fat intake at short-term follow-up.
Conclusions
The scientific evidence for the effect of stages-of-changebased lifestyle
interventions in primary care is limited. Limiting aspects in the stages-
of-change concept with respect to complex behaviors as physical activity
and dietary behavior are discussed.
Ray E. Helfer, The perinatal period, a window of opportunity for enhancing

parent-infant communication: An approach to prevention, Child Abuse &
Neglect, Volume 11, Issue 4, 1987, Pages 565-579, ISSN 0145-2134,
10.1016/0145-2134(87)90082-2.
Abstract: The perinatal period, broadly defined, encompasses the time frame
from one year before to 18 to 24 months after the birth of the child. This
period constitutes a window of opportunity through which parent-infant
interaction may be reinforced, offering the possibility of decreasing the
risk of family dysfunction. This review article clarifies the relationship
between the enhancement of parent-infant interactions and the prevention of
child abuse and neglect. It contains a detailed discussion of the
capabilities of the newborn and places in perspective the difficulty
experienced when parents who were themselves mistreated in childhood
struggle to establish a system of communication with their own newborn
children. The perinatal intervention program, a program intended to teach
new parents the skills of interaction with their newborns, is described and
placed into perspective with other perinatal programs which have been
reported to be capable of augmenting the capacity for communication. The
authors review the research data demonstrating the efficacy of these
perinatal parent-infant programs. The paper concludes with a review of
effective interventions, a discussion of what can be expected of each, and
suggestions for the practical application of the programs during the
perinatal period. The authors recognize that no program taken in isolation
is sufficient; taken together they have the ability to improve parent-child
relations, and they thus constitute a multifaceted approach to the
prevention of child abuse and neglect.
Zahra Ghodsi, Maryam Asltoghiri, Mina Hajiloomohajerani, Exercise and

pregnancy: duration of labor stages and Perinea tear rates, Procedia -
Social and Behavioral Sciences, Volume 31, 2012, Pages 441-445, ISSN 1877-
0428, 10.1016/j.sbspro.2011.12.082.
Abstract: Labor is painful, and the onset of it is full of fair for most
pregnant women. In addition, women frequently suffer perinea trauma while
giving birth. This study aimed to evaluate the effects of exercise on
duration of labor and perinea tear rates among pregnant women. 174 women
singleton gestation were selected by using a continued method, and assigned
in training or a control group. They elected to follow either a light
intensity exercise program throughout pregnancy until delivery. Training
included 3times/week, 3045 min. Pregnancy outcomes include of
duration of labor and perinea tear were recorded for two groups. Episiotomy
rates, overall spontaneous tears and intact perineum rates were similar in
the study and control groups (PV = 0/19). The rates of intact
perineum were significantly higher in the trained group (36.8% vs. 23.8%)
and women in the training group had slightly lower rates of second-degree
tears (40.2% vs. 53.6%), although, both of these outcomes did not reach
statistical significance. There was meaningful difference between the
trained and control group in duration of the first stage of labor, but it
was not meaningful in duration of the second stage. The training showed
neither a protective nor a detrimental significant effect on the occurrence
of perinea trauma. However, exercise training during pregnancy is with a
shorter labor which creates a good feeling in women.
Keywords: Exercise; pregnancy; labor stages; Perinea tear
Oliver Jones, Wendy Reid, The development of a new speciality training

programme in obstetrics and gynaecology in the UK, Best Practice &
Research Clinical Obstetrics & Gynaecology, Volume 24, Issue 6,
December 2010, Pages 685-701, ISSN 1521-6934,
10.1016/j.bpobgyn.2010.06.001.
Abstract: In 2004, the Royal College of Obstetricians and Gynaecologists
(RCOG) established a working group of experienced Fellows, Members,
trainees and educationalists, who were responsible for writing and
coordinating the development of a new curriculum in obstetrics and
gynaecology. The curriculum would underpin the new 7-year speciality
training programme. In December 2006, the UK Postgraduate Medical Education
and Training Board approved the curriculum. In August 2007, the new
Speciality Training and Education programme in Obstetrics and Gynaecology
was launched.
The curriculum forms the backbone of the 7-year speciality training

programme in obstetrics and gynaecology. The programme is divided into
three levels of training: basic, intermediate and advanced. The programme
is competency-based rather than being focussed on time periods or the
number of hours or number of procedures required to progress through the
programme. Successful progress is achieved by meeting the requirements at
designated waypoints defined within the programme.
The curriculum outlines not only the knowledge and technical clinical skill
requirements, but also the professional skills and attitudes that must
consistently be adopted by health-care professionals in a modern health
service. The curriculum was originally benchmarked against the General
Medical Councils Good Medical Practice criteria:(1)
Good clinical care;
(2)
Good medical practice;
(3)
Successful relationships with patients;
(4)
Working with colleagues;
(5)
Teaching and training;
(6)
Probity;
(7)
Health.
Keywords: curriculum; programme; GMC; good medical practice; workplace
based assessment; learning outcomes; competencies; knowledge criteria;
clinical competency; professional skills and attitudes
David C. Geary, Sexual selection and human life history, In: Robert V.
Kail, Editor(s), Advances in Child Development and Behavior, JAI, 2003,
Volume 30, Pages 41-101, ISSN 0065-2407, ISBN 9780120097302, 10.1016/S0065-
2407(02)80039-8.
Tamara L. Taillieu, Douglas A. Brownridge, Violence against pregnant women:

Prevalence, patterns, risk factors, theories, and directions for future
research, Aggression and Violent Behavior, Volume 15, Issue 1, January
February 2010, Pages 14-35, ISSN 1359-1789, 10.1016/j.avb.2009.07.013.
Abstract: Violence against women is a global concern, and it is estimated
that one in every five women will experience some form of violence in their
lifetime (World Health Organization, 2005). Violence during pregnancy is of
special concern due to the potential negative consequences to both the
mother and her unborn child. This paper examines and consolidates findings
from the extant research concerning the prevalence of violence against
pregnant women, the nature and patterns of violence experienced by pregnant
women, the factors that place women at risk for experiencing pregnancy
violence, and the theories that may contribute to a better understanding of
the violence directed at this specific vulnerable population. A number of
areas that warrant attention in future research are discussed to address
gaps in the extant literature that, if overcome, would facilitate a better
understanding of violence against pregnant women.
Keywords: Pregnancy; Violence against women; Risk factor; Prevalence;
Theory
Jonathan B. Kotch, Dorothy C. Browne, Christopher L. Ringwalt, Vincent

Dufort, Ellen Ruina, Paul W. Stewart, Jin-Whan Jung, Stress, social
support, and substantiated maltreatment in the second and third years of
life, Child Abuse & Neglect, Volume 21, Issue 11, November 1997, Pages
1025-1037, ISSN 0145-2134, 10.1016/S0145-2134(97)00063-X.
Abstract: Objective: The purpose of this research was to determine whether
risk factors for a maltreatment report in the first year of life,
especially the interaction of life event stress and social support, persist
into the second and third years of life.
Method: Predominantly low income mothers who had been interviewed shortly
after the birth of infants in a longitudinal cohort were re-interviewed
around the infants' first birthdays, and reports to North Carolina's
Central Registry of Child Abuse and Neglect were tracked for substantiated
maltreatment reports.
Results: Variables significantly associated with a substantiated

maltreatment report in the second or third year of life (p < .01) were
first year maltreatment reports and participation in Medicaid. Three
interactions between a stressful life event indicator variable and a social
support indicator variable were significant predictors of substantiated
second or third year reports (p < .05).
Conclusions: Even in the presence of significant risk factors from the

first year of life, life event stress can increase the risk of a
substantiated maltreatment report in the second or third years of life, but
social support may moderate the effect of life events.
Keywords: Child abuse; Child neglect; Life change events; Stress;
Psychological; Social support
Michael V. Relf, Julie Mekwa, Cynthia Chasokela, Winnie Nhlengethwa,

Elizabeth Letsie, Jasintha Mtengezo, Keabitsa Ramantele, Tony Diesel,
Christina Booth, Lisa Deng, R. Kevin Mallinson, Dorothy Powell, Adele Webb,
Amanda Liddle, Janette Yu-Shears, Carolyn Hall, Barbara Aranda-Naranjo,
Deborah Parham Hopson, Essential Nursing Competencies Related to HIV and
AIDS, Journal of the Association of Nurses in AIDS care, Volume 22, Issue
1, Supplement, JanuaryFebruary 2011, Pages e5-e40, ISSN 1055-3290,
10.1016/j.jana.2010.07.007.
Abstract: With nearly 33 million global citizens living with HIV or AIDS,
the need for a highly qualified, competent nursing workforce is critical.
With the recent increase in global funding to expand access to
antiretroviral therapy, there have been considerable efforts to improve the
capacity of nurses to initiate and maintain antiretroviral therapy while
evaluating its effectiveness, monitoring for side effects, reducing the
incidence of drugdrug interactions (including drug interactions related to
therapies provided by traditional healers), promoting adherence to
therapies, and providing management of symptoms. Therefore, using a
participatory action approach, nursing leaders from six sub-Saharan African
countries collaborated to develop the essential nursing competencies
related to HIV and AIDS. These competencies can help to guide preservice
education related to HIV and AIDS, to strengthen in-service or capacity-
building programs designed for already qualified nurses, and to guide
policy and regulatory reform in the context of task-shifting, task-sharing,
and scope of nursing practices.
This is an online Supplement to the Journal of the Association of Nurses in

AIDS Care. Visit www.nursesinaidscarejournal.org for easy navigation. A
Supplement Preview was published in the January/February 2011 issue, Volume
22, Number 1.
The Supplement Preview and Online Supplement are supported by grant number
U92HA07230 from the U.S. Department of Health and Human Services, Health
Resources and Services Administration, funded by the President's Emergency
Plan for AIDS Relief.
Mary M. Dott, Nasreen Orakail, Hameeda Ebadi, Filiberto Hernandez, Kitty

MacFarlane, Patricia L. Riley, Roberta Prepas, Brian J. McCarthy,
Implementing a Facility-Based Maternal and Perinatal Health Care
Surveillance System in Afghanistan, Journal of Midwifery & Women's
Health, Volume 50, Issue 4, JulyAugust 2005, Pages 296-300, ISSN 1526-
9523, 10.1016/j.jmwh.2005.02.013.
Abstract: Afghanistan has one of the highest maternal and perinatal
mortality rates in the world. Lack of a health information system presented
obstacles to efforts to improve the quality of care and reduce mortality.
To rapidly overcome this deficit in a large womens hospital, staff
implemented a facility-based maternal and perinatal surveillance system
known as BABIES, which is specially designed for intervention and
evaluation in low-resource settings. During a 12-month period, 15,509
deliveries resulted in 28 maternal deaths and a perinatal mortality rate of
56 per 1000 births. When stratified by birth weight and perinatal period of
death, fetuses weighing at least 2500 g who died during the antepartum
period contributed the most cases of perinatal death. This finding suggests
that the greatest reduction in perinatal mortality would be realized by
increasing access to high-quality antepartum care. Among fetuses weighing
at least 2500 g, 93 deaths occurred during the intrapartum period. These
deaths will continue to be monitored to ensure that the chosen
interventions are improving intrapartum care for mothers and newborns.
Because of its simplicity, flexibility, and ability to identify
interventions, BABIES is a valuable tool that enables clinicians and
program managers to prioritize resources.
Keywords: Afghanistan; surveillance; maternal mortality; perinatal
mortality
Dennis Drotar, Debby Eckerle, Jackie Satola, John Pallotta, Betsy Wyatt,
Maternal interactional behavior with nonorganic failure-to-thrive infants:
A case comparison study, Child Abuse & Neglect, Volume 14, Issue 1,
1990, Pages 41-51, ISSN 0145-2134, 10.1016/0145-2134(90)90079-9.
Abstract: Mothers of 47 6-month-old infants with early histories of
nonorganic failure to thrive (NOFT) infants and a matched comparison group
of physically healthy infants were observed in interactions with their
infants in their homes one month following hospitalization. Mothers of NOFT
infants were observed to have less adaptive social interactional behavior,
less positive affective behavior, and demonstrated more arbitrary
termination of feedings. No group differences were found in flexibility or
sensitivity of maternal feeding, or in environmental circumstances such as
number of persons present, noise level, or level of activity. These salient
deficiencies in maternal interactional behavior may continue to disrupt the
NOFT child's physical growth and psychological development following
initial diagnosis and hospitalization. Additional studies are needed to
identify patterns of maternal interactional behavior which influence
psychological prognosis and to assess the responsiveness of maternal
interactional behavior to intervention.
Keywords: Nonorganic failure to thrive; Maternal-child interaction; Feeding
interaction
Margarita Alegria, Melissa Vallas, Andres J. Pumariega, Racial and Ethnic

Disparities in Pediatric Mental Health, Child and Adolescent Psychiatric
Clinics of North America, Volume 19, Issue 4, October 2010, Pages 759-774,
ISSN 1056-4993, 10.1016/j.chc.2010.07.001.
Keywords: Ethnic; Racial; Disparities; Youth; Mental health; Minorities;
Health care
, CHAPTER 7 - Complications of Pregnancy, In: Stephen D. Ratcliffe, MD,

MSPH, Elizabeth G. Baxley, MD, Matthew K. Cline, MD, and Ellen L.
Sakornbut, MD, Editor(s), Family Medicine Obstetrics (Third Edition),
Mosby, Philadelphia, 2008, Pages 151-201, ISBN 9780323043069, 10.1016/B978-
032304306-9.50012-4.
Lesley M. Barclay, Midwifery in Australia and surrounding reions: Dilemmas,

debates and Development, Reproductive Health Matters, Volume 6, Issue 11,
May 1998, Pages 149-156, ISSN 0968-8080, 10.1016/S0968-8080(98)90110-0.
Abstract: This paper discusses the professional issues currently facing
midwives and maternity services in Australia and the Pacific region, which
are influenced by midwifery being predominantly a women's profession and by
working in health systems that are dominated by medicine and nurses. In
Australia, the educational preparation of midwives has recently shifted
from hospitals to universities, and only nurses can train to be midwives,
even though urban midwives rarely work as nurses during their careers. This
situation is different in rural Australia and the Pacific islands, where
nurse-midwives maybe the only health workers for whole villages and towns,
yet the need for a dual system of traininghas notbeen accepted anywhere in
Australia. This paper argues for the incorporation of research into
practice; the use of high quality, research-based materials to guide the
provision of safe, women-centred, midwifery care; and improvements in the
profile, quality and contribution of midwifery to maternal and child health
services throughout the region.
Ursula Pauli-Pott, Mothers with depressive symptoms: Cross-situational

consistency and temporal stability of their parenting behavior, Infant
Behavior and Development, Volume 31, Issue 4, December 2008, Pages 679-687,
ISSN 0163-6383, 10.1016/j.infbeh.2008.04.010.
Abstract: In the present study, it has been hypothesized that anxious and
depressed mothers may show less typical behavior in a laboratory
observational setting because they may be more affected by unfamiliarity
and the social evaluative meaning of the situation. They may thus show low
consistency across laboratory and home assessments.
A sample of 101 motherinfant pairs participated in the longitudinal study.

Laboratory and home observations of motherinfant interaction episodes were
conducted at the infant ages of 4, 8, and 12 months.
Consistent with expectations, at 4 months the association between

laboratory- and home-assessed maternal sensitivity was significantly
moderated by maternal depression/anxiety: in highly anxious/depressed
mothers the association between laboratory- and home-assessed sensitivity
was weak, whereas a strong association was found in mothers with low
anxiety/depression. At 8 months this interaction was still marginally
significant and at 12 months it had disappeared.
Thus, mothers with depressive symptoms showed less consistent behavior

across the two settings of the first assessment wave, and with increased
familiarity with the procedures of the longitudinal study, their behavioral
consistency increased and no longer differed from that of well mothers.
Keywords: Parenting behavior; Motherinfant interaction; Maternal
depression; Anxiety
Annah N. Abrams, Anna C. Muriel, Paula K. Rauch, Chapter 24 - Consultation

with Children, In: Theodore A. Stern, M.D., Gregory L. Fricchione, M.D.,
Ned H. Cassem, M.D.,S.J., Michael S. Jellinek, M.D., and Jerrold F.
Rosenbaum, M.D., Editor(s), Massachusetts General Hospital Handbook of
General Hospital Psychiatry (Fifth Edition), Mosby, Philadelphia, 2004,
Pages 389-409, ISBN 9780323027670, 10.1016/B978-0-323-02767-0.50028-0.
Katy Dawley, Origins of nurse-midwifery in the United States and its

expansion in the 1940s, Journal of Midwifery & Women's Health, Volume
48, Issue 2, MarchApril 2003, Pages 86-95, ISSN 1526-9523, 10.1016/S1526-
9523(03)00002-3.
Abstract: This article reviews the origins of nurse-midwifery in the United
States during the early decades of the 20th century and explores
professional expansion between 1940 and 1950. Nurse-midwifery emerged from
the vision of public health nurses, obstetricians, and social reformers
concerned about high maternal and infant mortality rates at the turn of the
century. Desirous of promoting child health, they provided prenatal care
for pregnant women and assisted physicians, while also supporting women
during labor and birth at home. Seeking to expand their specialty by
introducing nurse-midwifery, they joined the campaign to eliminate
traditional immigrant and African American midwives. By the early 1930s,
there were only two sites for the practice of nurse-midwifery in the United
States: Frontier Nursing Service and Maternity Center Association. Over the
next 20 years, nurse-midwifery expanded in response to physician shortages,
the emergence of a childbirth education movement, and womens demands for
participation in birth. In the 1940s, the greatest expansion occurred in
the South and Southwest in home birth, birthing centers, and an occasional
community hospital.
Keywords: nurse-midwifery history; prenatal care history; nurse-midwifery
manpower; nurse-midwifery education; midwifery; obstetric nursing; home
childbirth
Dana A. Glei, Noreen Goldman, Germn Rodr

guez, Utilization of care during
pregnancy in rural Guatemala: does obstetrical need matter?, Social Science
& Medicine, Volume 57, Issue 12, December 2003, Pages 2447-2463, ISSN
0277-9536, 10.1016/S0277-9536(03)00140-0.
Abstract: This study examines factors associated with the use of biomedical
care during pregnancy in Guatemala, focusing on the extent to which
complications in an ongoing or previous pregnancy affect a woman's
decisions to seek care. The findings, based on multilevel models, suggest
that obstetrical need, as well as demographic, social, and cultural
factors, are important predictors of pregnancy care. In contrast, measures
of availability and access to health services have modest effects. The
results also suggest the importance of unobserved variablessuch as quality
of carein explaining women's decisions about pregnancy care. These results
imply that improving proximity to biomedical services is unlikely to have a
dramatic impact on utilization in the absence of additional changes that
improve the quality of care or reduce barriers to access. Moreover, current
efforts aimed at incorporating midwives into the formal health-care system
may need to extend their focus beyond the modification of midwife practices
to consider the provision of culturally appropriate, high-quality services
by traditional and biomedical providers alike.
Keywords: Pregnancy; Prenatal care; Pregnancy complications; Biomedical
care; Guatemala; Multilevel models
Derrick M. Gordon, Arazais Oliveros, Samuel W. Hawes, Derek K. Iwamoto,

Brett S. Rayford, Engaging fathers in child protection services: A review
of factors and strategies across ecological systems, Children and Youth
Services Review, Volume 34, Issue 8, August 2012, Pages 1399-1417, ISSN
0190-7409, 10.1016/j.childyouth.2012.03.021.
Abstract: Current policy regarding child protection services places
increasing demands for providers to engage fathers whose children are
involved in the child protection process. This requisite brings to the fore
the ongoing challenges that fathers have historically faced in working
within these systems. Despite this need, there is little empirical evidence
regarding the factors and strategies that impact the engagement of fathers
in interventions relevant to child protection services. This comprehensive
and systemic review synthesizes the available literature regarding factors
and strategies that may foster paternal involvement in the child protection
system and their services. We organize the literature concerning paternal
engagement in child and family services around an ecological model that
examines paternal engagement from individual, family, service provider,
program, community and policy levels. We consider factors and strategies
along a continuum of engagement through intent to enroll, enrollment, and
retention. This review advances theory by elucidating key factors that
foster father engagement. The review also highlights the gaps in the
literature and provides strategies for how researchers can address these
areas. Future directions in the arenas of practice and policy are
discussed.
Keywords: Fathers; Child protection services; Engagement in services;
Review
Debra Pascali-Bonaro, Mary Kroeger, Continuous female companionship during

childbirth: a crucial resource in times of stress or calm, Journal of
Midwifery & Women's Health, Volume 49, Issue 4, Supplement, JulyAugust
2004, Pages 19-27, ISSN 1526-9523, 10.1016/j.jmwh.2004.04.017.
Abstract: Continuous support by a lay woman during labor and delivery
facilitates birth, enhances the mothers memory of the experience,
strengthens mother-infant bonding, increases breastfeeding success, and
significantly reduces many forms of medical intervention, including
cesarean delivery and the use of analgesia, anesthesia, vacuum extraction,
and forceps. The contribution of doula care has become increasingly
available in industrial countries and is beginning to be adopted in
hospitals in underdeveloped countries. Research continues to demonstrate
the far-reaching value of supportive companionship as a corollary to
professional health care during birth. Mothers who are at risk because of
medical or social factors and those delivering in situations of stress,
including disasters, can benefit greatly from labor support. J Midwifery
Womens Health 2004;49(suppl 1):1927 2004 by the American College of
Nurse-Midwives.
Keywords: childbirth; obstetric labor; massage; developing countries;
stress; disasters; doula; continuous support; labor support
Roxane Gardner, Daniel B. Raemer, Simulation in Obstetrics and Gynecology,

Obstetrics and Gynecology Clinics of North America, Volume 35, Issue 1,
March 2008, Pages 97-127, ISSN 0889-8545, 10.1016/j.ogc.2007.12.008.
Abstract: Simulation is a practical and safe approach to the acquisition
and maintenance of task-oriented and behavioral skills across the spectrum
of medical specialties, including obstetrics and gynecology. Since the
1990s, the profession of obstetrics and gynecology has come to appreciate
the value of simulation and major steps are being taken toward
incorporating this technique into specialty-specific training, evaluation,
and credentialing programs. This article provides an overview of simulators
and simulation in health care and describes the scope of their current use
and anticipated applications in the field of obstetrics and gynecology.
Teresa A. Wilmoth, John P. Elder, An assessment of research on

breastfeeding promotion strategies in developing countries, Social Science
& Medicine, Volume 41, Issue 4, August 1995, Pages 579-594, ISSN 0277-
9536, 10.1016/0277-9536(94)00363-X.
Abstract: Breastfeeding and its impact on child survival in developing
countries have been well documented. Governments are being urged to
encourage breastfeeding through legislation and promotional campaigns. The
success of promotional programs depends not only on the interventions
themselves but on the acceptance and acquisition of the desired knowledge,
skills and behaviors. During the past decade, a variety of strategies have
been used in an attempt to promote breastfeeding. These efforts include:
(1) modifying hospital policies; (2) using social supports; (3) providing
incentives; (4) educating mothers and health workers; and (5) initiating
legislation and political action to create policies aimed toward healthier
infant feeding practices. Research regarding these promotional activities
has been both qualitative and quantitative in nature, designed to provide
answers concerning the relative success of different promotional
approaches. To varying degrees, findings and conclusions of breastfeeding
promotion research can enhance the design, implementation and
sustainability of these projects. However, programs and research designs
are poorly described in the literature, providing vague conclusions and
little guidance for future program planning.
Keywords: breastfeeding; maternal and child health; infant mortality;
health promotion
J.R. Roche, N.C. Friggens, J.K. Kay, M.W. Fisher, K.J. Stafford, D.P.
Berry, Invited review: Body condition score and its association with dairy
cow productivity, health, and welfare, Journal of Dairy Science, Volume 92,
Issue 12, December 2009, Pages 5769-5801, ISSN 0022-0302, 10.3168/jds.2009-
2431.
Abstract: The body condition score (BCS) of a dairy cow is an assessment of
the proportion of body fat that it possesses, and it is recognized by
animal scientists and producers as being an important factor in dairy
cattle management. The scale used to measure BCS differs between countries,
but low values always reflect emaciation and high values equate to obesity.
The intercalving profile of BCS is a mirror image of the milk lactation
profile. Cows lose condition for 50 to 100 d postcalving, because of
homeorhetic changes that occur in the somatotropic axis and the sensitivity
of peripheral tissues to insulin, and the upregulation of lipolytic
pathways in adipose tissue. Management and feeding have little effect on
early postcalving BCS loss (wk 1 to 4 postcalving) until the natural period
of insulin resistance has passed and the somatotropic axis has recoupled.
There is evidence, however, that management and diet can influence the
timing of recoupling of the somatotropic axis and the sensitivity of
peripheral tissues to insulin, and gene expression differences in adipose
tissue 30 d in milk confirm an effect of energy intake on lipogenic
enzymes. The BCS in which a cow calves, nadir BCS, and the amount of BCS
she loses postcalving are associated with milk production, reproduction,
and health. Body condition score may also be a valid indicator of animal
welfare, but further research is required to determine the effect of BCS
and BCS change on how a cow feels. Although the actual strength of the
association may vary, there is relative consistency in the associations
among calving and nadir BCS, and BCS change on milk production, postpartum
anestrous, the likelihood of a successful pregnancy and days open, the risk
of uterine infection, and the risk of metabolic disorders. For many
production and health variables, the association with BCS is nonlinear,
with an optimum calving BCS of 3.0 to 3.25 (5-point scale); lower calving
BCS is associated with reduced production and reproduction, whereas calving
BCS 3.5 (5-point scale) is associated with a reduction in early lactation
dry matter intake and milk production and an increased risk of metabolic
disorders. Ongoing research into the automation of body condition scoring
suggests that it is a likely candidate to be incorporated into decision
support systems in the near future to aid producers in making operational
and tactical decisions.
Keywords: body condition score; health and welfare; reproduction; review
Ruth A. Lawrence, Robert M. Lawrence, Chapter 1 - Breastfeeding in modern

medicine, Breastfeeding (Sixth Edition), Mosby, Philadelphia, 2005, Pages
1-37, ISBN 9780323028233, 10.1016/B978-0-323-02823-3.50006-1.
Mariana Widmer, Ana P. Betran, Mario Merialdi, Jennifer Requejo, Ted Karpf,
The role of faith-based organizations in maternal and newborn health care
in Africa, International Journal of Gynecology & Obstetrics, Volume
114, Issue 3, September 2011, Pages 218-222, ISSN 0020-7292,
10.1016/j.ijgo.2011.03.015.
Global disparities in maternal and newborn health represent one of the
starkest health inequities of our times. Faith-based organizations (FBOs)
have historically played an important role in providing maternal/newborn
health services in African countries. However, the contribution of FBOs in
service delivery is insufficiently recognized and mapped.
Objectives
A systematic review of the literature to assess available evidence on the
role of FBOs in the area of maternal/newborn health care in Africa.
Search strategy
MEDLINE and EMBASE were searched for articles published between 1989 and
2009 on maternal/newborn health and FBOs in Africa.
Results
Six articles met the criteria for inclusion. These articles provided
information on 6 different African countries. Maternal/newborn health
services provided by FBOs were similar to those offered by governments, but
the quality of care received and the satisfaction were reported to be
better.
Conclusion
Efforts to document and analyze the contribution of FBOs in
maternal/newborn health are necessary to increase the recognition of FBOs
and to establish stronger partnerships with them in Africa as an untapped
route to achieving Millennium Development Goals 4 and 5.
Keywords: Faith-based organizations; Maternal and newborn health;
Millennium Development Goals
Helen Simpson, Debbie Barker, Role of the midwife and the obstetrician in
obstetric critical care a case study from the James Cook University
Hospital, Best Practice & Research Clinical Obstetrics &
6934, 10.1016/j.bpobgyn.2008.06.007.
Abstract: The role of the obstetrician and the midwife are fundamental to
the successful antenatal management, delivery and postpartum management of
the critically ill obstetric patient. However, there is a dearth of
published literature on the integrated management of these roles. This
chapter addresses these issues by reporting on experiences at James Cook
University Hospital in developing a more holistic approach to patient
management and critical care through appraisal of these roles, and
resulting extension of the role of the midwife to encompass physiological
assessment, understanding the effects of pregnancy on disease,
interpretation of, and acting on, blood results including arterial gases,
and development of the service through the development of guidelines and
undertaking audits. The role of the midwife has been extended taking an
overview of critical care of the mother, baby and family. The resulting
development of the role of the obstetrician encompasses leadership,
clinical knowledge, documentation, guideline development, risk management
and the communication functions of debrief, audit and education.
Development of the roles has reduced admissions to intensive care and
increased patient satisfaction and adherence to policies at James Cook
University Hospital. This paper provides a critical appraisal of this role
development and discusses some of the lessons learned.
Keywords: critical care; obstetrics; maternity; obstetrician; midwife; role
Philippe Msellati, Improving mothers' access to PMTCT programs in West

Africa: A public health perspective, Social Science & Medicine, Volume
10.1016/j.socscimed.2009.05.034.
Abstract: Despite technical means and apparent political will, the
percentage of pregnant women involved in preventing mother-to-child
transmission (PMTCT) interventions is not increasing as fast as public
health authorities would expect. This is even more striking when compared
to the scaling up of access to antiretroviral treatment. It seems important
to analyze the successes and failures of the programs and the scaling-up
of PMTCT programs. This is a major issue for women at two levels: women are
very concerned about the health of their children, and they are the ones
who implement prevention in collaboration with health services. A review of
achievements and failures described from a public health perspective may
lead to greater understanding of the social aspects involved in PMTCT
program achievements and failures. This paper is based on the combination
of a literature review and empirical evidence collected during 15 years of
PMTCT implementation, childcare research and treatment programs in West
Africa. The analysis aims to identify the social issues that explain the
gap between PMTCT program aims and achievements in order to encourage
research in the social sciences regarding relationships between mothers and
the care system. We find it is possible to build programs at the national
level that have a high degree of acceptance of testing and intervention,
with a progressive decline in HIV infection among children. However, many
obstacles remain, highlighting the necessity to broaden access to HIV
screening, develop mass campaigns on testing for couples and improve HIV
care and training for caregivers. Because HIV-infected pregnant women are
experiencing great psychological distress, healthcare providers must use an
approach that is as friendly as possible.
Keywords: West Africa; Mothers; Access to care; HIV; Preventing mother-to-
child transmission (PMTCT); Women; Intervention adherence
Suellen Miller, Nancy L. Sloan, Beverly Winikoff, Ana Langer, Fariyal F.

Fikree, Where is the E in MCH? The need for an evidence-based approach in
safe motherhood, Journal of Midwifery & Women's Health, Volume 48,
Issue 1, JanuaryFebruary 2003, Pages 10-18, ISSN 1526-9523, 10.1016/S1526-
9523(02)00369-0.
Abstract: Measuring the impact of obstetric interventions on maternal
mortality and/or morbidity is especially difficult in developing countries,
where most maternal deaths occur. Therefore, program planning has been
based on theory rather than proved effectiveness. After reviewing both the
strategies that have been promoted to reduce maternal mortality and the
adequacy of existing evidence used to justify their selection, the
investigators highlight reasons why rigorous criteria for the selection and
evaluation of interventions should be adopted. Adequate evaluation of
intervention effectiveness under real-life conditions in developing
countries is an efficient way to identify interventions for large-scale
program replication and could speed progress in reducing maternal deaths.
Keywords: evidence-based approach; safe motherhood; maternal mortality
Bridget K Hamre, Robert C Pianta, Self-reported depression in nonfamilial

caregivers: prevalence and associations with caregiver behavior in child-
care settings, Early Childhood Research Quarterly, Volume 19, Issue 2, 2nd
Quarter 2004, Pages 297-318, ISSN 0885-2006, 10.1016/j.ecresq.2004.04.006.
Abstract: The current study describes the prevalence of self-reported
depressive symptoms in a sample of 1217 nonfamilial caregivers and examines
the relation between depression and the quality of interactions between
caregivers and young children. One hundred and fourteen of these caregivers
(9.4%) reported clinically significant levels of depressive symptoms.
Analyses provided evidence of small, but consistent and unique associations
between caregivers self-reported depression and the quality of their
interactions with children. Caregivers reporting more depression were less
sensitive and more withdrawn than caregivers reporting fewer depressive
symptoms. Depression was more closely associated with negative behavior for
caregivers working in family child-care settings, as well as among
caregivers with less education and among those that spend more time without
other adults present. The current study provides preliminary evidence that
expanding knowledge of caregivers characteristics may be an important
component of understanding the nonfamilial caregiving environment.
Keywords: Caregivers; Depression; Child-care setting
Vikram Patel, Ricardo Araya, Sudipto Chatterjee, Dan Chisholm, Alex Cohen,
Mary De Silva, Clemens Hosman, Hugh McGuire, Graciela Rojas, Mark van
Ommeren, Treatment and prevention of mental disorders in low-income and
middle-income countries, The Lancet, Volume 370, Issue 9591, 1521
September 2007, Pages 991-1005, ISSN 0140-6736, 10.1016/S0140-
6736(07)61240-9.
Abstract: Summary
We review the evidence on effectiveness of interventions for the treatment
and prevention of selected mental disorders in low-income and middle-income
countries. Depression can be treated effectively in such countries with
low-cost antidepressants or with psychological interventions (such as
cognitive-behaviour therapy and interpersonal therapies). Stepped-care and
collaborative models provide a framework for integration of drug and
psychological treatments and help to improve rates of adherence to
treatment. First-generation antipsychotic drugs are effective and cost
effective for the treatment of schizophrenia; their benefits can be
enhanced by psychosocial treatments, such as community-based models of
care. Brief interventions delivered by primary-care professionals are
effective for management of hazardous alcohol use, and pharmacological and
psychosocial interventions have some benefits for people with alcohol
dependence. Policies designed to reduce consumption, such as increased
taxes and other control strategies, can reduce the population burden of
alcohol abuse. Evidence about the efficacy of interventions for
developmental disabilities is inadequate, but community-based
rehabilitation models provide a low-cost, integrative framework for care of
children and adults with chronic mental disabilities. Evidence for mental
health interventions for people who are exposed to conflict and other
disasters is still weakespecially for interventions in the midst of
emergencies. Some trials of interventions for prevention of depression and
developmental delays in low-income and middle-income countries show
beneficial effects. Interventions for depression, delivered in primary
care, are as cost effective as antiretroviral drugs for HIV/AIDS. The
process and effectiveness of scaling up mental health interventions has not
been adequately assessed. Such research is needed to inform the continuing
process of service reform and innovation. However, we recommend that
policymakers should act on the available evidence to scale up effective and
cost-effective treatments and preventive interventions for mental
disorders.
Amal Omer-Salim, Lars-ke Persson, Pia Olsson, Whom can I rely on? Mothers
approaches to support for feeding: An interview study in suburban Dar es
Salaam, Tanzania, Midwifery, Volume 23, Issue 2, June 2007, Pages 172-183,
ISSN 0266-6138, 10.1016/j.midw.2006.05.002.
Abstract: Objective
to explore and describe mothers perceptions of baby feeding and approaches
to support for baby feeding.
Design
individual qualitative semi-structured interviews conducted with mothers.
Method used for analysis was qualitative content analysis.
Setting
suburban Dar es Salaam, Tanzania.
Participants
8 mothers with babies under 6 months of age.
Findings
the study revealed four categories of mothers perceptions of baby feeding:
(1) baby feeding, housework and paid work have to adjust to each other; (2)
breast feeding has many benefits; (3) water or breast milk can be given to
quench baby's thirst; and (4) crying provides guidance for baby feeding.
Four different themes describing approaches to support emerged from the
data: (1) adhering to diverse sources; (2) relying wholeheartedly on a
mother figure; (3) working as a parental team; and (4) making arrangements
for absence from the child.
knowledge of the different approaches to support for baby feeding described
in this study can help define counselling and promotional strategies in
order to reach mothers with more effective messages and support for optimal
baby-feeding practices.
Keywords: Infant feeding; Mother's perceptions; Support; Tanzania;
Interviews
Phyllis C. Leppert, An analysis of the reasons for Japan's low infant

mortality rate, Journal of Nurse-Midwifery, Volume 38, Issue 6, November
December 1993, Pages 353-357, ISSN 0091-2182, 10.1016/0091-2182(93)90017-B.
(http://www.sciencedirect.com/science/article/pii/009121829390017B)
Abstract: Japan's infant mortality rate in 1991 was four per 1,000, the
lowest in the world. Contributing factors are the universal use of the
Boshi Kenko Techo (maternal-child health handbook) and universal access to
care. Most births occur to women aged 2529 years and there are few
unmarried mothers. Ninety-nine and seven-tenths percent of births are
attended by qualified professionals either in hospitals or private clinics,
with an average stay of one week postpartum. Abortion is available when
contraceptives fail. There are government subsidies for medical, obstetric,
and pediatric complications. Japanese citizens are highly literate and seek
out medical advice, and their society is organized to support children.
Efficient systems of community support, public health education, and
excellent medical care encompass events from conception to school age.
Lisa M. Klesges, Karen C. Johnson, Kenneth D. Ward, Marie Barnard, SMOKING

CESSATION IN PREGNANT WOMEN, Obstetrics and Gynecology Clinics of North
America, Volume 28, Issue 2, 1 June 2001, Pages 269-282, ISSN 0889-8545,
10.1016/S0889-8545(05)70200-X.
Anne Duggan, Debra Caldera, Kira Rodriguez, Lori Burrell, Charles Rohde,
Sarah Shea Crowne, Impact of a statewide home visiting program to prevent
child abuse, Child Abuse & Neglect, Volume 31, Issue 8, August 2007,
Pages 801-827, ISSN 0145-2134, 10.1016/j.chiabu.2006.06.011.
To assess the impact of a voluntary, paraprofessional home visiting program
in preventing child maltreatment and reducing the multiple, malleable
psychosocial risks for maltreatment for which families had been targeted.
Methods
This collaborative, experimental study focused on 6 Healthy Families Alaska
(HFAK) programs; 325 families were enrolled in 20002001, randomized to
intervention and control groups, and interviewed to measure baseline
attributes. Follow-up data were collected when children were 2 years old
(85% follow-up rate). Outcomes included maltreatment reports, measures of
potential maltreatment and parental risks, for example, poor mental health,
substance use, and partner violence. HFAK records were reviewed to measure
home visiting services. Home visitors were surveyed to measure perceived
effectiveness and training adequacy.
Results
Parental risks were common at baseline, and one-sixth of families had a
substantiated child protective services report in the child's first 2 years
of life. There was no overall program effect on maltreatment reports, and
most measures of potential maltreatment. Home visited mothers reported
using mild forms of physical discipline less often than control mothers.
The groups were similar in their use of more severe forms of physical
discipline. There was no program impact on parental risks. There was no
impact on outcomes for families with a high dose of home visiting. Home
visitors often failed to address parental risks and seldom linked families
with community resources. Contradictions in the model compromised
effectiveness.
Conclusions
The program did not prevent child maltreatment, nor reduce the parental
risks that had made families eligible for service. Research is needed to
develop and test strategies to improve the effectiveness of home visiting.
Keywords: Home visiting; Child abuse prevention; Substance abuse;
Depression; Domestic violence
Matthew N. Bartels, Jonathan H. Whiteson, Augusta S. Alba, Heakyung Kim,

Cardiopulmonary Rehabilitation and Cancer Rehabilitation. 1. Cardiac
Rehabilitation Review, Archives of Physical Medicine and Rehabilitation,
Volume 87, Issue 3, Supplement, March 2006, Pages 46-56, ISSN 0003-9993,
10.1016/j.apmr.2005.11.027.
Abstract: Bartels MN, Whiteson JH, Alba AS, Kim H. Cardiopulmonary
rehabilitation and cancer rehabilitation. 1. Cardiac rehabilitation review.
Cardiac rehabilitation includes not only the rehabilitation of people with

ischemic heart disease but also those with congestive heart failure, heart
transplantation, congenital heart disease, and other conditions. New
advances in medical treatment have arisen, and there are new approaches in
treatment, including alternative medicine and complementary care. New
surgical approaches that help restore cardiac function have also been
introduced, and rehabilitation professionals must be aware of these
advances and be able to incorporate this knowledge into the practice of
rehabilitation medicine.
Overall Article Objectives
(a) To identify major categories of cardiac disease, (b) to elucidate
appropriate interventions and support for patients with coronary artery
disease, (c) to describe the new interventions available for the treatment
of cardiac disease, and (d) to describe the appropriate role of cardiac
rehabilitation for people with various forms of cardiac disease.
Keywords: Arrhythmia; Cardiomyopathies; Cardiovascular diseases;
Complementary therapies; Coronary artery bypass; Heart defects, congenital;
Heart failure, congestive; Heart transplantation; Hypertension, pulmonary;
Ischemic heart disease; Myocardial infarction; Nutrition; Rehabilitation
Kelly R. Culwell, Marcel Vekemans, Upeka de Silva, Manuelle Hurwitz,

Barbara B. Crane, Critical gaps in universal access to reproductive health:
Contraception and prevention of unsafe abortion, International Journal of
Gynecology & Obstetrics, Volume 110, Supplement, July 2010, Pages S13-
S16, ISSN 0020-7292, 10.1016/j.ijgo.2010.04.003.
Abstract: Unsafe abortion accounts for a significant proportion of maternal
deaths, yet it is often forgotten in discussions around reducing maternal
mortality. Prevention of unsafe abortion starts with prevention of unwanted
pregnancies, most effectively through contraception. When unwanted
pregnancies occur, provision of safe, legal abortion services can further
prevent unsafe abortions. If complications arise from unsafe abortion,
emergency treatment must be available. Recommendations made on this issue
during the Precongress Workshop held prior to the 2009 FIGO World Congress
in Cape Town, South Africa, were part of a report that was adopted by the
FIGO General Assembly. These recommendations address prevention of unsafe
abortion and its consequences and support access to safe abortion care to
the full extent allowed by national laws, along with 6 strategies for
implementation, including integration of family planning into other
reproductive health services, adequate training for providers, task-sharing
with mid-level providers, and using evidence to discuss this issue with key
stakeholders.
Keywords: Abortion; Contraception; Human rights; Maternal mortality;
Prevention
Walter J. Rogan, Beth C. Gladen, Breast-feeding and cognitive development,

Early Human Development, Volume 31, Issue 3, January 1993, Pages 181-193,
ISSN 0378-3782, 10.1016/0378-3782(93)90194-Y.
(http://www.sciencedirect.com/science/article/pii/037837829390194Y)
Abstract: Eight-hundred fifty-five newborns were enrolled in a prospective
study between 1978 and 1982 and then followed through school age. To
determine whether the mode of infant feeding affected developmental scores
or school grades, prospective data were collected on how the children were
fed; 788 of the children had Bayley tests at 6 months, 720 at 12 months,
676 at 18 months and 670 at 2 years. McCarthy testing was done on 645
children at 3 years, 628 at 4 years and 636 at 5 years. Testers were not
specifically blind to feeding method. The families provided report cards
from grade 3 or higher for 366 children. There were statistically
significant but small increases in scores among breast-fed children on at
least some subscales of the Bayley and McCarthy at all time points from 2
years through 5 years and slightly higher English grades on report cards in
both crude analyses and in multivariate analyses that allowed adjustment
for the most plausible confounding variables. We conclude that, in a
volunteer, 95% white sample of middle class children, those breast-fed
scored slightly better than those bottle fed; the effect is small but still
detectable at school age.
Keywords: intelligence tests; child development; infant feeding; birth
order; maternal age
Russell A. Isabella, Origins of maternal role satisfaction and its

influences upon maternal interactive behavior and infant-mother attachment,
Infant Behavior and Development, Volume 17, Issue 4, OctoberDecember 1994,
Pages 381-387, ISSN 0163-6383, 10.1016/0163-6383(94)90030-2.
Abstract: This longitudinal study sought to examine the origins of maternal
role satisfaction, and the influence of mothers' perceptions of their
various roles upon subsequent interactions with their infants and the
quality of infants' 1-year attachment to mother. Interviews and
questionnaires provided assessments of first-time mothers' (N = 32)
prenatal marital satisfaction and social support as well as 4-month
perceptions of their various life roles (self, wife, homemaker, employee);
observations were employed to assess mothers' 9-month interactive behaviors
and the quality of infant-mother attachment at 1 year. Path analysis
revealed that mothers reporting high levels of satisfaction with their
marriages and high levels of family support during the prenatal period were
most likely to report a higher degree of role satisfaction at 4 months.
High levels of role satisfaction were in turn predictive of optimal (i.e.,
sensitive) interactions with infants at 9 months, and these sensitive
interactions contributed to development of secure infant-mother attachments
by 1 year. These findings demonstrate the importance of mothers' social
contexts in shaping their perceptions of themselves and the importance of
these perceptions in guiding mothers' interactions and relationships with
their infants.
Keywords: role satisfaction; parenting; social support; mother-infant
interaction; marriage
The Transforming Maternity Care Vision Team, Martha Cook Carter, Maureen
Corry, Suzanne Delbanco, Tina Clark-Samazan Foster, Robert Friedland, Robyn
Gabel, Teresa Gipson, R. Rima Jolivet, Elliott Main, Carol Sakala, Penny
Simkin, Kathleen Rice Simpson, 2020 Vision for A High-Quality, High-Value
Maternity Care System, Women's Health Issues, Volume 20, Issue 1,
Supplement, JanuaryFebruary 2010, Pages S7-S17, ISSN 1049-3867,
10.1016/j.whi.2009.11.006.
Abstract: A concrete and useful way to create an action plan for improving
the quality of maternity care in the United States is to start with a view
of the desired result, a common definition and a shared vision for a high-
quality, high-value maternity care system. In this paper, we present a
long-term vision for the future of maternity care in the United States. We
present overarching values and principles and specific attributes of a
high-performing maternity care system. We put forth the 2020 Vision for a
High-Quality, High-Value Maternity Care System to serve as a positive
starting place for a fruitful collaborative process to develop specific
action steps for broad-based maternity care system improvement.
Deborah Maine, Detours and shortcuts on the road to maternal mortality

reduction, The Lancet, Volume 370, Issue 9595, 1319 October 2007, Pages
1380-1382, ISSN 0140-6736, 10.1016/S0140-6736(07)61580-3.
, Citations from the literature: This is a selection of abstracts taken

from the literature in the field of gynecology and obstetrics which the
Journal's Editors feel may be of interest to our readers, International
Journal of Gynecology & Obstetrics, Volume 78, Issue 3, September 2002,
Pages 293-319, ISSN 0020-7292, 10.1016/S0020-7292(02)00245-X.
Donna Cherniak, Jane Fisher, Explaining obstetric interventionism:

Technical skills, common conceptualisations, or collective
countertransference?, Women's Studies International Forum, Volume 31, Issue
10.1016/j.wsif.2008.05.010.
Abstract: The usual explanations for the widespread increased use of
Caesarean surgery are that it is a technically straightforward and safe
procedure associated with improved perinatal outcomes and that women are
choosing to give birth by surgery. It is proposed in this article that
obstetric clinicians share internalized beliefs which shape their
interactions with childbearing women and can depersonalize maternity care
and contribute to the use of operative interventions in childbirth. The
origins, validity and impact on clinical practice of these assumptions are
analyzed. It is suggested that the belief that birth is only normal
retrospectively creates an anxiety-laden approach to care in which the
prospect of catastrophes leads to avoidance and intervention; and that
considering the foetus as a separate patient results in increased
surveillance of women's behaviours. Physician authority reflects
traditional power relations in health care and information from technology
precludes other ways of knowing.
Colleen E Huebner, William E Barlow, Lynda T Tyll, Brian D Johnston, Robert

S Thompson, Expanding developmental and behavioral services for newborns in
primary care: Program design, delivery, and evaluation framework, American
Journal of Preventive Medicine, Volume 26, Issue 4, May 2004, Pages 344-
355, ISSN 0749-3797, 10.1016/j.amepre.2004.01.003.
Healthy Steps (HS) for Young Children strengthens the healthcare system as
a source of developmental and behavioral support for parents. This series
of papers presents a study of HS as implemented within a large health
maintenance organization that tested the benefit of beginning intervention
services during pregnancy with an extension program called PrePare (PP).
Methods
The design was a quasi-experimental comparison of intervention families
with families receiving usual care. Within the intervention, families were
assigned randomly to begin receiving Healthy Steps services prenatally
(PP+HS) or shortly after birth (HS). We used a systems model,
PRECEDE/PROCEED, for planning, implementation, and process evaluation.
Outcomes examined when the infants were aged 3 months included changes in
family social support and capacity for parenting, parenting behaviors, and
satisfaction and loyalty to the health plan.
Results
The sample of 439 families was distributed as follows: usual care (n=136),
prenatal initiation of services (PP+HS; n=151), and postnatal Healthy Steps
(HS; n=152). Information about program implementation, including provider
satisfaction, is provided for the early phases of the study (through age 3
months). The intervention was delivered with fidelity and with minimal
disruption to the practice styles of pregnancy providers, most of whom
considered the program valuable to their patients. Relative to families in
the comparison group, families in the intervention group received more
usual care services and more intervention-specific services.
Conclusions
The pregnancy and newborn phases of the intervention were embedded
successfully within the existing healthcare delivery system. The program
was considered valuable for parents by providers and parents. Participating
families received more services and a greater variety of services than
families in usual care. Whether these differences result in beneficial
outcomes for families or the health plan are topics of the subsequent
papers.
Marie-Claude Paquette, Carol M. Devine, Dietary Trajectories in the

Menopause Transition Among Qubec Women, Journal of Nutrition Education,
Volume 32, Issue 6, November 2000, Pages 320-328, ISSN 0022-3182,
10.1016/S0022-3182(00)70591-7.
Abstract: This qualitative study explored perimenopausal women's
perceptions and experiences of continuity and change in dietary behavior.
This study used a naturalistic paradigm and three in-depth qualitative
interviews over a 13-month period. A purposive sample of 23 perimenopausal
women was recruited from community health centers and social organizations
in rural and urban areas of Qubec.The semistructured interview guide
focused on dietary and lifestyle changes, health and body changes, social
roles, and the menopause experience. Grounded theory analysis was performed
on the transcribed interviews. Women's narratives described three types of
dietary trajectories: unsuccessful dieting, small change, and progressive
change. Women with similar trajectories shared experiences with food,
dieting practices, self-efficacy, and transition in the maternal role.
Although most women reported continuing on the same dietary trajectory for
most of their adult lives, a few described changes in their diets. Some
women associated their small changes in diet with being informed of the
potential development of chronic diseases, whereas others radically changed
their diets following life events such as the development of an illness.
Menopause per se was not perceived by women as a time for dietary change.
Health and nutrition professionals could improve the impact of their
efforts by recognizing the contribution of past dietary behavior to current
dietary practices. Dietary advice would also benefit from being tailored to
women's existing dietary trajectories.
Robynn Zender, Ellen Olshansky, Women's Mental Health: Depression and

Anxiety, Nursing Clinics of North America, Volume 44, Issue 3, September
2009, Pages 355-364, ISSN 0029-6465, 10.1016/j.cnur.2009.06.002.
Keywords: Women; Mental health; Anxiety; Depression; Co-morbid conditions
Susan Panzarini, Teen mothering: Behaviors and interventions, Journal of
Adolescent Health Care, Volume 9, Issue 5, September 1988, Pages 443-448,
ISSN 0197-0070, 10.1016/0197-0070(88)90048-4.
Abstract: Data are reviewed that support the hypothesis that many
adolescents interact with their infants in ways that may increase the
infant's risk of developmental delay. The negative, long-term consequences
of adolescent child-bearing create in environment that also augments this
risk. Early intervention programs developed to address such risks are
reviewed regarding their focus and content. Research designs used to
evaluate their effectiveness are critiqued. The confounding of treatment
approach with the frequency of contacts is a major limitation preventing an
adequate evaluation of results. However, it is emphasized that despite a
diversity of approaches to treatment and a lack of understanding as to what
is responsible for the changes, intervention programs have been successful
in improving adolescent maternal-infant interactions and/or enhancing
infant development.
Keywords: Childbearing Mothering Program evaluation Maternal-infant
interaction
Virginia Schmied, Margaret Cooke, Rosalind Gutwein, Elizabeth Steinlein,

Caroline Homer, Time to listen: Strategies to improve hospital-based
postnatal care, Women and Birth, Volume 21, Issue 3, September 2008, Pages
99-105, ISSN 1871-5192, 10.1016/j.wombi.2008.04.002.
In Australia and internationally, women report high levels of
dissatisfaction with hospital-based postnatal care.
Aim
To design and implement strategies to improve hospital-based postnatal care
at a Sydney metropolitan hospital.
Method
This was an Action Research study. In Phase One, midwives considered the
literature and participated in group discussions and interviews to
determine their perceptions of postnatal care and the factors that
facilitate or hinder the provision of quality care. In Phase Two, midwives
participated in 12 working group meetings to design strategies to improve
care.
Results
Several important principles of postnatal care were described, including
building a relationship with women, meeting their individual needs, being
flexible in approach and providing continuity of care. Listening to
women, being there, and normalising experiences and expectations were
believed to be critical to achieving these principles. A key strategy One
to One Time was designed to provide women with an uninterrupted period of
time each day with a midwife who was available to listen to their needs and
concerns and discuss issues related to their health and that of their baby.
Conclusion
Midwives designed and implemented strategies that they believed would
improve in-hospital postnatal care.
Keywords: Postnatal care; Women's health; Midwifery; Health services
research; Communication; Assessment of health care needs
Ann Oakley, Social support in pregnancy: The soft way to increase

birthweight?, Social Science & Medicine, Volume 21, Issue 11, 1985,
Pages 1259-1268, ISSN 0277-9536, 10.1016/0277-9536(85)90275-8.
Abstract: This paper examines the thesis that social support in pregnancy
is capable of affecting birthweight as one easily measurable aspect of
pregnancy outcome. The focus of the paper is on birthweight, since low
birthweight is a relatively stable and important factor in social
inequalities in perinatal health. The paper reviews the published
literature on social support in pregnancy including simple observational
and nonrandomized intervention studies and also randomized controlled
trials of social interventions. The methodological problems associated
with some of these studies are discussed. However, it is concluded that
there is considerable evidence to suggest that intervention programmes
aimed at improving the social side of antenatal care are capable of
affecting birthweight and other hard measures of pregnancy outcome. It is
suggested that traditional professional approaches to pregnancy which
divide the medical from the social perspective, have acted to prevent
recognition of this evidence and its relevance to maternity care policy.
Michael Paech, Aneeta Sinha, Obstetric audit and its implications for
obstetric anaesthesia, Best Practice & Research Clinical Obstetrics
& Gynaecology, Volume 24, Issue 3, June 2010, Pages 413-425, ISSN 1521-
6934, 10.1016/j.bpobgyn.2009.12.002.
Abstract: After briefly expounding the principles of an audit, this article
focusses on the role of obstetric audit and how it can influence, and even
shape, obstetric anaesthetic practice. The impact may be on service
delivery, anaesthetic practice or the generation of new information. The
relevance of maternal mortality reporting and of obstetric haemorrhage
audit to anaesthetic practice is used to illustrate these concepts. Further
examples include how different types of audit of pregnancy outcome,
obstetric practice or areas of cross-interest to both obstetricians and
anaesthetists are used by anaesthetists to evaluate health-care delivery,
their own practices and to generate new audit and research agendas. Audits
drive change and, hopefully, improvements that continue to make pregnancy a
safer and more satisfying event for the mother and child.
Keywords: audit, clinical; audit, medical; audit, obstetric; obstetric
anaesthesia
Shelley Rowlands, Michael Permezel, 1 Physiology of pain in labour,

Baillire's Clinical Obstetrics and Gynaecology, Volume 12, Issue 3,
0.
Abstract: Labour pain is the result of many complex interactions. Although
not fully determined, the pain arises from distension of the lower uterine
segment and cervical dilatation. The neural mechanism of labour has some
features similar to other forms of acute pain; nociceptive information is
relayed in small A delta and C afferent fibres to the dorsal horn of the
spinal cord, mediated by neurotransmitters; from there it may be involved
in the initiation of segmental spinal reflexes or pass through the
spinothalamic tract to the brain. Many factors are activated during labour
which may modify the nocioceptive impulse at different stages of its
passage. Some of these factors act synergistically to promote anti-
nociception that peaks at delivery.
Keywords: labour; nociception; pregnancy-induced hypoalgesia; -endorphin;
dynorphin- receptors; placental-opioid-enhancing factor
Cindy J. Jones, Debra K. Creedy, Jenny A. Gamble, Australian midwives'

attitudes towards care for women with emotional distress, Midwifery, Volume
28, Issue 2, April 2012, Pages 216-221, ISSN 0266-6138,
10.1016/j.midw.2010.12.008.
Abstract: Objective
to assess Australian midwives' attitudes towards caring for women with
emotional distress and their perceptions of the extent to which workplace
policies and processes hindered such care.
Design
a postal survey.
Setting
members of the Australian College of Midwives.
Participants
815 Australian midwives completed the survey.
Measurements
a modified version of the 17-item REASON questionnaire (McCall et al.,
2002) that was originally developed for used by General Practitioners to
measure their attitudes towards their role in the management of patients
with mental health disorders.
Findings
An exploratory factor analysis with Varimax rotation identified four
factors that reflected midwives' (1) perceptions of systemic problems that
hindered emotional care, (2) attitudes towards working with women
experiencing emotional health problems, (3) perceived competence in using
treatment techniques and (4) attitudes and perceived competence towards the
referral of women with depression and anxiety to other health
professionals.
participating midwives indicated their willingness to offer assistance and
acknowledged the importance of providing emotional care to women. In
practice, emotional care by midwives is impeded by perceived lack of
competency rather than a lack of interest. Midwives' competency in the
assessment and care of women with conditions such as depression and anxiety
may be enhanced through continuing professional education.
Keywords: Midwives' attitudes; Emotional care/distress; Depression; Anxiety
Anne Duggan, Elizabeth McFarlane, Loretta Fuddy, Lori Burrell, Susan M

Higman, Amy Windham, Calvin Sia, Randomized trial of a statewide home
visiting program: impact in preventing child abuse and neglect, Child Abuse
& Neglect, Volume 28, Issue 6, June 2004, Pages 597-622, ISSN 0145-
2134, 10.1016/j.chiabu.2003.08.007.
Abstract: Objectives: To assess the impact of home visiting in preventing
child abuse and neglect in the first 3 years of life in families identified
as at-risk of child abuse through population-based screening at the childs
birth.
Methods: This experimental study focused on Hawaii Healthy Start Program

(HSP) sites operated by three community-based agencies. From 11/94 to
12/95, 643 families were enrolled and randomly assigned to intervention and
control groups. Child abuse and neglect were measured by observed and self-
reported parenting behaviors, all hospitalizations for trauma and for
conditions where hospitalization might have been avoided with adequate
preventive care, maternal relinquishment of her role as primary caregiver,
and substantiated CPS reports. Data were collected through annual maternal
interviews (88% follow-up each year of all families with baseline
interviews); observation of the home environment; and review of CPS, HSP,
and pediatric medical records.
Results: HSP records rarely noted home visitor concern about possible
abuse. The HSP and control groups were similar on most measures of
maltreatment. HSP group mothers were less likely to use common
corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to
one agencys reduction in threatening to spank the child. HSP group mothers
reported less neglectful behavior (AOR=.72, p=.02), related to a trend
toward decreased maternal preoccupation with problems and to improved
access to medical care for intervention families at one agency.
Conclusions: The program did not prevent child abuse or promote use of
nonviolent discipline; it had a modest impact in preventing neglect.
Possible targets for improved effectiveness include the programs
implementation system and model.
Keywords: Home visitation; Program evaluation; Child abuse and neglect
South Africa Every Death Counts Writing Group, Every death counts: use of
mortality audit data for decision making to save the lives of mothers,
babies, and children in South Africa, The Lancet, Volume 371, Issue 9620,
1218 April 2008, Pages 1294-1304, ISSN 0140-6736, 10.1016/S0140-
6736(08)60564-4.
Abstract: Summary
South Africa is one of the few developing countries with a national
confidential inquiry into maternal deaths. 164 health facilities obtain
audit data for stillbirths and neonatal deaths, and a new audit network
does so for child deaths. Three separate reports have been published,
providing valuable information about avoidable causes of death for mothers,
babies, and children. These reports make health-system recommendations,
many of which overlap and are intertwined with the scarcity of progress in
addressing HIV/AIDS. The leaders of these three reports have united to
prioritise actions to save the lives of South Africa's mothers, babies, and
children. The country is off-track for the health-related Millennium
Development Goals. Mortality in children younger than 5 years has
increased, whereas maternal and neonatal mortality remain constant. This
situation indicates the challenge of strengthening the health system
because of high inequity and HIV/AIDS. Coverage of services is fairly high,
but addressing the gaps in quality and equity is essential to increasing
the number of lives saved. Consistent leadership and accountability to
address crosscutting health system and equity issues, and to prevent
mother-to-child transmission of HIV, would save tens of thousands of lives
every year. Audit is powerful, but only if the data lead to action.
Sandra M. Stith, Ting Liu, L. Christopher Davies, Esther L. Boykin, Meagan

C. Alder, Jennifer M. Harris, Anurag Som, Mary McPherson, J.E.M.E.G. Dees,
Risk factors in child maltreatment: A meta-analytic review of the
literature, Aggression and Violent Behavior, Volume 14, Issue 1, January
February 2009, Pages 13-29, ISSN 1359-1789, 10.1016/j.avb.2006.03.006.
Abstract: This review presents the results of a series of meta-analyses
identifying the relative strength of various risk factors for child
physical abuse and neglect. Data from 155 studies examining 39 different
risk factors were included in the review. Large effect sizes were found
between child physical abuse and three risk factors (parent anger/hyper-
reactivity, family conflict and family cohesion). Large effect sizes were
also found between child neglect and five risk factors (parentchild
relationship, parent perceives child as problem, parent's level of stress,
parent anger/hyper-reactivity, and parent self-esteem).
Keywords: Child maltreatment; Child physical abuse; Child neglect; Risk
factors; Meta-analysis
William L Hasler, The irritable bowel syndrome during pregnancy,

Gastroenterology Clinics of North America, Volume 32, Issue 1, March 2003,
Pages 385-406, ISSN 0889-8553, 10.1016/S0889-8553(02)00136-X.
Judith Galtry, The impact on breastfeeding of labour market policy and

practice in Ireland, Sweden, and the USA, Social Science & Medicine,
10.1016/S0277-9536(02)00372-6.
Abstract: In recent decades there has been a marked rise in the labour
market participation of women with infants in many countries. Partly in
response to this trend, there are calls for greater emphasis on infant and
child health in research and policy development on parental leave and other
workfamily balancing measures. Yet achieving high rates of breastfeeding
as a health objective has thus far received relatively little attention in
this context.
Biomedical literature outlines the important health benefits conferred by

breastfeeding, including upon infants and young children among middle class
populations in developed countries. International recommendations now
advise exclusive breastfeeding for 6 months. However, research indicates
that the timing of the mother's resumption of employment is a key factor
influencing the duration of exclusive breastfeeding. There would thus
appear to be considerable potential for labour policy and practice,
particularly maternity/parental leave provisions, to positively influence
breastfeeding practice.
Taking the case studies of Ireland, Sweden, and the United States, this
paper explores the implications of labour market and early childhood policy
for breastfeeding practice. The equity tensions posed by the breastfeeding
maternal employment intersection are also examined. The paper concludes
that both socio-cultural support and labour market/health/early childhood
policy are important if high rates of both breastfeeding and women's
employment are to be achieved in industrialised countries.
Keywords: Breastfeeding; Parental leave; Family and medical leave; Gender
equity; Early childhood services; Ireland; Sweden; USA
Susan L Norris, Phyllis J Nichols, Carl J Caspersen, Russell E Glasgow,

Michael M Engelgau, Leonard Jack Jr, Susan R Snyder, Vilma G Carande-Kulis,
George Isham, Sanford Garfield, Peter Briss, David McCulloch, Task Force on
Community Preventive Services, Increasing diabetes self-management
education in community settings: A systematic review, American Journal of
Preventive Medicine, Volume 22, Issue 4, Supplement 1, May 2002, Pages 39-
66, ISSN 0749-3797, 10.1016/S0749-3797(02)00424-5.
Abstract: Overview: This report presents the results of a systematic review
of the effectiveness and economic efficiency of self-management education
interventions for people with diabetes and forms the basis for
recommendations by the Task Force on Community Preventive Services. Data on
glycemic control provide sufficient evidence that self-management education
is effective in community gathering places for adults with type 2 diabetes
and in the home for adolescents with type 1 diabetes. Evidence is
insufficient to assess the effectiveness of self-management education
interventions at the worksite or in summer camps for either type 1 or type
2 diabetes or in the home for type 2 diabetes. Evidence is also
insufficient to assess the effectiveness of educating coworkers and school
personnel about diabetes.
Keywords: blood glucose self-monitoring; community health services;
decision making; diabetes mellitus; evidence-based medicine; health
education; patient education; preventive health services; public health
practice; review literature; self-care; self-efficacy; self-help groups
Z Gill, J.U Ahmed, Experience from Bangladesh: implementing emergency

obstetric care as part of the reproductive health agenda, International
Journal of Gynecology & Obstetrics, Volume 85, Issue 2, May 2004, Pages
213-220, ISSN 0020-7292, 10.1016/j.ijgo.2004.01.004.
Abstract: This paper describes the activities of the Ministry of Health and
Family Welfare of the Government of Bangladesh and UNFPA to introduce
emergency obstetric care (EmOC) services into the reproductive health care
agenda. Working through the existing system of Maternal and Child Welfare
Centers (MCWC), the quality and availability of comprehensive Reproductive
Health and Emergency Obstetric Care services was improved. Investments in
training, infrastructure, management information systems, quality assurance
mechanisms and linkages between health care facilities in Bangladesh, have
produced positive results in terms of increased utilization of these
services. The Ministry of Health first implemented services in one division
of the country and later scaled up to include all of the MCWCs nationally.
While there are still obstacles to preventing obstetric deaths in
Bangladesh, this experience shows that improvements in the quality and
expansion of the range of services in existing health systems is an
important step toward increasing the use of reproductive health care
services by the women who need them most.
Keywords: Bangladesh; Emergency obstetric care; Maternal mortality;
Reproductive health
Charles N. Oberg, Andrea Aga, Childhood Poverty and the Social Safety Net,
Current Problems in Pediatric and Adolescent Health Care, Volume 40, Issue
10, November 2010, Pages 237-262, ISSN 1538-5442,
10.1016/j.cppeds.2010.08.002.
Abstract: Childhood poverty in the USA remains an issue that concerns the
child, the family, the community, each state, and the nation. It also is a
topic that pediatricians must become cognizant of because of the impact it
has on the children we care for daily. It goes beyond the specific income
threshold that sets the federal poverty level; rather it impacts on the
ability of families to acquire life's basic needs to allow their children
the opportunity to reach their full potential. These basic needs include
adequate nutrition to grow and develop in an optimal fashion and a secure
and stable home in a safe neighborhood, which allows for play, exploration,
and physical activity. It must also include access to health insurance
coverage as well as a physician, health center, and health system to meet
their medical needs. In addition, we must provide early education
opportunities to nurture the social and emotional health of our children
and prepare each child for school. The school environment must promote
academic achievement and the broader community must foster opportunities to
minimize violence and reduce the need for incarceration. The integration of
such provisions represents a broadening and redefinition of the Social
Safety Net that incorporates both public and private sector efforts to
maximize the life potential of each child.
Ariel Karolinski, Agustina Mazzoni, Jos M. Belizn, Fernando Althabe,

Eduardo Bergel, Pierre Buekens, Lost opportunities for effective management
of obstetric conditions to reduce maternal mortality and severe maternal
morbidity in Argentina and Uruguay, International Journal of Gynecology
& Obstetrics, Volume 110, Issue 2, August 2010, Pages 175-180, ISSN
0020-7292, 10.1016/j.ijgo.2010.05.002.
Abstract: Objective
To review the use of evidence-based practices in the care of mothers who
died or had severe morbidity attending public hospitals in two Latin
American countries.
Methods
This study is part of a multicenter intervention to increase the use of
evidence-based obstetric practice. Data on maternal deaths and women
admitted to intensive care units whose deliveries occurred in 24 hospitals
in Argentina and Uruguay were analyzed. Primary outcomes were use rates of
effective interventions to reduce maternal mortality (MM) and severe
maternal morbidity (SMM).
Results
A total of 106 women were included: 26 maternal deaths and 80 women with
SMM. Some effective interventions for severe acute hemorrhage had a high
use rate, such as blood transfusion (91%) and timely cesarean delivery
(75%), while active management of the third stage of labor (25%) showed a
lower rate. The overall use rate of effective interventions was 58% (95%
CI, 49%67%). This implies that 42% of the women did not receive one of the
effective interventions to reduce MM and SMM.
Conclusion
This study shows a low use of effective interventions to reduce MM and SMM
in public hospitals in Argentina and Uruguay. Dissemination and
implementation of evidence-based practices must be guaranteed to
effectively achieve progress on maternal health.
Keywords: Audit of clinical practice; Evidence-based medicine; Maternal
mortality; Obstetric emergencies; Physician's practice patterns; Process
evaluation (health care); Quality of Health Care; Utilization Review
Joseph K. Ruminjo, Pamela Fenney Lynam, A fifteen-year review of female

sterilization by minilaparotomy under local anesthesia in Kenya,
Contraception, Volume 55, Issue 4, April 1997, Pages 249-260, ISSN 0010-
7824, 10.1016/S0010-7824(97)00004-8.
Abstract: This paper is a comprehensive review of literature concerning the
Kenyan experience with female sterilization through minilaparotomy under
local anesthesia (MLLA). A composite picture from analysis of several
studies that include some 12,000 clients since 1979 reveals an average
Kenyan user to be 3134 years old (SD 4.9) with 5.96.8 children (SD 1.7
1.8). In up to 96% of cases, the indication for choosing sterilization is
personal socio-economic considerations. The majority of clients (97%99%)
report satisfaction with their choice of sterilization at the first follow-
up visit, and 9699% state that they would recommend the method to others.
The operation takes an average of 14 min (SD 4.55.3) skin-to-skin
through a 2.52.8 cm incision (SD 0.5). A mean of 18 cm3 of 1% lignocaine
is used (SD 2.7). Most clients (76.4%) have no post-operative complaints;
those who do have any complaints report minor transitory problems.
Similarly, most clients (96%) have moderate, little, or no peri-operative
pain, but 1.9%5% report much pain. The intra-operative and early
complication rate is 0.9%. Some 3.3% of clients suffer at least one
complication, some multiple, and the complication rate at 6 weeks is 4.1%,
with major complications occurring in 0.7% of cases, and minor
complications in 3.4%. The crude failure rate is 0.4% in the first year and
0.1% in the second year; when corrected for luteal phase pregnancies, which
account for 50% of all failures, the actual failure rate is 0.2% in the
first year and 0.1% in the second year both for interval and postpartum
procedures.
This literature review finds outpatient MLLA to be a relatively safe,

simple, effective, and well-accepted option for most Kenyan couples seeking
contraception that is intended to be permanent. Counseling, adequate client
assessment, and voluntarism have been shown to be essential elements, not
only for client satisfaction and avoidance of possible future regret, but
also for technical ease of the operative procedure. Recommendations that
derive from the Kenya experience are made.
Keywords: female sterilization; sterilization; voluntary surgical
contraception; Africa; Kenya; reproductive health; family planning
Valerie J. Hull, Breast-feeding and fertility: The sociocultural context,

1, 1987, Pages 77-109, ISSN 0020-7292, 10.1016/0020-7292(87)90399-7.
Keywords: Breast-feeding; Fertility; Lactational infecundity; Fertility
regulation
O. Chatillon, C. Even, La dpression de lantepartum : prvalence,
diagnostic, traitement, L'Encphale, Volume 36, Issue 6, December 2010,
Pages 443-451, ISSN 0013-7006, 10.1016/j.encep.2010.02.004.
Abstract: RsumIntroduction
La survenue de la dpression pendant la grossesse est une situation
frquente et bien distincte de la dpression du postpartum. Elle soulve de
nombreuses questions quant ses complications et aux possibilits
thrapeutiques.
Objectifs
Proposer une revue systmatique des donnes concernant la prvalence, les
facteurs de risque, et les complications lies la dpression de
lantepartum, ainsi que des techniques de dpistage et des traitements
actuellement tudis dans cette situation.
Mthodologie
Revue des tudes, des revues et des mta-analyses disponibles, partir des
bases de donnes Pubmed et Embase. Les articles relatifs la dpression du
postpartum et traitant spcifiquement du trouble bipolaire ont t exclus.
Rsultats
pidmiologie : la prvalence est value entre 5 et 15 %. Les facteurs de
risque sont ceux de toute dpression, auxquels sajoutent lambivalence
vis--vis de la grossesse, les antcdents dinterruption spontane de
grossesse, les grossesses mdicalement assistes ou compliques. Diagnostic
et dpistage : aucun outil spcifique nest disponible mais certaines
chelles (EPDS, PRIME-MD PHQ) ont t valides. Complications : les
complications sont pour la mre, celles de toute dpression, ainsi quun
risque major de complications obsttricales et de survenue dune
dpression du postpartum. Pour lenfant natre, les complications sont la
prmaturit, lhypotrophie et un risque possiblement accru de mort subite.
Traitements : les antidpresseurs tricycliques sont largement dcrits comme
srs durant la grossesse. Pour les inhibiteurs slectifs de la recapture de
la srotonine (ISRS), la majorit des donnes est rassurante, mais des
tudes rcentes soulvent le risque de malformations cardiaques et
dhypertension artrielle pulmonaire nonatale pour certains dentre eux.
Llectroconvulsivothrapie, rserve aux cas les plus svres, est dusage
sr sous rserve de prcautions. La plupart des psychothrapies valides
dans la dpression nont pas t spcifiquement tudies durant la
grossesse. Les autres traitements potentiels (photothrapie, rTMS) ont
montr des rsultats prometteurs, mais en trop faible nombre.
Conclusion
La dpression de lantepartum est une pathologie frquente, potentiellement
grave en labsence de traitement. La validation doutils de dpistage est
souhaitable. La dcision dun traitement mdicamenteux ne devrait pas tre
retarde pour les formes svres. Pour les formes modres, le choix
thrapeutique pourrait pencher en faveur dapproches non mdicamenteuses
moins dltres, au premier rang desquelles les psychothrapies, dont une
valuation plus approfondie est souhaitable.
SummaryIntroduction
The occurrence of depression during pregnancy is a frequent situation that
must be distinguished from postpartum depression. It raises many questions
regarding its complications and therapeutic options.
Objectives
To provide a systematic review of available data on prevalence, risk
factors, and adverse outcomes of antepartum depression, as well as on
screening tools and treatments currently available.
Methods
Studies, reviews, and meta-analyses were searched through the Pubmed and
Embase databases. Articles related to postpartum depression or specifically
focusing on bipolar disorder were excluded.
Results
Epidemiology: Prevalence is estimated between 5 and 15%. Risk factors, in
addition to those of any depression, are an ambivalent attitude towards
pregnancy, previous miscarriages, and medically-assisted or complicated
pregnancies. Diagnosis and screening: No specific tool has yet been
designed to diagnose or screen antepartum depression, but some scales
(EPDS, PRIME-MD PHQ) have been validated. Adverse outcomes: For the mother,
adverse outcomes are those of any depression, in addition to an increased
risk of delivery complications and of postpartum depression. For the child,
there is an increased risk for preterm birth, low birth-weight, and
possibly sudden death. Treatments: Tricyclic antidepressants are widely
described as safe during pregnancy. SSRIs show much reassuring data, even
though recent studies have raised concerns about cardiac malformations and
persistent pulmonary hypertension of the newborn. Electroconvulsive therapy
is only indicated in the most severe cases but appears secure under
specific safety measures. Most psychotherapies have not been specifically
assessed during pregnancy. Other treatments (bright light therapy, rTMS)
have shown some promising but not robust results.
Conclusion
Antepartum depression is frequent, and potentially severe if not treated.
Validation of specific screening tools is warranted. Pharmacological
treatment should not be postponed in cases of severe depression. Regarding
moderate depressions, it appears reasonable to turn to non-pharmacological
treatments, primarily psychotherapies, which therefore should be more
thoroughly studied.
Keywords: Dpression; Grossesse; Antepartum; Depression; Pregnancy;
Antepartum
Nadia Zanon Narchi, Exercise of essential competencies for midwifery care

by nurses in So Paulo, Brazil, Midwifery, Volume 27, Issue 1, February
2011, Pages 23-29, ISSN 0266-6138, 10.1016/j.midw.2009.04.007.
Abstract: General objective
to analyse the exercise of essential competencies for midwifery care by
nurses and/or midwives in the public health system of So Paulo (eastern
zone), Brazil.
Specific objectives
to develop a profile of the public health institutions and of the nurses
and/or midwives who care for women before, during and following childbirth;
to identify the activities performed in providing such care, as well as
their frequency; and to specify the possible obstacles or difficulties
encountered by them when exercising their competencies.
Design
a descriptive and exploratory research design, using a quantitative
approach.
Setting
the study was conducted in all public health services of So Paulo (eastern
zone), Brazil, namely 59 basic health-care units and six hospitals, during
the period of October 2006December 2007.
Participants
the study population consisted of 272 nurses and/or midwives who provide
care for pregnant women and newborns at the primary health-care units and
maternity hospitals of the public health system. Participants comprised
100% of hospital nurse coordinators (n=6), 61% of hospital maternity
nursing and/or midwifery staff (n=62) and 64% (n=204) of nursing and/or
midwifery staff working at primary health-care units.
Methods and findings
the data collection was based on a single form given to the coordinators
and two questionnaires, one handed out to antenatal and postnatal nursing
and/or midwifery staff and another handed out to labour and birth nursing
and/or midwifery staff. The results showed that nurses and/or midwives
providing care for women during pregnancy, labour, birth and the postnatal
period did not put the essential competencies for midwifery care into
practice, because they encountered institutional barriers and personal
resistance, and lacked protocols based on best practice and on the exercise
of essential competencies needed for effective midwifery care.
Key conclusions
the model of care in the public health services of So Paulo (eastern zone)
is based much more on hierarchical positions than on professional
competencies or on the recommendations of the scientific community. As a
result, health authorities need to review their midwifery policies to
improve maternalinfant care by nurses and/or midwives in order to ensure
the implementation of best midwifery practice.
Practical implications
the results of this study support actions to improve the quality of care
delivered to women and their families, while integrating nursing and
midwifery care in So Paulo, Brazil.
Keywords: Nursing and midwifery care; Essential competencies; Health
services
Mei-Yu Yu, Rosemary Sarri, Women's health status and gender inequality in
China, Social Science & Medicine, Volume 45, Issue 12, December 1997,
Pages 1885-1898, ISSN 0277-9536, 10.1016/S0277-9536(97)00127-5.
Abstract: This paper examines the health status of women in China by
reviewing levels and trends of female mortality at several phases of a
woman's life cycle focusing on infancy, girlhood, childbearing and old age.
The mortality rates of Chinese women and men are compared for the period
19501990 as are comparisons with women in selected countries. The cause-
specific death rate, expressed as a percentage of all deaths, and the
burden of disease, measured in terms of the disability-adjusted life years
(DALYs), are used to reflect the changing patterns of female diseases and
causes of deaths. Significant improvement in the health status of Chinese
women since 1950 is widely acknowledged as a major achievement for a
developing country with the largest population in the world, but the
differentials in women's health by region and urban/rural areas are
considerable. The Physical Quality of Life Index (PQLI) indicates that the
overall level of physical well-being of Chinese women has increased in
recent decades, but disparity in health between men and women still exists.
The Gender-Related Development Index (GDI) further reveals that China has
achieved significant progress in women's health during the past four
decades, but far less has been achieved with respect to gender equality
overall. The final sections of the paper focus on the discussion of some
health problems faced by the female population during the process of
economic reform since the 1980 s. In order to promote gender equality
between women and men, concerns on women's health care needs are
highlighted.
Keywords: Chinese women; health status; mortality; gender equality
Gaynor D. Maclean, An historical overview of the first two decades of

striving towards Safe Motherhood, Sexual & Reproductive Healthcare,
10.1016/j.srhc.2009.10.002.
Abstract: The paper examines some of the progress and problems encountered
during the first two decades of the Safe Motherhood Initiative. Sufficient
statistics are cited to identify the immensity of the persisting problems
associated with maternal death and morbidity before the study focuses on
some of the endeavours designed to enable women to survive their natural
function of giving birth. Varying attitudes and approaches that have
characterised the initiatives launched in the past 20 years are reviewed
and their changing emphases noted. The stress on treating the medical
causes of maternal death in the early years have been complemented by
increasing attention to social and political issues as time has elapsed.
The advent of the Millennium Development Goals (MDGs) has impelled efforts
to provide skilled attendance for all women during childbirth; the poor,
socially disadvantaged and vulnerable being those most at risk. MDG 5,
concerning maternal health, is perceived as pivotal in the context of
global development. Maternal death when viewed from the human rights
perspective is perceived as a social injustice rather than a health
disadvantage and Safe Motherhood is currently considered increasingly as a
basic human right. The study offers a synthesis of concepts and actions
that are contributing to building Safe Motherhood across the globe in the
21st century. In considering the factors that inhibit the degree of safety
associated with giving birth, global efforts that are tackling a persisting
buffer zone are identified and continuous action urged in order to strive
towards the targets set for 2015.
Keywords: Safe Motherhood; Skilled attendance; Human rights; Millennium
Development Goals
Donald E. Greydanus, Helen D. Pratt, Dilip R. Patel, Concepts of

Contraception for Adolescent and Young Adult Women with Chronic Illness and
Disability, Disease-a-Month, Volume 58, Issue 5, May 2012, Pages 258-320,
ISSN 0011-5029, 10.1016/j.disamonth.2012.02.001.
Mihira V Karra, Kathleen G Auerbach, Lynn Olson, Erlinda P Binghay,

Hospital infant feeding practices in metropolitan Chicago: An evaluation of
five of the Ten steps to successful breast-feeding, Journal of the
American Dietetic Association, Volume 93, Issue 12, December 1993, Pages
1437-1439, ISSN 0002-8223, 10.1016/0002-8223(93)92248-V.
Susan M. Love, Ana M. Suarez, Marianne E. Love, Young mothers and babies
wellness program, Children and Youth Services Review, Volume 30, Issue 12,
December 2008, Pages 1437-1446, ISSN 0190-7409,
10.1016/j.childyouth.2008.04.012.
Abstract: Young Mothers and Babies Wellness Program is a comprehensive
mental health and sobriety treatment plan for pregnant and parenting young
women emancipating from probation department or child welfare services and
their infants. The Program provides interventions to establish safe,
nurturing and responsive relationships between mothers and babies. This
article includes rationale for treating this high risk population and its
focus on mother-infant dyads; program design, lists of scientifically
supported protocolson the individual, relationship and contextual levels;
and a plan to evaluate the integrity of its delivery, responses to
treatment, and program outcome goals. If these mothers are helped to
achieve the multiple goals of mental health, sobriety, economic well-being,
positive social skills, and secure attachment relationships with their
children; they can begin to break the powerful cycle of intergenerational
poverty, mental illness and maltreatment that plagues our society.
Keywords: Child welfare; Juvenile probation; Evidence-based practice;
Mental health programs; Prevention
Paul Ramchandani, Alan Stein, Jonathan Evans, Thomas G O'Connor, the ALSPAC
study team, Paternal depression in the postnatal period and child
development: a prospective population study, The Lancet, Volume 365, Issue
9478, 25 June1 July 2005, Pages 2201-2205, ISSN 0140-6736, 10.1016/S0140-
6736(05)66778-5.
Depression is common and frequently affects mothers and fathers of young
children. Postnatal depression in mothers affects the quality of maternal
care, and can lead to disturbances in their children's social, behavioural,
cognitive, and physical development. However, the effect of depression in
fathers during the early years of a child's life has received little
attention.
Methods
As part of a large, population-based study of childhood, we assessed the
presence of depressive symptoms in mothers (n=13351) and fathers (n=12884)
8 weeks after the birth of their child with the Edinburgh postnatal
depression scale (EPDS). Fathers were reassessed at 21 months. We
identified any subsequent development of behavioural and emotional problems
in their children (n=10024) at age 35 years with maternal reports on the
Rutter revised preschool scales.
Findings
Information was available for 8431 fathers, 11833 mothers, and 10024
children. Depression in fathers during the postnatal period was associated
with adverse emotional and behavioural outcomes in children aged 35 years
(adjusted odds ratio 209, 95% CI 142308), and an increased risk of
conduct problems in boys (266, 167425). These effects remained even
after controlling for maternal postnatal depression and later paternal
depression.
Interpretation
Our findings indicate that paternal depression has a specific and
persisting detrimental effect on their children's early behavioural and
emotional development.
Anna Bennetts, Nathan Shaffer, Chomnad Manopaiboon, Pattrawan Chaiyakul,

Wimol Siriwasin, Philip Mock, Kunyarat Klumthanom, Sumaleelak Sorapipatana,
Chanidapa Yuvasevee, Sujira Jalanchavanapate, Leslie Clark, Determinants of
depression and HIV-related worry among HIV-positive women who have recently
given birth, Bangkok, Thailand, Social Science & Medicine, Volume 49,
Issue 6, September 1999, Pages 737-749, ISSN 0277-9536, 10.1016/S0277-
9536(99)00108-2.
Abstract: HIV-infected pregnant women have been the focus of considerable
research related to biomedical issues of mother-to-child transmission
worldwide. However, there have been few reports on the psychological well-
being of new mothers with HIV, either in developed or developing countries.
As part of a perinatal HIV transmission and family impact study in Bangkok,
predictors of psychological scales were evaluated from interview data
(N=129) collected 1824 months postpartum. Standardised questionnaires were
used to assess depressive symptoms and HIV-related worry. Depressive
symptomatology and HIV-related worry were common amongst these women.
Multivariate logistic regression analysis identified several factors that
predicted these psychological outcomes. High depression scores were
associated with women who were no longer in a relationship with their
partner (odds ratio (OR) 5.72, confidence interval (CI) 2.1814.97) and who
used venting coping strategies (OR 2.15, CI 1.443.21). Higher levels of
HIV-related worry were associated with women whose babies were HIV-infected
(OR 3.51, CI 1.2810.69), who had not disclosed their HIV status to others
(OR 3.05, CI 1.297.24) and who reported that their HIV-infection was
something about which their family would be ashamed (OR 3.44, CI 1.34
9.77). Based on the current findings, intervention strategies we propose
are psychological interventions which address disclosure issues, feelings
of shame and coping strategies as well as financial assistance for single
mothers. Interventions that require few resources such as group counselling
or support merit special consideration.
Keywords: HIV; Pregnancy; Depression; Psychological adaptation
Lelia Duley, The Global Impact of Pre-eclampsia and Eclampsia, Seminars in

Perinatology, Volume 33, Issue 3, June 2009, Pages 130-137, ISSN 0146-0005,
10.1053/j.semperi.2009.02.010.
Abstract: Over half a million women die each year from pregnancy related
causes, 99% in low and middle income countries. In many low income
countries, complications of pregnancy and childbirth are the leading cause
of death amongst women of reproductive years. The Millennium Development
Goals have placed maternal health at the core of the struggle against
poverty and inequality, as a matter of human rights. Ten percent of women
have high blood pressure during pregnancy, and preeclampsia complicates 2%
to 8% of pregnancies. Preeclampsia can lead to problems in the liver,
kidneys, brain and the clotting system. Risks for the baby include poor
growth and prematurity. Although outcome is often good, preeclampsia can be
devastating and life threatening. Overall, 10% to 15% of direct maternal
deaths are associated with preeclampsia and eclampsia. Where maternal
mortality is high, most of deaths are attributable to eclampsia, rather
than preeclampsia. Perinatal mortality is high following preeclampsia, and
even higher following eclampsia. In low and middle income countries many
public hospitals have limited access to neonatal intensive care, and so the
mortality and morbidity is likely to be considerably higher than in
settings where such facilities are available. The only interventions shown
to prevent preeclampsia are antiplatelet agents, primarily low dose
aspirin, and calcium supplementation. Treatment is largely symptomatic.
Antihypertensive drugs are mandatory for very high blood pressure. Plasma
volume expansion, corticosteroids and antioxidant agents have been
suggested for severe preeclampsia, but trials to date have not shown
benefit. Optimal timing for delivery of women with severe preeclampsia
before 32 to 34 weeks' gestation remains a dilemma. Magnesium sulfate can
prevent and control eclamptic seizures. For preeclampsia, it more than
halves the risk of eclampsia (number needed to treat 100, 95% confidence
interval 50 to 100) and probably reduces the risk of maternal death. A
quarter of women have side effects, primarily flushing. With clinical
monitoring serious adverse effects are rare. Magnesium sulfate is the
anticonvulsant of choice for treating eclampsia; more effective than
diazepam, phenytoin, or lytic cocktail. Although it is a low cost effective
treatment, magnesium sulfate is not available in all low and middle income
countries; scaling up its use for eclampsia and severe preeclampsia will
contribute to achieving the Millennium Development Goals.
Keywords: pre-eclampsia; prevention; treatment; maternal mortality;
maternal health
Mark B. Stephens, Lynn A. Fenton, Scott A. Fields, OBSTETRIC ANALGESIA,

Primary Care: Clinics in Office Practice, Volume 27, Issue 1, 1 March 2000,
Pages 203-220, ISSN 0095-4543, 10.1016/S0095-4543(05)70156-1.
, Position of the American Dietetic Association: Vegetarian Diets, Journal

of the American Dietetic Association, Volume 109, Issue 7, July 2009, Pages
1266-1282, ISSN 0002-8223, 10.1016/j.jada.2009.05.027.
appropriately planned vegetarian diets, including total vegetarian or vegan
diets, are healthful, nutritionally adequate, and may provide health
benefits in the prevention and treatment of certain diseases. Well-planned
vegetarian diets are appropriate for individuals during all stages of the
life cycle, including pregnancy, lactation, infancy, childhood, and
adolescence, and for athletes. A vegetarian diet is defined as one that
does not include meat (including fowl) or seafood, or products containing
those foods. This article reviews the current data related to key nutrients
for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine,
calcium, and vitamins D and B-12. A vegetarian diet can meet current
recommendations for all of these nutrients. In some cases, supplements or
fortified foods can provide useful amounts of important nutrients. An
evidence-based review showed that vegetarian diets can be nutritionally
adequate in pregnancy and result in positive maternal and infant health
outcomes. The results of an evidence-based review showed that a vegetarian
diet is associated with a lower risk of death from ischemic heart disease.
Vegetarians also appear to have lower low-density lipoprotein cholesterol
levels, lower blood pressure, and lower rates of hypertension and type 2
diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower
body mass index and lower overall cancer rates. Features of a vegetarian
diet that may reduce risk of chronic disease include lower intakes of
saturated fat and cholesterol and higher intakes of fruits, vegetables,
whole grains, nuts, soy products, fiber, and phytochemicals. The
variability of dietary practices among vegetarians makes individual
assessment of dietary adequacy essential. In addition to assessing dietary
adequacy, food and nutrition professionals can also play key roles in
educating vegetarians about sources of specific nutrients, food purchase
and preparation, and dietary modifications to meet their needs.
Caroline A Stone, Chapter 10 - Osteopathy and obstetrics, Visceral and

Obstetric Osteopathy, Churchill Livingstone, Edinburgh, 2007, Pages 285-
327, ISBN 9780443102028, 10.1016/B978-0-443-10202-8.50015-0.
Sarah Hudson Scholle, Roger F Haskett, Barbara H Hanusa, Harold Alan

Pincus, David J Kupfer, Addressing depression in obstetrics/gynecology
practice, General Hospital Psychiatry, Volume 25, Issue 2, MarchApril
2003, Pages 83-90, ISSN 0163-8343, 10.1016/S0163-8343(03)00006-9.
Abstract: Efforts to improve the care of depression in primary care
patients have largely ignored the potential of obstetrics/gynecology
(OB/GYN) practices. We describe feasibility studies of a depression
screening and care management intervention in three diverse OB/GYN
practices. Patients were screened using the Patient Health Questionnaire. A
depression care manager offered education and referral assistance to women
who screened positive for depression. The prevalence of depression was
higher in the hospital clinic (20.2%, 47/233) than the suburban clinic
(10.7%, 8/75) or the office practice (8.2%, 48/583). Seventy-two women
participated in the care management intervention. Patient satisfaction with
the intervention was high and at 1-month follow-up, 31.9% of patients had
kept or scheduled a new mental health appointment. Depression interventions
developed in primary care can be successfully adapted for use with patients
in OB/GYN practices. Additional modifications, particularly efforts to
improve coordination of care with both general medical and mental health
providers, are needed.
Keywords: Depression; Obstetrics; Gynecology; Primary care; Screening
Lois McKellar, Jan Pincombe, Ann Henderson, Encountering the culture of

midwifery practice on the postnatal ward during Action Research: An
impediment to change, Women and Birth, Volume 22, Issue 4, December 2009,
Pages 112-118, ISSN 1871-5192, 10.1016/j.wombi.2009.02.003.
The reduction of time available to midwives during the hospital postnatal
stay suggests that there is a need to review postnatal care. Innovative
strategies are required which give attention to specific family needs and
assist in the transition to parenthood. Nevertheless, new ideas and changes
are not always readily accepted in midwifery practice.
Aim
To enhance the provision of postnatal care to parents in the early
postnatal period given time constraints for parents hospital stay.
Methods
Action research was employed to explore the educational experiences of
parents in the postnatal period. An action research group (ARG) was
established, comprising predominantly of midwives. Based on data collected
from parents through questionnaires, focus groups and interviews, three
actions were developed and implemented on a postnatal ward.
Results
The actions were evaluated by 122 parents through self-report
questionnaires. Midwives working on the postnatal ward and midwives
involved in the ARG provided feedback regarding the actions through
separate focus group discussions. The parents who participated in the study
and, the midwives involved in the ARG, were positive about the actions and
perceived them to be beneficial in preparing parents for parenthood. Many
of the ward midwives, however, were negative about the actions and
questioned their benefit for midwifery practice.
Discussion
The negativity of the ward midwives regarding the innovations implemented
in the study contrasted strikingly with the positive responses from both
parents and the action research midwives. Two themes emerged which may
explain the response of midwives to the actions, notably, a lack of
ownership of the actions and the problematic nature of the current culture
of the postnatal-care environment.
Conclusion
It appears that the provision of hospital postnatal care has been
influenced by an underlying culture in midwifery practice, which in turn,
has impeded the change required to enhance postnatal care.
Keywords: Midwifery; Postnatal care; Action research; Institutional change;
Midwifery culture
Carol Rockhill, Ian Kodish, Caroline DiBattisto, Michelle Macias, Chris

Varley, Sheryl Ryan, Anxiety Disorders in Children and Adolescents, Current
Problems in Pediatric and Adolescent Health Care, Volume 40, Issue 4, April
2010, Pages 66-99, ISSN 1538-5442, 10.1016/j.cppeds.2010.02.002.
Abstract: Anxiety disorders are among the most common and functionally
impairing mental health disorders to occur in childhood and adolescence.
Primary care providers can expect to treat youth who have anxiety disorders
frequently, and this article aims to provide the tools necessary to
evaluate and manage patients who present with anxiety symptoms during
childhood or adolescence. This article discusses the epidemiology of
anxiety disorders, including the increased risk of future anxiety disorders
and other mental health problems that are associated with having an anxiety
disorder in childhood and adolescence. Next, the etiology of anxiety
disorders is delineated, including discussion of genetic, cognitive-
behavioral, physiological, and ecological explanatory models, and a summary
of neurophysiological findings related to childhood and adolescent anxiety.
Next, methods and tools are presented for assessment and treatment of
anxiety disorders, with a focus on assessment and treatment that can be
initiated in a primary care setting. Evidence-based therapy and medication
interventions are reviewed. The article includes a focus on developmental
differences in symptom presentation, assessment techniques, and treatment
strategies, such that a primary care provider will have tools for working
with the wide age range in their practices: preschool children through
adolescents. We conclude that many effective intervention strategies exist,
and their improving availability and ease of use makes it both critical and
achievable for children and adolescents with anxiety disorders to be
accurately diagnosed and treated with evidence-based medication and
therapy.
Vanora A. Hundley, Bilal I. Avan, David Braunholtz, Wendy J. Graham, Are

birth kits a good idea? A systematic review of the evidence, Midwifery,
10.1016/j.midw.2011.03.004.
Abstract: Objective
to identify the current state of knowledge regarding the effects of births
kits on clean birth practices and on newborn and maternal outcomes.
Design
the scoping review was informed through a systematic literature review; a
call for information distributed to experts in maternal and child health,
relevant research centres and specialist libraries; and a search of the web
sites of groups working in the area of maternal and child health. Data were
synthesised to produce a summary of the state of knowledge regarding birth
kits. Meta-analysis was not attempted because of the varied study designs
and the heterogeneous nature of the interventions.
Participants
births kit use was identified in 51 low resource countries, but evaluations
were scarce, with only nine studies reporting effects of intervention
packages including births kits.
Findings
the quality of evidence for inferring causality was weak, with only one
randomised controlled trial. In two studies, births kit use along with co-
interventions resulted in a statistically significant increase in the
likelihood of the attendant having clean hands. The impact on other aspects
of cleanliness was less clear. Intervention packages which include births
kits were associated with reduced newborn mortality (three studies),
omphalitis (four studies), and puerperal sepsis (three studies). The one
study that considered maternal mortality was not large enough to estimate
relative reduction with much precision. None of the studies reported any
adverse effects; however, none explicitly described looking for negative
consequences.
Conclusion
providing birth kits to facilitate clean practices seems commonsense, but
there is no evidence to indicate effects, positive or negative, separate
from those achieved by a broader intervention package. More robust methods
and knowledge systems are needed to understand the contextual factors and
share relevant implementation lessons.
Keywords: Birth kits; Clean birth practices; Systematic review
Marianne Weiss, Norah Louise Johnson, Shelly Malin, Teresa Jerofke, Cecilia
Lang, Eileen Sherburne, Readiness for Discharge in Parents of Hospitalized
Children, Journal of Pediatric Nursing, Volume 23, Issue 4, August 2008,
Pages 282-295, ISSN 0882-5963, 10.1016/j.pedn.2007.10.005.
Abstract: Parental preparation for a child's discharge from the hospital
sets the stage for successful transitioning to care and recovery at home.
In this study of 135 parents of hospitalized children, the quality of
discharge teaching, particularly the nurses' skills in delivery of parent
teaching, was associated with increased parental readiness for discharge,
which was associated with less coping difficulty during the first 3 weeks
postdischarge. Parental coping difficulty was predictive of greater
utilization of posthospitalization health services. These results validate
the role of the skilled nurse as a teacher in promoting positive outcomes
at discharge and beyond the hospitalization.
Keywords: Discharge teaching; Discharge readiness; Discharge transition
Jill Schiff Boissonnault, Rebecca Gourley Stephenson, Chapter 13 - The

Obstetric Patient, In: William G. Boissonnault, PT, DHSc, FAAOMPT,
Editor(s), Primary Care for the Physical Therapist, W.B. Saunders, Saint
Louis, 2005, Pages 239-270, ISBN 9780721696591, 10.1016/B978-072169659-
1.50020-4.
K.Alison Clarke-Stewart, Virginia D Allhusen, David J McDowell, Luke
Thelen, Justin D Call, Identifying psychological problems in young
children: How do mothers compare with child psychiatrists?, Journal of
Applied Developmental Psychology, Volume 23, Issue 6, FebruaryMarch 2003,
Pages 589-624, ISSN 0193-3973, 10.1016/S0193-3973(03)00006-6.
Abstract: Children (N=115) in a randomly selected nonclinic sample were
evaluated by their mothers (using the Achenbach Child Behavior Checklist,
or CBCL) and a child psychiatrist (who conducted a clinical interview and
observation) when they were 2 and 5 years old. Compared to psychiatrists,
mothers tended to overreport externalizing problems and underreport
internalizing problems (particularly separation anxiety) at age 2. Mothers'
reports, however, were predictive of children's social and language
abilities and problems assessed at later ages and by fathers.
Psychiatrists' reports added to the predictability of child functioning
beyond mothers' reports, particularly for problems reported by teachers
when the children were 4 and 5 years old. Mothers' and psychiatrists'
reports of children's problems at age 5 were more similar than at age 2,
and there was no value added by psychiatrists' evaluations. Both mothers'
and psychiatrists' reports of children's problems were related to risk
factors of attachment insecurity and poor parenting, but mothers' reports,
relative to psychiatrists', were more closely related to difficult
temperament and mothers' own dysphoric functioning, whereas psychiatrists'
reports were more closely related to child's gender.
Keywords: Psychological problems; Behavior problems; Externalizing;
Internalizing; Clinical diagnosis
N. Simelela, Women's access to modern methods of fertility regulation,

September 2006, Pages 292-300, ISSN 0020-7292, 10.1016/j.ijgo.2006.04.014.
Abstract: Preventing unintended pregnancies through access to modern family
planning could avert 2035% of maternal deaths, saving the lives of more
than 100,000 women each year. Obstacles to wider access still exist, but
they may be overcome by overt policy commitment to reproductive health
services, partnership between stakeholders, community involvement and
quality programs.
Keywords: Access to contraception; Sexual and reproductive rights; Family
planning; Quality of care
Scott B. Patten, Sidney H. Kennedy, Raymond W. Lam, Claire O'Donovan, Marie

J. Filteau, Sagar V. Parikh, Arun V. Ravindran, Canadian Network for Mood
and Anxiety Treatments (CANMAT) Clinical Guidelines for the Management of
Major Depressive Disorder in Adults. I. Classification, Burden and
Principles of Management, Journal of Affective Disorders, Volume 117,
Supplement 1, October 2009, Pages S5-S14, ISSN 0165-0327,
10.1016/j.jad.2009.06.044.
Major depressive disorder (MDD) is one of the most burdensome illnesses in
Canada. The purpose of this introductory section of the 2009 revised CANMAT
guidelines is to provide definitions of the depressive disorders (with an
emphasis on MDD), summarize Canadian data concerning their epidemiology and
describe overarching principles of managing these conditions. This section
on Classification, Burden and Principles of Management is one of 5
guideline articles in the 2009 CANMAT guidelines.
Methods
The CANMAT guidelines are based on a questionanswer format to enhance
accessibility to clinicians. An evidence-based format was used with updated
systematic reviews of the literature and recommendations were graded
according to the Level of Evidence using pre-defined criteria. Lines of
Treatment were identified based on criteria that included evidence and
expert clinical support.
Results
Epidemiologic data indicate that MDD afflicts 11% of Canadians at some time
in their lives, and approximately 4% during any given year. MDD has a
detrimental impact on overall health, role functioning and quality of life.
Detection of MDD, accurate diagnosis and provision of evidence-based
treatment are challenging tasks for both clinicians and for the health
systems in which they work.
Limitations
Epidemiologic and clinical data cannot be seamlessly linked due to
heterogeneity of syndromes within the population.
Conclusions
In the eight years since the last CANMAT Guidelines for Treatment of
Depressive Disorders were published, progress has been made in
understanding the epidemiology and treatment of these disorders. Evidence
supporting specific therapeutic interventions is summarized and evaluated
in subsequent sections.
Keywords: Major Depressive Disorder; Canadian Network for Mood and Anxiety
Treatments (CANMAT); Classifications; Principle of management; Burden;
Prevalence
Robert W. Amler, Stanley Barone Jr., Aysenil Belger, Cheston M. Berlin Jr.,
Christopher Cox, Harry Frank, Michael Goodman, Jean Harry, Stephen R.
Hooper, Roger Ladda, Judy S. LaKind, Paul H. Lipkin, Lewis P. Lipsitt,
Matthew N. Lorber, Gary Myers, Ann M. Mason, Larry L. Needham, Babasaheb
Sonawane, Theodore D. Wachs, Janice W. Yager, Hershey Medical Center
Technical Workshop Report: Optimizing the design and interpretation of
epidemiologic studies for assessing neurodevelopmental effects from in
utero chemical exposure, NeuroToxicology, Volume 27, Issue 5, September
2006, Pages 861-874, ISSN 0161-813X, 10.1016/j.neuro.2006.07.008.
(http://www.sciencedirect.com/science/article/pii/S0161813X0600180X)
Abstract: Neurodevelopmental disabilities affect 38% of the 4 million
babies born each year in the U.S. alone, with known etiology for less than
25% of those disabilities. Numerous investigations have sought to determine
the role of environmental exposures in the etiology of a variety of human
neurodevelopmental disorders (e.g., learning disabilities, attention
deficit-hyperactivity disorder, intellectual disabilities) that are
manifested in childhood, adolescence, and young adulthood. A comprehensive
critical examination and discussion of the various methodologies commonly
used in investigations is needed. The Hershey Medical Center Technical
Workshop: Optimizing the design and interpretation of epidemiologic studies
for assessing neurodevelopmental effects from in utero chemical exposure
provided such a forum for examining these methodologies. The objective of
the Workshop was to develop scientific consensus on the key principles and
considerations for optimizing the design and interpretation of
epidemiologic studies of in utero exposure to environmental chemicals and
subsequent neurodevelopmental effects. (The Panel recognized that the
nervous system develops post-natally and that critical periods of exposure
can span several developmental life stages.) Discussions from the Workshop
Panel generated 17 summary points representing key tenets of work in this
field. These points stressed the importance of:
a well-defined, biologically plausible hypothesis as the foundation of in
utero studies for assessing neurodevelopmental outcomes;
understanding of the exposure to the environmental chemical(s) of interest,

underlying mechanisms of toxicity, and anticipated outcomes;
the use of a prospective, longitudinal cohort design that, when possible,

runs for periods of 25 years, and possibly even longer, in an effort to
assess functions at key developmental epochs;
measuring potentially confounding variables at regular, fixed time

intervals;
including measures of specific cognitive and socialemotional domains along

with non-cognitive competence in young children, as well as comprehensive
measures of health;
consistency of research design protocols across studies (i.e., tests,

covariates, and analysis styles) in an effort to improve interstudy
comparisons;
emphasis on design features that minimize introduction of systematic error

at all stages of investigation: participant selection, data collection and
analysis, and interpretation of results; these would include (but not be
limited to) reducing selection bias, using double-blind designs, and
avoiding post hoc formulation of hypotheses;
a priori data analysis strategies tied to hypotheses and the overall

research design, particularly for methods used to characterize and address
confounders in any neurodevelopmental study;
actual quantitative measurements of exposure, even if indirect, rather than

methods based on subject recall;
careful examination of standard test batteries to ensure that the battery

is tailored to the age group as well as what is known about the specific
neurotoxic effects on the developing nervous system;
establishment of a system for neurodevelopmental surveillance for tracking

the outcomes from in utero exposure across early developmental time periods
to determine whether central nervous system injuries may be lying silent
until developmentally challenged;
ongoing exploration of computerized measures that are culturally and

linguistically sensitive, and span the age range from birth into the
adolescent years;
routine incorporation of narrative in manuscripts concerning the

possibility of spurious (i.e., false positive and false negative) test
results in all research reportage (this can be facilitated by detailed,
transparent reporting of design, covariates, and analyses so that others
can attempt to replicate the study);
forthright, disciplined, and intellectually honest treatment of the extent

to which results of any study are conclusive that is, how generalizable
the results of the study are in terms of the implications for the
individual study participants, the community studied, and human health
overall;
confinement of reporting to the actual research questions, how they were

tested, and what the study found, and avoiding, or at least keeping to a
minimum, any opinions or speculation concerning public health implications;
education of clinicians and policymakers to critically read scientific

reports, and to interpret study findings and conclusions appropriately; and
recognition by investigators of their ethical duty to report negative as

well as positive findings, and the importance of neither minimizing nor
exaggerating these findings.
Keywords: Neurodevelopment; Workshop report; In utero; Environmental chemicals; Epidemiologic studies
J. Valentin, Basic anatomical and physiological data for use in

radiological protection: reference values: ICRP Publication 89, Annals of
the ICRP, Volume 32, Issues 34, SeptemberDecember 2002, Pages 1-277, ISSN
0146-6453, 10.1016/S0146-6453(03)00002-2.
Abstract: This report presents detailed information on age- and gender-
related differences in the anatomical and physiological characteristics of
reference individuals. These reference values provide needed input to
prospective dosimetry calculations for radiation protection purposes for
both workers and members of the general public.
The purpose of this report is to consolidate and unify in one publication,

important new information on reference anatomical and physiological values
that has become available since Publication 23 was published by the ICRP in
1975. There are two aspects of this work. The first is to revise and extend
the information in Publication 23 as appropriate. The second is to provide
additional information on individual variation among grossly normal
individuals resulting from differences in age, gender, race, or other
factors.
This publication collects, unifies, and expands the updated ICRP reference
values for the purpose of providing a comprehensive and consistent set of
age- and gender-specific reference values for anatomical and physiological
features of the human body pertinent to radiation dosimetry. The reference
values given in this report are based on: (a) anatomical and physiological
information not published before by the ICRP; (b) recent ICRP publications
containing reference value information; and (c) information in Publication
23 that is still considered valid and appropriate for radiation protection
purposes.
Moving from the past emphasis on Reference Man, the new report presents a
series of reference values for both male and female subjects of six
different ages: newborn, 1 year, 5 years, 10 years, 15 years, and adult. In
selecting reference values, the Commission has used data on Western
Europeans and North Americans because these populations have been well
studied with respect to antomy, body composition, and physiology. When
appropriate, comparisons are made between the chosen reference values and
data from several Asian populations.
The first section of the report provides summary tables of all the
anatomical and physiological parameters given as reference values in this
publication. These results give a comprehensive view of reference values
for an individual as influenced by age and gender.
The second section describes characteristics of dosimetric importance for

the embryo and fetus. Information is provided on the development of the
total body and the timing of appearance and development of the various
organ systems. Reference values are provided on the mass of the total body
and selected organs and tissues, as well as a number of physiological
parameters.
The third section deals with reference values of important anatomical and
physiological characteristics of reference individuals from birth to
adulthood. This section begins with details on the growth and composition
of the total body in males and females. It then describes and quantifies
anatomical and physiological characteristics of various organ systems and
changes in these characteristics during growth, maturity, and pregnancy.
Reference values are specified for characteristics of dosimetric
importance.
The final section gives a brief summary of the elemental composition of

individuals. Focusing on the elements of dosimetric importance, information
is presented on the body content of 13 elements: calcium, carbon, chloride,
hydrogen, iodine, iron, magnesium, nitrogen, oxygen, potassium, sodium,
sulphur, and phosphorus.
Keywords: Anatomy; Physiology; Reference Man; Dosimetry; Radiation
protection
J. Renee Matich, Laura S. Sims, A comparison of social support variables

between women who intend to breast or bottle feed, Social Science &
Medicine, Volume 34, Issue 8, April 1992, Pages 919-927, ISSN 0277-9536,
10.1016/0277-9536(92)90260-W.
Abstract: Social support has been identified as an important element for
encouragement and success of lactation. The sources, types and amounts of
perceived social support were determined for women during their third
trimester of pregnancy and at four weeks of postpartum breastfeeding.
Differences in social support were reported for women who stated an
intention to breastfeed and those who planned to bottle feed. The tangible,
emotional and informational functions of social support were measured as
aggregate values across support sources. Tangible and emotional support
were not significantly different between intended breast or bottle feeders.
However, informational support was higher for women who intended to
breastfeed compared to those who intended to bottle feed. Mean scores were
then analyzed for specific individuals who might provide support. The
baby's father was a more important source of tangible support for intended
breastfeeders. Intended breastfeeders also indicated they received more
emotional and information support from the baby's father and prenatal
classes. Tangible, emotional and informational support did not change pre-
and postnatally for women who breastfed. However, certain sources did
provide more support postnatally. Finally, predictors such as level of
education, a belief that breastfeeding was better for health and emotional
closeness, fewer children, moderate tangible and emotional support and more
informational support were identified for women who intended to breastfeed
Keywords: social support; breastfeeding; lactation; infant feeding
Dianne S Elfenbein, Marianne E Felice, Adolescent pregnancy, Pediatric

Clinics of North America, Volume 50, Issue 4, August 2003, Pages 781-800,
ISSN 0031-3955, 10.1016/S0031-3955(03)00069-5.
Jo Fordyce, Chapter 4 - The antenatal period, In: Jill Mantle, BA FCSP

DIPTP, Jeanette Haslam, MPHIL GRADDIPPHYS MCSP SRP, and Sue Barton, MSC
DIPED MCSP DIPTP DIPRG&RT DIPTHRF SRP, Editor(s), Physiotherapy in
Obstetrics and Gynaecology (Second Edition), Butterworth-Heinemann, Oxford,
2004, Pages 93-139, ISBN 9780750622653, 10.1016/B978-0-7506-2265-3.50012-5.
Jeanne Raisler, Michelle O'Grady, Jody Lori, Clinical teaching and learning
in midwifery and women's health, Journal of Midwifery & Women's Health,
Volume 48, Issue 6, NovemberDecember 2003, Pages 398-406, ISSN 1526-9523,
10.1016/j.jmwh.2003.08.005.
Abstract: Although there is an abundance of literature about clinical
teaching in the health professions, a much smaller body of information
focuses on the art and science of clinical teaching in midwifery and
women's health. We reviewed preceptor handbooks, training manuals, and Web
sites created by nursing and nurse-midwifery education programs, medical
and pharmacy schools, and national associations of health professionals.
Using the search terms clinical teaching, clinical learning, preceptor,
clerkship, residency training, and midwifery education, we searched the
MEDLINE and CINAHL databases and health sciences libraries for relevant
articles and books. The information and practical strategies about clinical
teaching that we found are synthesized and presented in this article. It
includes a discussion of challenges in clinical teaching; an overview of
expectations and responsibilities of the education program, students, and
preceptors; suggestions about orienting students to clinical sites;
clinical teaching strategies and skills; suggestions for incorporating
critical thinking and evidence-based care into clinical teaching;
guidelines for giving constructive feedback and evaluation; characteristics
of excellent clinical teachers; and suggestions about how education
programs and professional associations can support and develop clinical
sites and preceptors. The Appendix contains manuals, books, and Web sites
devoted to clinical teaching.
Keywords: clinical teaching; clinical learning; preceptor; clerkship;
residency training; midwifery education
Pranee C. Lundberg, Alganesh Gerezgiher, Experiences from pregnancy and

childbirth related to female genital mutilation among Eritrean immigrant
women in Sweden, Midwifery, Volume 24, Issue 2, June 2008, Pages 214-225,
ISSN 0266-6138, 10.1016/j.midw.2006.10.003.
Abstract: Objective
to explore Eritrean immigrant women's experiences of female genital
mutilation (FGM) during pregnancy, childbirth and the postpartum period.
Design
qualitative study using an ethnographic approach. Data were collected via
tape-recorded interviews.
Setting
interviews in the Eritrean women's homes located in and around Uppsala,
Sweden.
Participants
15 voluntary Eritrean immigrant women.
Data collection and analysis
Semi-structured interview and open-ended questions were used. The
interviews were tape-recorded, transcribed verbatim and then analysed.
Findings
six themes of experiences of FGM among Eritrean women during pregnancy and
childbirth were identified. They are (1) fear and anxiety; (2) extreme pain
and long-term complications; (3) health-care professionals knowledge of
circumcision and health-care system; (4) support from family, relatives and
friends; (5) de-infibulation; and (6) decision against female circumcision
of daughters.
Key conclusion and implications for practice
the Eritrean women had experiences of FGM and had suffered from its
complications during pregnancy, childbirth and the postpartum period.
Midwives and obstetricians should have competence in managing women with
FGM, and they need increased understanding of cultural epistemology in
order to be able to provide quality care to these women. At antenatal
centres, circumcised women should be advised to de-infibulate before
pregnancy. Special courses about anatomical differences should be offered
to these women and their husbands. It is also important to inform them
about Swedish law, which prohibits all forms of FGM.
Keywords: Female genital mutilation; Eritrean immigrant women; Experiences;
Pregnancy; Childbirth; Postpartum period; Sweden
M. Tankeyoon, N. Dusitsin, Sopon Chalapati, Suporn Koetsawang, S. Saibiang,
M. Sas, J.J. Gellen, O. Ayeni, R. Gray, A. Pinol, L. Zegers, Effects of
hormonal contraceptives on milk volume and infant growth: WHO Special
Programme of Research and Development and Research Training in Human
Reproduction, Contraception, Volume 30, Issue 6, December 1984, Pages 505-
522, ISSN 0010-7824, 10.1016/0010-7824(84)90001-5.
Abstract: WHO conducted a three-centre study in Hungary and Thailand to
evaluate the effects of hormonal contraception on lactation and infant
growth. Women choosing oral contraceptives were randomly assigned to a
combined oral contraceptive containing 30ug ethinyl estradiol and 150ug
levonorgestrel (N=86) or a progestin-only preparation containing 75ug dl-
norgestrel (N=85). Identical packaging and treatment schedules allowed
double-blind observation. One-hundred-and-eleven women using no
contraception or non-hormonal methods acted as controls. In the two Thai
centres 59 women using depot-medroxyprogesterone acetate formed an
additional comparison group. All subjects were healthy women with normal
deliveries, whose infants had normal birth weights and satisfactory growth
in the neonatal period.
Breast milk volume was determined by pump expression using standardized

procedures. Information was obtained on nursing frequency and
supplementation, infant growth and morbidity. Pretreatment observations at
6 weeks post-partum were used as a baseline, and subjects were followed-up
at 9, 12, 16, 20 and 24 weeks post-partum.
Women using combined oral contraceptives had a decline in milk volume

within 6 weeks of initiating treatment, whereas no significant decrease was
observed in the other treatment groups. After 18 weeks of treatment,
combined oral contraceptive users experienced a 41.9% decline in milk
volume, compared to 12.0% with progestin-only minipills and 6.1% in the
non-hormonal controls. The prevalence of complementary feeding and
withdrawals due to inadequate milk supply were comparable in the four
treatment groups. However, data were not available on the daily amounts of
complementary feeds. There were no significant differences in growth of
infants between treatment groups. Thus, women may have compensated for
declines in milk volume by more supplementary feeding or by more prolonged
and intense suckling episodes.
We conclude that 30 ug estrogen-containing combined oral contraceptives

impair milk secretion, but in the selected healthy group of mothers and
children studied with the prevailing level of supplementary feeding, this
did not adversely affect infant growth.
Paula P. Meier, Janet L. Engstrom, Aloka L. Patel, Briana J. Jegier,

Nicholas E. Bruns, Improving the Use of Human Milk During and After the
NICU Stay, Clinics in Perinatology, Volume 37, Issue 1, March 2010, Pages
217-245, ISSN 0095-5108, 10.1016/j.clp.2010.01.013.
Keywords: Human milk feeding; Newborn intensive care unit; Milk dose and
exposure period; Prematurity-specific morbidity
Linda A Bartlett, Denise J Jamieson, Tila Kahn, Munawar Sultana, Hoyt G

Wilson, Ann Duerr, Maternal mortality among Afghan refugees in Pakistan,
1999-2000, The Lancet, Volume 359, Issue 9307, 23 February 2002, Pages 643-
649, ISSN 0140-6736, 10.1016/S0140-6736(02)07808-X.
Estimated at 36 million, Afghans are the largest population of refugees in
the world. Information on the magnitude, causes, and preventable factors of
maternal deaths among Afghan refugees may yield valuable information for
prevention.
Methods
Deaths were recorded between Jan 20, 1999, and Aug 31, 2000, during a
census carried out in 12 Afghan refugee settlements in Pakistan. Deaths
among women of reproductive age (1549 years) were further investigated by
verbal autopsy interviews to determine their cause, risk factors, and
preventability, and to ascertain the barriers faced to obtaining health
care.
Findings
The census identified 134406 Afghan refugees and 1197 deaths; a crude
mortality rate of 55 (95% CI 5258) per thousand population. Among the
66 deaths among women of reproductive age, deaths due to maternal causes
(n=27) exceeded any other cause (41% [95% CI 2953]). 16 liveborn and nine
stillborn infants were born to women who died of maternal causes; six of
the liveborn infants died after birth. Therefore, 60% (15 of 24) of infants
born to these women were either born dead or died after birth. Compared
with women who died of non-maternal causes, women who died of maternal
causes had a greater number of barriers to health care (p=0001), and their
deaths were more likely to be preventable (p<005).
Interpretation
Maternal deaths account for a substantial burden of mortality among Afghan
refugee women of reproductive age in Pakistan. The high prevalence of
barriers to health care access indicates opportunities for reducing
maternal deaths in refugee women and their children.
Christopher Harshaw, Alimentary epigenetics: A developmental

psychobiological systems view of the perception of hunger, thirst and
satiety, Developmental Review, Volume 28, Issue 4, December 2008, Pages
541-569, ISSN 0273-2297, 10.1016/j.dr.2008.08.001.
Abstract: Hunger, thirst and satiety have an enormous influence on
cognition, behavior and development, yet we often take for granted that
they are simply inborn or innate. Converging data and theory from both
comparative and human domains, however, supports the conclusion that the
phenomena hunger, thirst and satiety are not innate but rather emerge
probabilistically as a function of experience during individual
development. The metatheoretical perspective provided by developmental
psychobiological systems theory provides a useful framework for organizing
and synthesizing findings related to the development of the perception of
hunger, thirst and satiety, or alimentary interoception. It is argued that
neither developmental psychology nor the psychology of eating and drinking
have adequately dealt with the ontogeny of alimentary interoception and
that a more serious consideration of the species-typical developmental
system of food and fluid intake and the many modifications that have been
made therein is likely necessary for a full understanding of both
alimentary and emotional development.
Keywords: Hunger; Thirst; Satiety; Developmental systems theory;
Interoceptive development; Interoceptive awareness; Emotion; Emotional
development
Tanja Hofer, Annette Hohenberger, Petra Hauf, Gisa Aschersleben, The link
between maternal interaction style and infant action understanding, Infant
Behavior and Development, Volume 31, Issue 1, January 2008, Pages 115-126,
ISSN 0163-6383, 10.1016/j.infbeh.2007.07.003.
Abstract: The present study investigates whether the maternal interaction
style is related to 6-month-old infants action interpretation. We tested
6-month-olds ability to interpret an unfamiliar human action as goal-
directed using a modified version of the paradigm used by Woodward, A. L.
(1999). Infant's ability to distinguish between purposeful and non-
purposeful behaviours. Infant Behavior & Development, 22, 145160 and
Kirly, I., Jovanovic, B., Prinz, W., Aschersleben, G., & Gergely, G.
(2003). The early origins of goal attribution in infancy. Consciousness
& Cognition, 12, 732751. Additionally, all infants and their mothers
participated in a free play situation to assess maternal interaction styles
as measured by the CARE-Index. According to mothers distinct interaction
styles, infants were divided into three groups. Results suggest that at 6
months of age infants of mothers with a modestly controlling interaction
style are better at interpreting a human action as goal-directed than
infants of sensitive and relative unresponsive mothers. The ability to
understand human action as goal-directed might be a corollary of an
adaptive strategy in infancy.
Keywords: Maternal interaction style; Infants; Early action understanding;
Goal-directed actions
Jennifer Prah Ruger, Karen M. Emmons, Economic Evaluations of Smoking

Cessation and Relapse Prevention Programs for Pregnant Women: A Systematic
Review, Value in Health, Volume 11, Issue 2, MarchApril 2008, Pages 180-
190, ISSN 1098-3015, 10.1111/j.1524-4733.2007.00239.x.
Abstract: AbstractObjective
Smoking cessation and relapse prevention during and after pregnancy reduces
the risk of adverse maternal and infant health outcomes, but the economic
evaluations of such programs have not been systematically reviewed. This
study aims to critically assess economic evaluations of smoking cessation
and relapse prevention programs for pregnant women.
Methods
All relevant English-language articles were identified using PubMed
(January 19662003), the British National Health Service Economic
Evaluation Database, and reference lists of key articles. Economic
evaluations of smoking cessation and relapse prevention among pregnant
women were reviewed. Fifty-one articles were retrieved, and eight articles
were included and evaluated. A single reviewer extracted methodological
details, study designs, and outcomes into summary tables. All studies were
reviewed, and study quality was judged using the criteria recommended by
the Panel on Cost-Effectiveness in Health and Medicine and the British
Medical Journal (BMJ) checklist for economic evaluations.
Results
The search retrieved 51 studies. No incremental cost-effectiveness studies
or cost-utility studies were found. A narrative synthesis was conducted on
the eight studies thatmet the inclusion criteria. Roughly one-third
employed costbenefit analyses (CBA). Those conducting CBA have found
favorable benefitcost ratios of up to 3:1; for every dollar invested $3
are saved in downstream health-related costs.
Conclusions
CBA suggests favorable costbenefit ratios for smoking cessation among
pregnant women, although currently available economic evaluations of
smoking cessation and relapse prevention programs for pregnant women
provide limited evidence on cost-effectiveness to determine optimal
resource allocation strategies. Although none of these studies had been
performed in accordance with Panel recommendations or BMJ guidelines, they
are, however, embryonic elements of a more systematic framework. Existing
analyses suggest that the return on investment will far outweigh the costs
for this critical population. There is significant potential to improve the
quality of economic evaluations of such programs; therefore, additional
analyses are needed. The article concludes with ideas on how to design and
conduct an economic evaluation of such programs in accordance with accepted
quality standards.
Keywords: economic evaluations; pregnant women; relapse prevention; smoking
cessation; systematic review
Michael Favin, Bonnie Bradford, Deborah Cubular, Maternal health in
developing countries, Midwifery, Volume 1, Issue 2, June 1985, Pages 75-85,
ISSN 0266-6138, 10.1016/S0266-6138(85)80002-4.
Abstract: This is the first chapter in the information for action issue
paper, Improving Maternal Health in Developing Countries, prepared for
UNICEF by the World Federation of Public Health Associations. The remaining
chapters in this paper are entitled:
Program actions to improve maternal health,
Access to Maternal Health Services,
Planning and Monitoring Maternal Health Services.
There are four appendices:
Appendix A describes the value of training Traditional Birth Attendants;
Appendix B reviews the maternal child birth record cards available in some
countries;
Appendix C describes the Programmes to improve maternal health in

developing countries; and
Appendix D contains an annotated bibliography of 25 relevant books and

papers, and a bibliography of 155 references.
This issue paper is available from APHA Publication Sales, 1015 15th
Street, NW Washington, DC 20005, USA at a cost of $9 (there are reductions
for bulk orders).
D. Elizabeth Jesse, Jacqueline Walcott-McQuigg, Anne Mariella, Melvin S.

Swanson, Risks and Protective Factors Associated With Symptoms of
Depression in Low-Income African American and Caucasian Women During
Pregnancy, Journal of Midwifery & Women's Health, Volume 50, Issue 5,
10.1016/j.jmwh.2005.05.001.
Abstract: This article describes the risks and protective factors for
symptoms of depression in pregnancy among low-income African American and
Caucasian women. Data were collected from 130 women who were between 16 and
28 weeks gestation and enrolled in an urban prenatal clinic. The
questionnaires used in the face-to-face interviews consisted of
sociodemographic items, the Beck Depression Inventory (BDI-II), the
Prenatal Psychosocial Profile (PPP), 3 items from the Jarel Spiritual Well-
Being Scale, the Spiritual Perspective Scale, and 4 items on health risk
behaviors. Twenty-seven percent of the women reported depressive symptoms
at levels indicating risk for clinical depression. However, there were no
significant differences between African American and Caucasian women.
Sociodemographic factors accounted for 13% of the variance (P < .01) in
BDI-II scores. Psychosocial and behavioral risk factors accounted for an
additional 19% of the BDI-II variance (P < .001), and psychosocial and
spiritual resources accounted for 7% of the variance (P < .001),
resulting in these variables accounting for 54% of the total variance in
BDI-II scores. Higher levels of stress, lower levels of self-esteem and
social support, and higher religiosity had a significant relationship with
more symptoms of depression. This supports the need to routinely screen for
and to assess factors associated with depressive symptoms in pregnant low-
income women.
Keywords: depression; pregnancy; psychosocial; religiosity; spirituality
Ezer Kang, Claude Ann Mellins, Warren Yiu Kee Ng, Lisa-Gaye Robinson,
Elaine J. Abrams, Standing between two worlds in Harlem: A developmental
psychopathology perspective of perinatally acquired human immunodeficiency
virus and adolescence, Journal of Applied Developmental Psychology, Volume
29, Issue 3, MayJune 2008, Pages 227-237, ISSN 0193-3973,
10.1016/j.appdev.2008.02.001.
Abstract: Perinatal HIV infection in the US continues to evolve from a
fatal pediatric illness to a chronic medical condition of childhood and
adolescence. Although navigating this period is influenced by multi-leveled
deprivations commonly experienced by low-income minority families, HIV
alters the timing and experience of developmental milestones for many
adolescents with perinatal HIV. This selective review of the growing
developmental psychopathology literature and the authors' clinical work at
a pediatric HIV program in Harlem, NY provide an overview of how
developmental psychopathology offers an integrative framework that
elucidates how autonomy, peer relationships, and self-concept evolve among
1321 year old adolescents. This paper highlights the importance of
considering influences of both perinatal HIV and the culture of poverty on
adolescent development, and of adopting multilevel interventions and
research to address how interactions among biologic, environmental, and
HIV-related stressors (serostatus disclosure, medical treatment adherence,
illness stigma) influence the development of adolescents with perinatal
HIV.
Keywords: Adolescence; Perinatal HIV; Developmental psychopathology;
Behavioral and adjustment problems; Minority youth; Autonomy, Peer
relationships; Self-concept
Mar M. Snchez, Pamela M. Noble, Casie K. Lyon, Paul M. Plotsky, Michael

Davis, Charles B. Nemeroff, James T. Winslow, Alterations in diurnal
cortisol rhythm and acoustic startle response in nonhuman primates with
adverse rearing, Biological Psychiatry, Volume 57, Issue 4, 15 February
2005, Pages 373-381, ISSN 0006-3223, 10.1016/j.biopsych.2004.11.032.
Early adverse experiences represent risk factors for the development of
anxiety and mood disorders. Studies in nonhuman primates have largely
focused on the impact of protracted maternal and social deprivation, but
such intense manipulations also result in severe social and emotional
deficits very difficult to remediate. This study attempts to model more
subtle developmental perturbations that may increase the vulnerability for
anxiety/mood disorders but lack the severe deficits associated with
motherless rearing.
Methods
We investigated the consequences of repeated maternal separations between 3
to 6 months of age on rhesus monkeys hypothalamic-pituitary-adrenal (HPA)
axis function and acoustic startle reactivity.
Results
Repetitive maternal separation led to increased cortisol reactivity to the
separation protocol in female infants and alterations in mother-infant
interaction. It also resulted in a flattened diurnal rhythm of cortisol
secretion and increased acoustic startle reactivity at later ages.
Conclusions
Macaques with adverse rearing exhibited short-term and long-term
alterations in HPA axis function and increased acoustic startle response
comparable with changes associated with mood/anxiety disorders. The
magnitude of HPA axis reactivity to the separations and the alterations in
mother-infant relationship detected during the separation protocol
predicted some of the alterations in HPA axis and emotionality exhibited
later in life.
Keywords: HPA axis; fear; rhesus monkeys; maternal separation; amygdala;
behavioral inhibition
Suellen Miller, Deborah L Billings, Barbara Clifford, Midwives and

postabortion care: experiences, opinions, and attitudes among participants
at the 25th triennial congress of the international confederation of
midwives, Journal of Midwifery & Women's Health, Volume 47, Issue 4,
JulyAugust 2002, Pages 247-255, ISSN 1526-9523, 10.1016/S1526-
9523(02)00250-7.
Abstract: Midwifery practice may not include caring for women experiencing
complications from unsafe abortion, despite the importance of this care for
the health and lives of millions of women around the world. This article
summarizes data collected from midwives from 41 countries who attended the
25th Triennial Congress of the International Confederation of Midwives in
1999, focusing on their experiences with, and attitudes toward, the
provision of postabortion care. Barriers to provision of postabortion care
and factors for changes in postabortion care-related policies were
explored. Midwives from developing countries, where complications from
unsafe abortion present a serious public health problem, were cognizant of
the need to authorize, train, and equip midwives in postabortion care,
including the use of uterine evacuation of incomplete abortion with manual
vacuum aspiration. Changes in policy and practice are needed throughout the
world so that women will have access to quality, compassionate postabortion
care services regardless of where they live. Ensuring that midwives are
able to provide such services will help to reduce abortion-related
morbidity and mortality.
Carolyn Sargent, Joan Rawlins, Transformations in maternity services in

Jamaica, Social Science & Medicine, Volume 35, Issue 10, November 1992,
Pages 1225-1232, ISSN 0277-9536, 10.1016/0277-9536(92)90176-Q.
Abstract: Analysis of the current organization and delivery of maternity
care in Jamaica profits not only from an assessment of recent health issues
but from consideration of the development of maternity services over the
past century. Historical analysis indicates that a critical element in
public health policy has been the effort to encourage use of biomedical
obstetrical care and to eliminate the lay midwife. However, while women
increasingly patronize hospitals, the delivery of services has
deteriorated, resulting in widespread client dissatisfaction. Economic
contingencies have contributed to the decline in maternity services, but
health personnel manifest the ideology prevalent throughout the colonial
era equating social irresponsibility with health complications. The
cultural construction of illegitimacy and maternity is shown to be a
dimension of class relations having an impact on health policy throughout
Jamaica's history.
Keywords: reproduction; Caribbean; maternity care; medical history
Carmel M O'Meara, A diagnostic model for the evaluation of childbirth and

parenting education, Midwifery, Volume 9, Issue 1, March 1993, Pages 28-34,
ISSN 0266-6138, 10.1016/0266-6138(93)90039-U.
(http://www.sciencedirect.com/science/article/pii/026661389390039U)
Abstract: A research study examined current issues in childbirth and
parenting education in the Australian Capital Territory (ACT). In this
article continuing official scepticism about the effectiveness of these
programmes, despite evidence of consumer satisfaction and commitment from
service providers, is noted. A critical review of the literature reveals
the absence of a systematic framework for evaluation of childbirth
education programmes. A framework which incorporates a methodology for
health education planning and evaluation in a management context is
proposed as a means of overcoming this deficiency. This framework enables a
focus on the effectiveness of these health services from the perspective of
both clients and providers, and identification of strategic measures for
improving programme delivery and educational outcomes.
Mohamed Balley, Determinants of fertility in a rural society: Some evidence

from Sierra Leone, Social Science & Medicine, Volume 28, Issue 3, 1989,
Pages 285-292, ISSN 0277-9536, 10.1016/0277-9536(89)90272-4.
Abstract: Data from a sample of 2000 currently married women aged 1549
years, during a fertility and family planning survey carried out in rural
areas of Moyamba District of Sierra Leone in 1979, are used to investigate
the influences of background (wife's tribal and religious affiliations, and
current place of residence), socio-economic (wife's education and
occupation, and husband's education), and demographic (wife's current age,
age at first marriage, desired family size, and infant-child mortality)
variables on marital fertility in Sierra Leone.
An OLS regression analysis indicates that the demographic variables, size

of place of residence and wife's occupation affect fertility significantly.
Wife's educational level and tribal affiliation exhibit marginal effects on
fertility. Policy implications of these findings are discussed.
Keywords: Sierra Leone; rural; fertility; determinants
Pamela J. Maxson, Sharon E. Edwards, Amber Ingram, Marie Lynn Miranda,

Psychosocial differences between smokers and non-smokers during pregnancy,
Addictive Behaviors, Volume 37, Issue 2, February 2012, Pages 153-159, ISSN
0306-4603, 10.1016/j.addbeh.2011.08.011.
Abstract: Abstract
Despite the well-established adverse birth and childhood health outcomes
associated with maternal smoking, smoking rates among pregnant women remain
high. Psychosocial health attributes, including anxiety, depression,
perceived stress, self-efficacy, and personality characteristics, have
especially important roles in smoking behavior. Understanding who smokes
during pregnancy and what factors influence this behavior choice may be key
to improving the effectiveness of smoking cessation intervention programs.
We use data from a prospective cohort study of pregnant women to understand
the psychosocial health profiles of women who choose to smoke during
pregnancy compared to the profiles of women who do not smoke or
successfully quit smoking during pregnancy. Multinomial logistic regression
analyses on 1518 non-Hispanic black and non-Hispanic white women assessed
the association between smoking status and psychosocial health while
controlling for demographic characteristics. Higher levels of perceived
stress, depression, neuroticism, negative paternal support, and perceived
racism among non-Hispanic blacks were associated with higher odds of being
a smoker than a non-smoker (p < 0.05). Higher levels of self-
efficacy, extraversion, agreeableness, conscientiousness, interpersonal
support, positive paternal support, and perceived social standing were
associated with lower odds of being a smoker than a non-smoker
(p < 0.05). Our analysis indicates that women who smoked
during pregnancy experienced a more negative constellation of psychosocial
adversities than women who did not smoke. Given the psychosocial needs and
personality profiles experienced by smokers, more attention to the
psychosocial strengths and weaknesses of these women may allow for more
tailored smoking cessation programs, enhancing both the short- and long-
term effectiveness of such interventions.
Keywords: Pregnancy; Smoking; Psychosocial health
Henryk Kafka, Mark R. Johnson, Michael A. Gatzoulis, The Team Approach to

Pregnancy and Congenital Heart Disease, Cardiology Clinics, Volume 24,
10.1016/j.ccl.2006.08.009.
WHO/CHD Immunisation-Linked Vitamin A Supplementation Study Group,

Randomised trial to assess benefits and safety of vitamin A supplementation
linked to immunisation in early infancy, The Lancet, Volume 352, Issue
6736(98)02487-8.
The benefits and safety of vitamin A supplementation linked to immunisation
in infancy need to be assessed before it can be widely recommended. We
assessed the safety and benefits of maternal postpartum and infant vitamin
A supplementation administered with each of the three diphtheria-tetanus-
pertussis (DPT) and poliomyelitis immunisations and with a fourth dose with
measles immunisation.
Methods
From January, 1995, we enrolled 9424 mother-infant pairs from Ghana, India,
and Peru in this randomised, double-blind, placebo-controlled trial. 4716
mothers of infants in the vitamin A group received 200000 IU vitamin A,
and their infants were given 25000 IU vitamin A with each of the first
three doses of DPT/poliomyelitis immunisation at 6, 10, and 14 weeks. In
the control group, 4708 mothers and their infants received placebo at the
same times. At 9 months, with measles immunisation, infants in the vitamin
A group were given a further dose of 25000 IU and those in the control
group received 100000 IU vitamin A. Infants were followed up to age 12
months. The primary outcome measures were vitamin A status, signs of acute
toxic effects, anthropometric indicators, and severe morbidity. Analysis
was by intention to treat.
Findings
3933 (93%) of the eligible 4212 infants on vitamin A and 3938 (93%) of the
eligible 4227 controls received all four study doses. At the 6-month
follow-up, there was a small decrease in vitamin A deficiency in the
vitamin A group compared with controls (serum retinol 070 mol/L 101
[299%] vs 122 [371%; 95% Cl of the difference143% to 02%]). This
effect was no longer apparent at 9 and 12 months. There were no significant
between-group differences in mortality throughout the study. The rate ratio
to compare all deaths up to age 9 months in the two groups was 096 (95% Cl
073 to 127). Fewer than 1% of the infants had bulging fontanelle. The
intervention had no effect on anthropometric status, or on overall or
severe morbidity.
Interpretation
The trial confirmed the safety of the intervention, but shows no sustained
benefits in terms of vitamin A status beyond age 6 months or infant
morbidity.
H.S. Kaplan, J. Bock, Fertility Theory: Embodied-capital Theory of Life

History Evolution, In: Editors-in-Chief: Neil J. Smelser and Paul B.
Baltes, Editor(s)-in-Chief, International Encyclopedia of the Social &
Behavioral Sciences, Pergamon, Oxford, 2001, Pages 5561-5568, ISBN
9780080430768, 10.1016/B0-08-043076-7/02225-7.
Abstract: The embodied-capital theory generalizes existing life history
theory in evolutionary biology by treating the processes of growth,
development and maintenance as investments in stocks of somatic or
embodied-capital. In a physical sense, embodied capital is organized
somatic tissuemuscles, digestive organs, brains, etc. In a functional
sense, embodied capital includes strength, immune function, coordination,
skill, knowledge, and other abilities. Since such stocks tend to depreciate
with time, allocations to maintenance can also be seen as investments in
embodied capital. There are two trade-offs affecting natural selection on
fertility. The first is the trade-off between present and future
reproduction. By growing, an organism can increase its energy capture rates
in the future and thus increase its future fertility. This can be
understood in terms of optimal investments in own embodied capital vs.
reproduction. The second trade-off is between quantity and quality of
offspring, where quality is a function of parental investment in offspring
and reflects its ability to survive and reproduce. This can be understood
in terms of investments in the embodied-capital of offspring. Natural
selection has resulted in physiological and psychological mechanisms by
which individuals adjust fertility onset and fertility rates in relation to
changing environmental conditions. Embodied-capital theory links several
existing theories of demographic transition and, in so doing, provides a
new perspective on each one. It rationalizes the shift from natural
fertility to parity-specific fertility in terms of a changing
quality/quantity trade-off, as a transition from high fertility/low
parental investment to low fertility/high parental investment. It also
shows why the shift to lower mortality rates can lead to lower fertility,
but for very different reasons than traditional demographic transition
theory proposes.
Caroline Bckstrm, Elisabeth Hertfelt Wahn, Support during labour: first-

time fathers descriptions of requested and received support during the
birth of their child, Midwifery, Volume 27, Issue 1, February 2011, Pages
67-73, ISSN 0266-6138, 10.1016/j.midw.2009.07.001.
Abstract: Objective
to explore how first-time fathers describe requested and received support
during a normal birth.
Design
qualitative research design. Ten first-time fathers were interviewed during
the first postpartum week. Individual open-ended interviews were used to
explore the fathers descriptions, and the interviews were analysed using
qualitative analysis.
Setting
a labour ward at one hospital in a south-western county of Sweden in
November and December 2006.
Participants
first-time fathers who had experienced a normal birth at the hospital
during the study period.
Findings
the support described is presented as one main theme, being involved or
being left out, which included four underlying categories: an allowing
atmosphere, balancing involvement, being seen and feeling left out.
Key conclusions
fathers perceived that they were given good support when they were allowed
to ask questions during labour, when they had the opportunity to interact
with the midwife and their partner, and when they could choose when to be
involved or to step back. Fathers want to be seen as individuals who are
part of the labouring couple. If fathers are left out, they tend to feel
helpless; this can result in a feeling of panic and can put their
supportive role of their partner at risk.
the results of this study could initiate discussions about how health-care
professionals can develop support given to the labouring couple, with an
interest in increasing paternal involvement.
Keywords: Childbirth; Experience; Father; Midwife; Support
H. Hanaire, V. Lassmann-Vague, N. Jeandidier, E. Renard, N. Tubiana-Rufi,

A. Vambergue, D. Raccah, M. Pinget, B. Guerci, Treatment of diabetes
mellitus using an external insulin pump: the state of the art, Diabetes
& Metabolism, Volume 34, Issue 4, Supplement 1, September 2008, Pages
401-423, ISSN 1262-3636, 10.1016/S1262-3636(08)73972-7.
Abstract: The aim of diabetes treatment is to achieve tight glucose control
to avoid the development of chronic diabetic complications while reducing
the frequency of hypoglycaemic episodes. Continuous subcutaneous insulin
infusion (CSII) using an external pump is an intensive diabetes therapy
recognized to improve metabolic control and glycaemic instability, and to
reduce the frequency of severe hypoglycaemia. For years, the theoretical
advantages of the insulin pump (constancy of basal delivery, adjustable
basal rates, and low insulin depots allowing the reduction of glycaemic
variability) have contributed to its reported superiority compared with
multiple daily injections (MDI). However, insulin pump therapy is now
challenged by new MDI regimens based on long-acting insulin analogues that
could replace the use of CSII. As a consequence, health professionals now
have to determine which patients are likely to benefit the most from CSII.
Recently, several studies reported that children and adolescents, and
patients whose blood glucose imbalance was initially the most pronounced
with basal-bolus regimens, would particularly benefit from CSII. Other
indications were also proposed in marginal clinical situations with highly
selected patients in whom a significant improvement of blood glucose was
demonstrated. Finally, the use of CSII in type 2 diabetic patients now
appears to be a good alternative to the ineffective MDI regimens observed
in some of these patients. However, past experience with CSII indicates
that candidates for insulin pump therapy must be carefully selected and
strongly motivated to improve their glucose control. Use of CSII also
requires strict medical supervision by physicians and a regular programme
of patient education by paramedical teams, to ensure optimal responsible
use of this technique by healthcare professionals.
Keywords: External insulin pump; Intensive insulin therapy;
HbA1c; Glycaemic control; Indications; Diabetes; Review; Pompe
insuline externe; Insulinothrapie intensive; HbA1c; Contrle
glycmique; Indications; Diabte; Revue
Vronique Filippi, Carine Ronsmans, Oona MR Campbell, Wendy J Graham, Anne

Mills, Jo Borghi, Marjorie Koblinsky, David Osrin, Maternal health in poor
countries: the broader context and a call for action, The Lancet, Volume
368, Issue 9546, 28 October3 November 2006, Pages 1535-1541, ISSN 0140-
6736, 10.1016/S0140-6736(06)69384-7.
Abstract: Summary
In this paper, we take a broad perspective on maternal health and place it
in its wider context. We draw attention to the economic and social
vulnerability of pregnant women, and stress the importance of concomitant
broader strategies, including poverty reduction and women's empowerment. We
also consider outcomes beyond mortality, in particular, near-misses and
long-term sequelae, and the implications of the close association between
the mother, the fetus, and the child. We make links to a range of global
survival initiatives, particularly neonatal health, HIV, and malaria, and
to reproductive health. Finally, after examining the political and
financial context, we call for action. The need for strategic vision,
financial resources, human resources, and information are discussed.
Jan Weingrad Smith, Mary Rose Tully, Midwifery management of breastfeeding:

using the evidence, Journal of Midwifery & Women's Health, Volume 46,
Issue 6, NovemberDecember 2001, Pages 423-438, ISSN 1526-9523,
10.1016/S1526-9523(01)00206-9.
Abstract: Strong evidence supports breastfeeding as the appropriate health
choice for both mothers and infants. However, the mechanics of
breastfeeding are frequently less well understood. This review of both the
research and clinical evidence regarding appropriate breastfeeding
management is designed to aid the midwife and other health care
professionals in providing care and teaching, which will optimize maternal
and infant health.
Cesar G. Victora, Ana Langer, Fernando Barros, Jos Belizan, Ubaldo Farnot,
Jos Villar, Latin American Network for Perinatal and Reproductive Research
(LANPER), The Latin American multicenter trial on psychosocial support
during pregnancy: Methodology and baseline comparability, Controlled
Clinical Trials, Volume 15, Issue 5, October 1994, Pages 379-394, ISSN
0197-2456, 10.1016/0197-2456(94)90034-5.
Abstract: This article presents the methodology and baseline findings of a
large multicenter trial involving four countries from Latin America
(Argentina, Brazil, Cuba, and Mexico). The study was a randomized,
controlled, single-masked trial to investigate the impact of social support
during pregnancy on perinatal outcomes. Pregnant women with gestational
ages between 15 and 22 weeks were screened in health facilities in the four
countries. Those presenting with one or more risk factors for having a low-
birthweight baby were invited to join the trial. A total of 2235 women
between 500 and 600 in each countrywere randomized into an intervention (n
= 1110) or a control (n = 1125) group. Both groups were comparable in terms
of nearly all baseline variables. The intervention group received a minimum
of four visits at home by a trained health worker who provided direct
emotional support, health education, and an attempt to enhance the woman's
social support network. Over 90% of all women were evaluated at 36 weeks of
pregnancy and soon after delivery, and 85% at the 40th day postpartum. The
outcomes under study included intrauterine growth retardation, gestational
age, perinatal and maternal morbidity and mortality, labor interventions,
psychological distress and characteristics of the social support network,
among others. This trial showed that it was possible to select, screen,
randomize, visit, and evaluate a large number of women in four Latin
American countries using a standardized methodology.
Keywords: Social support; randomized controlled trial; multicenter trial
Leigh A. Gantner, Christine M. Olson, Evaluation of public health

professionals capacity to implement environmental changes supportive of
healthy weight, Evaluation and Program Planning, Volume 35, Issue 3, August
2012, Pages 407-416, ISSN 0149-7189, 10.1016/j.evalprogplan.2012.01.002.
Abstract: Community-based interventions to promote healthy weights by
making environmental and policy changes in communities may be an important
strategy in reversing the obesity epidemic. However, challenges faced by
local public health professionals in facilitating effective environmental
and policy change need to be better understood and addressed. To better
understand capacity-building needs, this study evaluated the efforts of the
Healthy Start Partnership, a university-community project to promote
healthy weights in young families in a rural eight-county area of upstate
New York. Qualitative interviews (n = 30) and pre/post surveys
(n = 31) were conducted over three years of the intervention.
Challenges faced by partners significantly slowed progress of environmental
interventions in some communities. First, many partners did not feel their
regular jobs afforded them sufficient time to do community work. Second,
many partners did not feel they had the personal political power to work on
broader environmental, policy, or system change issues. Third, facilitating
and policy change and reaching out to non-traditional partners, like
businesses, required developing a new set of public health skills. Fourth,
the long-time frame of environmental and policy work meant that many
efforts would exceed the grant period. Building local public health leaders
for environmental and policy change necessitates that these challenges are
acknowledged and addressed.
Keywords: Food environments; Capacity building; Public health professionals
F.P. Perera, V. Rauh, R.M. Whyatt, D. Tang, W.Y. Tsai, J.T. Bernert, Y.H.
Tu, H. Andrews, D.B. Barr, D.E. Camann, D. Diaz, J. Dietrich, A. Reyes,
P.L. Kinney, A Summary of Recent Findings on Birth Outcomes and
Developmental Effects of Prenatal ETS, PAH, and Pesticide Exposures,
NeuroToxicology, Volume 26, Issue 4, August 2005, Pages 573-587, ISSN 0161-
813X, 10.1016/j.neuro.2004.07.007.
Abstract: Inner-city minority populations are high-risk groups for adverse
birth outcomes and also more likely to be exposed to environmental
contaminants, including environmental tobacco smoke (ETS), benzo[a]pyrene
B[a]P, other ambient polycyclic aromatic hydrocarbons (global PAHs), and
residential pesticides. The Columbia Center for Children's Environmental
Health (CCCEH) is conducting a prospective cohort study of 700 northern
Manhattan pregnant women and newborns to examine the effects of prenatal
exposure to these common toxicants on fetal growth, early neurodevelopment,
and respiratory health. This paper summarizes results of three published
studies demonstrating the effects of prenatal ETS, PAH, and pesticides on
birth outcomes and/or neurocognitive development [Perera FP, Rauh V, Whyatt
RM, Tsai WY, Bernert JT, Tu YH, et al. Molecular evidence of an interaction
between prenatal environment exposures on birth outcomes in a multiethnic
population. Environ Health Perspect 2004;12:63062; Rauh VA, Whyatt RM,
Garfinkel R, Andrews H, Hoepner L, Reyes A, et al. Developmental effects of
exposure to environmental tobacco smoke and material hardship among inner-
city children. Neurotoxicol Teratol 2004;26:37385; Whyatt RM, Rauh V, Barr
DB, Camann DE, Andrews HF, Garfinkel R, et al. Prenatal insecticide
exposures, birth weight and length among an urban minority cohort. Environ
Health Perspect, in press].
To evaluate the effects of prenatal exposure to ETS, PAHs, and pesticides,

researchers analyzed questionnaire data, cord blood plasma (including
biomarkers of ETS and pesticide exposure), and B[a]P-DNA adducts (a
molecular dosimeter of PAHs). Self-reported ETS was associated with
decreased head circumference (P = 0.04), and there was a significant
interaction between ETS and adducts such that combined exposure had a
significant multiplicative effect on birth weight (P = 0.04) and head
circumference (P = 0.01) after adjusting for confounders.
A second analysis examined the neurotoxic effects of prenatal ETS exposure

and postpartum material hardship (unmet basic needs in the areas of food,
housing, and clothing) on 2-year cognitive development. Both exposures
depressed cognitive development (P < 0.05), and there was a significant
interaction such that children with exposure to both ETS and material
hardship exhibited the greatest cognitive deficit (7.1 points).
A third analysis found that cord chlorpyrifos, and a combined measure of

cord chlorpyrifos, diazinon, and propoxur-metabolite, were inversely
associated with birth weight and/or length (P < 0.05).
These results underscore the importance of policies that reduce exposure to

ETS, air pollution, and pesticides with potentially adverse effects on
fetal growth and child neurodevelopment.
Keywords: Environmental tobacco smoke; Material hardship; Birth outcomes;
PAH; Prenatal; Insecticides
A. Macedo, M. Marques, S. Bos, B.R. Maia, T. Pereira, M.J. Soares, J.

Valente, A.A. Gomes, V. Nogueira, M.H. Azevedo, Mother's personality and
infant temperament, Infant Behavior and Development, Volume 34, Issue 4,
December 2011, Pages 552-568, ISSN 0163-6383, 10.1016/j.infbeh.2011.06.009.
Abstract: We examined if perfectionism and the perception of being an
anxious person were associated with more negative infant temperament
ratings by the mothers. 386 women (mean age = 30.08; standard
deviation = 4.21) in their last trimester of pregnancy completed
the Multidimensional Perfectionism Scale (MPS), the Beck Depression
Inventory-II (BDI-II) and an item about their perception of being or not an
anxious person. The Portuguese version of the Diagnostic Interview for
Genetic Studies and the Operational Criteria Checklist for Psychotic
Illness were used to generate diagnoses according to DSM-IV and ICD-10
criteria. After delivery, women completed eight items of the Difficult
Infant Temperament Questionnaire (developed by our team) and filled in,
again, the BDI-II and were interviewed with the DIGS. Women with depression
(DSM-IV/ICD-10) and probable cases of depression using different cut-offs
adjusted to Portuguese prevalence (BDI-II), in pregnancy and postpartum,
were excluded. The Difficult Infant Temperament Questionnaire showed to
have factorial validity and internal consistency. There was a statistically
significant negative correlation between perfectionism total scale score
and item 6 from the temperament scale (is your baby irritable or fussy?).
Considering MPS 3-factor solution found for pregnancy there was also a
statistically significant negative correlation between SOP and the same
item. Women with low SOP differed from those with medium and high SOP in
the total temperament score. Moreover, the low SOP group differed from the
medium group on items three and four scores. There were no significant
associations with SPP, which is the dimension more closely associated with
negative outcomes. There was an association between anxiety trait status
(having it or not) and scoring low, medium or high in the infant
temperament scale. The proportion of anxious vs. non-anxious women
presenting a high score on the infant temperament scale was higher (24.2%
vs. 12.9%). Linear regressions showed that SOP (low vs. medium/high)
offered a significant contribution to the prediction of total temperament
scale score and items 3 and 4 scores, but a logistic regression did not
confirm trait anxiety as a significant predictor of mother's infant
temperament perception. Concluding, a major result concerns the fact that
higher levels of adaptive perfectionism (i.e. SOP) are associated (and
predict) a less negative view of their infant's temperament. These results
on the effect of mother's anxiety and perfectionism on the child
temperament perception might have treatment implications. As perfectionism
is not always maladaptive, some of its positive features could be used to
enhance women's self-efficacy/sense of parental competence in their role as
mothers and positive affect towards their infants. Also, antenatal
interventions aimed at minimising anxiety could help to optimise infant
temperament outcomes, which could, eventually, also, lead to subsequent
maternal and infant mental health better outcomes.
Keywords: Mother's personality; Perfectionism; Anxiety trait; Infant
temperament
Sheila A. Dugan, Exercise for Preventing Childhood Obesity, Physical

Medicine and Rehabilitation Clinics of North America, Volume 19, Issue 2,
May 2008, Pages 205-216, ISSN 1047-9651, 10.1016/j.pmr.2007.11.001.
Abstract: Childhood obesity is a key public health issue in the United
States and around the globe in developed and developing countries. Obese
children are at increased risk of acute medical illnesses and chronic
diseasesin particular, osteoarthritis, diabetes mellitus, and
cardiovascular disease, which can lead to poor quality of life; increased
personal and financial burden to individuals, families, and society; and
shortened lifespan. Physical inactivity and sedentary lifestyle are
associated with being overweight in children and adults. Thus it is
imperative to consider exercise and physical activity as a means to prevent
and combat the childhood obesity epidemic. Familiarity with definitions of
weight status in children and health outcomes like metabolic syndrome is
crucial in understanding the literature on childhood obesity. Exercise and
physical activity play a role in weight from the prenatal through
adolescent time frame. A child's family and community impact access to
adequate physical activity, and further study of these upstream issues is
warranted. Recommended levels of physical activity for childhood obesity
prevention are being developed.
Hubert Kolb, Kerstin Kempf, Stephan Martin, Michael Stumvoll, Rdiger

Landgraf, On what evidence-base do we recommend self-monitoring of blood
glucose?, Diabetes Research and Clinical Practice, Volume 87, Issue 2,
February 2010, Pages 150-156, ISSN 0168-8227,
10.1016/j.diabres.2009.10.014.
Abstract: Self-monitoring of blood glucose (SMBG) has been considered one
major breakthrough in diabetes therapy because, for the first time,
patients were able to determine their blood glucose levels during daily
life. It seems obvious that this must be of advantage to disease management
and clinical outcome, but it has become a nightmare for those trying to
provide evidence. Randomised controlled trials have yielded inconsistent
results on a benefit of SMBG-based treatment strategies not only in type 2
but surprisingly also in type 1 and gestational diabetes. Despite this,
SMBG is being considered indispensible in intensive insulin treatment, but
is being debated for other clinical settings. When considering the non-RCT
based reasons for recommending SMBG in type 1 and gestational diabetes it
becomes apparent that the same reasons also apply to type 2 diabetes.
Keywords: Self-monitoring of blood glucose; Type 1 diabetes; Type 2
diabetes; Gestational diabetes; Hypoglycaemia; HbA1c
Lynne M. Smith, Linda L. LaGasse, Chris Derauf, Penny Grant, Rizwan Shah,
Amelia Arria, Marilyn Huestis, William Haning, Arthur Strauss, Sheri Della
Grotta, Melissa Fallone, Jing Liu, Barry M. Lester, Prenatal
methamphetamine use and neonatal neurobehavioral outcome, Neurotoxicology
and Teratology, Volume 30, Issue 1, JanuaryFebruary 2008, Pages 20-28,
ISSN 0892-0362, 10.1016/j.ntt.2007.09.005.
Methamphetamine (MA) use among pregnant women is an increasing problem in
the United States. How prenatal MA exposure affects neonatal neurobehavior
is unknown.
Objective
To examine the neurobehavioral effects of prenatal MA exposure.
Design
The Infant Development, Environment and Lifestyle (IDEAL) study screened
13,808 subjects and 1632 were eligible and consented. 166 (n = 74
exposed) were enrolled in a longitudinal follow-up. Exposure was determined
by meconium assay and self-report with alcohol, marijuana, and tobacco
present in both groups. The NICU Network Neurobehavioral Scale (NNNS) was
administered within the first 5 days of life. Analyses conducted on NNNS
summary scores included exposure group effects, heavy MA use effects,
association with frequency of use by trimester, and doseresponse
relationships with amphetamine metabolites.
Results
After adjusting for covariates, exposure to MA was associated with
increased physiological stress. Heavy MA use was related to lower arousal,
more lethargy, and increased physiological stress. First trimester MA use
was related to elevated stress abstinence. Third trimester use was related
to poorer quality of movement. Higher level of amphetamine metabolites in
meconium was associated with increased CNS stress.
Conclusions
Prenatal MA exposure was associated with neurobehavioral patterns of
decreased arousal, increased stress, and poor quality of movement. The
doseresponse relationships may represent neurotoxic effects from MA.
Keywords: Prenatal exposure; Neurodevelopment; Drug; Meconium
Victoria Latifses, Debra Bendell Estroff, Tiffany Field, Joseph P. Bush,

Fathers massaging and relaxing their pregnant wives lowered anxiety and
facilitated marital adjustment, Journal of Bodywork and Movement Therapies,
10.1016/j.jbmt.2005.02.004.
Abstract: Summary
This study examined the effects of fathers massaging their pregnant wives
and practicing relaxation with them. Participants were married American
fathers who completed the Dyadic Adjustment Scale (DAS), the State-Trait
Anxiety Inventory (STAI), and the Paternal Fetal Attachment Scale. The
fathers learned to massage their pregnant wives, learned relaxation
techniques with their wives, or received no intervention. Massage therapy
lowered the fathers self-reported anxiety levels on the STAI and improved
marital adjustment on the DAS.
Keywords: Fatherhood; Marital adjustment; Anxiety; Massage therapy;
Relaxation training
Hein Raat, Anne Wijtzes, Vincent W.V. Jaddoe, Henritte A. Moll, Albert
Hofman, Johan P. Mackenbach, The health impact of social disadvantage in
early childhood; the Generation R study, Early Human Development, Volume
87, Issue 11, November 2011, Pages 729-733, ISSN 0378-3782,
10.1016/j.earlhumdev.2011.08.022.
Abstract: Inequalities in child health are of major concern to
policymakers, public health specialists and clinicians. This review of
studies within the context of the Generation R study illustrates that
inequalities in population health, at least partly, originate in pregnancy
and early childhood. The review shows inequalities with regard to the
health of the pregnant mother, with regard to the growth of the fetus, with
regard to birth outcomes, and with regard to health indicators in early
childhood. These results are shown with regard to both biological/somatic
outcomes, as well as with regard to psychosocial outcomes and healthy
lifestyles. Both socioeconomic inequalities and ethnic inequalities in
health are present. Although some inequalities can be explained by known
determinants, research needs to be done to reach a full understanding of
the pathways between social disadvantage and ill health in early childhood.
Keywords: Social disadvantage; Socio-economic status; Ethnic background;
Pregnancy; Preeclampsia; Gestational hypertension; Gestational diabetes;
Birth weight; Gestational age; Breastfeeding; Growth; Respiratory tract
infection; Overweight; Infant temperament; Behavioral problems; Health
Michele Heymann, Reproductive health promotion in Kosovo, Journal of

Midwifery & Women's Health, Volume 46, Issue 2, MarchApril 2001, Pages
74-81, ISSN 1526-9523, 10.1016/S1526-9523(01)00090-3.
Abstract: R elief agencies that specialize in postwar emergency relief and
then work to contribute to sustainable development as the crisis ends are
increasingly recognizing the positive impact of midwifery care and training
on reproductive health outcomes. Midwives are finding work and developing
new roles in postwar reconstruction and refugee health care. This article
describes the experiences of a nurse-midwife who worked for Mercy Corps
International in Kosovo and launched the Kosovo Womens Health Promotion
Project. A short history of the conflict in Kosovo, the effects of the war
on its people and the health care system, a description of womens health
care, and the status of women in Kosovo are included.
Donna M Strobino, Holly Grason, Cynthia Minkovitz, Charting a course for

the future of women's health in the United States: concepts, findings and
recommendations, Social Science & Medicine, Volume 54, Issue 5, March
2002, Pages 839-848, ISSN 0277-9536, 10.1016/S0277-9536(01)00113-7.
Abstract: The JHU Women's and Children's Health Policy Center, with the
federal Maternal and Child Health Bureau, undertook a review of the health
of women in the United States and invited experts to develop
recommendations on health policy, programs, practices and research. The
review included published research, program reviews, and policy reports on
women's physical health, mental health, and health behaviors, and on the
effects of health services, systems and financing on their health. Based on
trends in age, ethnic background, education, labor-force participation,
marriage and childbearing among women, the results of the reviews, and the
experts consultation, several recommendations were made for a forward
looking agenda. They included the need: (1) to focus broadly on women's
health, not just during pregnancy; (2) for comprehensive, integrated
programs and services addressing women's unique needs; (3) for integrated
programs and services across the lifespan; (4) for better provider training
about women's unique health needs, the differential effects of particular
problems on them, and the consequences of chronic health problems
heretofore considered primarily male problems; (5) to eliminate social
policies that single out women, particularly pregnant women, for punitive
actions; (6) to promote social policies that ensure economic security for
women; and (7) for vigorous public health leadership to shape the women's
health agenda, recognizing the social and economic context of their lives.
The social and economic trends among women in the US and the
recommendations for a women's health agenda have relevance to other
developed countries as well.
Keywords: Women's health; Health policy; US; Multiple roles
Fiona Cross-Sudworth, Amanda Williams, Sandy Herron-Marx, Maternity

services in multi-cultural Britain: Using Q methodology to explore the
views of first- and second-generation women of Pakistani origin, Midwifery,
10.1016/j.midw.2010.03.001.
Abstract: Objective
to explore first- and second-generation Pakistani womens experiences of
maternity services and the inter generational differences/comparisons.
Design
a retrospective Q methodology study of Pakistani women following
childbirth.
Setting
two Children's Centres in an inner city in the West Midlands.
Participants
women self-identified following distribution of information leaflets at
Childrens Centres. Fifteen women took part in interviews (Stage one) using
a semi-structured design and 16 women participated in the completion of the
Q grid sorting (Stage four).
Methods
a standard five-stage Q methodology process took place: (1) initial data
were gathered using a combination of individual face-to-face and focus
group semi-structured community-based interviews (developing the
concourse); (2) transcribed interviews were analysed for themes; (3) the
themes were reduced to statements that reflected the overall content of
the concourse using an unstructured evolving approach (giving the Q set);
(4) participants were asked to sort the statements (Q sorting) according to
a pre-designed distribution grid providing individual participant response
grids; and (5) the response grids were factor analysed using PQ Method
(V2.11), which generates clusters of participants rather than clusters of
variables. Factor loadings were calculated using factor analysis by
principal components with varimax rotation. This produced a list of
factors, each of which represents a story of womens experiences of
maternity services. Throughout the process, an Urdu interpreter was
involved.
Findings
six factors were identified: (1) confidence and empowerment of women who
had attended higher education and had family support; (2) isolation of some
women from both family and maternity services; (3) women who had poor
experiences of maternity services but good family support, and wanted
opportunities to be involved in service development; (4) women with
positive experiences of maternity care and influenced by traditional
cultural practices; (5) importance of information and support from health-
care professionals; and (6) importance of midwifery care to women.
Conclusion
there were no clear inter generational differences identified, but a
breadth of opinion and experience that seemed to be influenced by level of
both education and social support was found. Whereas some women had few
demands of maternity services, those who had less support and those with
language barriers had additional needs.
care given should be based on individual need but given within a wider
collaborative context in order to support women effectively. Increased
maternity service user involvement would also be welcomed for future
planning of maternity services.
Keywords: Ethnic minorities; Maternity service users; Confidence; Support
Betty R. Carruth, Wina Nevling, Jean D. Skinner, Developmental and food

profiles of infants born to adolescent and adult mothers, Journal of
Adolescent Health, Volume 20, Issue 6, June 1997, Pages 434-441, ISSN 1054-
139X, 10.1016/S1054-139X(97)00034-7.
To compare developmental markers and dietary intake of infants born to
lower socioeconomic adolescent and adult mothers.
Design:
Sixty-one adolescent (age 1418 years) and 60 adult (age 2228 years)
mothers met inclusion criteria of comparable socioeconomic status, age
range, urban/rural residence, and distribution of infants by gender.
Sample/setting:
Adolescent subjects were recruited in last trimester and adult mothers
postpartum. Interviews were conducted when infants were about 6 and 12
months of age. Data included age of occurrence for eight markers, age at
adding complementary foods, two 24-h dietary recalls, and two measurements
of growth.
Results:
Adolescent mothers reported a significantly earlier age at which the infant
holds a spoon by self and drinks alone from a trainer cup. Six other
markers were not significantly different between groups. Adolescent mothers
fed cereal significantly earlier than did adult mothers, but there were no
significant differences for fruit, vegetables, and meat. At 12 months,
infants of adolescents had intakes of vitamin D and iron which were <
100% of recommended allowances, as did infants of adult mothers for vitamin
D, iron, and zinc. Dietary fat was significantly higher at 6 and 12 months
and vitamin C was lower at 12 months for infants of adolescents compared to
the adult group.
Conclusions:
Compared to adult mothers, adolescent mothers reported earlier mean ages
for developmental markers related to self-feeding, and introduced cereal
earlier. In each group, selected nutrient intakes decreased from
recommended amounts in the 612-month period. Fat intakes were
significantly different between groups at 6 and 12 months.
Keywords: Adolescent mothers; Infant feeding; Infant development
Ruth A. Lawrence, Robert M. Lawrence, Chapter 22 - Breastfeeding Support

Groups and Community Resources, Breastfeeding (Seventh Edition), W.B.
10.1016/B978-1-4377-0788-5.10022-7.
Della A. Forster, Helen L. McLachlan, Breastfeeding Initiation and Birth

Setting Practices: A Review of the Literature, Journal of Midwifery &
Women's Health, Volume 52, Issue 3, MayJune 2007, Pages 273-280, ISSN
1526-9523, 10.1016/j.jmwh.2006.12.016.
Abstract: A number of practices during the intrapartum and very early
postnatal period may affect breastfeeding initiation. All women should be
encouraged to breastfeed soon after birth, with extra attention paid to the
identification and offer of extra support for those women at higher risk of
not successfully initiating and continuing breastfeeding. Factors that
affect breastfeeding initiation include: implementation of the Baby-
Friendly Hospital Initiative Ten Steps to Successful Breastfeeding at a
service level; avoidance of the use of intramuscular narcotic analgesia,
particularly near the end of the first stage of labour; not separating
mothers and babies after birth for routine procedures; and placing healthy
newborns on their mothers chest/abdomen (skin-to-skin) routinely. Single
strategies are unlikely to increase breastfeeding initiation as stand-alone
measures.
Keywords: analgesia; Baby-Friendly Hospital Initiative; breastfeeding
initiation; hospital practices; intrapartum care; lactation
Ruth Petersen, Kathryn A. Clark, Katherine E. Hartmann, Cathy L. Melvin,

Getting focused: missed opportunities for smoking interventions for
pregnant women receiving Medicaid, Preventive Medicine, Volume 40, Issue 2,
February 2005, Pages 209-215, ISSN 0091-7435, 10.1016/j.ypmed.2004.05.023.
Abstract: Background. The prevalence of smoking, and cessation and relapse
rates for pregnant women have health and financial implications. Our
objectives were to describe smoking among pregnant smokers receiving
Medicaid including characteristics associated with reporting discussion of
smoking with providers and the association between those discussions with
quitting and maintenance.
Methods. Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS)

data from 15 states for 20,287 women with Medicaid for prenatal care during
19982000.
Results. Thirty-four percent of women smoked before pregnancy (N = 7,686).

Most smokers (93%) and nonsmokers (88%) reported discussions about smoking
during prenatal care. Women were less likely to have discussed smoking if
they were lighter smokers (OR = 1.47; CI = 1.03, 2.12), or reported a
previous low-birthweight infant (OR = 1.72; CI = 1.032.86). Women
reporting discussions (compared to those not) were less likely to quit (ARR
= 0.70: CI = 0.590.91). Quitters reporting discussions (compared to those
not) were no more likely to maintain cessation (ARR = 0.89; CI = 0.7,
1.21).
Conclusions. Smoking cessation interventions can be improved for pregnant
women receiving Medicaid, especially if focused to address individual needs
of light smokers, those with previous low-birthweight infants, or those who
find it most difficult to quit.
Keywords: Pregnant women; Smoking; Smoking cessation; Prenatal care;
Pregnancy
Lorraine B. Sanders, Attitudes, Perceived Ability, and Knowledge About

Depression Screening: A Survey of Certified Nurse-Midwives/Certified
Midwives, Journal of Midwifery & Women's Health, Volume 51, Issue 5,
10.1016/j.jmwh.2006.02.011.
Abstract: A survey of certified nurse-midwives/certified midwives
(CNMs/CMs) attending the 2004 American College of Nurse-Midwives (ACNM)
annual meeting was undertaken to describe the depression screening
practices of CNMs/CMs and to examine factors associated with depression
screening. A relationship was found between attitude, perceived ability,
knowledge, education level, and depression screening, with attitude and
perceived ability having the strongest positive relationship to screening.
Attitude, perceived ability, knowledge, and education accounted for 20% of
the variance in depression screening conducted by CNMs/CMs. These findings
suggest that the management of depression is not fully integrated into the
practice of many CNMs/CMs. Further research is needed to assess screening
methods, interventions for the treatment of depression, and evaluation of
institutional barriers to depression screening.
Keywords: women; primary care; depression; screening; midwifery
Paula D. Zeanah, Letia O. Bailey, Susan Berry, Infant Mental Health and the
Real World- Opportunities for Interface and Impact, Child and Adolescent
Psychiatric Clinics of North America, Volume 18, Issue 3, July 2009, Pages
773-787, ISSN 1056-4993, 10.1016/j.chc.2009.03.006.
Keywords: Infant mental health; Preventive interventions; Evidence-based
practices
Janet Molzan Turan, Ayen Bulut, Hacer Nalbant, Nuriye Ortayl, Turul
Erbaydar, Challenges for the adoption of evidence-based maternity care in
Turkey, Social Science & Medicine, Volume 62, Issue 9, May 2006, Pages
2196-2204, ISSN 0277-9536, 10.1016/j.socscimed.2005.10.005.
Abstract: Evidence-based medicine is an important tool for improving the
quality of maternity care. However, getting providers to change their
practices may not be an easy or rapid process, and other factors, in
addition to knowledge of the literature, may be important. This study
documents the current state of obstetric practices at three maternity
hospitals in Istanbul, Turkey, and identifies attitudes, social pressures,
and perceptions that, according to the theory of planned behavior, may pose
challenges for adoption of evidence-based practices. Data were collected
through interviews with administrators, examination of hospital statistics,
provider and client interviews, and structured observations of maternity
care. Practices that did not follow current guidelines included routine
episiotomy, not allowing companionship during labor, use of procedures to
speed up labor without indications, routine enema, restriction of mobility,
restriction of oral fluids, supine position for delivery, and non-use of
active management of the third stage of labor. The findings indicate that
providers had negative attitudes about some recommended practices, while
they had positive attitudes towards some ineffective and/or harmful
practices. We identified social pressure to comply with practices
recommended by supervisors and peers, as well as the belief that limited
resources affect maternity care providers, opportunities to perform
evidence-based procedures. An underlying problem was the failure to involve
women in decision-making regarding their own maternity care. In addition to
informing providers about the evidence, it seems necessary to develop
standard protocols, improve physical conditions, and implement behavior
interventions that take into account provider attitudes, social pressures,
and beliefs.
Keywords: Evidence-based practice; Theory of planned behavior; Maternity
care; Turkey
David Olds, Peggy Hill, JoAnn Robinson, M.A. Nancy Song, Christina Little,
Update on home visiting for pregnant women and parents of young children,
Current Problems in Pediatrics, Volume 30, Issue 4, April 2000, Pages 109-
141, ISSN 0045-9380, 10.1067/mps.2000.105091.
Ruth A. Lawrence, Robert M. Lawrence, Chapter 22 - Breastfeeding support

groups and community resources, Breastfeeding (Sixth Edition), Mosby,
02823-3.50027-9.
Eliane Siegenthaler, Thomas Munder, Matthias Egger, Effect of Preventive

Interventions in Mentally Ill Parents on the Mental Health of the
Offspring: Systematic Review and Meta-Analysis, Journal of the American
Academy of Child & Adolescent Psychiatry, Volume 51, Issue 1, January
2012, Pages 8-17.e8, ISSN 0890-8567, 10.1016/j.jaac.2011.10.018.
Abstract: Objective
Mental illness in parents affects the mental health of their children. A
systematic review and a meta-analysis of the effectiveness of interventions
to prevent mental disorders or psychological symptoms in the offspring were
performed.
Method
The Cochrane, MEDLINE, EMBASE, and PsycINFO databases were searched for
randomized controlled trials of interventions in parents with mental
disorders. Outcomes in the child included incident mental disorders of the
same nature and internalizing (negative emotions, depressive symptoms,
anxiety) or externalizing (hyperactivity, aggressiveness, behavioral
problems) symptoms. Relative risks and standardized mean differences in
symptom scores were combined in random-effects meta-analysis.
Results
Thirteen trials including 1,490 children were analyzed. Interventions
included cognitive, behavioral, or psychoeducational components. Seven
trials assessed the incidence of mental disorders and seven trials assessed
symptoms. In total 161 new diagnoses of mental illness were recorded, with
interventions decreasing the risk by 40% (combined relative risk 0.60, 95%
CI 0.450.79). Symptom scores were lower in the intervention groups:
standardized mean differences were 0.22 (95% CI 0.37 to 0.08) for
internalizing symptoms (p = .003) and 0.16 (95% confidence interval 0.36
to 0.04) for externalizing symptoms (p = .12).
Conclusions
Interventions to prevent mental disorders and psychological symptoms in the
offspring of parents with mental disorders appear to be effective.
Keywords: preventive intervention; mentally ill parents; internalizing and
externalizing symptoms; randomized controlled trials; meta-analysis
Suzette Tardif, Angela Carville, David Elmore, Lawrence E. Williams, Karen

Rice, Chapter 8 - Reproduction and Breeding of Nonhuman Primates, Nonhuman
Primates in Biomedical Research (Second Edition), Academic Press, Boston,
2012, Pages 197-249, ISBN 9780123813657, 10.1016/B978-0-12-381365-7.00008-
X.
Abstract: This chapter provides an overview of reproductive biology and
husbandry and management of captive nonhuman primates for breeding
purposes. The reproductive biology section includes overviews of
hypothalamic-pituitary-gonadal function and puberty as well as specific
sections on female and male reproductive physiology. The breeding overview
is generally limited to taxonomic groups most commonly bred for use in
research facilities: macaques, baboons, squirrel monkeys, owl monkeys, and
marmosets. For each of these taxonomic groups, the review provides
information on typical group compositions; enclosure types; factors used in
decisions regarding retention or removal of offspring and breeders;
island/semi-free ranging production systems, if relevant; Specific-
Pathogen-Free colony production and management, if relevant; and population
management, including expected production figures. Pregnancy management is
described in more detail, primarily for macaques and marmosets, including
methods to detect ovulation and pregnancy, tracking of prenatal growth and
development, maternal changes during pregnancy, and prevalence and causes
of prenatal mortality. Finally, an overview of acquisition of nonhuman
primates from foreign breeding programs is provided.
T.A. Wiegers, General practitioners and their role in maternity care,

Health Policy, Volume 66, Issue 1, October 2003, Pages 51-59, ISSN 0168-
8510, 10.1016/S0168-8510(03)00025-3.
Abstract: During the last century the perception of pregnancy and
childbirth has changed from a normal, physiological life-event to a
potentially dangerous condition. Maternity care has become more and more
obstetrical care, focussed on pathology and complications. The involvement
of general practitioners (GPs) in maternity care is strongly reduced and
almost everywhere the same reasons are found: interference with lifestyle
and interruption of office routine, fear of litigation and costs of
malpractice insurance, insufficient training and insufficient numbers of
cases to retain competency. In Canada, the USA, and to a lesser extent in
Australia and New Zealand, GPs still providing intrapartum care are GP-
obstetricians rather than maternity care providers. They provide low-risk
as well as high-risk obstetrical care, especially in rural areas with few
specialist obstetricians. In Europe, GPs do not provide high-risk
obstetrical care. Instead they emphasize their role as generalist, and
compete with midwives for a central role in maternity care for women with
an uncomplicated pregnancy. The ongoing medicalisation of childbirth and
the changing attitudes towards the demands of maternity care practice have
diminished the role of GPs or family physicians. If they want to stay
involved in maternity care in the future they need to cooperate with
midwives, preferably in shared care programs.
Keywords: General practitioners; Family physicians; Maternity care;
Midwifery care; Obstetrics
Tak Yeung Leung, Tony Kwok Hung Chung, Severe chronic morbidity following
childbirth, Best Practice & Research Clinical Obstetrics &
Gynaecology, Volume 23, Issue 3, June 2009, Pages 401-423, ISSN 1521-6934,
10.1016/j.bpobgyn.2009.01.002.
Abstract: Three special, chronic morbidities of childbirth are reviewed
with the most up-to-date knowledge in this article. Firstly, obstetric
fistulas secondary to prolonged obstructed labour are still prevalent
tragedies in underdeveloped countries. The damage is not only physical but
psychosexual and social. The surgical skill and technology required to
prevent and to treat obstetric fistulas are simple, but culture-social
antagonism, geographic distance, political instability and financial
constraint have to be overcome before effective management can take place.
Congenital brachial plexus palsy is associated with shoulder dystocia and
macrosomia, and both excessive exogenous traction and strong endogenous
pushing forces contribute to its occurrence. As shoulder dystocia and
macrosomia are not easily predictable, regular training and drill is
essential to ensure proper management of shoulder dystocia. Most of the
babies with brachial palsy will recover in 3 months but a minority of
patients will suffer a more severe degree of damage, requiring early micro-
neurosurgical intervention. Finally, although birth asphyxia is not the
major cause of cerebral palsy, brain injury resulting from acute
intrapartum hypoxic-ischemic insult is potentially alleviated by early
neonatal hypothermic therapy. Both clinical and radiological assessments
are essential in selecting suitable candidates for this innovative
neuroprotective strategy.
Keywords: obstetric fistula; brachial plexus palsy; Erb's palsy; cerebral
palsy; chronic morbidity; childbirth; prevention
Peter M. Foggin, Marion E. Torrance, Drashi Dorje, Wenzha Xuri, J. Marc

Foggin, Jane Torrance, Assessment of the health status and risk factors of
Kham Tibetan pastoralists in the alpine grasslands of the Tibetan plateau,
Social Science & Medicine, Volume 63, Issue 9, November 2006, Pages
2512-2532, ISSN 0277-9536, 10.1016/j.socscimed.2006.06.018.
Abstract: The health status of Tibetan herders in the Sanjiangyuan region
of the Tibetan Plateau, in southwest Qinghai Province, is assessed in this
paper. The field study was conducted in 2002 in the context of a broader
community development and research framework, the ultimate goal of which is
to achieve an effective region-specific programme of preventative health
care and training for Tibetan pastoralists. Specifically, the authors
analysed the impact of a number of potentially health-related environmental
and lifestyle risk factors on self-reported health indicators, with a
special emphasis on mother and child health. Several health status
indicators were used, including a general morbidity index and a measurement
of functional incapacity due to illness in the sample households. Maternal
and child health findings were alarming with high rates of miscarriage and
infant loss, with no traditional midwives to assist in pregnancy and
delivery. Preventable childhood illnesses were also common. Other
debilitating diseases included hepatitis, tuberculosis, arthritis (gout),
gall bladder disease, peptic ulcers and back pain. Finally, binary logistic
regression analysis showed a significant link between general morbidity and
the time it takes to obtain water. The survey findings, validated by the
focus groups, indicate a real need for increased accessibility and quality
of health service provision to women and men and effective preventative
health strategies.
Keywords: Health status; Risk factors; Mother-and-child health;
Pastoralists; Tibet
Angela M. Jukkala, Susan J. Henly, Readiness for neonatal resuscitation:

Measuring knowledge, experience, and comfort level, Applied Nursing
Research, Volume 20, Issue 2, May 2007, Pages 78-85, ISSN 0897-1897,
10.1016/j.apnr.2006.01.006.
Abstract: Neonatal resuscitation is a complex procedure that requires the
use of specialized knowledge and skills in an emotionally charged and
stressful situation. Knowledge about neonatal resuscitation, frequent
performance of skills, and comfort level with skill performance are
dimensions of quality implementation of neonatal resuscitation. The
Neonatal Resuscitation Index and Neonatal Resuscitation Experience Index
are self-report instruments designed to measure these important variables.
Information about nurses' responses to the Neonatal Resuscitation Index and
Neonatal Resuscitation Experience Index, psychometric properties, and
implications for research and practice are discussed in this article.
Anne Esdale, Helen L. Harris, Evaluation of a closed circuit television
patient education program: Structure, process and outcome, Patient
Education and Counseling, Volume 7, Issue 2, June 1985, Pages 193-215, ISSN
0738-3991, 10.1016/0738-3991(85)90009-6.
Abstract: Few planners of a closed circuit television (CCTV) patient-
education program have shared the evaluation of their program with other
health agencies who are planning or considering such programs. This paper
addresses the evaluation of the structure and process of developing and
implementing such a program, and analyzes the outcome and cost
effectiveness of one CCTV program.
Two separate studies of patients at this hospital revealed that 6.5% and
1.7% of patients viewed the CCTV channel. The authors examined the possible
factors contributing to the poor viewing habits of patients: (1) technical
malfunctions, (2) low patient awareness, (3) minimal staff promotion, (4)
nature of patient population.
Planning processes and program structure are also examined to determine how
they contributed to the outcomes. For example, incorrect planning
assumptions and marketing strategies and failure to predict system barriers
were possible factors.
Finally, the costs involved in planning, implementing and monitoring the

CCTV program are examined.
Keywords: Closed circuit television; Health education evaluation
S. Darius Tandon, Constance D. Mercer, Elizabeth L. Saylor, Anne K. Duggan,

Paraprofessional home visitors perspectives on addressing poor mental
health, substance abuse, and domestic violence: A qualitative study, Early
Childhood Research Quarterly, Volume 23, Issue 3, 3rd Quarter 2008, Pages
419-428, ISSN 0885-2006, 10.1016/j.ecresq.2008.02.002.
Abstract: This research was conducted to understand paraprofessional home
visitors perceptions of their training in addressing poor mental health,
substance abuse, and domestic violence, and their actions in working with
families in addressing these issues. Five focus groups were conducted with
a total of 28 paraprofessional home visitors. Three main themes emerged
from qualitative analysis. Home visitors experienced tension between
addressing families more pressing needs such as housing or utilities and
addressing poor mental health, substance abuse, and domestic violence. Home
visitors felt that they received extensive training in these risk areas,
but that this training focused heavily on knowledge acquisition rather than
skill development. Home visitors also desired more guidance in addressing
families poor mental health, substance abuse, and domestic violence
concernsnamely, more clarity on the extent to which they should address
these issues during visits and more and varied supervision. Home visitors
need more training on how to initiate conversations about mental health,
substance abuse, and domestic violence, including how to transition
conversations from other client needs. Home visiting programs must clarify
home visitors roles in addressing clients poor mental health, substance
abuse, and domestic violence and provide additional and varied supervision
to home visitors.
Keywords: Home visiting; Psychosocial risk factors; Qualitative research
Tamunosa Okiwelu, Julia Hussein, Sam Adjei, Daniel Arhinful, Margaret

Armar-Klemesu, Safe motherhood in Ghana: Still on the agenda?, Health
Policy, Volume 84, Issues 23, December 2007, Pages 359-367, ISSN 0168-
8510, 10.1016/j.healthpol.2007.05.012.
Abstract: Objective
This paper is an exploration of health sector and programming issues that
resulted from a description of safe motherhood activities in Ghana.
Methods
Descriptions of safe motherhood programmes were collected from various
stakeholders through structured interviews. The characteristics of the
programmes were compared to national safe motherhood aims and in the
context of the reproductive health and sector-wide environment in Ghana.
Results
Thirteen safe motherhood programmes were described. Their goals were wide
ranging and did not necessarily target pregnant and postpartum women only.
Community based interventions were slightly less dominant than service
provision activities. A broad funding base was identified, strongly
represented by external donors. Many funding contributions were not part of
the Ghana government's Sector-Wide Approach (SWAp) to health.
Conclusions
Although reduction in maternal mortality ratio is a priority in Ghana's
policy, many funding agencies supporting what are known as safe
motherhood programmes are actually pursuing a somewhat broader
reproductive health agenda. The evidence that this situation has actually
led to a dilution of the maternal mortality reduction agenda is
inconclusive, although our analysis has resulted in lessons which could be
used to avert any risk to achieving this key millennium development goal.
Government can use the SWAp to keep interests focused on the need for
maternal mortality reduction, without detriment to other priorities.
Strengthening partnerships will allow civil society and community focused
interests to have a voice in influencing SWAp agendas. Good programme
design with clear understanding of the link between programme components
and objectives will help in making sure that maternal mortality targets are
indeed achieved.
Keywords: Safe motherhood; Maternal mortality; Ghana; Sector-Wide
Approaches (SWAPs); Health policy
Oleg Bilukha, Robert A. Hahn, Alex Crosby, Mindy T. Fullilove, Akiva

Liberman, Eve Moscicki, Susan Snyder, Farris Tuma, Phaedra Corso, Amanda
Schofield, Peter A. Briss, Task Force on Community Preventive Services, The
effectiveness of early childhood home visitation in preventing violence: A
systematic review, American Journal of Preventive Medicine, Volume 28,
Issue 2, Supplement 1, February 2005, Pages 11-39, ISSN 0749-3797,
10.1016/j.amepre.2004.10.004.
Cinara Sacomori, Fernando Luiz Cardoso, Cristiane Vanderlinde, Pelvic floor

muscle strength and body self-perception among Brazilian pregnant women,
Physiotherapy, Volume 96, Issue 4, December 2010, Pages 337-343, ISSN 0031-
9406, 10.1016/j.physio.2010.02.003.
To examine the relationship between pelvic floor muscle strength and body
self-perception variables in pregnant women; and, more specifically, to
determine the influence of the number of pregnancies (primigravidas vs
multigravidas) on the strength of contraction of the pelvic floor muscles
and on the body self-perception of pregnant women.
Design
Comparative cross-sectional research.
Setting
Public health centres from Florianpolis, Brazil.
Participants
Thirty-five pregnant women (18 primigravidas, 17 multigravidas) with a mean
age of 25.5 (standard deviation 5.7) years.
Pelvic floor strength measured through manual palpation, and body self-
perception using the Questionnaire of Corporeality and Human Sexuality.
Results
Pelvic floor muscle strength was positively correlated with schooling [rho
() = 0.496] and body self-perception variables: finding the body
beautiful ( = 0.476), finding the body sexy
( = 0.520), feeling that others find them sexy
( = 0.364), finding the body proportional ( = 0.412),
touching the body generally ( = 0.554) and recognising the smell
of the body ( = 0.454). Primigravidas found their bodies more
beautiful and were more satisfied with their bodies. On a scale of 0 to 6,
multigravid participants expressed a greater wish than primigravid
participants to be thinner (median difference 2, 95% confidence interval 0
3, P = 0.03). Pelvic floor strength did not differ between
groups.
Conclusions
The results suggest a relationship between pelvic floor muscle strength and
body self-perception. Professionals involved in women's health may have a
role in helping their patients to understand their bodies.
Keywords: Pregnancy; Pelvic floor muscles; Body self-perception
Martine Hausberger, Hlne Roche, Sverine Henry, E. Kathalijne Visser, A

review of the humanhorse relationship, Applied Animal Behaviour Science,
Volume 109, Issue 1, January 2008, Pages 1-24, ISSN 0168-1591,
10.1016/j.applanim.2007.04.015.
Abstract: Despite a long history of humanhorse relationship, horse-related
incidents and accidents do occur amongst professional and non professional
horse handlers. Recent studies show that their occurrence depend more on
the frequency and amount of interactions with horses than on the level of
competency, suggesting a strong need for specific research and training of
individuals working with horses. In the present study, we review the
current scientific knowledge on humanhorse relationships. We distinguish
here short occasional interactions with familiar or unfamiliar horses (e.g.
veterinary inspection) and long-term bonds (e.g. horseowner).
An important aspect of the horsehuman relationship is to try and improve

the development and maintenance of a strong positive relationship. Studies
show that deficits in the management conditions (housing, feeding,
possibilities for social contact, and training methods) may lead to
relational problems between horses and humans. Different methods have been
used to assess and improve the humanhorse relation, especially at the
young age. They reveal that the time and type of contact all play a role,
while recent studies suggest that the use of familiarized social models
might be a great help through social facilitation.
We argue that an important theoretical framework could be Hinde's [Hinde,

R., 1979. Towards Understanding Relationships. Academic Press, Londres]
definition of a relationship as an emerging bond from a series of
interactions: partners have expectations on the next interaction on the
basis of the previous ones. Understanding that a relationship is built up
on the basis of a succession of interactions is an important step as it
suggests that attention is being paid to the positive or negative
valence of each interaction as a step for the next one. A better knowledge
of learning rules is certainly necessary in this context not only to train
the horse but also to counterbalance the unavoidable negative inputs that
exist in routine procedures and reduce their impact on the relationship.
It appears clearly that research is needed in order to assess how to better

and safely approach the horse (e.g. research in position, posture, gaze,
etc.), what type of approaches and timing may help in developing a positive
bond, what influence human management and care have on the relationship,
and how this can be adapted to have a positive influence on the
relationship. Also the interaction between rider and horse, the search for
the optimal match between two individuals, is an aspect of the horsehuman
relationship that requires attention in order to decrease the number of
horse-riding accidents and reduced states of welfare. On the other hand,
adequate knowledge is readily available that may improve the present
situation rapidly. Developing awareness and attention to behavioural cues
given by horses would certainly help decreasing accidents among
professionals when interacting. Scientists therefore should play a major
role in transmitting not only elements of the current knowledge of the
ethology of the horse but also by helping developing observational skills.
Keywords: Horsehuman relationship; Interaction; Handling; Management;
Review
Anita A. Davies-Adetugbo, Sociocultural factors and the promotion of

exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria,
Social Science & Medicine, Volume 45, Issue 1, July 1997, Pages 113-
125, ISSN 0277-9536, 10.1016/S0277-9536(96)00320-6.
Abstract: Child survival strategies include prolonged and intensive
breastfeeding, together with its early initiation, and breastmilk only for
the first six months of life. This paper reports on local knowledge and
attitudes of breastfeeding and the sociocultural factors that shape its
practice in poor rural Yoruba communities of Southwestern Nigeria. The
study has conducted 10 focus group discussions among homogeneous groups of
grandmothers, pregnant women, lactating mothers, husbands, and community
health workers, and a questionnaire survey of 256 third trimester pregnant
women. All women in these communities breastfeed their infants on demand,
and for up to two years, because breastmilk is universally accepted as the
best food for babies, and breastfeeding spaces births. Prelacteal feedings
of water herbal infusions and ritual fluids are the norm, and breastmilk is
supplemented, from birth, with water and teas. Exclusive breastfeeding is
considered dangerous to the infant: the baby has an obligatory requirement
for supplementary water to quench its thirst and promote its normal
development, and for herbal teas which serve as food and medicine.
Colostrum is discarded because it is dirty, like pus, and therefore
potentially harmful to the infant, although 24% of the survey sample would
give it to their babies. Expressed breastmilk is suspect as it can get
contaminated, poisoned or bewitched. Complementary foods are introduced as
early as two months because of perceived lactation insufficiency. The
commonest supplement is a watery maize porridge of low nutrient density.
Breast-feeding can also be dangerous, as toxins and contaminants can be
passed to the infant through breast-milk. The most serious conflict with
the WHO/UNICEF recommendations is the lack of local credibility of
exclusive breastfeeding. According to local knowledge, the early
introduction of water, herbal teas, and of complementary foods is designed
to enhance child survival, while these are supposed to do the exact
opposite by the WHO/UNICEF rationale, by exposing the infant to
contaminants early, thereby increasing diarrheal morbidity and mortality.
Child survival interventions need to address this conflict.
Keywords: breastfeeding; child nutrition; child survival; Yoruba;
anthropology
W. Knzel, J. Herrero, P. Onwuhafua, T. Staub, C. Hornung, Maternal and

perinatal health in Mali, Togo and Nigeria, European Journal of Obstetrics
& Gynecology and Reproductive Biology, Volume 69, Issue 1, October
1996, Pages 11-17, ISSN 0301-2115, 10.1016/0301-2115(95)02528-6.
Abstract: Objective: The health care system in many developing countries is
less efficient compared with that in the industrialized world. The aim of
the present study was to investigate the differences of the efficiency of
the health care in obstetrics in Nigeria, Mali and Togo. Study design: The
data were collected in African district hospitals from Lom/Togo (n =
1002), Bamako/Mali (n = 1462) and Kaduna/Nigeria (n = 1055) with a
routinely applied questionnaire analyzed at the University Giessen and
compared with the data from the Department of Obstetrics and Gynaecology
Giessen (Germany) (referral hospital) (n = 1313) and the total data pool of
the perinatal survey 1993 in Hesse (n = 58 430). Results: The medical
history indicates important differences: the incidence of young mothers
below 18 is highest in Mali (9.8%) compared with Nigeria (2.7%) and Togo
(2.6%) (Hesse 0.6%). In general there is an increased rate of previous
pregnancies of more than five: 1328% (Hesse 2.1%). The rate of prenatal
visits is also reduced: more than ten visits have 2% in Togo, 10.6% in Mali
and 15.5% in Nigeria (Hesse 72%). Ultrasound examinations are very rare (1
12%) and tocolysis is nearly unknown. As a result the incidence of dead
infants in the medical history is high: Mali 28%, Togo 18%, Nigeria 10.8%
(Hesse 1.7%), as well as the rate of low birth weight infants. This is also
reflected in the perinatal mortality which ranged from 115 in Mali, 77 in
Togo and 68 in Nigeria (Hesse 5.3, Ob/Gyn Giessen 16.4). Conclusion: The
improvement of perinatal and maternal health in the developing world can
only be achieved if family planning, prenatal care, selection of high risk
pregnancies goes in parallel with a sound organization implemented and
supported by the government.
Keywords: Perinatal mortality; Mali; Togo; Nigeria; Germany
N Gerein, S Mayhew, M Lubben, A framework for a new approach to antenatal

care, International Journal of Gynecology & Obstetrics, Volume 80,
Issue 2, February 2003, Pages 175-182, ISSN 0020-7292, 10.1016/S0020-
7292(02)00331-4.
Abstract: A framework for a new approach to antenatal care (ANC) is
presented to improve maternal health. Based on evaluations of ANC, safe
motherhood programs, gender and social theory, it suggests that managers
should draw upon existing family and community support systems, and develop
partnerships beyond the health service. Policy and program changes are
required in: professional mandates for ANC providers, organization of ANC
services, service protocols, training programs, policy towards TBAs,
referral care, and service support systems.
Keywords: Antenatal care; Safe birth planning; Maternal health; Community
participation; Antenatal care policy
Heather A. Flynn, Frederic C. Blow, Sheila M. Marcus, Rates and predictors

of depression treatment among pregnant women in hospital-affiliated
obstetrics practices, General Hospital Psychiatry, Volume 28, Issue 4,
10.1016/j.genhosppsych.2006.04.002.
Abstract: Objective
The purpose of this study was to provide information on rates of depression
treatment among pregnant women at risk for depression and among those with
clinician-diagnosed current major depressive disorder (MDD) and to examine
predictors of depression treatment.
Method
Women seeking prenatal care completed a screening survey (including the
Center for Epidemiological Studies-Depression Scale) in several hospital-
based obstetrics clinics. Women identified as high risk for depression
completed diagnostic interviews (n=276) during pregnancy, consisting of the
Structured Clinical Interview for DSM-IV, measures of depression symptom
severity (Beck Depression Inventory-II), health functioning (SF-36) and
current and past psychiatric treatment.
Results
Among women with a current MDD diagnosis, most of whom were experiencing a
recurrence, 33% were currently receiving any depression treatment. The
presence of current MDD was not found to be related to use of treatment.
Prior history of MDD, history of psychiatric treatment and depression
severity were significant predictors of depression treatment during
pregnancy.
Conclusions
Most women with current MDD were found to be either untreated or
suboptimally treated, and prenatal MDD was not predictive of treatment.
These findings point to the need for effective detection, targeted follow-
up assessment and treatment linkage interventions to be studied in medical
settings that encounter perinatal women.
Keywords: Antenatal depression; Obstetrics; Treatment rates
Lynn T. Singer, Robert Arendt, Sonia Minnes, Kathleen Farkas, Ann Salvator,
Neurobehavioral outcomes of cocaine-exposed infants, Neurotoxicology and
Teratology, Volume 22, Issue 5, SeptemberOctober 2000, Pages 653-666, ISSN
0892-0362, 10.1016/S0892-0362(00)00092-1.
Abstract: The present study investigated the neurobehavioral outcomes of
fetal cocaine exposure. Attempts were made to control, by design or
statistical analysis, for significant confounders. Timing and amount of
drug exposures were considered, and biologic measures of exposure were
quantified to classify exposure severity.
One hundred sixty-one non-cocaine and 158 cocaine-exposed (82 heavily and
76 lightly exposed) infants were seen at a mean-corrected age of 43 weeks
post-conception and administered the Neurobehavioral Assessment (NB
Assessment). Heavily cocaine-exposed infants had more jitteriness and
attentional problems than lightly and non-exposed infants. They also had
more movement and tone abnormalities, and sensory asymmetries than non-
exposed infants. Heavily exposed infants were more likely to be identified
with an abnormality than non-exposed infants and there was a trend toward
heavily exposed infants being more likely to be identified with an
abnormality than lightly exposed infants. Furthermore, there was a trend
for heavily exposed infants to be less likely to be testable than non-
exposed infants.
After the confounding and mediating factors were considered, heavily

cocaine-exposed infants were four times as likely to be jittery and nearly
twice as likely to demonstrate any abnormality than lightly and non-exposed
infants, but all other effects were no longer significant. Higher
concentrations of the cocaine metabolites of cocaine, cocaethylene, and
benzoylecgonine (BZE) were related to higher incidence of movement and tone
abnormalities, jitteriness, and presence of any abnormality. Higher
cocaethylene levels were related to attentional abnormalities and higher
meta-hydroxybenzoylecgonine (m-OH-BZE) was related to jitteriness. Drug
effects on attention were mediated by maternal psychological distress,
suggesting that this factor should be considered in future studies of drug
exposure effects.
Keywords: Cocaine; Neonatal behaviorAttention; Drugs; Maternal distress;
Marijuana; Alcohol; Cigarettes; Motor development; Teratology
Dawn Durain, Politics in the birthing room, Nursing Clinics of North

America, Volume 37, Issue 4, December 2002, Pages 795-802, ISSN 0029-6465,
10.1016/S0029-6465(02)00023-3.
Carol A. Newnham, Jeannette Milgrom, Helen Skouteris, Effectiveness of a

Modified MotherInfant Transaction Program on Outcomes for Preterm Infants
from 3 to 24 months of age, Infant Behavior and Development, Volume 32,
Issue 1, January 2009, Pages 17-26, ISSN 0163-6383,
10.1016/j.infbeh.2008.09.004.
Abstract: Mothers of hospitalised preterm infants were randomised into an
intervention or control condition. Intervention mothers received a modified
MotherInfant Transaction Program over seven sessions prior to infant
discharge and two sessions over the next 3 months. Infant temperament,
motherinfant interaction and parenting stress were assessed at 3 and 6
months and infant development was measured by parental report at 24 months.
Intervention compared with control dyads showed enhanced motherinfant
interactions, infants were temperamentally more approaching and easier,
had fewer regulatory problems (colic, sleep, excessive crying), and had
more developed communication skills, while mothers were less stressed by
their infant at 3 months. These early gains in the development of preterm
infants and in the relationship with and adjustment of their mothers, may
explain the process by which intervention infants in the original study
showed increasing cognitive advantages to 9 years of age [Rauh, V. A.,
Nurcombe, B., Achenbach, T., & Howell, C. (1990). The motherinfant
transaction program. Clinical Perinatology, 17, 3145].
Keywords: Preterm infant; Motherinfant interaction; Temperament; Infant
development
Susan Watt, Jean Chamberlain, Water, climate change, and maternal and
newborn health, Current Opinion in Environmental Sustainability, Volume 3,
10.1016/j.cosust.2011.10.008.
Abstract: The health vulnerabilities of age and gender are confounded by
poverty, food insecurity, water-related disease, and general health status.
Natural hazards and extreme weather events further compromise health. This
paper examines the research related to water, climate change, and maternal
and newborn health published in English between January 2000 and March 2011
to what research is needed to improve our understanding of this
association. We argue that the focused attention of environmental scholars
is needed to better understand adaptation and mitigation strategies for
these at-risk groups. We also argue for the disaggregation of health data
to better examine these relationships.
MargaretB McNay, JohnE.E Fleming, forthee....towhom%

nosoundisdissonantwhichtellsoflife% coleridge, Ultrasound in Medicine
& Biology, Volume 25, Issue 1, January 1999, Pages 3-56, ISSN 0301-
5629, 10.1016/S0301-5629(98)00129-X.
Abstract: In this article, we record the history of obstetric ultrasound as
it developed worldwide in the second half of the twentieth century. The
technological advances during this period saw the evolution of equipment
from the original adapted metal flaw detectors producing a simple A-scan to
the modern, purpose built, real-time colour flow machines with three-
dimensional capability (Fig. 1). Clinically, ultrasound began as a research
tool, but the poor quality of the images led to the ridicule of many of the
early investigators. However, because of their perseverance, ultrasound
developed into an imaging modality providing immense diagnostic
capabilities and facilitating with precision many invasive procedures,
diagnostic and therapeutic, both of which have made significant
contributions to patient care. In this history, we recall the people, the
personalities, and the problems they encountered during the development of
ultrasound and how these problems were resolved, so that ultrasound now is
available for use in the care of pregnant women throughout the developed
world.
Keywords: History; Ultrasound imaging; Diagnosis; Obstetrics; Fetus; Fetal
measurement; Fetal abnormality; Fetal therapy; Color Doppler
A. Tibary, J. Rodriguez, S. Sandoval, Reproductive emergencies in camelids,
Theriogenology, Volume 70, Issue 3, August 2008, Pages 515-534, ISSN 0093-
691X, 10.1016/j.theriogenology.2008.04.024.
Abstract: Emergencies in theriogenology practice go beyond just saving the
life of the patient, but also preserving its reproductive abilities.
Camelid emergency medicine is a relatively new field. This paper discusses
the most common reproductive emergencies, their diagnosis, treatment, and
prognosis in male and female camelids. The conclusions drawn are based
primarily on clinical observations by the authors over the last 25 years.
Special consideration is given to peculiarities of the species,
particularly in the choice of obstetrical manipulations and therapies.
Keywords: Camelid; Pregnancy; Infertility; Neonatology; Emergency
Birgitta Salomonsson, Siw Alehagen, Klaas Wijma, Swedish midwives views on

severe fear of childbirth, Sexual & Reproductive Healthcare, Volume 2,
10.1016/j.srhc.2011.07.002.
Abstract: Objective
To describe the views of Swedish midwives on severe fear of childbirth
(SFOC).
Study design
In this cross sectional study, a random sample of 1000 midwives, selected
from the database of the Swedish Association of Midwives, received a
questionnaire. The response rate was 84% (n = 834), with 726
questionnaires included in the final analysis.
The views of midwives on SFOC in different contexts of work: antenatal care
clinic (ACC), labour ward (LW) either ACC/LW or Neither-Nor ACC/LW.
Results
The majority of respondents thought that the frequency of SFOC has
increased during the last 10 years (67%), and that pregnant women
today are more likely to discuss their fears (70%). Midwives at ACCs
thought that special education in SFOC is needed (p < 0.001)
and that they have more responsibility to identify women with SFOC
(p < 0.001) than midwives at LWs. The majority of respondents,
both at ACCs (60%) and LWs (65%), intuitively sensed when they were meeting
a woman with SFOC. Opinions among midwives who alternate between working in
ACCs and LWs reflected the views of the midwives working either in an ACC
or an LW.
Conclusions
The views of midwives on SFOC are partly in concordance and partly
contradictory in relation to the different workplaces as well as research
data. Knowledge of the views of midwives on SFOC is a necessary pre-
requisite to improve care for pregnant women.
Keywords: Anxiety; Fear of childbirth; Midwives; Sweden; Views
Aileen MacLaren, Wendy Imberg, Current issues in the midwifery management

of women living with HIV/AIDS, Journal of Nurse-Midwifery, Volume 43, Issue
6, NovemberDecember 1998, Pages 502-525, ISSN 0091-2182, 10.1016/S0091-
2182(98)00055-X.
Abstract: Changes in the clinical management of women living with human
immunodeficiency virus (HIV) have occurred as a result of significant gains
in the scientific knowledge of this retrovirus. As the incidence of
HIV/AIDS continues to escalate among female adults and adolescents in the
United States, all primary health care providers must anticipate the
likelihood of encountering clients with HIV infection. Midwives must be
adequately prepared to meet the challenges of managing women with HIV in
the early stages of the disease. This article presents a comprehensive
review of current demographic trends related to the HIV/AIDS epidemic among
U.S. women and a brief overview of the essential immunopathogenesis of HIV.
Contemporary issues related to universal counseling, updated testing
procedures, and reproductive decision-making are covered. Initial primary
care concerns and the management of newly infected seropositive women are
included, with a focus on gynecologic issues. Guidance in the current
management of HIV-positive pregnant women is offered. Updated
antiretroviral prophylaxis recommendations are presented, to prevent
perinatal transmission and to delay maternal immunosuppression with
subsequent opportunistic infections. The article concludes with
implications for health care professionals who provide care for this unique
cohort of women.
Doreen L. Wiggins, Michael E. Wiggins, THE FEMALE ATHLETE, Clinics in

Sports Medicine, Volume 16, Issue 4, 1 October 1997, Pages 593-612, ISSN
0278-5919, 10.1016/S0278-5919(05)70044-2.
Abstract: As we approach the year 2000, women's participation in
competitive athletics has become the norm rather than the exception. With
this increased sports participation, the physician needs to be prepared to
care for female athletes and their special needs.
The growth in women's sport participation occurred as a result of

legislation passed in 1972 called Title IX.15 This legislation essentially
states that any secondary or collegiate school that receives federal
assistance must offer equal athletic opportunities to men and women,
requiring equity in areas of participation, scholarship, dollars, and
athletic benefits. Since the passage of this legislation, high school and
collegiate female athletic participation has increased more than 600% to a
total of 1.9 million female athletes.20
Women are now a major power in competitive sports. More than 3000 female
athletes participated in the 1992 Olympics. A 27% increase occurred at the
1996 Games, with more than 3800 female athletes participating. The Atlanta
1996 Olympics saw a large amount of media coverage focused on female
events. The gold medal women's soccer match attracted more than 64,000
spectators. US women won gold medals in team soccer, softball, gymnastics,
and basketball, and they dominated the track and field events. World-class
female athletes are now appearing on modeling runways, women's magazine
covers, and billboards. This media attention and success of female athletes
has shown that athletic women can be attractive and feminine and yet be
strong, powerful, and fiercely competitive.
This article presents and discusses the most important issues specific to
the female athlete. It is our goal that the sports medicine physician will
have a better understanding of the pertinent issues regarding the female
athlete, so that he or she may be better able to care for these athletes in
competition and in training.
Melissa D. Avery, Georgeanne T. DelGiudice, High-tech skills in low-tech

hands: Issues of advanced practice and collaborative management, Journal of
Nurse-Midwifery, Volume 38, Issue 2, Supplement, MarchApril 1993, Pages
S9-S17, ISSN 0091-2182, 10.1016/0091-2182(93)90092-U.
Abstract: Nurse-midwifery practice has been defined by the American College
of Nurse-Midwives (ACNM) as the independent management of essentially
normal newborns and women occurring within a health care system which
provides for medical consultation, collaborative management or referral.
As the health care delivery system in the United States becomes
increasingly complex and reliant on new forms of technology, it has become
necessary to clarify roles and responsibilities for the nurse-midwife. In
addition, mechanisms for acquiring new skills and for collaborating with
physician colleagues must be well understood. A question frequently asked
is where the boundaries of nurse-midwifery practice end and those of
medical practice begin. Although practice scenarios vary for individual
nurse-midwives and nurse-midwifery services, recent statements approved by
the ACNM Board of Directors discuss these issues in an attempt to clarify
the potentially confusing areas of collaboration and skill acquisition.
This article explores the areas of expanded nurse-midwifery practice and
collaborative management. Although individual clinical skills are not
necessarily endorsed, a step-by-step approach that nurse-midwives can use
for incorporation of new skills is presented. The concepts discussed will
be a valuable tool to nurse-midwives in their practice.
Nancy Murphy, Teresa Such-Neibar, Cerebral palsy diagnosis and management:

the state of the art, Current Problems in Pediatric and Adolescent Health
Care, Volume 33, Issue 5, May 2003, Pages 146-169, ISSN 1538-5442,
10.1016/S1538-5442(03)00002-6.
Ramona T. Mercer, Relationship of the birth experience to later mothering

behaviors, Journal of Nurse-Midwifery, Volume 30, Issue 4, JulyAugust
1985, Pages 204-211, ISSN 0091-2182, 10.1016/0091-2182(85)90144-2.
Abstract: The relationship of perception of the childbirth experience and
later mothering behaviors was studied among three age groups of first-time
mothers (15 to 19, 20 to 29, and 30 to 42 years) at 1, 4, 8, and 12 months
after birth. The perception of the birth experience had a significantly
positive relationship with later maternal behaviors among the teenage group
at all test periods, and among the 20-year-old group at all except the 8-
month test period. The 30- to 42-year-old mothers' maternal behaviors were
not related to their perceptions of the birth experience.
Keith A. Frey, Shannon M. Navarro, Milton Kotelchuck, Michael C. Lu, The

clinical content of preconception care: preconception care for men,
American Journal of Obstetrics and Gynecology, Volume 199, Issue 6,
Supplement B, December 2008, Pages S389-S395, ISSN 0002-9378,
10.1016/j.ajog.2008.10.024.
Abstract: Little attention has been given to men's preconception health and
health care. This paper reviews the key elements of an approach to
optimizing the preconception health status of men. Preconception care for
men is important for improving family planning and pregnancy outcomes,
enhancing the reproductive health and health behaviors of their female
partners, and preparing men for fatherhood. Most importantly, preconception
care offers an opportunity, similar to the opportunity it presents for
women, for disease prevention and health promotion in men. Currently, no
consensus exists on service delivery of preconception care for menwho
should provide preconception care to whom, where, when, and how, and there
are significant barriers to this care including the organization,
financing, training, and demand. Finally, much more research on the content
and how to effectively market and implement preconception care for men is
needed.
Keywords: father; health promotion; preconception; risk assessment
Jeanette Haslam, Chapter 3 - Physical and physiological changes of labour

and the puerperium, In: Jill Mantle, BA FCSP DIPTP, Jeanette Haslam, MPHIL
GRADDIPPHYS MCSP SRP, and Sue Barton, MSC DIPED MCSP DIPTP DIPRG&RT DIPTHRF
SRP, Editor(s), Physiotherapy in Obstetrics and Gynaecology (Second
Edition), Butterworth-Heinemann, Oxford, 2004, Pages 53-91, ISBN
9780750622653, 10.1016/B978-0-7506-2265-3.50011-3.
K. Winnard, No longer giving life through death, International Journal of

Gynecology & Obstetrics, Volume 48, Supplement, June 1995, Pages S7-
S20, ISSN 0020-7292, 10.1016/0020-7292(95)02318-7.
Abstract: Pragmatic approaches to safe motherhood consider the needs of
both clients and providers: the sociological and physical environments
within which a woman lives and moves through to reach a level of care that
fulfills her health needs; and the conditions of formal and traditional
health care systems within which a health care provider works and moves
through to reach a level of professional satisfaction and quality care that
fulfills her/his needs and responsibilities. These movements toward higher
levels of care are interdependent; without one, the other falters.
Clients and providers are partners in this dance of health. Five
approaches employed by the MotherCare Project shape maternal health
programs. Presented in geometric form, they each describe movements leading
client and provider to more satisfying positions in receiving and giving
health care, respectively. Strategies to enhance these movements are the
subject of the subsequent chapters of this supplement.
Keywords: Safe motherhood; Client-provider behavior change
J. Morrison, R. Thapa, S. Hartley, D. Osrin, M. Manandhar, K. Tumbahangphe,

R. Neupane, B. Budhathoki, A. Sen, N. Pace, D.S. Manandhar, A. Costello,
Understanding how women's groups improve maternal and newborn health in
Makwanpur, Nepal: a qualitative study, International Health, Volume 2,
10.1016/j.inhe.2009.11.004.
Abstract: Summary
Women's groups, working through participatory learning and action, can
improve maternal and newborn survival. We describe how they stimulated
change in rural Nepal and the factors influencing their effectiveness. We
collected data from 19 women's group members, 2 group facilitators, 16
health volunteers, 2 community leaders, 21 local men, and 23 women not
attending the women's groups, through semi-structured interviews, group
interviews, focus group discussions and unstructured observation of groups.
Participants took photographs of their locality for discussion in focus
groups using photoelicitation methods. Framework analysis procedures were
used, and data fed back to respondents. When group members were compared
with 11 184 women who had recently delivered, we found that they were of
similar socioeconomic status, despite the context of poverty, and caste
inequalities. Four mechanisms explain the women's group impact on health
outcomes: the groups learned about health, developed confidence,
disseminated information in their communities, and built community capacity
to take action. Women's groups enable the development of a broader
understanding of health problems, and build community capacity to bring
health and development benefit.
Keywords: Neonatal; Women; Qualitative research; Process evaluation;
Community; Nepal
C. McCord, Q. Chowdhury, A cost effective small hospital in Bangladesh:

what it can mean for emergency obstetric care, International Journal of
Gynecology & Obstetrics, Volume 81, Issue 1, April 2003, Pages 83-92,
ISSN 0020-7292, 10.1016/S0020-7292(03)00072-9.
Abstract: Mortality has improved dramatically in most of South Asia as a
consequence of modest economic improvement, better nutrition and a
combination of health education, immunization, family planning and home
treatment of certain common diseases, especially diarrhea and respiratory
infections. However, death rates are still much higher than in parts of the
world with fully developed health services and residual mortality is
largely due to conditions which require very basic hospital services such
as surgery for complications of pregnancy, infections and trauma,
transfusion, intravenous fluids, oxygen and intensive antibiotics. All of
these can be made available in very simple and unsophisticated hospital
facilities. It has generally been assumed that the cost of such facilities
would be high, and cost effectiveness much less than that of preventive,
educational and home care programs. In 1995, our 50 bed hospital in rural
Bangladesh had a cost per patient-day of 525 Bangladesh Takas (US$13.15)
and a cost per capita for the population served of 25 Takas (US$0.62) per
year. Every month 180 patients were admitted, one-third with clearly life-
threatening or disabling conditions which could be successfully treated in
such a facility. We adapted the Disability Adjusted Life Year (DALY) method
of cost effectiveness analysis to calculate the DALYs (years of disability-
free life) preserved for individual patients during a 3-month period, using
what we considered to be very conservative estimates of the threat to life
and the efficacy of treatment. The total cost of all hospital activities
over the 3 months was divided by the sum of the DALYS for those patients
who were successfully treated for clearly life threatening or disabling
conditions, to give a cost per DALY of 437 Takas (US$10.93). This compares
favorably with estimates by others of a cost per DALY of US$30 for measles
immunization, $20 for acute lower respiratory infection detection and home
treatment, or $2 for tetanus immunization of pregnant women. Sixty-two
percent of the DALYS saved came from emergency obstetric care (EmOC)
related activities. We conclude that cost effective basic hospital service
can be added to immunization, family planning and other basic health
services now available in countries like Bangladesh with a very low
increase in total cost and that the benefits which would accrue,
particularly for maternal and perinatal mortality, would be great.
Keywords: Cost-effective; Emergency obstetric care; Hospital; Bangladesh
Yuqiong Wang, Xiujing Guo, Ying Lau, Kin Sin Chan, Lei Yin, Jing Chen,
Psychometric evaluation of the Mainland Chinese version of the Edinburgh
Postnatal Depression Scale, International Journal of Nursing Studies,
10.1016/j.ijnurstu.2009.01.010.
The Edinburgh Postnatal Depression Scale (EPDS) has been validated in many
countries, but not in Mainland China.
Objectives
This study investigated the reliability and validity of the Mainland
Chinese version of the EPDS.
Design
A three-stage design was used for this study. Stage I consisted of a multi-
stepped process of forward and backward translation, using a panel of six
experts to test content validity. Stage II established the psychometric
properties of the EPDS by examining the convergent, discriminant and
construct validity, internal consistency and stability of the scale. Stage
III established its sensitivity, specificity and the optimal cutoff score
of the EPDS according the DSM-IV-TR criteria using the Structured Clinical
Interview.
Setting
Three regional public hospitals in Chengdu.
Participants
A convenience sample was composed of 312 and 451 pregnant women at 2836
weeks gestation.
Method
Translation and back-translation of the original English instrument and
content validation by an expert panel. Receiver operating characteristic
(ROC) analysis was carried out to evaluate the global functioning of the
scale. The Beck Depression Inventory (BDI), Dyadic Adjustment Scale (DAS)
and standard SF-12 Health Survey (SF-12) were used to investigate the
convergent, discriminant and construct validity. The Cronbach's alpha
reliability coefficient, split-half reliability and testretest reliability
were used to examine the internal consistency and stability of the scale.
Results
The translation process was rigorously conducted to ensure that equivalence
was established. Content validity was confirmed by a satisfactory level of
agreement with a content validity index (CVI) of 0.93. The area under curve
(AUC) was 85.6% and the logistic estimate for the threshold score was 9.5
(sensitivity, 80.0%; specificity, 83.03%) for clinical depression.
Convergent and construct validity was supported and discriminant validity
suggested that the EPDS successfully discriminated among the non-depressed,
mildly and clinically depressed groups. The split-half reliability of the
EPDS was 0.76, Cronbach's alpha was 0.79 and testretest reliability was
0.85.
Conclusions
Based on the results of this psychometric testing, the Mainland Chinese
version of the EPDS is considered ready for use in the routine screening of
pregnant women. It is hoped that with this type of cross-cultural
information, the universality of the constructs of the instrument can be
reliably demonstrated.
Keywords: Mainland Chinese version of the EPDS; Psychometric evaluation;
ROC analysis; Sensitivity; Specificity
M.T. Islam, M.M. Hossain, M.A. Islam, Y.A. Haque, Improvement of coverage
and utilization of EmOC services in southwestern Bangladesh, International
Journal of Gynecology & Obstetrics, Volume 91, Issue 3, December 2005,
Pages 298-305, ISSN 0020-7292, 10.1016/j.ijgo.2005.06.029.
Abstract: Objective
The Government of Bangladesh has implemented safe motherhood programs
throughout the country supported by the United Nations Children's Fund
(UNICEF) and United Nations Population Fund (UNFPA) aimed at reducing
maternal morbidity and mortality. The objective of this study is to assess
the effect of the interventions on the UN emergency obstetric care (EmOC)
process indicators in Khulna division, Bangladesh.
Methods
Of the 71 government health facilities in Khulna division, 32 were
providing comprehensive and 20 were providing basic EmOC services. Another
4 facilities were providing comprehensive or basic EmOC services during the
first three-quarters but became non-functional during the last quarter.
EmOC data, from January to December 2002, were collected from all these 56
facilities to determine the levels of EmOC process indicators relative to
the UN guidelines and compared with baseline data from 1998 to 1999.
Results
There were 1.04 and 0.64 comprehensive and basic EmOC facilities
respectively per 500,000 population. When compared with the baseline data,
the coverage of comprehensive EmOC services was substantially increased
from 0.23 to 1.04 per 500,000 population, which achieves the minimum UN
standards but the coverage of basic EmOC services remained the same. The
data also showed that, compared with the baseline survey, the proportion of
births at the EmOC facilities increased 119% from 5.3% to 11.7%
(p < 0.001), met need increased 141% from 11.1% to 26.6%
(p < 0.001), and cesarean section as a proportion of all
expected births, increased 151% from 0.5% to 1.3% (p < 0.001),
while the overall case fatality rate (CFR) decreased by 51%
(p < 0.001).
Conclusion
With the exception of coverage of basic EmOC after the interventions, there
was significant improvement in all the EmOC process indicators in Khulna
division. However, most of the process indicators are still far from the
minimum recommended UN standards.
Recommendations
Efforts should continue to keep the EmOC facilities functional 24/7 while
increasing the number of basic EmOC facilities, and improving utilization
of services to reach the minimum UN standards. Community mobilization
should be directed to understand the danger signs and utilization of
services at functional facilities when necessary. Further research to
identify the factors influencing utilization of EmOC services and
continuous monitoring and periodical assessment of the process indicators
are recommended to evaluate the overall situation from time to time.
Keywords: Maternal mortality; Emergency obstetric care; Coverage;
Utilization; Process indicators; Bangladesh; Khulna
Lisa M. Nicholson, Patricia M. Schwirian, Elizabeth G. Klein, Theresa

Skybo, Lisa Murray-Johnson, Ihuoma Eneli, Bethany Boettner, Gina M. French,
Judith A. Groner, Recruitment and retention strategies in longitudinal
clinical studies with low-income populations, Contemporary Clinical Trials,
10.1016/j.cct.2011.01.007.
Conducting longitudinal research studies with low-income and/or minority
participants present a unique set of challenges and opportunities.
Purpose
To outline the specific strategies employed to successfully recruit and
retain participants in a longitudinal study of nutritional anticipatory
guidance during early childhood, conducted with a low-income, ethnically
diverse, urban population of mothers.
Methods
We describe recruitment and retention efforts made by the research team for
the MOMS Study (Making Our Mealtimes Special). The multilayered
approach for recruitment and retention included commitment of research
leadership, piloting procedures, frequent team reporting, emphasis on
participant convenience, incentives, frequent contact with participants,
expanded budget, clinical staff buy-in, a dedicated phone line, and the use
of research project branding and logos.
Results
Barriers to enrollment were not encountered in this project, despite
recruiting from a low-income population with a large proportion of African-
American families. Process evaluation with clinic staff demonstrated the
perception of the MOMS staff was very positive. Participant retention rate
was 75% and 64% at 6 months and 12 months post-recruitment,
respectively. We attribute retention success largely to a coordinated
effort between the research team and the infrastructure support at the
clinical sites, as well as project branding and a dedicated phone line.
Conclusions
Successful participant recruitment and retention approaches need to be
specific and consistent with clinical staff buy in throughout the project.
Keywords: Recruitment; Retention; Longitudinal studies; Low-income
populations
Lee A. Savio Beers, Ruth E. Hollo, Approaching the Adolescent-Headed

Family: A Review of Teen Parenting, Current Problems in Pediatric and
Adolescent Health Care, Volume 39, Issue 9, October 2009, Pages 216-233,
ISSN 1538-5442, 10.1016/j.cppeds.2009.09.001.
Abstract: In the USA, as many as 1 in 6 women nationwide become adolescent
mothers, making adolescent pregnancy and childbearing issues a frequently
encountered occurrence by pediatricians and adolescent medicine health care
providers. Both social and medical programs focus on prevention and
management of adolescent pregnancies; however, caring for the adolescent-
headed family is less well understood. For many teen parents, various
environmental and behavioral risks contributed to early childbearing and
parenting. Following delivery of the infant, many of these same psycho-
social, environmental, and educational factors continue to play a role in
the teen's ability to parent effectively. This review explores these
factors in relation to teen parenting as well as describes the limited data
available on outcomes of adolescent mothers and their infants. Despite
negative social stereotypes regarding adolescent fathers, research
suggesting that most fathers desire involvement with their infants and the
impact of and factors influencing father involvement is explored.
Understanding the dynamics of the coparenting relationship, an expanding
field of study, will aid practitioners in strengthening and supporting teen
parenting by both mothers and fathers. As most teen parents continue to
reside with their families, teen parenting has an important impact on the
multi-generational family structure. These relationships can serve both to
support and at times to hinder the adolescent parents' development as an
individual and as a parent. Successful interventions and programs to
support the adolescent-headed family take on various forms but are usually
comprehensive and multidisciplinary and consider the developmental status
of both the parent and the child. To best care for adolescent-headed
families, pediatricians and adolescent medicine providers should understand
the psychosocial, developmental, educational, and relationship issues that
influence adolescent parenting.
S. Rajput, A. Hassiotis, M. Richards, S.L. Hatch, R. Stewart, Associations

between IQ and common mental disorders: The 2000 British National Survey of
Psychiatric Morbidity, European Psychiatry, Volume 26, Issue 6, September
2011, Pages 390-395, ISSN 0924-9338, 10.1016/j.eurpsy.2010.07.002.
Associations have been described between lower IQ and serious mental
illness. Associations between common mental disorders (CMDs) and IQ have
received little research. The objective of this study was to investigate
the association between verbal IQ and CMD symptoms and diagnoses, and to
investigate the role of potential mediating and confounding factors.
Method
Data were analysed from a British national survey with an analysed sample
of 8054 people aged 1674 years. Associations between verbal IQ (NART) and
mental symptoms/disorders (CIS-R) were analysed with covariates including
education, social class, income, debt, problem drinking, life events,
physical health and relationship quality.
Results
CMD was associated with lower IQ. This association was stronger for
depressive disorder/symptoms than for generalised anxiety
disorder/symptoms. The most important covariates were education, social
class, income and relationship quality.
Conclusion
The association between lower IQ and CMD is partly accounted for by adverse
social/socioeconomic conditions. Stronger associations for depression than
anxiety may indicate an effect of IQ on the way mental distress is
communicated.
Keywords: Common mental disorders; Affective disorders; Depressive
disorder; Anxiety disorders; Intelligence; IQ; Epidemiology; Cross-
sectional survey
Kishwar Azad, Sarah Barnett, Biplob Banerjee, Sanjit Shaha, Kasmin Khan,
Arati Roselyn Rego, Shampa Barua, Dorothy Flatman, Christina Pagel, Audrey
Prost, Matthew Ellis, Anthony Costello, Effect of scaling up women's groups
on birth outcomes in three rural districts in Bangladesh: a cluster-
randomised controlled trial, The Lancet, Volume 375, Issue 9721, 39 April
2010, Pages 1193-1202, ISSN 0140-6736, 10.1016/S0140-6736(10)60142-0.
Two recent trials have shown that women's groups can reduce neonatal
mortality in poor communities. We assessed the effectiveness of a scaled-up
development programme with women's groups to address maternal and neonatal
care in three rural districts of Bangladesh.
Methods
18 clusters (with a mean population of 27953 [SD 5953]) in three districts
were randomly assigned to either intervention or control (nine clusters
each) by use of stratified randomisation. For each district, cluster names
were written on pieces of paper, which were folded and placed in a bottle.
The first three cluster names drawn from the bottle were allocated to the
intervention group and the remaining three to control. All clusters
received health services strengthening and basic training of traditional
birth attendants. In intervention clusters, a facilitator convened 18
groups every month to support participatory action and learning for women,
and to develop and implement strategies to address maternal and neonatal
health problems. Women were eligible to participate if they were aged 1549
years, residing in the project area, and had given birth during the study
period (Feb 1, 2005, to Dec 31, 2007). Neither study investigators nor
participants were masked to treatment assignment. In a population of 229
195 people (intervention clusters only), 162 women's groups provided
coverage of one group per 1414 population. The primary outcome was neonatal
mortality rate (NMR). Analysis was by intention to treat. This trial is
registered as an International Standard Randomised Controlled Trial, number
ISRCTN54792066.
Findings
We monitored outcomes for 36113 births (intervention clusters, n=17514;
control clusters, n=18599) in a population of 503163 over 3 years. From
2005 to 2007, there were 570 neonatal deaths in the intervention clusters
and 656 in the control clusters. Cluster-level mean NMR (adjusted for
stratification and clustering) was 339 deaths per 1000 livebirths in the
intervention clusters compared with 365 per 1000 in the control clusters
(risk ratio 093, 95% CI 080109).
Interpretation
For participatory women's groups to have a significant effect on neonatal
mortality in rural Bangladesh, detailed attention to programme design and
contextual factors, enhanced population coverage, and increased enrolment
of newly pregnant women might be needed.
Funding
Women and Children First, the UK Big Lottery Fund, Saving Newborn Lives,
and the UK Department for International Development.
I. Thorsdottir, I. Gunnarsdottir, G.I. Palsson, Association of birth weight

and breast-feeding with coronary heart disease risk factors at the age of 6
years, Nutrition, Metabolism and Cardiovascular Diseases, Volume 13, Issue
5, October 2003, Pages 267-272, ISSN 0939-4753, 10.1016/S0939-
4753(03)80030-3.
Abstract: Background and Aim:
It has been shown that early growth and nutrition affect health in
childhood and later life. The aim of this study was to assess the
association of birth weight and breast-feeding in infancy with body mass
index (BMI) and serum lipids at the age of six years. The contributions of
current macronutrient intake, maternal age and BMI were assessed.
Methods and Results:
This was a longitudinal observational study of 120 randomly chosen children
whose birth weight and duration of breast-feeding had been recorded. At the
age of six years, their weight and height, and serum cholesterol (total,
LDL and HDL) and triglyceride levels were measured at healthcare centres in
Iceland. Dietary intake at six years was estimated using 3-day weighed food
records. The duration of breast-feeding negatively correlated with BMI in
6-year-old boys (B=0.190.07, p=0.011) but not in girls; after adjusting
for maternal BMI, the relationship in boys was of borderline significance
(p=0.087). The 6-year-old boys who had been breast-fed for <6 months had
a significantly higher BMI (18.0 2.5 kg/m2) than those breast-fed for 89
months (15.8 1.2 kg/m2, p=0.006) or 10 months (15.7 1.2 kg/m2,
p=0.005). A longer duration of breast-feeding was related to higher HDL-
cholesterol levels in 6-year-old girls (B=0.030.01, p=0.032), but not
boys. Birth weight was not related to BMI or serum lipid levels at the age
of 6 years.
Conclusion:
In this high birth weight population, a longer duration of breast-feeding
may be effective in preventing childhood overweight, at least among boys.
Breast-feeding also seems to be related to an improved lipid profile in
girls.
Keywords: Infants; birth weight; infant nutrition; nutrition; body mass
index; child; lipids
Helen. L McLachlan, Della. A Forster, Jane Yelland, Joanne Rayner, Judith

Lumley, Is the organisation and structure of hospital postnatal care a
barrier to quality care? Findings from a state-wide review in Victoria,
Australia, Midwifery, Volume 24, Issue 3, September 2008, Pages 358-370,
ISSN 0266-6138, 10.1016/j.midw.2006.10.006.
Abstract: Objective
to describe the structure and organisation of hospital postnatal care in
Victoria, Australia.
Design
postal survey sent to all public hospitals in Victoria ( n = 71 ) and key-
informant interviews with midwives and medical practitioners ( n = 38 ).
Setting
Victoria, Australia.
Participants
providers of postnatal care in Victorian public hospitals.
Findings
there is significant diversity across Victoria in the way postnatal units
are structured and organised and in the way care is provided. There are
differences in numerous practices, including maternal and neonatal
observations and the length of time women spend in hospital after giving
birth. Although the benefits of continuity of care are recognised by health
care providers, continuity is difficult to provide in the postnatal period.
Postnatal care is provided in busy, sometimes chaotic environments, with
many barriers to providing effective care and few opportunities for women
to rest and recover after childbirth. The findings in this study can, in
part, be explained by the lack of evidence that has been available to guide
early postnatal care.
current structures such as standard postnatal documentation (clinical
pathways) and fixed length of stay, may inhibit rather than support
individualised care for women after childbirth. There is a need to move
towards greater flexibility in providing of early postnatal care, including
alternative models of service delivery; choice and flexibility in the
length of stay after birth; a focus on the individual with far less
emphasis on care being structured around organisational requirements; and
building an evidence base to guide care.
Keywords: Postnatal care; Midwifery; Organisation of care; Continuity of
care; Health services research
Elizabeth Leedam, Traditional birth attendants, International Journal of
Gynecology & Obstetrics, Volume 23, Issue 4, September 1985, Pages 249-
274, ISSN 0020-7292, 10.1016/0020-7292(85)90020-7.
Abstract: In many countries 6080% of deliveries are assisted by
traditional birth attendants (TBAs). Over the last several decades efforts
have been made to regulate, upgrade through training or replace the TBA.
The strength of the TBA stems from the fact that she is part of the
cultural and social life of the community in which she lives. Her weakness
lies in the traditional practices which may have dangers for her clients.
With suitable training and supervision these dangers can be minimized and
her potential used to improve the health of mothers and babies.
Increasingly countries are recognizing that the TBA will represent a major
resource where women do not have access to services for either cultural or
geographic barriers. The effective use of this resource will require an
understanding and appreciation of the TBA's role and contribution by all
health authorities, flexibility in the development of training programs and
the cooperation of the TBAs themselves.
Keywords: Traditional birth attendants; Pregnancy; Delivery care; Training;
Evaluation; Training costs; Regulatory status
Patricia Rosen, Supporting women in labor: analysis of different types of

caregivers, Journal of Midwifery & Women's Health, Volume 49, Issue 1,
JanuaryFebruary 2004, Pages 24-31, ISSN 1526-9523,
10.1016/j.jmwh.2003.10.013.
Abstract: Continuous labor support offers multiple benefits for mothers and
infants. The type of caregiver that is the best support person in labor has
not been identified. A critical review of the English language literature
was conducted to describe the current state of knowledge on different types
of labor support persons. Randomized trials and other published reports
were identified from relevant databases and hand searches. Studies were
reviewed and assessed by using a structured format. Eight randomized trials
met the selection criteria for inclusion in this analysis. These trials
investigated untrained and trained lay women, female relatives, nurses, lay
midwives, and student lay midwives as labor support persons. Support by
untrained lay women starting in early labor and continuing into the
postpartum period demonstrates the most consistent beneficial effect on
childbirth outcomes. However, more randomized controlled trials are
warranted before firm conclusions may be drawn.
Keywords: labor; obstetrics; natural childbirth; nurse-midwives; social
support
Christopher B. Wilson, Pearay L. Ogra, CHAPTER 5 - Human Milk, Infectious

Diseases of the Fetus and Newborn (Seventh Edition), W.B. Saunders,
6400-8.00005-5.
S.E. Cohen, L.C. Andes, B. Carvalho, Assessment of knowledge regarding

cardiopulmonary resuscitation of pregnant women, International Journal of
Obstetric Anesthesia, Volume 17, Issue 1, January 2008, Pages 20-25, ISSN
0959-289X, 10.1016/j.ijoa.2007.10.002.
The 2000-2002 triennial UK Report on Confidential Enquiries into Maternal
Deaths concluded that over 50% of maternal deaths involved substandard care
and that many could have been prevented. Catastrophic events leading to
cardio-respiratory arrest may necessitate the resuscitation of pregnant
women in various hospital locations. This study was designed to evaluate
knowledge about resuscitation of parturients among anesthesiologists,
obstetricians and emergency physicians.
Methods
A 12-question survey was distributed anonymously to residents and faculty
in the anesthesia (ANES), obstetrics (OB), and emergency medicine (EM)
departments at Stanford University Medical Center/Lucile Packard Childrens
Hospital, Stanford, California. Questions were designed to elicit knowledge
deficiencies in four critical areas: need for left uterine displacement
(LUD), advanced cardiac life support algorithms (ACLS), physiologic changes
of pregnancy (PHYS), and the recommendation to perform cesarean delivery in
parturients (>20 weeks gestation) after 4-5 min of unsuccessful
resuscitation for cardiac arrest (5CD).
Results
In total, 74/75 physicians (43% ANES, 37% OB, and 20% EM) completed the
test. ANES scored highest in overall test scores, and in knowledge of PHYS
(P < 0.05). Scores for LUD and 5CD were similar among groups,
but 25-40% of these questions were answered incorrectly. In the ACLS
category, the EM group scored highest (93%).
Conclusion
We conclude that knowledge of important basic concepts, including the need
for LUD and the potential benefit of early cesarean delivery during cardiac
arrest, is inadequate among all three specialties. All three departments
should provide ACLS physician training with emphasis on the special
considerations for parturients.
Keywords: Advanced cardiac life support; Pregnancy; Resuscitation
Susan Brandt Graham, A structural analysis of physicianmidwife interaction

in an obstetrical training program, Social Science & Medicine, Volume
32, Issue 8, 1991, Pages 931-942, ISSN 0277-9536, 10.1016/0277-
9536(91)90248-B.
(http://www.sciencedirect.com/science/article/pii/027795369190248B)
Abstract: In June 1987 a major Southwestern Medical Center hired a
complement of Certified Nurse Midwives to help relieve an increased Labor
and Delivery workload. Prior to that time, all deliveries had been done by
Obstetrics/Gynecology resident physicians, who continue to deliver the
majority of patients. This paper analyses interaction between the two
groups of obstetrical practitioners, and relates conflicts to the differing
structural models of their relationship held by the two groups and
unwittingly reinforced by administrator. Recommendations for reducing
structural conflicts are presented.
Keywords: physician-midwife interaction; obstetrical practice; medical
anthropology; structural analysis; medical education
Lawrence V. Harper, Ontogenetic and Phylogenetic Functions of the

ParentOffspring Relationship in Mammals, In: Daniel S. Lehrman, Robert A.
Hinde and Evelyn Shaw, Editor(s), Advances in the Study of Behavior,
9780120045037, 10.1016/S0065-3454(08)60155-2.
Zbeyde Koum, Mine Yurdakul, Factors affecting the use of emergency

obstetric care among pregnant women with antenatal bleeding, Midwifery,
Available online 30 May 2012, ISSN 0266-6138, 10.1016/j.midw.2012.02.008.
Abstract: Objective
to investigate the factors that affect the use of emergency obstetric care
services among pregnant women in Turkey with antenatal bleeding.
Design
descriptive, cross-sectional study.
Setting
Mersin Maternity and Child Hospital, Mersin, Turkey.
Participants
125 pregnant women who had been admitted to the emergency department for
antenatal bleeding.
Findings
advanced age, high level of education, lack of health insurance, receiving
antenatal care, nuclear family structure and knowledge of the danger signs
during pregnancy were found to affect the use of emergency obstetric care
services among pregnant women with antenatal bleeding.
Key conclusions
delays in seeking emergency obstetric care among pregnant women with
antenatal bleeding are due to the difficulties faced by women when deciding
whether or not to seek health care. Access to health services and health
institutions themselves do not cause any delay in terms of provision of
emergency obstetric care to pregnant women with antenatal bleeding.
pregnant women should be informed about the causes of antenatal bleeding,
what to do in the case of bleeding, and the need to seek health care as
soon as possible. In addition, midwives should inform families and pregnant
women about the use of emergency medical services and the relevant
procedures.
Keywords: Emergency obstetric care; Delay models; Antenatal bleeding
Rebecca Bergman, IsraelTeam nursing in public health: (To be published in

four parts) Part IA study leading to a planned programme for team nursing
in public health in Israel, International Journal of Nursing Studies,
10.1016/0020-7489(64)90024-0.
Abstract: The State of Israel, established in 1948, has since trebled its
population, primarily as a result of unselected mass immigration. With each
wave of immigrants came serious public health problems, such as infant
mortality, tuberculosis, and trachoma. The official and voluntary agencies
with dedicated personnel confronted and overcame the dangers by emergency
and long-range programs. Continued immigration required a constant
alertness. The outstanding public health problems in Israel today are
comparable with those of the Western world: mental health, chronic illness,
and geriatrics.
Co-ordinated planning of the health agencies, under the leadership of the

Ministry of Health, emphasized comprehensive regional health services with
a continuum of intra and extramural services for prevention, treatment, and
rehabilitation.
Four major agencies offered public health nursing services, primarily in

maternal, child, and school health. Experimental programs with integrated
preventive and curative services for family health have met with success,
and will probably be the future pattern.
The shortage of professional nurses in Israel was reflected in public

health nursing, Thirty-seven per cent of all the public health nursing
service personnel were practical nurses, with a higher percentage of
auxiliaries in the new development areas than in the cities. Some of the
practical nurses worked in clinics under the direct supervision of
professional nurses, others in independent field assignments under the
guidance of the area supervisor. The practical nurses received an intensive
orientation of several weeks to three months to prepare them for their
specific assignment. Very few aides were employed in public health nursing.
Resources of nursing personnel were from immigration (unknown quantity),

and from the local schools of nursing, which graduated slightly over 200
registered nurses and about 400 practical nurses annually. Post-basic
public health nursing preparation was given in three eight-month courses,
with less than 40 graduates annually.
It is expected that the public health nursing services will expand to

provide extramural curative, rehabilitation, and habilitation programs
necessitating an increase in personnel, and the delegation of activities to
auxiliary personnel in a safe and efficient organizational pattern.
Heather M. Whitford, Beth Alder, Martyn Jones, A longitudinal follow up of

women in their practice of perinatal pelvic floor exercises and stress
urinary incontinence in North-East Scotland, Midwifery, Volume 23, Issue 3,
September 2007, Pages 298-308, ISSN 0266-6138, 10.1016/j.midw.2006.05.009.
to establish the reported practice of pelvic floor exercises and stress
urinary incontinence after delivery.
Design
a longitudinal study using a postnatal postal questionnaire.
Participants
257 women in the North-East of Scotland were sent questionnaires between
June and December 2000, 612 months after delivery (previously recruited
and interviewed during the last trimester of pregnancy). One hundred and
sixty-three women responded (63.4%).
Findings
more women reported the practice of pelvic floor exercises after delivery
than during pregnancy: 134 (83.2%) compared with 123 (76.4%). Six to 12
months after delivery, 96 (60%) women said that they were still doing the
exercises. A third of respondents (n=54, 33.1%) reported stress
incontinence at some time since having the baby. Of those reporting
incontinence at the time of questionnaire completion, six (19.3%) said the
incontinence was moderate or severe, whereas eight (34.7%) reported
incontinence once a week or more. Women who had an operative vaginal
delivery (forceps or ventouse delivery) were more likely to report the
practice of pelvic floor exercises than those having a spontaneous vaginal
delivery. No significant difference was found in reported rates of stress
incontinence between women who had different modes of delivery. The
practice of pelvic floor exercises daily or more often during pregnancy was
associated with less reported postnatal incontinence compared with less
frequent practice.
Key conclusions
self-reported rates of practice of pelvic floor exercises increased from
pregnancy to the immediate postnatal period and subsequently declined. A
third of women reported the symptoms of stress incontinence after delivery.
Daily or more frequent practice of the exercises during pregnancy may be
required in order to prevent postnatal incontinence (although further
research is required to confirm this finding).
midwives should continue to encourage regular and frequent practice of
pelvic floor exercises in the postnatal period and beyond. They also need
to ask about symptoms of stress incontinence and refer as necessary.
Keywords: Pelvic floor exercises; Pregnancy; Postnatal; Stress urinary
incontinence
Vernica Schiappacasse, Soledad D

az, Ana Zepeda, Reynaldo Alvarado, Carmen
Herreros, Health and growth of infants breastfed by Norplant contraceptive
implants users: a six-year follow-up study, Contraception, Volume 66, Issue
1, July 2002, Pages 57-65, ISSN 0010-7824, 10.1016/S0010-7824(02)00319-0.
Abstract: The objective of the study was to evaluate safety to infants
whose mothers used Norplant levonorgestrel implants during breastfeeding. A
nonrandomized clinical trial design was used. Participants were 220 and 222
healthy breastfed infants of mothers initiating use of Norplant or T-Cu
IUD, respectively, at 55 days to 60 days postpartum. Infants were followed
from birth through age 6 years. Breastfeeding pattern, infant growth, and
disease events were recorded monthly in the first year, three-monthly in
the second, and annually thereafter.
Most mothers continued use of Norplant (96.4%) and T-Cu (94.1%) during
lactation, and 2140 months of infant exposure to levonorgestrel were
accumulated. Breastfeeding pattern and infants growth, from admission
through age 6 years, were similar in both groups. In the first year,
breastfed infants in the Norplant group had higher incidence rates (p <
0.05) of mild episodes of respiratory infections (adjusted RR 1.17, CI
1.081.27), skin conditions (adjusted RR 1.46, CI 1.201.79), and eye
infections (unadjusted RR 1.49, CI 1.032.18) than the control group. Later
on, a higher proportion of infants in the T-Cu group showed neurological
conditions.
Although breastfeeding patterns and infant growth is not affected by

Norplant use during lactation, the effect on infants health of steroidal
contraception should be further evaluated.
Keywords: Norplant implants; Contraception; Breastfeeding; Infant health;
Copper T-IUD
Allison A. Cowett, Robert M. Golub, William A. Grobman, Cost-effectiveness

of dilation and evacuation versus the induction of labor for second-
trimester pregnancy termination, American Journal of Obstetrics and
Gynecology, Volume 194, Issue 3, March 2006, Pages 768-773, ISSN 0002-9378,
10.1016/j.ajog.2005.09.003.
Abstract: Objective
The purpose of this study was to compare the cost-effectiveness of dilation
and evacuation versus misoprostol induction of labor for second-trimester
termination.
Study design
Using decision analysis, we compared the cost-effectiveness of dilation and
evacuation and misoprostol induction of labor for second-trimester
termination. Complications for dilation and evacuation and induction of
labor included repeat dilation and curettage, cervical laceration repair,
hospital admission, laparotomy, hysterectomy, and maternal death. Induction
of labor complications also included failed induction of labor. The primary
outcome was cost per quality-adjusted life year. Sensitivity analyses were
performed for all relevant variables.
Results
Dilation and evacuation was less costly and more effective than misoprostol
induction of labor for second-trimester termination with baseline
estimates. In 1-way sensitivity analysis, the model was robust to all
variation in probabilities and costs. In Monte Carlo simulation with 1000
trials and a cost-effectiveness threshold of $50,000/quality-adjusted life
year, dilation and evacuation was the preferred approach in 97.9% of
trials.
Conclusion
Dilation and evacuation is less expensive and more effective than
misoprostol induction of labor for second-trimester termination.
Keywords: Cost-effectiveness; Second-trimester pregnancy termination;
Dilation and evacuation; Misoprostol; Induction of labor
Kayli Wild, Lesley Barclay, Paul Kelly, Nelson Martins, Birth choices in
Timor-Leste: A framework for understanding the use of maternal health
services in low resource settings, Social Science & Medicine, Volume
10.1016/j.socscimed.2010.09.012.
Abstract: The high rate of maternal mortality in Timor-Leste is a
persistent problem which has been exacerbated by the long history of
military occupation and ongoing political crises since independence in
1999. It is similar to other developing countries where there have been
slow declines in maternal mortality despite 20 years of Safe Motherhood
interventions. The national Ministry of Health, United Nations (UN)
agencies and non-government organisations (NGOs) have attempted to reduce
maternal mortality by enacting policies and interventions to increase the
number of births in health centres and hospitals. Despite considerable
effort in promoting facility-based delivery, most Timorese women birth at
home and the lack of midwives means few women have access to a skilled
birth attendant. This paper investigates factors influencing access to and
use of maternal health services in rural areas of Timor-Leste. It draws on
21 interviews and 11 group discussions with Timorese women and their
families collected over two periods of fieldwork, one month in September
2006 and five months from July to December 2007. Theoretical concepts from
anthropology and health social science are used to explore individual,
social, political and health system issues which affect the way in which
maternal health services are utilised. In drawing together a range of
theories this paper aims to extend explanations around access to maternal
health services in developing countries. An empirically informed framework
is proposed which illustrates the complex factors that influence womens
birth choices. This framework can be used by policy-makers, practitioners,
donors and researchers to think critically about policy decisions and where
investments can have the most impact for improving maternal health in
Timor-Leste and elsewhere.
Keywords: Timor-Leste; Maternal health; Access; Health seeking behaviour;
Developing countries; Maternity services; Policy making; Utilization
W.J. Graham, J. Hussein, Universal reporting of maternal mortality: An

achievable goal?, International Journal of Gynecology & Obstetrics,
10.1016/j.ijgo.2006.04.004.
Abstract: This paper aims to highlight the importance of aspiring to
achieve universal reporting of maternal deaths as a part of taking
responsibility for these avoidable tragedies. The paper first discusses the
reasons for reporting maternal deaths, distinguishing between individual
case notification and aggregate statistics. This is followed by a summary
of the status of reporting at national and international levels, as well as
major barriers and facilitators to this process. A new framework is then
proposed the REPORT framework, designed to highlight six factors
essential to universal reporting. Malaysia is used to illustrate the
relevance of these factors. Finally, the paper makes a Call to Action by
FIGO to promote REPORT and to encourage health professionals to play their
part in improving the quality of reporting on all maternal deaths not
just those directly in their care.
Keywords: Maternal mortality; Maternal death; Reporting; Measurement;
Trends
S. Ahmed, S.A. Holtz, Social and economic consequences of obstetric

fistula: Life changed forever?, International Journal of Gynecology &
Obstetrics, Volume 99, Supplement 1, November 2007, Pages S10-S15, ISSN
0020-7292, 10.1016/j.ijgo.2007.06.011.
To summarize the social, economic, emotional, and psychological
consequences incurred by women with obstetric fistula; present the results
of a meta-analysis for 2 major consequences, divorce/separation and
perinatal loss; and report on improvements in health and self-esteem and on
the possibility of social reintegration following successful fistula
repair.
Methods
We conducted a review of the literature published between 1985 and 2005 on
fistula in developing countries. We then performed a meta-analysis for 2 of
the major consequences of having a fistula, divorce/separation and
perinatal child loss.
Results
Studies suggest that surgical treatment usually closes the fistula and
improves the physical and mental health of affected women.
Conclusion
With additional social support and counseling, women may be able to
successfully reintegrate socially following fistula repair.
Keywords: Meta-analysis; Obstetric fistula; Social consequences;
Rehabilitation
Carol Wilkins, A qualitative study exploring the support needs of first-

time mothers on their journey towards intuitive parenting, Midwifery,
10.1016/j.midw.2005.07.001.
to gain an understanding of the experiences of first-time mothers in the
early weeks of motherhood in order to elicit what areas of support these
women find empowering in easing their adjustment.
Design
a grounded theory approach was used. Data were collected through individual
in-depth interviews.
Setting
an area in the South of England with maternity services provided by a
consultant obstetric unit and four midwife-led centres.
Participants
eight primiparous women aged 2039 years, who had given birth normally at
term to a healthy baby.
Findings
five categories expert to novice, losing touch, perceiving expertise,
restoring balance and falling into place revealed a journey women
travelled as they left behind their comfortable, controlled lives in which
they were experts and faced the unknown world of motherhood. Eventually,
practice, support and knowledge shared with peers facilitated proficiency
and intuitive mothering. Throughout this transition, the overriding concern
of the mothers was to develop confidence and skills to give optimal care to
their baby. Doing it right emerged as the core category.
an understanding of the factors women considered to be supportive or
inhibitive in easing their adjustment to motherhood might enable midwives
to move beyond more traditional forms of postnatal care to explore
innovative ways of providing and facilitating access to supportive
resources.
Keywords: Adaptation; Motherhood; Parenting; Support
Andrew G. Hendrickx, W. Richard Dukelow, Chapter 14 - Breeding, In: B.

Taylor Bennett, Christian R. Abee and Roy Henrickson, Editor(s), Nonhuman
Primates in Biomedical Research, Academic Press, San Diego, 1995, Pages
335-374, ISBN 9780120886616, 10.1016/B978-012088661-6/50021-1.
Abstract: Effective maintenance of a breeding colony of nonhuman primates
is based on a number of factors. The first of these is a basic knowledge of
the reproductive physiology of the species involved. This subject has been
treated extensively in Chapter 9. Unfortunately, the status of nonhuman
primate research is such that there are often large gaps in breeding
knowledge, particularly in the species that are not normally held in
captivity or are heavily involved in research programs. For the effective
breeding of these animals, one must rely on reports from zoological gardens
and private or commercial colonies. Additionally, field studies of the
animals activities in the wild are very useful in establishing breeding
colonies. The final factor is often the common sense husbandry that
individuals acquire through work with a large variety of animals in captive
situations. This combination of sources of knowledge will become evident in
this chapter as we deal with Old World species and a few of the New World
species, where a great deal is known of their reproductive biology and
breeding behavior. We will also examine the great apes, the prosimians, and
some other less well-known species where the knowledge is incomplete and a
combination of the factors just mentioned must be applied. It must be
emphasized that this chapter does not present a comprehensive bibliography;
rather, an attempt was made to include those references which best
illustrate the breadth of knowledge that has been accumulated on breeding
nonhuman primates under a variety of conditions.
Richard J Bodnar, Maria M Hadjimarkou, Endogenous opiates and behavior:

2001, Peptides, Volume 23, Issue 12, December 2002, Pages 2307-2365, ISSN
0196-9781, 10.1016/S0196-9781(02)00306-6.
Abstract: This paper is the twenty-fourth installment of the annual review
of research concerning the opiate system. It summarizes papers published
during 2001 that studied the behavioral effects of the opiate peptides and
antagonists. The particular topics covered this year include the molecular
biochemical effects and neurochemical localization studies of endogenous
opioids and their receptors (Section 2), and the roles of these opioid
peptides and receptors in pain and analgesia (Section 3); stress and social
status (Section 4); tolerance and dependence (Section 5); learning and
memory (Section 6); eating and drinking (Section 7); alcohol and drugs of
abuse (Section 8); sexual activity and hormones, pregnancy, development and
endocrinology(Section 9); mental illness and mood (Section 10); seizures
and neurologic disorders (Section 11); electrical-related activity and
neurophysiology (Section 12); general activity and locomotion (Section 13);
gastrointestinal, renal and hepatic functions (Section 14); cardiovascular
responses (Section 15); respiration and thermoregulation (Section 16); and
immunological responses (Section 17).
Keywords: Endogenous opiates; Opiate system; Behavioral effects
Hanan F. Abdul-Rahim, Niveen Mohammad Elias Abu-Rmeileh, Laura Wick,

Cesarean section deliveries in the occupied Palestinian territory (oPt): An
analysis of the 2006 Palestinian Family Health Survey, Health Policy,
Volume 93, Issues 23, December 2009, Pages 151-156, ISSN 0168-8510,
10.1016/j.healthpol.2009.07.006.
Abstract: Objective
Against the backdrop of a rise in cesarean section deliveries from 6.0% in
1996 to 14.8% in 2006, the objective of this study was to investigate
socio-demographic, clinical and service-related factors associated with
cesarean sections in the occupied Palestinian territory.
Methods
Data from the Palestinian Family Health Survey 2006 were used to examine
last births in the 5 years preceding the survey to women aged 1549 years.
Bivariate and multivariate associations between type of delivery (dependent
variable) and selected factors were analyzed using logistic regression.
Selected maternal outcomes were also investigated with type of delivery as
the independent variable.
Results
Cesarean section deliveries were significantly associated with maternal age
(35+ years), primiparity, low birth weight and residence area in the West
Bank and Gaza. There was no significant difference in the prevalence of
cesarean deliveries by sector in the West Bank, but in Gaza, they were
significantly more common in the governmental sector.
Conclusions
There is a need for detailed audits of cesarean section deliveries,
nationally and at the facility level, in order to avoid unnecessary
interventions in the context of high fertility, rising poverty and
fragmented health services. Variations by governorate should be studied
further for focused interventions.
Keywords: Cesarean sections; Prevalence; Developing countries; Health
systems
Subha Sri B, Sarojini N, Renu Khanna, An investigation of maternal deaths

following public protests in a tribal district of Madhya Pradesh, central
India, Reproductive Health Matters, Volume 20, Issue 39, June 2012, Pages
11-20, ISSN 0968-8080, 10.1016/S0968-8080(12)39599-2.
Abstract: Since 2005, the Government of India has initiated several
interventions to address the issue of maternal mortality, including efforts
to improve maternity services and train community health workers, and to
give cash incentives to poor women if they deliver in a health facility.
Following local protests against a high number of maternal deaths in 2010
in Barwani district in Madhya Pradesh, central India, we undertook a fact-
finding visit in January 2011 to investigate the 27 maternal deaths
reported in the district from April to November 2010. We found an absence
of antenatal care despite high levels of anaemia, absence of skilled birth
attendants, failure to carry out emergency obstetric care in obvious cases
of need, and referrals that never resulted in treatment. We present two
case histories as examples. We took our findings to district and state
health officials and called for proven means of preventing maternal deaths
to be implemented. We question the policy of giving cash to pregnant women
to deliver in poor quality facilities without first ensuring quality of
care and strengthening the facilities to cope with the increased patient
loads. We documented lack of accountability, discrimination against and
negligence of poor women, particularly tribal women, and a close link
between poverty and maternal death.
Keywords: maternal mortality and morbidity; maternity benefits;
reproductive health policy and programmes; health systems; accountability;
India
Stephen Magura, Alexandre B. Laudet, Parental substance abuse and child

maltreatment: Review and implications for intervention, Children and Youth
Services Review, Volume 18, Issue 3, 1996, Pages 193-220, ISSN 0190-7409,
10.1016/0190-7409(96)00001-1.
Abstract: This paper reviews the link between the incidence of child abuse
and neglect and parental substance abuse. Parenting and women-specific
components are needed in existing drug abuse treatment programs. In
addition, parenting and pregnant women who are substance abusers can
benefit from comprehensive, family-centered treatment services where
recovery is addressed in the context of total family needs. The paper
reviews selected family preservation programs and family-oriented drug
abuse treatment programs and presents preliminary findings from the
authors' ongoing outcome evaluation of New York City's Family
Rehabilitation Program.
Jeanne C. Marsh, Brenda D. Smith, Maria Bruni, Integrated substance abuse

and child welfare services for women: A progress review, Children and Youth
Services Review, Volume 33, Issue 3, March 2011, Pages 466-472, ISSN 0190-
7409, 10.1016/j.childyouth.2010.06.017.
Abstract: A review of empirical literature reveals improvements in service
utilization and outcomes for women when substance abuse and child welfare
services are integrated. The increased use of substances by women involved
in the child welfare system has resulted in a call for integrated,
coordinated, evidence-based practices. Since the late 1990s, specific
system- and service-level strategies have been developed to coordinate and
integrate the provision of substance abuse and child welfare services such
that women are remaining in treatment longer and are more likely to reduce
substance use and be reunited with their children. The strategies reviewed
provide useful guidelines for developing components of effective, evidence-
based programs for substance-involved women in the child welfare system.
Keywords: Integrated services; Substance abuse; Child welfare; Women
B.R. Sharma, Neha Gupta, Forensic considerations of pregnancy-related

maternal deaths: An overview, Journal of Forensic and Legal Medicine,
Volume 16, Issue 5, July 2009, Pages 233-238, ISSN 1752-928X,
10.1016/j.jflm.2008.12.005.
Abstract: During the 20th century, risks to women associated with
childbirth in developed countries have been dramatically reduced on account
of many factors that include technological advancements in obstetrical
care, greater access to health services and fewer births occurring at the
extremes of womens reproductive age span. However, pregnancy-related
maternal deaths continue to be a major health concern in developing
countries. In the year 2005, an estimated 536,000 women died of maternal
causes worldwide of which 86% occurred in sub-Saharan Africa and South Asia
and less than 1% in more developed countries. The large regional
differences in maternal deaths demonstrate that most of these deaths are
preventable. It is nevertheless important to monitor patterns of pregnancy-
related mortality and serious morbidity and to be sensitive to what
observed patterns or changes may tell us in order to continue to safeguard
women during this critical period and the monitoring process must begin
with ascertainment of the accuracy of routine reporting of deaths
associated with pregnancy and childbirth. We examine the pregnancy-related
maternal deaths with a forensic view point.
Keywords: Pregnancy-related maternal death; Maternal mortality rate;
Maternal mortality ratio; Vital registration; Standard of care; Unsafe
abortion; Verbal autopsy
Julee B. Waldrop, Christina K. Anderson, Debra H. Brandon, Guideline-based

Educational Intervention to Decrease the Risk for Readmission of Newborns
With Severe Hyperbilirubinemia, Journal of Pediatric Health Care, Available
online 22 October 2011, ISSN 0891-5245, 10.1016/j.pedhc.2011.09.002.
The purpose of this study was to determine if educational intervention with
medical providers in combination with a management tool to facilitate
clinical guideline usage would (a) increase quality of care, (b) increase
compliance with published guidelines, and (c) decrease hospital
readmissions as a result of hyperbilirubinemia in the first week of life.
Method
A quality improvement initiative was undertaken with a
preintervention/postintervention design.
Intervention
An educational intervention was offered to persons who provide medical care
to newborns. The charts of newborns were reviewed before and after the
intervention in three samples: a care quality sample (N = 244), a
compliance sample (N = 240), and a readmission sample.
Results
In the quality care sample, documentation of three quality care indicators
improved significantly and one worsened significantly. In the compliance
sample, the percentage of infants who were given appropriate follow-up
appointments in primary care based on their hyperbilirubinemia risk at
discharge improved (p = .03), and the readmission rate of newborns within
the first week of life as a result of hyperbilirubinemia decreased by 50%.
Discussion
An educational intervention with a clinical tool may help change provider
practice. Longer follow-up is needed to determine if the impact is
sustainable.
Keywords: Hyperbilirubinemia; infant; quality improvement; educational
intervention; guidelines
Sara Gable, Russell A. Isabella, Maternal contributions to infant

regulation of arousal, Infant Behavior and Development, Volume 15, Issue 1,
JanuaryMarch 1992, Pages 95-107, ISSN 0163-6383, 10.1016/0163-
6383(92)90009-U.
Abstract: The purpose of the current study was to longitudinally examine
the relations between general characteristics of maternal behavior and the
degree to which infants demonstrate an ability to regulate arousal. Thirty-
two infant-mother dyads were visited at home and videotaped in two 3-min
episodes of face-to-face interaction at 1 and 4 months infant age. Infant
gaze behavior, head orientation, and facial expressions provided a
composite index of infant arousal regulation. Results revealed positive
within- and across-time associations between maternal interactive behaviors
and infants' arousal-regulating abilities. Two features of 1-month maternal
beahaviorstate and physical activitywere highlighted in the prediction of
4-month infant arousal regulation. More specifically, hierarchical
regression analyses revealed that these 1-month maternal behaviors
accounted for a significant percent of the variance in 4-month infant
arousal regulation, whereas earlier infant arousal regulation and
concurrent maternal behaviors made insignificant contributions.
Keywords: interaction; infant arousal regulation; face-to-face
Sally S Cohen, Deanne R Williams, Managed care and reproductive health,

161, ISSN 0091-2182, 10.1016/S0091-2182(98)00008-1.
Abstract: Managed care poses special challenges to midwives providing
reproductive health care. This is owing to the sensitive nature of issues
surrounding reproductive health and aspects of managed care that may impede
a womans ability to obtain continuous, confidential, and comprehensive
care from the provider of her choice. Variations across payers (ie,
Medicare, Medicaid, and commercial insurers) regarding covered benefits and
reimbursement of midwifery services also may create obstacles. Furthermore,
some physicians and managed care organizations are embracing policies that
threaten the ability of midwives to function as primary health care
providers for women. Despite these hurdles, midwives have the potential to
remain competitive in the new marketplace. This article underscores the
importance of being knowledgeable about legislation and policy issues
surrounding the financing of midwifery services, quality performance
measurement for HMOs as they pertain to reproductive health, and
discussions regarding which clinicians should be defined as primary care
providers.
Kathleen Restifo, Susan Bgels, Family processes in the development of

youth depression: Translating the evidence to treatment, Clinical
Psychology Review, Volume 29, Issue 4, June 2009, Pages 294-316, ISSN 0272-
7358, 10.1016/j.cpr.2009.02.005.
Abstract: There is strong evidence that family factors play a role in the
development, maintenance and course of youth depression. However, to date
few clinical trials of psychotherapy for youth depression employ family
therapy interventions or target the known family risk factors. This is
surprising given recent meta-analytic findings showing only modest effect
sizes for psychotherapy for youth depression, and that cognitive therapies
do not outperform non-cognitive therapies. The aim of this review is to 1)
use a developmental systems approach to review empirical evidence on family
risk factors for youth depression to identify potential targets for
treatment, 2) examine the extent to which these family risk factors have
been targeted in clinical trials for youth depression, and 3) provide a
road map for the development of empirically validated family-based
interventions for youth depression.
Strong evidence was found supporting a relationship between family factors

at multiple system levels and depressive symptoms or disorders. Support for
several different hypothesized causal mechanisms as well as bidirectional
effects was found. A comparison of the identified risk factors and
psychotherapy trials for youth depression indicated that few RCT's target
family factors; among those that do, only a few of the family risk factors
are targeted. Recommendations for translation of empirical knowledge of
family risk factors and mechanisms to develop empirically valid family-
based interventions to enhance existing treatments for youth depression are
provided.
Keywords: Depression; Youth; Family processes; Family systems; Treatment
Jennifer S. Silk, Daniel S. Shaw, Joanna T. Prout, Flannery O'Rourke, Tonya

J. Lane, Maria Kovacs, Socialization of emotion and offspring internalizing
symptoms in mothers with childhood-onset depression, Journal of Applied
Developmental Psychology, Volume 32, Issue 3, MayJune 2011, Pages 127-136,
ISSN 0193-3973, 10.1016/j.appdev.2011.02.001.
Abstract: This study examines how mothers with and without a history of
childhood-onset depression respond to their 39 year-old children's
emotions. Motherchild dyads included 55 offspring of mothers with a
history of childhood-onset depressive disorders and 57 offspring of never-
depressed mothers. Mothers with a history of childhood depression were less
likely than control mothers to respond in supportive ways to their
children's negative emotions and were more likely to magnify, punish, or
neglect their children's negative emotions. Magnification, neglect, and
punishment of children's negative emotions were concurrently associated
with children's internalizing symptoms, and neglect and punishment were
associated with internalizing over a one year follow-up. Maternal neglect
of children's negative emotion was positively associated with later
internalizing symptoms for children who already had higher internalizing
symptoms at the initial assessment. Findings suggest that atypical
socialization of emotion may be one mechanism in the development of
internalizing disorders.
Keywords: Maternal depression; Socialization; Emotion regulation;
Internalizing symptoms
Louis Z. Cooper, Charles A. Alford Jr., Chapter 28 - Rubella, Infectious

Diseases of the Fetus and Newborn Infant (Sixth Edition), W.B. Saunders,
Philadelphia, 2006, Pages 893-926, ISBN 9780721605371, 10.1016/B0-72-
160537-0/50030-X.
Abstract: The impact of rubella virus infection and the progress made
toward controlling congenital rubella infection have been well
chronicled.1,2,3,4,5,6,7,8,9 Rubella was first recognized in the mid-18th
century as a clinical entity by German researchers, who called it R theln.
However, they considered it to be a modified form of measles or scarlet
fever.1 Manton10 first described it as a separate disease in the English
literature in 1815. In 1866, Veale11 gave it a short and euphonious name,
rubella. The disease was considered mild and self-limited.
Rubella became a focus of major interest in 1941, only after Gregg, 12 an

Australian ophthalmologist, associated intrauterine acquisition of
infection with production of cataracts and heart disease. Although his
findings were initially doubted, numerous reports of infants with
congenital defects after maternal rubella infection soon appeared in the
literature.1 Subsequent investigations showed that the major defects
associated with congenital rubella infection included congenital heart
disease, cataracts, and deafness. Mental retardation and many defects
involving almost every organ have also been reported.2,3,4,7,13,14 Before
the availability of specific viral diagnostic studies, the frequency of
fetal damage after maternal infection in the first trimester was estimated
to be in excess of 20%, a figure now known to be much too low.
Recognition of the teratogenic potential of rubella infection led to

increased efforts to isolate the etiologic agent. The viral cause of
rubella was suggested by experimental infections in humans and monkeys as
early as 1938 but was not confirmed until reports of the isolation of the
viral agent in cell cultures were made independently in 1962 by Weller and
Neva at Harvard University School of Public Health and by Parkman,
Buescher, and Artenstein at Walter Reed Army Institute for
Research.15,16,17,18,19,20 This accomplishment paved the way for the
development of serologic tests and a vaccine.2,3,4,21,22,23 Efforts to
develop a vaccine were hastened by the tragic events associated with a
worldwide rubella pandemic from 1962 through 1964, which in the United
States resulted in approximately 12.5 million cases of clinically acquired
rubella, 11,000 fetal deaths, and 20,000 infants born with defects
collectively referred to as the congenital rubella syndrome; 2100 infants
with congenital rubella syndrome died in the neonatal period.24 The
estimated cost to the U.S. economy was approximately $2 billion. Routine
use of rubella vaccine, in a two-dose schedule as measles-mumps-rubella
vaccine (MMR) has not prevented importation-related infection, but it has
eliminated indigenous rubella in the United States (personal communication
from the CDC, 2004). However, congenital rubella syndrome remains a problem
in many countries, with current estimates of 100,000 new cases annually.25
In 1969, three strains of live-attenuated rubella vaccine were licensed in

various countries: HPV-77 (high-passage virus, 77 times), grown in duck
embryo for five passages (DE-5) or dog kidney for 12 passages (DK-12);
Cendehill, grown in primary rabbit cells; and RA 27/3 (rubella abortus,
27th specimen, third explant), grown in human diploid fibroblast
culture.26,27,28 Although these and other strains of vaccine are now used
globally, the RA 27/3 vaccine has been used exclusively in the United
States since 1979.2,3,4,7,29
In addition to providing the impetus for vaccine research and development,

the rubella pandemic provided the scientific community with a unique
opportunity to gain knowledge about the nature of intrauterine and
extrauterine infections and the immunity stimulated by both. The quest for
more knowledge using the tools of molecular biology has continued since
vaccine licensure and serves as a tribute to Greggs historic contribution
to our understanding of intrauterine infection.
Much interest has focused on the epidemiology of rubella and congenital

rubella syndrome in countries with immunization programs, the desirability
of introducing vaccine in countries without a program, and the optimal
strategy to control congenital rubella (i.e., universal immunization versus
selective immunization of females).3,5,6,7,30,31,32,33,34,35 Vaccination of
all children and of susceptible adolescents and young adults, particularly
females, has had such a dramatic impact on the occurrence of rubella and
congenital rubella in the United States that efforts are now in progress to
eliminate congenital rubella syndrome from the United States.5,24,31,36
Given the magnitude of international travel, this goal will remain elusive
until similar goals are adopted by other countries. The Pan American Health
Organization (PAHO) has adopted a resolution calling on all countries of
the Western Hemisphere to eliminate rubella by 2010.37 However, among
developing countries, rubella immunization has not yet been given priority.
Duration and quality of vaccine-induced

immunity5,8,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57 and
adverse events associated with immunization, particularly arthritis and the
risk of the vaccine to the fetus,5,8,58,59,60,61,62,63,64,65 have been a
concern, but the vaccine continues to confer long-lasting immunity while
placing the vaccinated person at minimal risk of adverse events. Success in
eliminating indigenous disease in the United States and the absence of
teratogenicity observed after massive immunization programs (20012002) in
Latin America offer considerable assurance about the long-term efficacy and
safety of rubella vaccine. In Brazil, where 28 million women were immunized
in mass campaigns, and in Costa Rica, more than 2400 susceptible pregnant
women were immunized. Although infants were infected, none had evidence of
congenital rubella syndrome.
Research on the characteristics of the rubella virus, its effect on the

developing fetus, the hosts immune response, and diagnostic methodology
has yielded new information about the structural proteins of the virus and
about the difference in the immune response to these proteins after
congenital and acquired
infections.66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86
Differences in antibody profile may be useful in diagnosing congenital
infection retrospectively and may provide further information on the
pathogenesis of congenital infection.64,85,87 Techniques that detect
rubella-specific antibodies within minutes have been developed by using
latex agglutination and passive hemagglutination.88,89,90,91,92,93,94
Studies to examine the subclass distribution of immunoglobulin G (IgG) and
the kinetics of rubella-specific immunoglobulins (including IgA, IgD, and
IgE) after acquired rubella, congenital infection, and vaccination may
eventually lead to the development of additional diagnostic
tools.95,96,97,98,99 In particular, rubella IgG avidity testing can be
helpful in distinguishing between recently acquired and remote
infection.100,101,102
Improved laboratory methods defined the risk of fetal infection and

congenital damage in all stages of
pregnancy.103,104,105,106,107,108,109,110 The risk of fetal infection after
first-trimester maternal infection and subsequent congenital anomalies
after fetal infection may be higher than previously reported (81% and 85%,
respectively, in one study).105 The fetus may be at risk of infection
throughout pregnancy, even near term, although the occurrence of defects
after infection beyond 16 to 18 weeks gestation is small. Sensitive
laboratory assays have shown that subclinical reinfection after previous
natural infection, as after vaccination, may be accompanied by an IgM
response, making differentiation between subclinical reinfection and
asymptomatic primary infection at times difficult.41,51,53,55 IgG avidity
testing may be helpful also in this situation. Although reinfection usually
poses no threat to the fetus, rare instances of congenital infection after
maternal reinfection have been
reported.41,43,45,47,51,52,53,55,111,112,113,114,115,116
Follow-up of patients with congenital rubella has provided information

about the pathogenesis, immune status, interplay between congenital
infection, and human leukocyte antigen (HLA) haplotypes and the long-term
outcome associated with congenital
infection.117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,1
33,134 These studies have documented that congenital infection is
persistent, that virtually every organ may be affected, and that
autoimmunity and immune complex formation are probably involved in many of
the disease processes, particularly in the delayed and persistent clinical
manifestations. They also confirm earlier studies, noting an increased risk
of diabetes mellitus and other endocrinopathies in patients with congenital
rubella syndrome compared with rates for the general population.
May Loo, Kapitel 10 - Hufige Erkankungen im Kindesalter aus westlicher und

chinesischer Sicht, Akupunktur bei Kindern, Urban & Fischer, Munich, 2007,
Pages 195-371, ISBN 9783437573606, 10.1016/B978-343757360-6.50014-1.
Pamela M Peeke, Sharon Frishett, The Role of Complementary and Alternative

Therapies in Women's Mental Health, Primary Care: Clinics in Office
Practice, Volume 29, Issue 1, March 2002, Pages 183-197, ISSN 0095-4543,
10.1016/S0095-4543(03)00081-2.
Bjrn Ekman, Indra Pathmanathan, Jerker Liljestrand, Integrating health

interventions for women, newborn babies, and children: a framework for
action, The Lancet, Volume 372, Issue 9642, 1319 September 2008, Pages
990-1000, ISSN 0140-6736, 10.1016/S0140-6736(08)61408-7.
Abstract: Summary
For women and children, especially those who are poor and disadvantaged, to
benefit from primary health care, they need to access and use cost-
effective interventions for maternal, newborn, and child health. The
challenge facing weak health systems is how to deliver such packages.
Experiences from countries such as Iran, Malaysia, Sri Lanka, and China,
and from projects in countries like Tanzania and India, show that outcomes
in maternal, newborn, and child health can be improved through integrated
packages of cost-effective health-care interventions that are implemented
incrementally in accordance with the capacity of health systems. Such
packages should include community-based interventions that act in
combination with social protection and intersectoral action in education,
infrastructure, and poverty reduction. Interventions need to be planned and
implemented at the district level, which requires strengthening of district
planning and management skills. Furthermore, districts need to be supported
by national strategies and policies, and, in the case of the least
developed countries, also by international donors and other partners. If
packages for maternal, newborn and child health care can be integrated
within a gradually strengthened primary health-care system, continuity of
care will be improved, including access to basic referral care before and
during pregnancy, birth, the postpartum period, and throughout childhood.
Anne CC Lee, Joy E. Lawn, Simon Cousens, Vishwajeet Kumar, David Osrin,
Zulfiqar A. Bhutta, Steven N. Wall, Allyala K. Nandakumar, Uzma Syed, Gary
L. Darmstadt, Linking families and facilities for care at birth: What works
to avert intrapartum-related deaths?, International Journal of Gynecology
& Obstetrics, Volume 107, Supplement, October 2009, Pages S65-S88, ISSN
0020-7292, 10.1016/j.ijgo.2009.07.012.
Delays in receiving effective care during labor and at birth may be fatal
for the mother and fetus, contributing to 2 million annual intrapartum
stillbirths and intrapartum-related neonatal deaths each year.
Objective
We present a systematic review of strategies to link families and
facilities, including community mobilization, financial incentives,
emergency referral and transport systems, prenatal risk screening, and
maternity waiting homes.
Results
There is moderate quality evidence that community mobilization with high
levels of community engagement can increase institutional births and
significantly reduce perinatal and early neonatal mortality. Meta-analysis
showed a doubling of skilled birth attendance and a 36% reduction in early
neonatal mortality. However, no data are available on intrapartum-specific
outcomes. Evidence is limited, but promising, that financial incentive
schemes and community referral/transport systems may increase rates of
skilled birth attendance and emergency obstetric care utilization; however,
impact on mortality is unknown. Current evidence for maternity waiting
homes and risk screening is low quality.
Conclusions
Empowering communities is an important strategy to reduce the large burden
of intrapartum complications. Innovations are needed to bring the poor
closer to obstetric care, such as financial incentives and cell phone
technology. New questions need to be asked of old strategies such as risk
screening and maternity waiting homes. The effect of all of these
strategies on maternal and perinatal mortality, particularly intrapartum-
related outcomes, requires further evaluation.
Keywords: Asphyxia neonatorum; Birth asphyxia; Cash transfers; Community-
based health insurance; Community mobilization; Community transport system;
Demand for obstetric care; Hypoxia; Maternity waiting homes stillbirth;
Neonatal mortality; Risk screening; Vouchers
Robert Bryce, 5 Social and midwifery support, Baillire's Clinical

Obstetrics and Gynaecology, Volume 4, Issue 1, March 1990, Pages 77-88,
ISSN 0950-3552, 10.1016/S0950-3552(05)80213-5.
Gamal I. Serour, Luis Cabero Roura, FIGOA professional nonprofit

organization: Reproductive, maternal, and child health policy and programs
to address noncommunicable childhood disease, International Journal of
Gynecology & Obstetrics, Volume 115, Supplement 1, November 2011, Pages
S48-S49, ISSN 0020-7292, 10.1016/S0020-7292(11)60014-3.
F Donnay, Maternal survival in developing countries: what has been done,

what can be achieved in the next decade, International Journal of
Gynecology & Obstetrics, Volume 70, Issue 1, 1 July 2000, Pages 89-97,
ISSN 0020-7292, 10.1016/S0020-7292(00)00236-8.
Abstract: Every year, approximately 600 000 women die of pregnancy-
related causes 98% of these deaths occur in developing countries. For
every woman who dies, at least 30 suffer injuries and often, permanent
disability. The challenge today is to re-orient programmes on priority
interventions, and to mobilize sufficient resources for their
implementation. More resources have been put into antenatal care than into
delivery care and the management of complications of births and unsafe
abortions. This article describes the effective strategies for reducing
maternal death, their policy requirements and programmatic implications,
and provides examples of successful developing country programmes. Priority
interventions include: (1) improving availability and use of essential
obstetric care for the management of complications; (2) strengthening
family planning services; (3) ensuring skilled attendance at birth; (4)
promoting women-friendly health services; (5) increasing district-level
planning with community participation; and (6) monitoring process with
process indicators. Finally, the promotion of safe motherhood as a right is
of crucial importance. Needed now is political commitment as well as
coordinated action for the implementation of large-scale programmes in low-
income countries.
Keywords: Maternal mortality; Obstetric care; Midwifery
Ruth A. Lawrence, Robert M. Lawrence, Chapter 20 - Reproductive Function

During Lactation, Breastfeeding (Seventh Edition), W.B. Saunders,
0788-5.10020-3.
O. Omondi-Ogutu, I250 Using standards based audit to improve the quality of

maternal care: Experiences from Kenya, International Journal of Gynecology
& Obstetrics, Volume 107, Supplement 2, October 2009, Pages S62-S63,
ISSN 0020-7292, 10.1016/S0020-7292(09)60250-2.
Anne Duggan, Loretta Fuddy, Lori Burrell, Susan M Higman, Elizabeth

McFarlane, Amy Windham, Calvin Sia, Randomized trial of a statewide home
visiting program to prevent child abuse: impact in reducing parental risk
factors, Child Abuse & Neglect, Volume 28, Issue 6, June 2004, Pages
623-643, ISSN 0145-2134, 10.1016/j.chiabu.2003.08.008.
Abstract: Objectives: To assess the impact of a home visiting program in
reducing malleable parental risk factors for child abuse in families of
newborns identified, through population-based screening, as at-risk of
child abuse.
Methods: This randomized trial focused on Healthy Start Program (HSP) sites
operated by three community-based organizations on Oahu, HI, USA. From
11/94 to 12/95, 643 families were enrolled and randomly assigned to
intervention and control groups. Mothers in both groups were interviewed
annually for 3 years (88% follow-up each year) to measure mental health,
substance use, and partner violence. HSP records were reviewed to measure
home visiting services provided. Home visitors were surveyed annually to
measure their perceived competence.
Results: Malleable parental risks for child abuse were common at baseline.
There was no significant overall program effect on any risk or on at-risk
mothers desire for and use of community services to address risks. There
was a significant reduction in one measure of poor mental health at one
agency and a significant reduction in maternal problem alcohol use and
repeated incidents of physical partner violence for families receiving 75%
of visits called for in the model. Home visitors often failed to recognize
parental risks and seldom linked families with community resources. HSP
training programs were under-developed in preparing staff to address risks
and to link families with community resources.
Conclusions: Overall, the home visiting program did not reduce major risk
factors for child abuse that made families eligible for service. Research
is needed to develop and test strategies to improve home visiting
effectiveness in reducing parental risks for child abuse.
Keywords: Home visiting; Child abuse prevention; Substance abuse;
Depression; Domestic; Violence
Philip B. Adongo, James F. Phillips, Beverly Kajihara, Clara Fayorsey,

Cornelius Debpuur, Fred N. Binka, Cultural eactors constraining the
introduction of family planning among the Kassena-Nankana of Northern
Ghana, Social Science & Medicine, Volume 45, Issue 12, December 1997,
Pages 1789-1804, ISSN 0277-9536, 10.1016/S0277-9536(97)00110-X.
Abstract: This study presents a focus group investigation of reasons why
women in a rural, Sahelian community are reluctant to adopt family planning
even when convenient services are made freely available. First, women
opting to practice contraception must do so at considerable risk of social
ostracism or familial conflict. Implementing individual preference is
something that must be done without the support of others. Second, few
women view personal decisions about contraceptives as theirs to make. Women
and children are the property of the corporate family-kin and community
militate against reproductive control. Third, although children are highly
valued for a variety of economic, social, and cultural reasons, mortality
risks remain extremely high. Low fertility imposes the unacceptable risk
that a woman will have no surviving children at the end of her reproductive
life. Taken together, these findings attest to the inadequacy of service
strategies focused on the contribution of distribution, individual agency,
or personal choice. Outreach should also build a sense of community
legitimacy for the program, collective health action, and traditional
leadership support for family planning behavior.
Keywords: fertility; contraception; family planning; Ghana; barriers to
contraceptive use; traditional reproductive motives
Y. Zhao, S. Cui, J. Yang, W. Wang, A. Guo, Y. Liu, W. Liang, Basic public

health services delivered in an urban community: a qualitative study,
Public Health, Volume 125, Issue 1, January 2011, Pages 37-45, ISSN 0033-
3506, 10.1016/j.puhe.2010.09.003.
To understand the advancements in and barriers to the implementation of
measures to improve basic public health services in an urban Chinese
community.
Study design
A qualitative study based on semi-structured interviews. Interviews were
audio-taped, transcribed and analysed using thematic content analysis.
Methods
In-depth interviews were undertaken with the directors of the management
centres for community health services in 15 of the 18 districts in Beijing
from December 2008 to February 2009. Content analysis of the data was
completed in May 2009.
Results
Fifteen types of free basic public health services had been delivered in
Beijing. Some were supplied at a low level. An average of 2.38 per person
per year was provided for inhabitants since 2008, but demand for funding
far exceeded monies available. Teams consisting of general practitioners,
community nurses and public health specialists delivered these services.
The number of practitioners and their low levels of skill were insufficient
to provide adequate services for community residents. Respondents gave
recommendations of how to resolve the above problems.
Conclusions
In order to improve the delivery of basic public health services, it is
necessary for Beijing Municipal Government to supply clear and detailed
protocols, increase funding and increase the number of skilled
practitioners in the community health services.
Keywords: Public health; Community medicine; Qualitative research China
M. Labbok, Breastfeeding: A woman's reproductive right, International

Journal of Gynecology & Obstetrics, Volume 94, Issue 3, September 2006,
Pages 277-286, ISSN 0020-7292, 10.1016/j.ijgo.2006.04.008.
Abstract: This paper explores the importance of breastfeeding as a women's
issue in the health and political contexts, covering the role of global
institutions, health practitioners, and national decision-makers in
furthering the goals of supporting breastfeeding as a woman's right to
health. The roles and responsibilities of the Obstetrician/Gynecologist are
highlighted.
Keywords: Breastfeeding; Rights; Baby-friendly; Code of Marketing; Global
Strategy; Infant feeding
Hui-shan Wang, Xiaona Huang, Xi-cheng Liu, Hui Ding, Lijing Zhang, Fan
Jiang, Odio Mauricio, T-O-124 IMPACT OF PRENATAL MATERNAL BELIEFS ON
INFANTS' NIGHTTIME SLEEP ARRANGEMENTS IN THE FIRST 3 MONTHS OF LIFE, Sleep
Medicine, Volume 12, Supplement 1, September 2011, Pages S90-S91, ISSN
1389-9457, 10.1016/S1389-9457(11)70337-9.
Amos Grunebaum, Frank Chervenak, Daniel Skupski, Effect of a comprehensive

obstetric patient safety program on compensation payments and sentinel
events, American Journal of Obstetrics and Gynecology, Volume 204, Issue 2,
February 2011, Pages 97-105, ISSN 0002-9378, 10.1016/j.ajog.2010.11.009.
Abstract: Our objective was to describe a comprehensive obstetric patient
safety program and its effect on reducing compensation payments and
sentinel adverse events. From 2003 to 2009, we implemented a comprehensive
obstetric patient safety program at our institution with multiple
integrated components. To evaluate its effect on compensation payments and
sentinel events, we gathered data on compensation payments and sentinel
events retrospectively from 2003, when the program was initiated, through
2009. Average yearly compensation payments decreased from $27,591,610
between 2003-2006 to $2,550,136 between 2007-2009, sentinel events
decreased from 5 in 2000 to none in 2008 and 2009. Instituting a
comprehensive obstetric patient safety program decreased compensation
payments and sentinel events resulting in immediate and significant
savings.
Keywords: compensation payments; medical liability; obstetric adverse
outcomes; patient safety; sentinel events
Cristina Puentes-Markides, Women and access to health care, Social Science

& Medicine, Volume 35, Issue 4, August 1992, Pages 619-626, ISSN 0277-
9536, 10.1016/0277-9536(92)90356-U.
Abstract: This paper is concerned with access to health care for women in
developing countries, with specific reference to Latin American and
Caribbean countries. It reviews the available literature on the concept of
access as it relates to other variables such as accountability,
affordability and acceptability of health services, taking into
consideration the effects of the generalized socio-economic crisis that has
affected most countries during the last decade, as well as equity
objectives.
Various approaches to defining variables affecting access to health care

appear in the literature reviewed. While some of them indicate that ability
to pay for services act as a major determinant of access to health care,
others point to behavioral issues related to motivation, health seeking
behavior or perception of illness as a deterrent to women in the low
socioeconomic strata, while others indicate that sociocultural issues, such
as values, education, religion or demographic variables related to age,
influence access to health care. The paper concludes with some comments on
policies and strategies for securing access to health and healthcare,
indicating the need to move away from traditional solutions including
framing gender-based health differences in status and access adequately,
promoting and strengthening social participation of women in policy making.
Keywords: women; access; health services; healthcare; health policy
George M Tarabulsy, Marc A Provost, Julie Deslandes, Diane St-Laurent,
Ellen Moss, Jean-Pascal Lemelin, Annie Bernier, Jean-Franois Dassylva,
Individual differences in infant still-face response at 6 months, Infant
Behavior and Development, Volume 26, Issue 3, August 2003, Pages 421-438,
ISSN 0163-6383, 10.1016/S0163-6383(03)00039-0.
Abstract: This study examined the association between infant still-face
response and assessments of maternal behavior taken outside the still-face
procedure (SFP). We also addressed the contributions of risk status and
infant difficultness. Forty-one adolescent motherinfant dyads (high risk),
and thirty-five adult motherinfant dyads (low risk) were seen when infants
were 6 months old. Home visits were carried out to obtain maternal ratings
of infant difficultness and to conduct observations of maternal interactive
behavior. The SFP was conducted at the university two weeks later. Infant
still-face response was coded for positive affect, negative affect and
self-soothing behavior. Regression analyses revealed that maternal behavior
was associated with negative affect and self-soothing behavior. In both
cases risk status significantly moderated these effects. Infant
difficultness significantly moderated the association between maternal
behavior and self-soothing behavior, and marginally moderated the link
between maternal behavior and negative affect.
Keywords: Still-face procedure; Maternal behavior; Temperament; Social
risk; Infant emotional response
Angela C. LaRosa, Frances P. Glascoe, Michelle M. Macias, Parental

Depressive Symptoms: Relationship to Child Development, Parenting, Health,
and Results on Parent-Reported Screening Tools, The Journal of Pediatrics,
10.1016/j.jpeds.2009.02.028.
Abstract: Objective
To determine whether parents with depressive symptoms can accurately
complete parent-reported developmental screens, and to explore effects of
parental depressive symptoms on perceptions of children's health and
parenting behaviors.
Study design
A total of 382 parent-child (ages 0 to 2 years) dyads from pediatric sites
across 17 U.S. states were evaluated with the directly administered and
parent-reported Brigance Infant Toddler Screen, the Brigance Parent-Child
Interactions Scale, a child development and health rating scale, and a
caretaker depression screen. Groups were compared by parental status by
depression screening.
Results
Fifteen percent of parents had positive scores on screening for depression.
Parents with a positive screen result for depression were twice as likely
to rate their children as below average or average and to perceive health
problems in their children. Their children were 1.7 times more likely to
perform below Brigance Screen cutoffs. Parents with a positive screen
result for depression were as accurate as parents with a negative screen
result for depression in identifying delayed or average development but
were significantly less likely to rate their above-average children as such
and reported fewer positive parenting practices.
Conclusion
Parents with a positive depression screen result were as accurate in
identifying developmental problems as parents with a negative depression
screen result. Parental depressive symptoms are negatively associated with
parenting behaviors, parental perspective on health and development, and
child outcomes, which supports screening for depression and intervening
promptly.
Sheila Kilbane, Eric Knudtson, Kathy Vesha, Smokingcessation in women,
Primary Care Update for OB/GYNS, Volume 9, Issue 5, SeptemberOctober 2002,
Pages 164-168, ISSN 1068-607X, 10.1016/S1068-607X(02)00110-5.
Abstract: It is a testament to the power of tobacco addiction that
millions of tobacco users have been unable to overcome their dependence and
save themselves from its consequences: perpetual worry, unceasing expense,
and compromised health (Fiore MC, Bailey WC, Cohen SJ, et al., 2000).
Nearly one quarter of the women in this country smoke, and it is the
leading cause of preventable death in U.S. women. Smoking during pregnancy
contributes significantly to medical complications suffered by both mother
and fetus. Despite these statistics, many medical schools and residency
programs do not give adequate training on smoking cessation interventions.
The U.S. Public Health Service has outlined an effective and fairly simple
strategy that can be integrated into any office setting. An organized
clinical approach with properly trained staff can improve the quality of
life for thousands of women and infants and save millions of dollars across
the country. It takes a few extra minutes of a physicians time, but those
few minutes have a significant impact on a patients quitting success. This
article describes current trends in smoking prevalence, the latest facts
about nicotine replacement therapy, and the U.S. Public Health Services
and the American College of Obstetricians and Gynecologists (ACOG)
approved recommendations for smoking cessation.
Antoine Guedeney, Nicole Guedeney, Susana Tereno, Romain Dugravier, Tim

Greacen, Bertrand Welniarz, Thomas Saias, Florence Tubach, the CAPEDP Study
Group, Infant rhythms versus parental time: Promoting parentinfant
synchrony, Journal of Physiology-Paris, Volume 105, Issues 46, December
2011, Pages 195-200, ISSN 0928-4257, 10.1016/j.jphysparis.2011.07.005.
Abstract: Traditional psychoanalytic theories of early development have
been put into question by developmental psychology, and particularly by
attachment theory. Psychopathology appears to be more linked to
interpersonal relationship problems rather than to intra-psychic conflict,
as hypothesized in Freudian drive theory. Establishing synchrony between
parent and infant is probably one of the major tasks of the first year of
life. Attachment theory appears to be an effective paradigm to understand
how caregiver responses to stressful infant situations give way to
different regulatory strategies, which impact on the effectiveness of the
stress buffer systems and its physiological impact on emotion and stress
regulation. This paper underlines the importance of synchronization between
infant and caregiver; it highlights the key concept of attachment
disorganization and of its relationship with sustained social withdrawal as
a defence mechanism and an alarm signal when synchronization fails, and
underlines the importance of early interventions promoting parentinfant
synchrony.
Keywords: Parentinfant synchrony; Attachment disorganization; Parenting;
Infant social withdrawal behavior; Early prevention and intervention
Lauren S Blum, Tamanna Sharmin, Carine Ronsmans, Attending Home vs. Clinic-
Based Deliveries: Perspectives of Skilled Birth Attendants in Matlab,
Bangladesh, Reproductive Health Matters, Volume 14, Issue 27, May 2006,
Pages 51-60, ISSN 0968-8080, 10.1016/S0968-8080(06)27234-3.
Abstract: In an effort to make skilled attendance at birth more accessible,
some countries in Asia have begun major initiatives to promote the option
of home delivery with a midwife. Yet there is little empirical evidence
from the region to suggest that home-based care is as safe or effective as
care in medical facilities. Qualitative research involving key informant
and in-depth interviews and group discussions was carried out in 2003 and
2004 in Matlab, a rural area of Bangladesh, to examine the feasibility of
home- vs. facility-based delivery from the perspective of 13 skilled birth
attendants. The findings illuminate major constraints encountered during
home deliveries, including poor transportation, inappropriate environment
for delivery, insufficient supplies and equipment, lack of security, and
inadequate training and medical supervision, which may prevent the
provision of skilled care. Most difficult was the pressure by families to
adhere to traditional childbirth norms and convincing families to accept
the need for referral. The advantages highlighted of attending births in a
health facility were the safe, clean environment, availability of supplies,
ability to accommodate other work activities and make quick referrals, and
higher coverage. The study illuminates practical, cultural and medical
issues that need to be taken into consideration when choosing between home-
and facility-based strategies and designing safe motherhood interventions.
Keywords: childbirth; safe motherhood; midwifery; qualitative research;
Bangladesh
Ana Langer, Cesar Victoria, Magda Victoria, Fernando Barros, Ubaldo Farnot,
Jose Belizan, Jose Villar, The Latin American trial of psychosocial support
during pregnancy: A social intervention evaluated through an experimental
design, Social Science & Medicine, Volume 36, Issue 4, February 1993,
Pages 495-507, ISSN 0277-9536, 10.1016/0277-9536(93)90411-V.
Abstract: Perinatal health problems are a public health priority in Latin
America. Among the identified risk factors, psychological and social
conditions play a crucial role. However, care during pregnancy and delivery
in the region is usually hospital-centered and does not address women's
psychological and social conditions. The preeminence of research on
perinatal health, along with the necessity for testing interventions that
represent alternative models to improve women's health, gave the Latin
American Network for Perinatal and Reproductive Research grounds to develop
a multicenter randomized controlled trial to evaluate a program of social
support and health education during pregnancy.
The conceptual framework for this study was based on an ecological model of
social support, i.e. a model in which social support and health education
play a synergistic role and are meant to modify stressful situations and
negative health-related behaviors. The target population consisted of women
attending obstetric hospitals before the 22nd gestational week, at high
psychological and social risk (n = 2236).
The intervention consisted of four to six home visits, carried out by

social workers, and had four main components: the reinforcement of pregnant
women's social support network, emotional support, health education, and
the improvement of health services utilization. The maon foci of the
intervention were determined after an ethnographic study was carried out to
identify stress-producing situations and needs for support during
pregnancy. Besides the home visits, the program also offered a hot-line, an
office in the hospital, a specially designed poster and booklet, and a
guided tour of the health institution. Since this was a multicenter
trial, the program's standardization was a crucial methodological aspect
that was achieved through the training course for the home-visitors team.
Biological and psychosocial outcomes were measured in both experimental and
control groups at the 36th week of gestational age, post-partum and at the
40th day after delivery.
The attributes of the multicenter population showed an important

variability, reflecting differences in the countries or hospitals'
population prevalent attributes. The results of the program's
implementation were analyzed, demonstrating that home visitors adapted
topics discussed during the interviews to the women's conditions and the
stage of pregnancy during which the visit took place.
In this paper, we demonstrate the fwasibility of measuring social
interventions through an experimental design; we discuss the benefits of
developing an explicit conceptual and analytical framework; we show the
possibility of applying a social program to a numerous and heterogenous
population; and we propose a methodology for the development of a social
program which is specific to a population's needs, standardized and
flexible at the same time.
Keywords: social support; perinatal health; clinical trials; multicenter
studies
I.S. Rogers, P.M. Emmett, J. Golding, The incidence and duration of breast
feeding, Early Human Development, Volume 49, Supplement, 29 October 1997,
Pages S45-S74, ISSN 0378-3782, 10.1016/S0378-3782(97)00053-4.
Abstract: Information obtained from a variety of sources shows different
rates of initiation and duration of breast feeding and different
supplementation strategies. Among populations of developing countries, in
general, the mothers resident in rural areas are more likely to breast feed
than those in urban areas; in addition the better off or more highly
educated are less likely to breast feed. In contrast in the developed
countries, the better educated and the higher social class mothers are more
likely to breast feed. There is some evidence that delay in initiation of
breast feeding, lack of professional support, conflicting advice from
health professionals and the presence of free samples of artificial milk
(whether or not given to the mother) can result in a mother failing to
establish breast feeding. Additionally, mothers who smoke cigarettes are
less likely to breast feed successfully. Whilst breast feeding is almost
universal in a number of developing countries, many also commonly use
complementary feeds. In some countries, particularly in Asia, it is still
commonplace for a child not to be given the mother's colostrum, and
therefore for the first breast feed to occur well after the first 24 h.
Keywords: Breast feeding; Developing countries; Developed countries;
Mothers
Francesca Francavilla, Gianna Claudia Giannelli, Does family planning help

the employment of women? The case of India, Journal of Asian Economics,
10.1016/j.asieco.2011.06.001.
Abstract: This paper gives some insight into the existence of a positive
effect of family planning programmes on women's employment in developing
countries. We study married women aged 1549 living throughout India using
a sample drawn from the National Health Family Survey (NFHS-2) for 1998
1999. We focus on a programme of doorstep services delivered by health or
family planning (FP) workers who are sent to visit women in their assigned
areas. Results derived from the estimation of fixed effect linear
probability and conditional logit models show a positive and significant
correlation of the share of women living in a local area (village, town or
city) that has been visited by FP workers with the probability of women's
employment. A multinomial analysis also shows that the largest positive
effect of FP in rural India is to be found on paid work, as opposed to
unpaid work, suggesting a potential empowering feedback of demographic
measures through labour earnings.
Keywords: India; Women's employment; Family planning; Urban and rural
development
Joan A. Heath, Danielle M. Zerr, Chapter 35 - Infections Acquired in the

Nursery: Epidemiology and Control, Infectious Diseases of the Fetus and
Newborn Infant (Sixth Edition), W.B. Saunders, Philadelphia, 2006, Pages
1179-1205, ISBN 9780721605371, 10.1016/B0-72-160537-0/50037-2.
Katrina M. Turner, Carolyn Chew-Graham, Liz Folkes, Deborah Sharp, Women's

experiences of health visitor delivered listening visits as a treatment for
postnatal depression: A qualitative study, Patient Education and
Counseling, Volume 78, Issue 2, February 2010, Pages 234-239, ISSN 0738-
3991, 10.1016/j.pec.2009.05.022.
Abstract: Objective
To explore women's experiences of health visitor delivered listening visits
as a treatment for postnatal depression.
Methods
In-depth interviews with 22 women who had received listening visits as a
treatment for postnatal depression.
Results
All the women reported the visits as beneficial, although many of them had
required additional intervention to manage their symptoms. Women who had a
previous history of depression and women whose depression was not
attributed to events in the postnatal period perceived the listening visits
to be less beneficial. Receiving visits from a research health visitor,
rather than their practice health visitor, was felt to be advantageous.
Conclusion
Women with postnatal depression may report listening visits as helpful but
insufficient to manage their depression. The extent to which women report
listening visits as beneficial appears to be linked to the causes of their
depression, the way in which the visits are delivered and by whom.
Practitioners managing women with postnatal depression should discuss
possible causes and previous episodes of depression before suggesting
listening visits as a treatment. They need to explain what the visits will
entail, ensure that additional types of treatment remain available and
encourage women to utilise other forms of support.
Keywords: Postnatal depression; Listening visits; Primary care; Health
visitors; Qualitative research
Kathleen M. Zanolli, Richard A. Saudargas, Sandra Twardosz, The development

of toddlers' responses to affectionate teacher behavior, Early Childhood
Research Quarterly, Volume 12, Issue 1, 1997, Pages 99-116, ISSN 0885-2006,
10.1016/S0885-2006(97)90045-4.
Abstract: The development of new teacher-toddler affectional systems was
examined. Ten toddlers were observed on the first 40 days of day care
attendance during free play. The children's responses to their teacher's
smiling, affectionate words, and affectionate contact were recorded.
Smiling received affectionate child responses earlier than did affectionate
words or contact. Smiling was also more likely to receive affectionate
responses overall. The teachers' frequency of smiling predicted the
likelihood of affectionate child responses to affectionate contact better
than did the teachers' frequency of affectionate contact. The key role of
smiling in the development of reciprocal affection is discussed.
Sandra L. Huffman, Luann H. Martin, First feedings: Optimal feeding of

infants and toddlers, Nutrition Research, Volume 14, Issue 1, January 1994,
Pages 127-159, ISSN 0271-5317, 10.1016/S0271-5317(05)80374-4.
Abstract: In developing countries, detrimental feeding practices and poor
weaning diets, characterized by inadequate calories, protein, and
micronutrients, account for high levels of malnutrition, morbidity, and
mortality among children 624 months of age. In most cases, nutritional
status does not deteriorate after the second or third year of life.
Nevertheless, nutrition interventions frequently fail to target young
children. Children between the ages of 624 months represent a small
proportion of beneficiaries of supplementary feeding programs. Increases in
household income, particularly when controlled by men, may not be used for
the purchase of additional food or better quality food for young children.
Women's time, labor, and income constraints are barriers to the adoption of
diet and behavior changes that would improve child nutrition. Under two
morbidity levels will remain high unless child survival and development
programs address these constraints and target the at-risk population
through programs that emphasize exclusive breastfeeding during the first
six months of life, improved complementary foods, and better feeding
practices.
Keywords: infant feeding; malnutrition; weaning; child growth;
breastfeeding
Janet Draper, Robert Newell, A discussion of some of the literature

relating to history, repair and consequences of perineal trauma, Midwifery,
10.1016/S0266-6138(96)90058-3.
Abstract: Objective: to review the key literature on perineal trauma,
discussing the historical background, the materials and techniques used,
the possible consequences of repair and assess midwives' current and
potential contribution to perineal repair.
Literature search: the literature was identified using conventional search

techniques: Midwifery Information Resource Service (MIDIRS) and the
Cochrane Pregnancy and Childbirth Database. Keywords used during the search
were: episiotomy, perineal trauma and adverse effects. Associated keywords
words were sexuality, pain and psychology.
Key conclusions: current practice in the UK is inconsistent with the

available evidence, perineal trauma can cause long term problems, and
midwives are in an ideal position to take forward evidence-based perineal
repair.
Implications for practice: midwives need adequate education and training in

perineal repair but are likely to be more effective in performing the
repair. Systematic evaluation of the impact of extending midwives'
influence in this area is essential.
Jennifer MacLeod, Geoffrey Nelson, Programs for the promotion of family

wellness and the prevention of child maltreatment: a meta-analytic review,
Child Abuse & Neglect, Volume 24, Issue 9, September 2000, Pages 1127-
1149, ISSN 0145-2134, 10.1016/S0145-2134(00)00178-2.
Abstract: Objective: The objectives were to determine the effectiveness of
programs in promoting family wellness and preventing child maltreatment and
to identify factors that moderate program success.
Method: Meta-analysis, employing a 3-step model testing procedure, was used

to review 56 programs designed to promote family wellness and prevent child
maltreatment.
Results: The effect sizes for proactive interventions were larger at

follow-up than at post-assessment, while the effect sizes for reactive
interventions were higher at post-assessment than follow-up. The lowest
effect sizes for home visitation programs on child maltreatment were for
programs with 12 or fewer visits and less than a 6-month duration.
Intensive family preservation programs with high levels of participant
involvement, an empowerment/strengths-based approach, and a component of
social support had higher effect sizes than programs without those
elements. Also, both home visitation and intensive family preservation
interventions achieved higher effect sizes with participants of mixed
socioeconomic status (SES) than participants with low SES.
Conclusions: The total mean weighted effect size was .41, indicating that
outcomes for the intervention group exceed 66% of those in
control/comparison groups. The findings from this review demonstrated that
child maltreatment can be prevented and that family wellness can be
promoted.
Keywords: Child maltreatment; Wellness; Prevention; Meta-analysis
Rosemary Mander, Ngai Fen Cheung, Issues arising in the planning of a

cross-cultural research project in China, Clinical Effectiveness in
Nursing, Volume 9, Supplement 2, 2006, Pages e212-e220, ISSN 1361-9004,
10.1016/j.cein.2006.09.001.
Abstract: Summary
This account demonstrates areas previously neglected in the cross-cultural
research literature. The aim is to examine challenges which researchers may
encounter when planning cross-cultural projects. Methodological issues
arising while preparing a qualitative research project are compared with
the literature. The research project, planned in Scotland, was undertaken
in three industrial cities in China. Semi-structured interviews were
planned with three groups of informants in each city. The informants were
(1) women who had given birth by caesarean one week or one year previously
(2) health care workers and (3) community members. The Scotland-based
researchers kept notes of their experiences of preparing and beginning this
project.
It was found that cultural issues should be recognised and addressed during
planning. These affect various aspects of the project, including
recruitment and fieldwork. Additionally, other influences, not only the
indigenous culture, are identified in the host setting. Further,
challenges presented by linguistic issues should not be underestimated. The
rapidity of change in countries like China has implications for
researchers. It is concluded that difficulties may be encountered in
planning cross-cultural research. Some may be anticipated and precautions
taken to minimise their effects. The research literature may not keep
abreast of change in rapidly-developing areas.
Keywords: China; Caesarean; Research methods; Cross-cultural; Planning;
Outsider
Elyse R. Park, Virginia P. Quinn, Yuchiao Chang, Susan Regan, Beverly

Loudin, Sharon Cummins, Kristin Perry, Nancy A. Rigotti, Recruiting
pregnant smokers into a clinical trial: Using a network-model managed care
organization versus community-based practices, Preventive Medicine, Volume
44, Issue 3, March 2007, Pages 223-229, ISSN 0091-7435,
10.1016/j.ypmed.2006.10.008.
Recruiting pregnant smokers into smoking cessation intervention trials is
challenging. Changes in health care systems offer new opportunities to
overcome many of the obstacles encountered by researchers attempting to
address the significant harm from maternal smoking. Investigators could
facilitate smoking cessation study recruitment by collaborating with health
care systems that systematically collect patient smoking status and record
it in a centralized, retrievable fashion. This paper reports the results of
utilizing this novel approach and compares it with a typical decentralized
practice-based recruitment strategy.
Methods
The study was conducted at Massachusetts General Hospital, in Boston,
Massachusetts, from 2000 to 2005. Four hundred forty-two pregnant smokers
were recruited for a randomized controlled trial of telephone-delivered
smoking counseling from two sources: a network-model managed care health
plan and community-based practices (CBP). At the health plan, study
recruitment was built on an existing system that permitted pregnant smokers
to be identified centrally. At the CBPs, identification and referral
systems had to be developed at each practice specifically for the study.
The two strategies were compared on the efficiency of recruitment,
characteristics of enrollees, and study outcome and process measures.
Results
The health plan strategy generated referrals nearly twice as fast as the
CBP strategy (30.4 vs. 17.0 per month), but because referrals were not
timely, a large proportion of women from the plan were too advanced in
pregnancy to be eligible to enroll in the study. As a result, the two
strategies yielded a comparable enrollment rate. Participants from the
health plan were older, better educated, less racially diverse, more likely
to be living with the baby's father, and less likely to have smokers in
their environment. These differences were largely explained by the
socioeconomic diversity of women recruited from the CBPs. Smoking cessation
outcomes did not differ by recruitment source.
Conclusions
A recruitment strategy using a health plan's centralized system was more
efficient than a practice-based recruitment strategy at identifying
potential study participants, but less efficient at generating study
participants from the referrals received. Importantly, participants
recruited by the two strategies differed by socioeconomic, but not
cessation-related, characteristics. To date, recruiting pregnant smokers
into intervention studies remains resource intensive and time consuming.
Participant identification and recruitment will be greatly enhanced by
health system innovations such as implementation of electronic medical
records.
Keywords: Smoking cessation; Pregnant women; Health care systems;
Recruitment
Kenneth A. Pass, Peter A. Lane, Paul M. Fernhoff, Cynthia F. Hinton, Susan

R. Panny, John S. Parks, Mary Z. Pelias, William J. Rhead, Sonya I. Ross,
Doris L. Wethers, Louis J. Elsas II, for CORN*, US Newborn Screening System
Guidelines II: Follow-up of Children, Diagnosis, Management, and Evaluation
Statement of the Council of Regional Networks for Genetic Services (CORN),
The Journal of Pediatrics, Volume 137, Issue 4, Supplement, October 2000,
Pages S1-S47, ISSN 0022-3476, 10.1067/mpd.2000.109437.
The Prevention of Maternal Mortality Network, Situation analyses of

emergency obstetric care: Examples from eleven operations research projects
in West Africa, Social Science & Medicine, Volume 40, Issue 5, March
1995, Pages 657-667, ISSN 0277-9536, 10.1016/0277-9536(95)80010-H.
Abstract: Situation analyses were conducted by 11 multidisciplinary teams
in the West African Prevention of Maternal Mortality (PMM) Network, with
technical assistance from Columbia University's Center for Population and
Family Health. Data on the functioning and use of facilities were used to
identify resource needs and management problems at facilities providing
emergency obstetric care in Ghana, Nigeria and Sierra Leone. The
researchers looked at the number and distribution of facilities, trends in
utilization patterns, time from admission to treatment at facilities,
functioning of referral systems, availability of essential supplies,
staffing patterns, and staff perceptions of services. Research methods
included patient flow studies, inventories of drugs and supplies, and
retrospective reviews of hospital records. Qualitative information was also
collected through interviews with staff.
This paper summarizes the principal findings of the situation analyses.

Normal deliveries fell markedly where users' fees were initiated. However,
the number of women with complications seen increased at several of these
sites. The lack of drugs and supplies at the facilities had an adverse
effect on utilization of non-emergency services and on women's survival
chances. Users' fees and unavailability of supplies contributed to
unacceptably long waiting times between admission and treatment at most
sites. These long waiting times were also found to be associated with
higher case fatality rates. Staff-to-patient ratios at the sites improved
or remained stable, and do not appear to be associated with changes in
quality of care. Strategies to address the problems identified include: the
establishment of small revolving fund schemes to ensure the availability of
supplies; the creation of 24-hr pharmacy services; the establishment of on-
call rooms for staff; and the improvement of staff attitudes and morale
through various types of training activities.
These situation analyses were useful for assessing health system factors
contributing to maternal deaths. The information on complicated cases and
on hospital functioning provided a marked improvement over previous studies
limited to data on deliveries and maternal deaths. Low-cost techniques such
as the patient-flow studies and drug and supply inventories provided
valuable information which was easily intelligible to program planners.
These types of studies are recommended for use prior to the development of
projects designed to reduce maternal deaths.
Sarah D. McDonald, Zhen Han, Michael W. Walsh, Hertzel C. Gerstein, Philip

J. Devereaux, Kidney Disease After Preeclampsia: A Systematic Review and
Meta-analysis, American Journal of Kidney Diseases, Volume 55, Issue 6,
June 2010, Pages 1026-1039, ISSN 0272-6386, 10.1053/j.ajkd.2009.12.036.
Preeclampsia (the development of proteinuria and hypertension after 20
weeks of gestation) is common; however, there is uncertainty about the
natural history of subsequent kidney disease. Our objective is to undertake
a systematic review and meta-analysis to determine whether women with a
history of preeclampsia are at increased risk of subsequent kidney disease.
Study Design
Systematic review and meta-analyses of observational studies.
Setting & Population
Studies examining kidney outcomes in women with a history of preeclampsia
compared with women with unaffected pregnancies.
Selection Criteria
From MEDLINE and EMBASE searches, we included case-control and cohort
studies of kidney outcomes at least 6 weeks postpartum in women with and
without a history of preeclampsia. 2 independent reviewers determined study
eligibility, extracted data, and assessed quality.
Study Factor
Preeclampsia.
Outcomes
Microalbuminuria, proteinuria, serum creatinine level, and estimated
glomerular filtration rate.
Results
7 cohort studies were included, involving 273 patients with preeclampsia
and 333 patients with uncomplicated pregnancies. At a weighted mean of 7.1
years postpartum, 31% of women with a history of preeclampsia had
microalbuminuria compared with 7% of women with uncomplicated pregnancies,
a 4-fold increased risk, whereas women with severe preeclampsia had an 8-
fold increase. Serum creatinine level and estimated glomerular filtration
rate were not significantly different at follow-up in women with and
without preeclampsia, making it unlikely that they would have been
different at baseline.
Limitations
Limitations of this systematic review include potential confounders that
were not explored in most or any of the original studies, the small size of
many studies, and possible publication bias (lack of negative studies).
Conclusion
Women with a history of preeclampsia have an increased risk of
microalbuminuria with a prevalence similar to the published prevalence in
patients with type 1 diabetes mellitus. Further research is needed to
determine whether the increased risk of microalbuminuria persists after
adjustment for a thorough set of confounding factors in larger populations
and the mechanisms underlying this association.
Keywords: Microalbuminuria; proteinuria; systematic reviews; meta-analysis
Lindsey Jeanne Leininger, Rebecca M. Ryan, Ariel Kalil, Low-income mothers'

social support and children's injuries, Social Science & Medicine,
10.1016/j.socscimed.2009.03.013.
Abstract: This study examined the association between low-income mothers'
perceived social support and the prevalence of their children's medically
treated accidents and injuries. Data were drawn from the National
Evaluation of Welfare-to-Work Strategies (NEWWS), an experimental
evaluation of 11 welfare-to-work programs in seven U.S. cities. In
regression models, maternal social support was significantly associated
with the likelihood that children experienced an accident or injury between
the ages of 8 and 10 such that children of mothers with very limited
support were at the highest risk. This association was robust to the
inclusion of a wide range of controls, including a prior measure of
accident and injury occurrence. A primary finding was that only children
whose mothers had the lowest levels of social support, characterized here
as socially isolated, suffered significantly higher rates of injury. This
suggests that social isolation presents a meaningful threat to child safety
and may play an important role in the etiology of child injury among low-
income families.
Keywords: USA; Social support; Injuries; Maternal health; Child health;
Mothers; Low-income; Children
Fiona A. Lynn, Fiona A. Alderdice, Grainne E. Crealey, James C. McElnay,

Associations between maternal characteristics and pregnancy-related stress
among low-risk mothers: An observational cross-sectional study,
International Journal of Nursing Studies, Volume 48, Issue 5, May 2011,
Pages 620-627, ISSN 0020-7489, 10.1016/j.ijnurstu.2010.10.002.
Pregnancy is viewed as a major life event and, while the majority of
healthy, low-risk women adapt well to pregnancy, there are those whose
levels of stress are heightened by the experience.
Objectives
To determine the level of pregnancy-related stress experienced by a group
of healthy, low-risk pregnant women and to relate the level of stress with
a number of maternal characteristics.
Design
An observational cross-sectional study.
Setting
A large, urban maternity centre in Northern Ireland.
Participants
Of the 306 pregnant women who were invited to participate, 278 provided
informed consent and were administered one self-complete questionnaire. Due
to the withdrawal criteria, 15 questionnaires were removed from the
analysis, resulting in a final sample of 263 healthy, low-risk pregnant
women.
Methods
Levels of stress were measured using a self-report measure designed to
assess specific worries and concerns relating to pregnancy. Maternal
characteristics collected included age, marital status, social status,
parity, obstetric history, perceived health status and wantedness for the
pregnancy. Regression analysis was undertaken using an ordinary linear
regression model.
Results
The mean prenatal distress score in the sample was 15.1
(SD = 7.4; range 046). The regression model showed that women
who had had previous pregnancies, with or without complications, had
significantly lower mean prenatal distress scores than primiparous women
(p < 0.01). Women reporting poorer physical health had higher
mean prenatal distress scores than those who reported at least average
health, while women aged 1620 experienced a mean increase in the reported
prenatal distress score (p < 0.05) in comparison to the
reference group of 36 years and over.
Conclusions
This study brings to light the prevalence of pregnancy-related stress
within a sample representative of healthy, low-risk women. Current
antenatal care is ill-equipped to identify women suffering from high levels
of stress; yet a growing body of research evidence links stress with
adverse pregnancy outcomes. This study emphasises that healthy, low-risk
women experience a range of pregnancy-related stress and identification of
stress levels, either through the use of a simple stress measurement tool
or through the associated factors identified within this research study,
provides valuable data on maternal well-being.
Keywords: Cross-sectional study; Low-risk pregnancy; Pregnancy-related
stress; Stress measurement
Peter Weinstock, Louis P. Halamek, Teamwork During Resuscitation, Pediatric

Clinics of North America, Volume 55, Issue 4, August 2008, Pages 1011-1024,
ISSN 0031-3955, 10.1016/j.pcl.2008.04.001.
Abstract: Effective resuscitation requires the integration of several
cognitive, technical, and behavioral skills. Because resuscitation is
performed by teams of health care professionals, these individuals must be
able to work together in a coordinated and efficient manner, making
teamwork a critical skill for care of patients in distress. Despite the
importance of teamwork in health care, little consensus exists as to what
it is, how it can most effectively be learned, and how it should be
assessed. This article reviews current knowledge on the measurement,
training, and importance of teamwork in pediatric resuscitation.
Annette S.H. Schultz, Nursing and tobacco reduction: a review of the

literature, International Journal of Nursing Studies, Volume 40, Issue 6,
August 2003, Pages 571-586, ISSN 0020-7489, 10.1016/S0020-7489(03)00038-5.
Abstract: Nurses have an instrumental role to play in tobacco reduction,
which is one strategy used to address tobacco use; a primary source of
preventable morbidity and mortality globally. The following review
addresses activities by two groups of nurses: nursing governance bodies and
nurse scientists, whom together provide vision and knowledge to support and
shape nursing practice. While nursing governance bodies and scientists have
contributed a great deal to tobacco reduction, there are also gaps. Areas
that require strengthening are: support for tobacco dependent nurses, basic
nursing education concerning tobacco dependency treatment, and integration
of tobacco dependence treatment into nursing practice.
Keywords: Tobacco reduction; Nurses; Literature review; Research agenda
Marie Berg, Anna Terstad, Swedish women's experiences of doula support

during childbirth, Midwifery, Volume 22, Issue 4, December 2006, Pages 330-
338, ISSN 0266-6138, 10.1016/j.midw.2005.09.006.
to describe women's experiences of having a doula present during
childbirth.
Design and setting
a qualitative study with a phenomenological approach in two large Swedish
cities. Data were collected via open-ended taped interviews 12 months
after childbirth. The analysis of the text of transcripts included search
for meaning units sorted into clusters for a final expression of the
essential structure of the phenomenon.
Data
interviews from 10 women aged between 25 and 35 years, both primiparous and
multiparous.
Findings
women's needs during childbirth were described in a metaphor, as a puzzle
consisting of different pieces where the doula was the necessary missing
piece. She was a mainstay functioning as an experienced adviser, an
affirmative person, a mediator, a guarantor, a fixer and as an accessible
presence.
Key conclusion
for these women, the doula fulfilled important needs. The roles of the
midwife and the doula differ, yet some of the evolved doula supportive
functions are also essential in the midwife's care. When a birthing woman
has chosen a doula, the challenge for the midwife is to support her in
collaboration with the doula and the partner if present. More research is
needed in order to determine whether the presence of a doula for the
midwife is an asset or a hindrance, and to find the essential prerequisites
for midwifedoula collaboration to be possible.
Keywords: Childbirth support; Women's experiences; Doula; Midwifery;
Phenomenological method
Penny P. Simkin, MaryAnn O'Hara, Nonpharmacologic relief of pain during

labor: Systematic reviews of five methods, American Journal of Obstetrics
and Gynecology, Volume 186, Issue 5, Supplement, May 2002, Pages S131-S159,
ISSN 0002-9378, 10.1016/S0002-9378(02)70188-9.
Abstract: Nonpharmacologic measures to reduce labor pain have been used
throughout history. Despite reports that some of these methods reduce pain,
increase maternal satisfaction, and improve other obstetric outcomes, they
have received limited attention in the medical literature and are not
commonly available to women in North America. The controlled studies of
nonpharmacologic methods are limited in number and sometimes provide
conflicting results. This systematic review was conducted to assess the
safety and efficacy of the best studied techniques, as well as to highlight
areas in need of further research. Five comfort measures were selected for
review, based on these criteria: they have been evaluated with prospective
controlled studies and they require institutional support (eg, skills,
policies, equipment). These 5 methods included continuous labor support,
baths, touch and massage, maternal movement and positioning, and
intradermal water blocks for back pain relief. An extensive search of
electronic databases and other sources identified studies for
consideration. Critical evaluation of controlled studies of these 5 methods
suggests that all 5 may be effective in reducing labor pain and improving
other obstetric outcomes, and they are safe when used appropriately.
Additional well-designed studies are warranted to further clarify their
effect and to evaluate their cost effectiveness. (Am J Obstet Gynecol
2002;186:S131-59.)
Keywords: Labor; comfort; pain relief; nonpharmacologic; intradermal;
intracutaneous; back pain; doula; support; positioning; ambulation;
massage; hydrotherapy
Loraine Bacchus, Gill Mezey, Susan Bewley, Women's perceptions and

experiences of routine enquiry for domestic violence in a maternity
service, BJOG: An International Journal of Obstetrics and Gynaecology,
Volume 109, Issue 1, January 2002, Pages 9-16, ISSN 1470-0328.
Abstract: Objective
A qualitative study examining women's perceptions and experiences of
routine enquiry for domestic violence in a maternity service.
Design
Purposive sampling was used to select a sub-sample from a larger group of
women who participated in a domestic violence in pregnancy screening study
undertaken at Guy's and St Thomas' Hospitals in London.
Setting
Interviews were conducted in women's homes and general practitioner's
surgeries.
Sample
Ten women who experienced domestic violence in the last 12 months
(including pregnancy), six women who experienced domestic violence in the
last 12 months, but not in pregnancy, and 16 women with no history of
domestic violence.
Methods
Semi-structured interviews conducted during the postpartum period (up to 14
months).
Main outcome measures Women's views on the acceptability and relevance of

routine enquiry for domestic violence.
Results
Routine enquiry for domestic violence in maternity settings is acceptable
to women if conducted in a safe, confidential environment by a trained
health professional who is empathic and non-judgemental. The effectiveness
of routine enquiry to elicit a history of domestic violence is influenced
by factors such as lack of time, confidential consulting time, continuity
of care, training and availability of resources.
Conclusions
Further research is needed to determine whether the use of on-site
specialist domestic violence workers will increase midwives' ability to
routinely enquire about domestic violence.
Katherine Camacho Carr, John W. Sellors, Cervical cancer screening in low

resource settings using visual inspection with acetic acid, Journal of
329-337, ISSN 1526-9523, 10.1016/j.jmwh.2004.02.015.
Abstract: Cervical cancer is one of the leading causes of death for middle-
aged women in the developing world, yet it is almost completely
preventable, if precancerous lesions are identified and treated in a timely
manner. Cervical cancer screening based on cytologic examination is largely
unavailable in developing countries or made available to a small, select
group of women in private facilities, maternal child health sites, or
family-planning clinics, missing the age groups at highest risk for
precancerous lesions. Visual inspection with acetic acid (VIA) can be used
to screen women. It can be done by nurses or midwives with appropriate
training. Although still under investigation, research results show that
VIA is simple, accurate, cost-effective, and acceptable to most women. This
article reviews the natural history of cervical cancer and important
aspects to consider related to cervical cancer screening in low resource
settings. The VIA technique is described in detail.
Keywords: cervical cancer; human papillomavirus; visual inspection with
acetic acid
Edgar Kestler, Beatriz Barrios, Elsa M. Hernndez, Vinicio del Valle,

Alejandro Silva, Humanizing access to modern contraceptive methods in
national hospitals in Guatemala, Central America, Contraception, Volume 80,
Issue 1, July 2009, Pages 68-73, ISSN 0010-7824,
10.1016/j.contraception.2009.01.006.
The overall situation in Guatemala, Central America, regarding programs
caring for women's reproductive health has been lagging behind for some
decades. Since the year 2000, 56% of Guatemalan families have lived below
the poverty line. Guatemala has one of the highest fertility rates
(lifetime births per woman) in Latin America and the Caribbean countries,
comparable to those observed in less developed countries in Africa.
Considering the lack of sex education, poor access to effective
contraceptive methods and issues of unwanted pregnancy, Guatemalan women
engage in illegal and unsafe abortions, which often causes harm and
sometimes death. A key strategy designed to improve women's health is
through free and informed access to contraceptive methods that are
effective and accepted by Guatemalan women.
Study Design
From July 1, 2003, to December 31, 2006, specially hired trained
facilitators visited 22 public hospitals for 1 week to train corresponding
physician staff in postabortion counseling, enabling them to assist
patients to select and use an effective contraceptive method. To monitor
the progress achieved, the trained facilitators returned 4 weeks later. The
main purpose of the training was to focus in strengthening the
understanding and technical capacity of the hospital staff to implement
postabortion contraceptive counseling and to enable women to obtain an
effective contraceptive method prior to hospital discharge.
Results
Out of 22 hospitals, 21 managed to improve their record for counseling
patients admitted for postabortion complications, from 31% to 96%.
Furthermore, the percentage of women being discharged from the hospital
with an effective contraceptive method rose from 20% to 64% from 2003 to
2006.
Conclusion
The successful results obtained during this study to meet postabortion
demands by Guatemalan women point out to the urgent need for the government
to expand this initiative within the national health system, including
health centers nationwide. This is one of the worldwide recommendations
previously made by the World Health Organization.
Keywords: Postabortion care; Guatemala modern contraceptive hospital
counseling
Cindy-Lee Dennis, Peer support within a health care context: a concept

analysis, International Journal of Nursing Studies, Volume 40, Issue 3,
March 2003, Pages 321-332, ISSN 0020-7489, 10.1016/S0020-7489(02)00092-5.
Abstract: Peer support, and the integration of peer relationships in the
provision of health care, is a concept of substantial significance to
health scientists and practitioners today, as the focus shifts from the
treatment of disease to health promotion. If the nursing profession is to
effectively incorporate peer relationships into support-enhancing
interventions as a means to improve quality care and health outcomes, it is
essential that this growing concept be clearly explicated. This paper
explores the concept of peer support through the application of Walker and
Avant's (Strategies for Theory Construction in Nursing, 3rd Edition,
Prentice-Hall, Toronto, 1995) concept analysis methodology. This analysis
will provide the nursing profession with the conceptual basis to
effectively develop, implement, evaluate, and compare peer support
interventions while also serving as a guide for further conceptual and
empirical research.
Keywords: Peer support; Concept analysis; Theory development; Nursing
science
Linda H Bearinger, Renee E Sieving, Jane Ferguson, Vinit Sharma, Global

perspectives on the sexual and reproductive health of adolescents:
patterns, prevention, and potential, The Lancet, Volume 369, Issue 9568, 7
13 April 2007, Pages 1220-1231, ISSN 0140-6736, 10.1016/S0140-
6736(07)60367-5.
Abstract: Summary
Worldwide, societal shifts and behavioural patterns exacerbated by unique
developmental vulnerabilities create a confluence of factors that place
today's adolescents at heightened risks for poor health outcomes. Country-
level data show that continued investment in effective prevention and
treatment strategies is essential to protect adolescents' sexual and
reproductive health. Whereas strategies must be tailored to the
developmental needs of this age group and their social contexts, effective
approaches are multifaceted. All adolescents need access to quality youth-
friendly services provided by clinicians trained to work with this
population. Sex education programmes should offer accurate, comprehensive
information while building skills for negotiating sexual behaviours. Girls
and boys also need equal access to youth development programmes that
connect them with supportive adults and with educational and economic
opportunities. Although progress has been made since the 1994 International
Conference on Population and Development, adolescents continue to be
disproportionately burdened by threats to their sexual and reproductive
health.
David C. Sands, Cindy E. Morris, Edward A. Dratz, Alice L. Pilgeram,

Elevating optimal human nutrition to a central goal of plant breeding and
production of plant-based foods, Plant Science, Volume 177, Issue 5,
November 2009, Pages 377-389, ISSN 0168-9452,
10.1016/j.plantsci.2009.07.011.
Abstract: High-yielding cereals and other staples have produced adequate
calories to ward off starvation for much of the world over several decades.
However, deficiencies in certain amino acids, minerals, vitamins and fatty
acids in staple crops, and animal diets derived from them, have aggravated
the problem of malnutrition and the increasing incidence of certain chronic
diseases in nominally well-nourished people (the so-called diseases of
civilization). Enhanced global nutrition has great potential to reduce
acute and chronic disease, the need for health care, the cost of health
care, and to increase educational attainment, economic productivity and the
quality of life. However, nutrition is currently not an important driver of
most plant breeding efforts, and there are only a few well-known efforts to
breed crops that are adapted to the needs of optimal human nutrition.
Technological tools are available to greatly enhance the nutritional value
of our staple crops. However, enhanced nutrition in major crops might only
be achieved if nutritional traits are introduced in tandem with important
agronomic yield drivers, such as resistance to emerging pests or diseases,
to drought and salinity, to herbicides, parasitic plants, frost or heat. In
this way we might circumvent a natural tendency for high yield and low
production cost to effectively select against the best human nutrition.
Here we discuss the need and means for agriculture, food processing, food
transport, sociology, nutrition and medicine to be integrated into new
approaches to food production with optimal human nutrition as a principle
goal.
Keywords: Breeder's dilemma; Plant genetic engineering; Biotechnology;
Malnutrition; Plant pathology; Green revolution
William F McCool, Margot Stone-Condry, Heather M Bradford, Breast health

care: A review, Journal of Nurse-Midwifery, Volume 43, Issue 6, November
December 1998, Pages 406-430, ISSN 0091-2182, 10.1016/S0091-2182(98)00065-
2.
Abstract: Breast health care was rarely acknowledged in the health and
science fields prior to this century and has only begun, in recent years,
to receive attention outside of pregnancy/lactation or cancer screening and
treatment. Yet much health care is involved with regard to this
reproductive and sexual organ. With any group of clients, practitioners of
womens health care must address an assortment of breast health matters.
This article offers an overview of the history of breast health care, the
epidemiology of benign breast conditions and cancer, the anatomy and
physiology of the breast, and breast development over the lifespan. Also
presented are a review of breast assessment and examination, suggestions
for routine care of the breast, and an overview of major health issues
related to this reproductive organ. Health issues addressed include, among
others, nodular and cystic changes, nipple discharge, breast/nipple pain,
mastitis, elective alterations, and cancer. Discussion is focused on the
latest approaches to optimal breast health care.
, References, Encounters with Children (Fourth Edition), Mosby,

Philadelphia, 2006, Pages 767-809, ISBN 9780323029155, 10.1016/B978-
032302915-5.50002-5.
Sandra A. Elliott, 11 Psychological strategies in the prevention and

treatment of postnatal depression, Baillire's Clinical Obstetrics and
Gynaecology, Volume 3, Issue 4, December 1989, Pages 879-903, ISSN 0950-
3552, 10.1016/S0950-3552(89)80070-7.
Abstract: Summary
Prevention or treatment of most postnatal psychological disorders currently
demands the manipulation of psychosocial not biological variables. How we
treat women matters in terms of the emotional outcome of pregnancy and
ultimately the family outcome. This is confirmed by two types of studies.
Firstly, there are the controlled trials of psychological strategies aimed
at the prevention or treatment of postnatal mood disturbance. Secondly,
there are the studies of the relationship between the type of obstetric and
midwifery care and emotional well-being following the birth. There have
been far too few of either type of study. Since the rapid advances in
medicine which relate to physical outcome have peaked, with mortality rates
at an all-time low, the 1990s should see more clinical and research effort
devoted to psychological outcomes. Perhaps some progress can now be made in
reducing postnatal psychiatric and psychological morbidity.
Daphne Blunt Bugental, David A. Beaulieu, A Bio-Social-Cognitive Approach

to Understanding and Promoting The Outcomes of Children with Medical and
Physical Disorders, Advances in Child Development and Behavior, JAI, 2004,
Volume 31, Pages 329-361, ISSN 0065-2407, ISBN 9780120097319,
10.1016/S0065-2407(03)31008-0.
Donald Caton, Maureen P. Corry, Fredric D. Frigoletto, David P. Hopkins,

Ellice Lieberman, Linda Mayberry, Judith P. Rooks, Allan Rosenfield, Carol
Sakala, Penny Simkin, Diony Young, The Nature and Management of Labor Pain:
Executive summary, American Journal of Obstetrics and Gynecology, Volume
186, Issue 5, Supplement, May 2002, Pages S1-S15, ISSN 0002-9378,
10.1016/S0002-9378(02)70178-6.
Abstract: This report describes the background and process for a rigorous
project to improve understanding of labor pain and its management, and
summarizes the main results and their implications. Labor pain and methods
to relieve it are major concerns of childbearing women, with considerable
implications for the course, quality, outcome, and cost of intrapartum
care. Although these issues affect many women and families and have major
consequences for health care systems, both professional and public
discourse reveal considerable uncertainty about many questions, including
major areas of disagreement. An evidence-based framework, including
commissioned papers prepared according to carefully specified scopes and
guidelines for systematic review methods, was used to develop more
definitive and authoritative answers to many questions in this field. The
papers were presented at an invitational symposium jointly sponsored by the
Maternity Center Association and the New York Academy of Medicine, were
peer-reviewed, and are published in full in this issue of the journal. The
results have implications for policy, practice, research, and the education
of both health professionals and childbearing women. (Am J Obstet Gynecol
2002;186:S1-15.)
Keywords: Labor pain; labor pain management; intrapartum care; informed
consent; evidence-based maternity care
Nancy K. Lowe, The nature of labor pain, American Journal of Obstetrics and
Gynecology, Volume 186, Issue 5, Supplement, May 2002, Pages S16-S24, ISSN
0002-9378, 10.1016/S0002-9378(02)70179-8.
Abstract: A somewhat paradoxic aspect of childbirth is the association of
this physiologic process with acute pain. The experience of pain during
labor is the result of complex processing of multiple physiologic and
psychosocial factors on a woman's individual interpretation of nociceptive
labor stimuli. The nature of labor pain, particularly its physiologic and
psychologic influences, is reviewed in the context of a multidimensional
framework of the pain experience and an understanding of the origin of
labor pain stimuli, of potential adverse effects of the pain response, and
of the concepts of suffering and comfort. (Am J Obstet Gynecol
2002;186:S16-24.)
Keywords: Childbirth; labor; pain; parturition; review
Ashley E. Darcy Mahoney, Lauren Hancock, Angela Iorianni-Cimbak, Martha

A.Q. Curley, Using high-fidelity simulation to bridge clinical and
classroom learning in undergraduate pediatric nursing, Nurse Education
Today, Available online 16 February 2012, ISSN 0260-6917,
10.1016/j.nedt.2012.01.005.
Abstract: Summary
In Patricia Benner's book, Educating Nurses: A Call for Radical
Transformation, she recommends essential changes in policy, curriculum, and
in the way nursing programs approach student learning. This study explored
how two of Benner's key recommendations, (1) integrating the theoretical
component and the clinical component and (2) moving education from an
emphasis on critical thinking to an emphasis on clinical reasoning, could
be achieved by integrating the use of high-fidelity patient simulation in a
pediatric curriculum. Qualitative and quantitative data were collected from
the group of traditional and nontraditional baccalaureate students
(n = 131). The quantitative data revealed learning objectives
were met over 80% of the time in simulation exercises and the qualitative
themes revealed a positive experience with the simulation exercises with a
large proportion of students offering the sentiments that these scenarios
become requirement prior to the start of clinical rotations.
Keywords: Simulation; Undergraduate nursing; Education
Claire B. Ernhart, Mary Morrow-Tlucak, Matthew R. Marler, Abraham W. Wolf,

Low level lead exposure in the prenatal and early preschool periods: Early
preschool development, Neurotoxicology and Teratology, Volume 9, Issue 3,
MayJune 1987, Pages 259-270, ISSN 0892-0362, 10.1016/0892-0362(87)90011-0.
Abstract: The hypothesis that low level lead exposure in the fetal and
early preschool years is related to neuropsychological deficit was examined
in a prospective study of child development. We also tested the hypothesis
of reverse causality, i.e., that lead level is a function of prior
developmental status. Fetal lead exposure was measured in maternal and cord
blood while preschool lead level was measured in venous blood samples at
ages six months, two years and three years. These blood lead measures (PbB)
were related to concurrent and ensuing scores on developmental measures at
six months, one year, two years, and three years. With statistical control
of covariate measures (age, sex, race, birth weight, birth order,
gestational exposure to other toxic substances, maternal intelligence, and
several indicators of the quality of the caretaking environment) as well as
potentially confounding risk factors (gestational exposure to alcohol and
other toxic substances), most statistically significant associations of PbB
with concurrent and later development were completely attenuated. Effects
of lead exposure, significant or not, were not consistent in direction. In
reverse-causality analyses, PbB was not related significantly to prior
measures of developmental retardation or acceleration. It was concluded
that the relationship of lead level and measures of development in these
early years was primarily a function of the dependence of each on the
quality of the caretaking environment.
Keywords: Low level lead exposure; Neuropsychological deficit; Reverse
causality; Preschool development; PbB
Kimberly A. Gray, Nancy L. Day, Sharon Leech, Gale A. Richardson, Prenatal

marijuana exposure: Effect on child depressive symptoms at ten years of
age, Neurotoxicology and Teratology, Volume 27, Issue 3, MayJune 2005,
Pages 439-448, ISSN 0892-0362, 10.1016/j.ntt.2005.03.010.
Abstract: Studies of the consequences of prenatal marijuana use have
reported effects predominantly on the behavioral and cognitive development
of the children. Research on other aspects of child neurobehavioral
development, such as psychiatric symptomatology, has been limited. This
study examines the relations between prenatal marijuana exposure (PME) and
child depressive symptoms at 10 years of age. Data are from the 10-year
follow-up of 633 motherchild dyads who participated in the Maternal Health
Practices and Child Development Project. Maternal prenatal and current
substance use, measures of the home environment, demographic status, and
psychosocial characteristics were ascertained at prenatal months four and
seven, at delivery, and at age 10. At age 10, the children also completed
the Children's Depression Inventory (CDI) [M. Kovacs. The Children's
Depression Inventory, Multi-Health Systems, Inc., North Tonawanda, NY,
(1992).], a self-report measure of current depressive symptoms.
Multivariate regressions were used to test trimester-specific effects of
marijuana and their associations with the CDI total score, while
controlling for significant prenatal predictors and significant current
covariates of childhood depression.
PME in the first and third trimesters predicted significantly increased

levels of depressive symptoms. This finding remained significant after
controlling for all identified covariates from both the prenatal period and
the current phase at age 10. These findings reflect an association with the
level of depressive symptoms rather than a diagnosis of a major depressive
disorder. Other significant correlates of depressive symptoms in the
children included maternal education, maternal tobacco use (prenatal or
current), and the child's composite IQ score. These findings are consistent
with recent reports that identify specific areas of the brain and specific
brain functions that are associated with PME.
Keywords: Prenatal marijuana; Depression; Children
Kristine M. Hallisy, Chapter 12 - The Adolescent Population, In: William G.

Boissonnault, PT, DHSc, FAAOMPT, Editor(s), Primary Care for the Physical
Therapist, W.B. Saunders, Saint Louis, 2005, Pages 175-238, ISBN
9780721696591, 10.1016/B978-072169659-1.50019-8.
Judith N. Wasserheit, The significance and scope of reproductive tract

infections among Third World women, International Journal of Gynecology
& Obstetrics, Volume 30, Supplement, 1989, Pages 145-168, ISSN 0020-
7292, 10.1016/0020-7292(89)90115-X.
Abstract: Due to biomedical, behavioral and societal factors, reproductive
tract infections are widespread in the Third World. Without early diagnosis
and accurate therapy, their complications severely compromise women's
health, fertility and productivity; infant health and survival; and the
effectiveness of family planning programs. Clinicians and public health
planners can address these treatable syndromes through research and
services in socially acceptable settings including family planning,
prenatal and MCH clinics. Specific approaches are discussed.
Keywords: Reproductive tract infections; Reproduction; Sexually transmitted
diseases; Third World; Contraceptive safety; Abortion
Lissette M. Piedra, Soo-Jung Byoun, Luciana Guardini, Valerie Cintrn,

Improving the parental self-agency of depressed Latino immigrant mothers:
Piloted intervention results, Children and Youth Services Review, Volume
34, Issue 1, January 2012, Pages 126-135, ISSN 0190-7409,
10.1016/j.childyouth.2011.09.007.
Abstract: Segmented assimilation theory posits that uneven rates of
intergenerational acculturationthe process by which immigrants and their
children learn the language and normative lifestyles of a new culturecan
be detrimental to the parentchild relationship. This paper presents
results on parental self-efficacy from an intervention studyVida Alegre
[Happy/Contented Life]for depressed immigrant mothers that includes a
three-session module based on Gottman & DeClaire (2001) concept of
emotional bidding. Using a mixed-methods design, this study examines
whether exposure to the intervention increased parental self-efficacy.
Outcome data from the Parenting Self-Agency Measure (PSAM) administered at
three points in timepre-test, post-test, and 3 months follow-upwas
analyzed using the Wilcoxon Signed-Ranks Test. Constant comparative
analysis was used to code 3 focus groups and 10 post-treatment interviews.
Results indicate a significant increase in parental self-efficacy between
pre-test and post-test. An analysis of mixed methods results further
highlights the importance of tailoring interventions to help immigrant
parents reinterpret their child's communications to strengthen family
relationships.
Keywords: Segmented assimilation theory; Cognitive behavioral intervention;
Mixed methods; Parenting self-efficacy; Immigrant mothers; Intervention
research
Ruth A. Lawrence, Robert M. Lawrence, Chapter 18 - Employment and Away From

Home Activities While Breastfeeding, Breastfeeding (Seventh Edition), W.B.
10.1016/B978-1-4377-0788-5.10018-5.
Dorit Bustan, Abraham Sagi, Effects of early hospital-based intervention on

mothers and their preterm infants, Journal of Applied Developmental
Psychology, Volume 5, Issue 4, OctoberDecember 1984, Pages 305-317, ISSN
0193-3973, 10.1016/0193-3973(84)90004-2.
Abstract: Mothers of eight Israeli preterm infants were exposed to a
standardized but individualized intervention during their stay in the
hospital and before their infants were discharged. Mothers and infants in
the intervention group were compared to eight control subjects using
various outcome measures. While the intervention did not affect maternal
personal attitudes and feelings, it positively affected the mother-infant
interactions and mothers' perceptions of their infants. The importance of
individualized interventions with parents of preterm infants is discussed.
Li-Yin Chien, Chen-Jei Tai, Kuei-Hui Chu, Yi-Li Ko, Yueh-Chi Chiu, The
number of Baby Friendly hospital practices experienced by mothers is
positively associated with breastfeeding: A questionnaire survey,
International Journal of Nursing Studies, Volume 44, Issue 7, September
2007, Pages 1138-1146, ISSN 0020-7489, 10.1016/j.ijnurstu.2006.05.015.
The objective of this study was to examine the association between number
of Baby Friendly hospital practices (based on World Health
Organization/United Nations Children's Fund Ten Steps to successful
breastfeeding) experienced by mothers and breastfeeding initiation during
hospital stay, breastfeeding at 1 month and breastfeeding at 3 months after
delivery.
Methods
The study population consisted of mothers who gave birth to infants without
congenital anomalies at hospitals in Taiwan from June to October of 2003,
inclusively. A total of 2079 mothers participated in the postal
questionnaire survey.
Results
Only 1% of women reported experiencing all 10-step practices, while 5.7% of
women did not report experiencing any Baby Friendly practices. Mothers who
delivered at certified Baby Friendly hospitals experienced more 10-step
practices. The level of breastfeeding increased as the number of 10-step
practices experienced increased at all three time points when confounders
were controlled in the model.
Conclusions
This study found a doseresponse relationship between number of 10-step
practices experienced and breastfeeding. However, very few women in Taiwan
reported experiencing all 10 steps. Our findings highlight the need for
greater attention to implement the 10 steps.
Keywords: Breastfeeding; Health-care quality; Maternal child health service
Jonathan E. Fielding, James N. Hyde Jr, Pearl K. Russo, A program for

prevention in massachusetts, Preventive Medicine, Volume 7, Issue 4,
December 1978, Pages 564-640, ISSN 0091-7435, 10.1016/0091-7435(78)90269-4.
Abstract: Since 1900 life expectancy at birth in the United States has
increased by about 25 years, an increase attributable mainly to a decline
in infant and child mortality. In place of deaths and disability from
communicable diseases, the nation has witnessed a major increase in heart
disease, cerebrovascular disease, lung cancer, cirrhosis of the liver,
accidents, homicide, and suicide. These have been linked to human behavior,
individual as well as collective. The Massachusetts Department of Public
Health has embarked on a major new program in prevention. As the principal
administrative unit within the state government charged with the protection
and promotion of the somatic health of the citizens of the Commonwealth,
the Department is in a unique position to play an important role in the
development of strategies for health promotion. The Department has selected
several target areas on which to concentrate its efforts, including: diet
and nutrition, physical inactivity, substance abuse, tobacco and drugs,
accidents, communicable diseases, and hypertension. Strategies for
intervention include community and worksite demonstration projects,
regulatory and legislative initiatives, school health programs, and the use
of media. The Department has listed a modest program of goals and
objectives to be reached within a 3-year period.
Kimberly Sidora-Arcoleo, Elizabeth Anson, Michael Lorber, Robert Cole,

David Olds, Harriet Kitzman, Differential Effects of a Nurse Home-Visiting
Intervention on Physically Aggressive Behavior in Children, Journal of
Pediatric Nursing, Volume 25, Issue 1, February 2010, Pages 35-45, ISSN
0882-5963, 10.1016/j.pedn.2008.07.011.
Abstract: Objective
The objective of this study is to examine the differential effects of nurse
home visiting (NV) on physical aggression (PA) among children aged 212
years.
Methods
This study used secondary data analysis from a randomized trial of NV
intervention.
Results
There were significant reductions in PA observed among NV girls at 2 years
old and NV children of high-psychological-resource mothers at 6 and 12
years old. Mediation analyses suggest that reductions in PA yield increased
verbal ability among girls.
Conclusions
Differential effects of intervention on PA by gender and mother's
psychological resources highlight the importance of subgroup analyses.
Identification of groups most likely to benefit may lead to more successful
interventions.
Keywords: Nurse home visiting; Physical aggression; Children
M.K. Green, C.S.S. Rani, A. Joshi, A.E. Soto-Pia, P.A. Martinez, A.

Frazer, R. Strong, D.A. Morilak, Prenatal stress induces long term stress
vulnerability, compromising stress response systems in the brain and
impairing extinction of conditioned fear after adult stress, Neuroscience,
Volume 192, 29 September 2011, Pages 438-451, ISSN 0306-4522,
10.1016/j.neuroscience.2011.06.041.
Abstract: Stress is a risk factor for the development of affective
disorders, including depression, post-traumatic stress disorder, and other
anxiety disorders. However, not all individuals who experience either
chronic stress or traumatic acute stress develop such disorders. Thus,
other factors must confer a vulnerability to stress, and exposure to early-
life stress may be one such factor. In this study we examined prenatal
stress (PNS) as a potential vulnerability factor that may produce stable
changes in central stress response systems and susceptibility to develop
fear- and anxiety-like behaviors after adult stress exposure. Pregnant
SpragueDawley rats were immobilized for 1 h daily during the last week of
pregnancy. Controls were unstressed. The male offspring were then studied
as adults. As adults, PNS or control rats were first tested for shock-probe
defensive burying behavior, then half from each group were exposed to a
combined chronic plus acute prolonged stress (CAPS) treatment, consisting
of chronic intermittent cold stress (4 C, 6 h/d, 14 days) followed on day
15 by a single session of sequential acute stressors (social defeat,
immobilization, cold swim). After CAPS or control treatment, different
groups were tested for open field exploration, social interaction, or cued
fear conditioning and extinction. Rats were sacrificed at least 5 days
after behavioral testing for measurement of tyrosine hydroxylase (TH) and
glucocorticoid receptor (GR) expression in specific brain regions, and
plasma adrenocorticotropic hormone (ACTH) and corticosterone. Shock-probe
burying, open field exploration and social interaction were unaffected by
any treatment. However, PNS elevated basal corticosterone, decreased GR
protein levels in hippocampus and prefrontal cortex, and decreased TH mRNA
expression in noradrenergic neurons in the dorsal pons. Further, rats
exposed to PNS plus CAPS showed attenuated extinction of cue-conditioned
fear. These results suggest that PNS induces vulnerability to subsequent
adult stress, resulting in an enhanced fear-like behavioral profile, and
dysregulation of brain noradrenergic and hypothalamicpituitaryadrenal
axis (HPA) activity.
Keywords: prenatal stress; traumatic stress; vulnerability; fear
extinction; tyrosine hydroxylase; HPA axis
Goldy C. George, Deanna M. Hoelscher, Theresa A. Nicklas, Steven H. Kelder,

Diet- and Body Size-related Attitudes and Behaviors Associated with Vitamin
Supplement Use in a Representative Sample of Fourth-grade Students in
Texas, Journal of Nutrition Education and Behavior, Volume 41, Issue 2,
MarchApril 2009, Pages 95-102, ISSN 1499-4046, 10.1016/j.jneb.2008.05.006.
Abstract: Objective
To examine diet- and body size-related attitudes and behaviors associated
with supplement use in a representative sample of fourth-grade students in
Texas.
Design
Cross-sectional data from the School Physical Activity and Nutrition study,
a probability-based sample of schoolchildren. Children completed a
questionnaire that assessed supplement use, food choices, diet-related
attitudes, and physical activity; height and weight were measured.
Setting
School classrooms.
Participants
Representative sample of fourth-grade students in Texas (n = 5967; mean age
= 9.7 years standard error of the mean [SEM] = .03 years, 46% Hispanic, 11%
African-American).
Main Outcome Measures
Previous day vitamin supplement consumption, diet- and body size-related
attitudes, food choices, demographic factors, and physical activity.
Analysis
Multivariable logistic regression models, P < .05.
Results
The prevalence of supplement use was 29%. Supplement intake was associated
with physical activity. Girls who used supplements were more likely to
report positive body image and greater interest in trying new food.
Relative to nonusers, supplement users were less likely to perceive that
they always ate healthful food, although supplement use was associated with
more healthful food choices in boys and girls (P < .001).
Conclusions and Implications
The widespread use of supplements and clustering of supplement use with
healthful diet and greater physical activity in fourth graders suggest that
supplement use be closely investigated in studies of dietdisease precursor
relations and lifestyle factors in children.
Keywords: vitamin supplement use; elementary schoolchild; food choices;
diet-related attitudes; multiethnic; probability-based sample; physical
activity
Leona Bull, Emma Whitehead, Smoking cessation intervention with pregnant
women and new parents: A survey of health visitors, midwives and practice
nurses, Journal of Neonatal Nursing, Volume 12, Issue 6, December 2006,
Pages 209-215, ISSN 1355-1841, 10.1016/j.jnn.2006.09.005.
Abstract: A survey was undertaken to examine the attitudes, knowledge and
practice of health visitors, midwives and practice nurses in relation to
smoking cessation intervention with pregnant women and new parents. In
total, 65 questionnaires were completed (52.42% return rate). Health
visitors, midwives and practice nurses were aware of the reasons why
pregnant women smoke as well as the health risks associated with smoking.
All claimed to intervene by asking if their patients smoked. Most
respondents claimed to record smoking status on health records and to give
cessation advice to their patients. However, fewer of the health
professionals provided advice to partners of women in their care and only a
minority had read the NICE clinical guidelines on nicotine replacement
therapies. There were limitations to the health professionals attitudes,
knowledge and practice that could affect the quality of smoking cessation
service offered to patients. Further training in evidence-based practice is
required.
Keywords: Smoking; Pregnancy; Parent; Health visitor; Nurse; Midwife;
Cessation
Terri Combs-Orme, Lisa Martin, Greer Litton Fox, Catherine A. Faver, Risk
for child maltreatment: New mothers' concerns and screening test results,
Children and Youth Services Review, Volume 22, Issue 7, July 2000, Pages
517-537, ISSN 0190-7409, 10.1016/S0190-7409(00)00101-8.
Abstract: Despite the potential usefulness of such information, child
maltreatment programs generally do not target services based on parents'
concerns about their likelihood of maltreating. This study investigated
responses by new mothers regarding concerns about caring for their new
infants, including concerns about maltreatment. A total of 170 new mothers
in the Labor and Delivery Units of four hospitals were interviewed and
asked about these concerns and their opinions about the causes of child
maltreatment. In addition, they were administered the Child Abuse Potential
Inventory (CAPI), a screening instrument for child abuse. Results indicate
that new mothers will admit to concerns about a range of child care issues,
including maltreatment. Moreover, there was a significant correlation
between mothers' concerns about child care and their scores on the CAPI.
Multiple regression results indicate that among sociodemographic variables,
only education and income were independently related to CAPI scores, while
only race predicted mothers' total concerns. Although lower power for that
model necessitates caution in interpretation, only expressed belief in
parenting ability as a cause of child maltreatment predicted mothers'
expressed concerns about maltreating their infants.
Heather J Rowe-Murray, Jane R.W Fisher, Operative intervention in delivery

is associated with compromised early mother-infant interaction, British
Journal of Obstetrics and Gynaecology, Volume 108, Issue 10, October 2001,
Pages 1068-1075, ISSN 0306-5456, 10.1016/S0306-5456(01)00242-X.
Abstract: Objective To investigate the effects of mode and place of
delivery on first motherinfant contact and maternal emotional wellbeing.
Design A prospective, longitudinal study.
Participants A sociodemographically representative sample of 203

consecutive primiparous women was recruited, of whom 81% (n=164) were
followed up.
Setting Four metropolitan hospitals, including one accredited baby friendly
hospital, in Melbourne, Australia, 1997.
Methods During the postnatal hospital stay women were interviewed and
medical records were inspected. Participants completed two self-report
psychometric measures: the Edinburgh Postnatal Depression Scale (EPDS) and
the Profile of Moods States (POMS). Follow up at eight months postpartum
comprised completion of a postal questionnaire and repeat administration of
the standardised self-report psychometric mood questionnaires.
Results The First Contact Index provides a measure of the first contact
between a mother and her baby after the birth. Two-way analysis of variance
revealed significant differences in First Contact Index between three modes
of delivery groups: spontaneous, instrumentally-assisted, and caesarean
section (P<0.001) and four hospital of delivery groups (P<0.001), but
there was no significant interaction effect (P=0.55). Significant negative
correlations existed between the First Contact Index and both the POMS and
EPDS scores at two days postpartum (POMS, r = -0.339, 95% CI -0.46 to
-0.22; EPDS, r = -0.279, 95% CI -0.41 to -0.16), even within delivery
groups, and these were still present at eight months postpartum (POMS, r =
-0.298, 95% CI -0.44 to -0.14, EPDS, r = -0.206, 95% CI -0.36 to -0.03).
Conclusion Instrumental and surgical delivery exert a negative impact on

first postnatal contact between a mother and her baby which has persistent
adverse maternal emotional correlates. Hospital practices associated with
obstetric intervention in delivery also varied and are amenable to change,
enabling optimal first motherbaby interaction regardless of mode of
delivery.
Jennifer R. Zebrack, Keith W. Brown, Preventive Health for Women: Screening

and Immunizations, Medical Clinics of North America, Volume 92, Issue 5,
September 2008, Pages 1011-1035, ISSN 0025-7125,
10.1016/j.mcna.2008.04.002.
Abstract: Women's preventive health issues are frequently encountered in
the outpatient setting. Many general internists feel uncomfortable meeting
the needs of women due to a general lack of knowledge of women's health and
inadequate training in the evaluation of female-specific care. In this
article, the authors summarize evidence-based guidelines for preventive
health and immunizations for women.
C. Santos, D. Diante Jr., A. Baptista, E. Matediane, C. Bique, P. Bailey,

Improving emergency obstetric care in Mozambique: The story of Sofala,
August 2006, Pages 190-201, ISSN 0020-7292, 10.1016/j.ijgo.2006.05.024.
Abstract: Objective: The 5-year project in the province of Sofala was
designed to improve access, quality and utilization of emergency obstetric
care (EmOC) by strengthening rural hospitals and health centers and
ultimately the health system's capacity to respond to emergencies more
quickly and effectively. Methods: Implementation consisted of attention to
infrastructure, human resource development, transportation and
communication systems, and management. Specific management aspects that
were targeted for improvement included: supportive supervision, logistics
for supplies, equipment and drugs, record keeping, monitoring and
evaluation, and quality improvement techniques such as maternal death
audits. Results: Access to EmOC improved with an increase in the number of
fully functional EmOC facilities from 4 to 18. The number of women with
obstetric complications who were admitted for treatment in participating
facilities tripled, and the proportion of those women dying declined by
half. Conclusions: Close collaboration and partnership with the provincial
health directorate make the sustainability of many results likely while the
replication of much of the Sofala model to other provinces is promising for
the national strategy to reduce maternal mortality.
Keywords: Emergency obstetric care; Maternal mortality; Mozambique; Health
facilities
Alanagh Raikes, Women's health in East Africa, Social Science &

Medicine, Volume 28, Issue 5, 1989, Pages 447-459, ISSN 0277-9536,
10.1016/0277-9536(89)90100-7.
Abstract: The MCH/FP services for women in Africa offer today limited
services that do not cater to the multiple and complex problems that women
face during their long productive lives. Many women are infertile, many
suffer and die from abortions, many cannot get access to safe contraceptive
technology or safe and sterile delivery services. At the same time women
are more stressed than ever before with a proletarianisation process that
has left them very often as the sole providers for their households, and
with an intensified role in agricultural production. The health needs of
women have thus intensified and become increasingly shaped by their growing
role in production and in the social reproduction of the household. The
paper examines the changing health needs of women in East Africa, why
MCH/FP health services have failed to meet these needs, and identifies the
types of services that women increasingly require.
Keywords: women's health; reproduction; social reproduction; production
processes; East Africa
Ponndara Ith, Angela Dawson, Caroline S.E. Homer, Women's perspective of

maternity care in Cambodia, Women and Birth, Available online 20 June 2012,
ISSN 1871-5192, 10.1016/j.wombi.2012.05.002.
Consideration of the needs of pregnant women and their ability and
willingness to attend maternal services and pay for them is central to the
provision of accessible and acceptable maternal care. Women's satisfaction
with maternal services is poorly understood in many developing countries,
including Cambodia in South East Asia. The objective of this study was to
investigate women's perceptions and experiences of private and public
skilled birth attendants, including midwives, during childbirth in
Cambodia.
Methods
A qualitative design using a naturalistic inquiry approach was undertaken
to seek sensitive personal issue. Thirty individual in-depth interviews
were conducted with women who had recently given birth at private and
public health facilities in one province in Cambodia. Data were analysed
using a thematic approach.
Findings
Women's choice of health facility was influenced by their perceptions of
safety and staff attitudes. Reported barriers to the effective utilisation
of public maternity services were costs associated with the birth, staff
attitudes and a lack of supportive care during labour and in the postpartum
period. Although private health care is more expensive than public health
care, some women reported a preference for private birth attendants as they
perceived them to provide safer and more supportive care in labour.
Conclusion
Women expect, but do not always receive humane, professional, supportive
and respectful treatment from public skilled birth attendants. While the
removal of unexpected costs and geographical barriers are important to
increasing public maternity care and service utilisation, improvements in
maternity services should focus on addressing provider attitudes and
enhancing communication skills during labour, birth and the immediate
postpartum period.
Keywords: Cambodia; Maternity care; Skilled birth attendant; Staff
attitude; Safe birth; Women
Harold Kalter, 1 - Teratology in the 20th century Environmental causes of

congenital malformations in humans and how they were established,
Teratology in the Twentieth Century, Elsevier Science, Amsterdam, 2003,
Pages 131-282, ISBN 9780444513649, 10.1016/B978-044451364-9/50009-7.
Kristina L. Gryboski, Maternal and non-maternal time-allocation to infant

care, and care during infant illness in rural Java, Indonesia, Social
Science & Medicine, Volume 43, Issue 2, July 1996, Pages 209-219, ISSN
0277-9536, 10.1016/0277-9536(95)00363-0.
Abstract: An estimated 60% of women in Central Java are engaged in income-
generating work. This study addresses the manner in which mothers allocate
time to infant care as well as to household maintenance and employment. The
study investigates the time-allocation to infant care by non-maternal
carers, both among infants whose mother is involved in income-generating
work and among infants whose mother is not employed.
The longitudinal study followed 60 households, one infant per household, of

the age range 325 months (mean infant age over the course of the study was
13.8 months). Each household was visited every 7 to 10 days from February
1991 through June 1991. One observation day and two separate recall-days
were recorded per month. Daily time allocation (6 a.m. to 6 p.m.) to infant
care by the mother and other individuals, frequency and minutes of
breastfeeding, and infants' non-breastmilk kilocalorie intake were
recorded. In addition, mothers recorded any infant symptom(s) on a daily
calendar provided to them, and this symptomdata and information on any
treatments and/or help-seeking for the infant was collected every 710
days.
One or more non-maternal caretaker participated in infant care on 90% of

the total sample days, for a median of 3 hr 15 min (mean 3 hr 50 min per
day), and participated in infant feeding on one-third of all sample days.
Grandmothers, sisters, and fathers of the infants were the most important
in terms of time allocated to infant care. One or more sister cared for the
infant on 30% of total sample days (mean 180 min, median 150 min, 5645
min), the father on 55% of sample days (mean 90 min, median 65 min, 5600
min), and grandmother(s) on 32% of sample days (mean 160 min, median 130
min, 5670 min). Non-maternal care was also substantial during days of
symptom-reporting; other carers participated in infant-care on 84% of days,
and fed the infant on 28% of days. The study findings suggest that health
education messages related to infant care and feeding could be usefully
targeted to other persons in addition to mothers.
Infant care on symptom-free days were compared to symptom-days using

Wilcoxon matched-pair test within each data-collection month (round). While
no significant differences were found for the time-allocation to infant
care by the mother or others on symptom-days compared to symptom-free days,
there was a mean 25% lower non-breastmilk kilocalorie intake on symptom-
days (P = 0.00) in four of five data-collection rounds. Mothers reported
that lack of appetite accompanied other symptom(s) on 46% of the days of
help-seeking in the modern sector. This reflects the mothers' concern for
infant appetite in association with illness.
Keywords: infant illness; infant care patterns; infant feeding; household
time-allocation; treatment-seeking; Indonesia
S. Acharya, How effective is antenatal care to promote maternal and

neonatal health?, International Journal of Gynecology & Obstetrics,
Volume 50, Supplement 2, October 1995, Pages S35-S42, ISSN 0020-7292,
10.1016/0020-7292(95)02483-S.
(http://www.sciencedirect.com/science/article/pii/002072929502483S)
Abstract: Antenatal care is effective, but relies heavily on the
sympathetic attitude of health personnel. Essential to its promotion is
community participation and involvement of family members. Transportation
to a well-equipped facility for emergency obstetric care is a critical
element. The effectiveness of antenatal care to reduce maternal morbidity
and mortality from certain major causes is reviewed.
Keywords: Antenatal care; Quality; Consistency; Community participation;
Attitude of health personnel
Harold Kalter, Teratology in the 20th century: Environmental causes of

congenital malformations in humans and how they were established,
Neurotoxicology and Teratology, Volume 25, Issue 2, MarchApril 2003, Pages
131-282, ISSN 0892-0362, 10.1016/S0892-0362(03)00010-2.
Keywords: Teratology; Environmental causes; Congenital malformations
Yookyong Lee, Early motherhood and harsh parenting: The role of human,
social, and cultural capital, Child Abuse & Neglect, Volume 33, Issue
9, September 2009, Pages 625-637, ISSN 0145-2134,
10.1016/j.chiabu.2009.02.007.
Abstract: Objective
This study examined the role of maternal human, social, and cultural
capital in the relationship between early motherhood and harsh parenting
behavior.
Methods
This study used data from the Fragile Families and Child Wellbeing (FFCW)
Study. Harsh parenting behaviors by mothers who were 19 years or younger at
birth of the focal child (n = 598) were compared with that of
adult mothers 26 years or older (n = 1,363). Measures included:
For harsh parenting behavior, three proxies were created from the Parent to
Child version of the Conflict Tactics Scales (CTS-PC) and self-reports of
maternal spanking. For maternal human capital, education, employment, and
depression were used. For maternal social capital, expected-social support,
paternal support, and lone caregiver status were included. For maternal
cultural capital, religious attendance and attachment to race/ethnic
heritage were used.
Results
Multivariate analyses indicated that adolescent motherhood has a
significant impact on all three harsh parenting behavior outcomes even
after controlling for demographic and maternal capital characteristics.
Working since the birth of the focal child, depression scores, paternal
support, expected-social support, and attendance at religious services made
independent contributions to the prediction of harsh parenting behavior.
Conclusions
Findings emphasize the importance of the prevention of adolescent
motherhood and suggest intervention strategies for reducing the risk of
maternal harsh parenting behavior. Further study is necessary to examine
the complicated relationships among maternal capital and parenting. One
method may be to focus on the development of measures of maternal capital,
notably measures of expectations regarding and perceptions of received
capital.
Findings from this study have implications for social work practice,
particularly for the prevention of adolescent pregnancy and intervention
with adolescent mothers and their children. First, the study calls for more
recognition of school social work and intervention programs in school
settings as important components of prevention services. Second, the
importance of identifying fathers and helping them become involved and
connected with their young families are highlighted. Finally, practitioners
should become more aware of the role of culture in young families as the
effect of cultural capital on parenting behavior becomes better understood.
Keywords: Early motherhood; Harsh parenting; Capital; Fragile Families and
Child Wellbeing Study
Shannon M. Bennett, Jill Ehrenreich-May, Brett T. Litz, Christina L.

Boisseau, David H. Barlow, Development and Preliminary Evaluation of a
Cognitive-Behavioral Intervention for Perinatal Grief, Cognitive and
Behavioral Practice, Volume 19, Issue 1, February 2012, Pages 161-173, ISSN
1077-7229, 10.1016/j.cbpra.2011.01.002.
Abstract: Perinatal loss, typically defined as fetal death beyond
20 weeks gestation through infant death 1-month postpartum, is a
potentially traumatizing experience for parents occurring in approximately
1% of births in the United States. Although many women recover, 15% to 25%
have enduring grief-related symptomatology and functional impairment.
Perinatal grief is a unique bereavement experience, but clinical resources
for detecting and treating severe perinatal grief are rare and
interventions are largely without empirical support. We developed and pilot
tested a cognitive-behavioral intervention targeting the psychological and
behavioral sequelae of perinatal bereavement. To initially evaluate the
feasibility and efficacy of the intervention, 5 women who suffered a
perinatal loss were randomized to a 2-week, 4-week, or 6-week baseline
period in a multiple-baseline single-case experimental design. In most
cases, after the respective baseline periods, there was a steady decline in
reported grief symptoms. These gains were largely maintained at a 6-week
follow-up assessment. This study provides initial evidence in support of
future research and clinical efforts tailoring cognitive behavioral
interventions to meet the specific needs of women who experience perinatal
loss.
Keywords: perinatal loss; prolonged grief; cognitive behavioral therapy
M. Kayongo, E. Esquiche, M.R. Luna, G. Frias, L. Vega-Centeno, P. Bailey,

Strengthening emergency obstetric care in Ayacucho, Peru, International
Journal of Gynecology & Obstetrics, Volume 92, Issue 3, March 2006,
Pages 299-307, ISSN 0020-7292, 10.1016/j.ijgo.2005.12.005.
Abstract: Objective
With support from the Averting Maternal Death and Disability (AMDD)
Program, CARE began the FEMME Project in 2000 to increase access and
utilization of emergency obstetric care (EmOC) services for the
approximately 48,000 pregnant women in the northern provinces of Ayacucho.
Methods
The project targeted 5 facilities with a comprehensive package of
interventions designed to improve capacity to provide quality EmOC services
and to promote a human rights approach in health care. Key program
activities included improvements in infrastructure, human resources
capacity development, development of service standards and protocols,
quality improvement activities, and promoting a rights-based approach to
health.
Results
By the end of the project, northern Ayacucho had 6 functioning EmOC
facilities: 3 comprehensive (including a non-FEMME project facility) and 3
basic. This exceeds the UN minimum recommendation of 5 EmOC facilities per
500,000 population. Other changes in the UN process indicators indicate an
increase in quality and utilization of EmOC services. Met need for EmOC
increased significantly from 30% in 2000 to a high of 84% in 2004. Case
fatality rates declined and the number of maternal deaths in the entire
region declined.
Conclusion
CARE's work in Ayacucho made an impact on policies and programs related to
EmOC throughout the region. Within CARE, project experiences have supported
maternal health programs particularly in the Latin American/Caribbean
region.
Keywords: Maternal mortality; Emergency obstetric care; Facility
interventions; Latin America; CARE
Suzanne Belton, Marcel Campbell, Sally Foxley, Bev Hamerton, Justin

Gladman, Sally McGrath, Neil Piller, Nathan Saunders, Fran Vaughan,
Evaluating the long-term effectiveness of the Maternity Emergency Care
course in remote Australia, Women and Birth, Volume 23, Issue 2, June 2010,
Pages 60-66, ISSN 1871-5192, 10.1016/j.wombi.2009.08.004.
The Council for Remote Area Nurses of Australia deliver the MEC course
which is the only short-course on maternity emergencies offered to non-
midwifery qualified remote area nurses and Aboriginal Health Workers. The
aim of the course is to improve the maternity emergency skills and
knowledge of health service providers who do not have midwifery
qualifications. There has been no long-term evaluation of the course since
its inception.
Research objective
To review the longer-term effectiveness of the maternity emergency care
(MEC) course which was developed in consultation with the Australian
College of Midwives (ACM) and rural and remote practitioners in 2003.
Participants and methods
Fifty-seven clinicians who completed the MEC course since 2003 responded to
a survey. Seven remote area health managers and two course facilitators
were interviewed.
Results
This study provides an evaluation of the experiences of non-midwives who
manage maternity emergencies in the rural and remote setting; their
perception of the skills, knowledge and confidence acquired through
participation in the MEC program.
Conclusions
The MEC course is valued by both remote health managers and practitioners.
The learning activities, skills and knowledge gained are reported to be
very beneficial and used by remote health practitioners.
Keywords: Maternity care; Maternity emergency; Training; Evaluation;
Midwifery; Australia; Indigenous; Remote health
Diane J. Abatemarco, Michael B. Steinberg, Cristine D. Delnevo, Midwives

Knowledge, Perceptions, Beliefs, and Practice Supports Regarding Tobacco
Dependence Treatment, Journal of Midwifery & Women's Health, Volume 52,
10.1016/j.jmwh.2007.03.019.
Abstract: Clinical practice guidelines and evidence-based reviews confirm
the efficacy of tobacco dependence treatment for pregnant women. The
purpose of this study was to examine tobacco dependence treatment practices
among certified nurse-midwives who treat pregnant women who smoke. Midwives
were surveyed to determine knowledge, perceptions, and beliefs about
tobacco cessation treatment and to identify practice environmental factors
that support treatment practices. Half of all midwives had not heard of the
US Public Health Service Guidelines (5 As) to assist smokers in cessation
treatment. We found varying levels of adherence to the clinical practice
guidelines. Nearly all midwives routinely ask, advise, and assess; while
fewer encourage patients to set a quit date or discuss medication options
(assist) and perform follow-up activities (arrange). Barriers significantly
associated with clinical tobacco treatment practice are lack of training
and competing priorities in the visit. One-office support, a system in
place to provide smoking cessation information and resources, was
associated with increased practice. In summary, midwives believe they
should be providing tobacco dependence treatment, yet they identify a need
for training. The findings of this study also indicate that sustained
practice change, which includes the entire practice environment, should be
targeted to enhance tobacco dependence treatment.
Keywords: clinician practice-based office supports; midwives tobacco
cessation counseling; pregnancy and tobacco treatment; tobacco dependence
treatment
Anna R. Magnusardottir, Laufey Steingrimsdottir, Holmfridur

Thorgeirsdottir, Geir Gunnlaugsson, Gudrun V. Skuladottir, Docosahexaenoic
acid in red blood cells of women of reproductive age is positively
associated with oral contraceptive use and physical activity,
Prostaglandins, Leukotrienes and Essential Fatty Acids, Volume 80, Issue 1,
January 2009, Pages 27-32, ISSN 0952-3278, 10.1016/j.plefa.2008.10.004.
Abstract: Optimal intake of the long-chain n-3 polyunsaturated fatty acid
(PUFA) docosahexaenoic acid (DHA) and proper balance between intake of n-6
PUFA and n-3 PUFA are important for human health. Considerable evidence
exists to show that DHA has a marked benefit during pregnancy. Lifestyle
factors can affect the biosynthesis of DHA from dietary precursors,
incorporation into membranes and degradation. The purpose of this study was
to investigate the PUFA composition of red blood cells (RBCs) from women
(n=40) in reproductive age, and how it is affected by diet and other
lifestyle factors. Of all the lifestyle factors tested oral contraceptive
use and physical activity were the ones correlated with DHA in RBCs, after
adjustment for DHA intake. The findings indicate that oral contraceptive
use and physical activity have a positive impact on the DHA status, as
assessed by RBC level, of women in reproductive age.
Keywords: Docosahexaenoic acid; Red blood cells; Oral contraceptives;
Physical activity; n-6/n-3 Polyunsaturated fatty acid ratio; Women of
reproductive age
Daphna Oyserman, Deborah Bybee, Carol Mowbray, Tamera Hart-Johnson, When

mothers have serious mental health problems: parenting as a proximal
mediator, Journal of Adolescence, Volume 28, Issue 4, August 2005, Pages
443-463, ISSN 0140-1971, 10.1016/j.adolescence.2004.11.004.
Abstract: Maternal mental health (MMH) problems are associated with lack of
confidence in one's parenting, overly lax or too harsh discipline, and
child academic underperformance. We asked if parenting mediates the effect
of MMH problems on academic outcomes even among mothers with serious mental
illness ( n = 164 ). Structural equation analyses show a significant
association between MMH problems and permissive (lack of parenting
confidence, lack of follow through) parenting and verbal hostility as well
as worse academic outcomes (school recorded grades, teacher reported
behaviour). Permissive parenting completely mediated the direct effect of
MMH on academic outcomes. Further analyses showed that the mediation effect
was attributed to a single component of permissive parentinglack of
parenting confidence.
Philip Wilson, Christine Puckering, Alex McConnachie, Helen Marwick, Nadja

Reissland, Christopher Gillberg, Inexpensive video cameras used by parents
to record social communication in epidemiological investigations in early
childhoodA feasibility study, Infant Behavior and Development, Volume 34,
10.1016/j.infbeh.2010.09.007.
Abstract: We tested the feasibility of parents recording social
interactions with their infants using inexpensive camcorders, as a
potential method of effective, convenient, and economical large scale data
gathering on social communication. Participants were asked to record two
short video clips during either play or a mealtime, and return the data.
Sixty-five video clips (32 pairs) were returned by 33 families, comprising
8.5% of families contacted, 44.6% of respondents and 51.6% of those sent a
camcorder, and the general visual and sound quality of the data was
assessed.
Audio and video quality were adequate for analysis in 85% of clips and
several social behaviours, including social engagement and contingent
responsiveness, could be assessed in 97% of clips. We examined two
quantifiable social behaviours quantitatively in both adults and infants:
gaze direction and duration, and vocalization occurrence and duration. It
proved difficult for most observers to obtain a simultaneous clear view of
the parents and infant's face.
Video clips obtained by parents are informative and usable for analysis.
Further work is required to establish the acceptability of this technique
in longitudinal studies of child development and to maximize the return of
usable data.
Keywords: Social interaction; Video camera; Communication; Autism; Infants
Harold M. Teel, Problems in maternal hygiene and their relation to

pediatrics, The Journal of Pediatrics, Volume 12, Issue 6, June 1938, Pages
803-825, ISSN 0022-3476, 10.1016/S0022-3476(38)80070-6.
Ross D. Parke, Social Development in Infancy: A 25-Year Perspective, In:

Hayne W. Reese, Editor(s), Advances in Child Development and Behavior, JAI,
1989, Volume 21, Pages 1-48, ISSN 0065-2407, ISBN 9780120097210,
10.1016/S0065-2407(08)60281-5.
Caroline S.E. Homer, Kathryn Henry, Virginia Schmied, Lynn Kemp, Nicky
Leap, Carolyn Briggs, It looks good on paper: Transitions of care between
midwives and child and family health nurses in New South Wales, Women and
Birth, Volume 22, Issue 2, June 2009, Pages 64-72, ISSN 1871-5192,
10.1016/j.wombi.2009.01.004.
The way in which women and their babies transition from maternity services
to the care of child and family health nurses differs across Australia. The
aim of the study was to understand the transition of care from one service
to another and how to promote collaboration in the first few weeks after
the birth.
Method
A descriptive study was undertaken. All midwifery, child and family health
and Families NSW managers in NSW were invited to participate by completing
a questionnaire.
Results
There was a wide range of transition of care models. These varied by
setting, geography, context and history. Three main models emerged from the
analysis. These were as follows:1.
Structured, non-verbal communication system that relied on paper-based or
computerised systems. This included either centralised referral or centre-
based referral processes.
2.
Liaison person model which was similar to purposeful contact, but with
everything vested in one clinician who is responsible for the coordination
and organisation.
3.
Purposeful contact model which was mostly for identified at-risk women and
included continuity of care with formal networks and face to face contact.
Discussion
There were a range of different models of transition of care identified in
NSW depending on local context, expertise, interests and policies. Some are
very structured and others have developed and evolved over time. Many
models seem to be dependant on the goodwill and enthusiasm of individual
clinicians.
Conclusion
A more coordinated and systematised approach needs to be developed.
Collaboration and communication between midwives and child and family
health nurses is essential if the needs of families are to be addressed
during this transition period.
Keywords: Midwives; Maternity services; Community child health; Child and
family health nurses; Health visitors; Maternal and child health
Anita Thapar, Stephan Collishaw, Daniel S Pine, Ajay K Thapar, Depression

in adolescence, The Lancet, Volume 379, Issue 9820, 1723 March 2012, Pages
1056-1067, ISSN 0140-6736, 10.1016/S0140-6736(11)60871-4.
Abstract: Summary
Unipolar depressive disorder in adolescence is common worldwide but often
unrecognised. The incidence, notably in girls, rises sharply after puberty
and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The
burden is highest in low-income and middle-income countries. Depression is
associated with substantial present and future morbidity, and heightens
suicide risk. The strongest risk factors for depression in adolescents are
a family history of depression and exposure to psychosocial stress.
Inherited risks, developmental factors, sex hormones, and psychosocial
adversity interact to increase risk through hormonal factors and associated
perturbed neural pathways. Although many similarities between depression in
adolescence and depression in adulthood exist, in adolescents the use of
antidepressants is of concern and opinions about clinical management are
divided. Effective treatments are available, but choices are dependent on
depression severity and available resources. Prevention strategies targeted
at high-risk groups are promising.
Sally Dodds, Nancy T Blaney, Elane M Nuehring, Theresa Blakley, Jean-Marie

Lizzotte, JoNell E Potter, Mary J OSullivan, Integrating mental health
services into primary care for HIV-infected pregnant and non-pregnant
women: whole lifea theoretically derived model for clinical care and
outcomes assessment, General Hospital Psychiatry, Volume 22, Issue 4, July
August 2000, Pages 251-260, ISSN 0163-8343, 10.1016/S0163-8343(00)00090-6.
Abstract: Poor women of color who are disproportionately both infected and
affected by HIV/AIDS also face multiple lifestyle and psychosocial burdens
that complicate effective delivery of health care, thereby contributing to
their poorer prognosis. Addressing these factors within the context of
HIV/AIDS primary care for women is the aim of Whole Life, a program to
integrate mental health services into primary care for HIV-infected
pregnant and non-pregnant women. Whole Life utilizes a theoretically
derived clinical services model that provides data for both clinical care
and patient outcomes research within the constraints of a clinical setting.
During a womans first two clinic visits, data are gathered in structured
interviews with standardized instrumentsadapted for relevance to the
populationthat meet clinical and service needs, as well as measure
components of the Whole Life model. Interviews are conducted by existing
front-line staff who have been trained in using these instruments to gather
information typically recorded in clinical notes. The implementation of
Whole Life to date clearly demonstrates the feasibility of mental health
primary care services integration in a publicly funded HIV primary care
clinic serving poor women of color.
Kimberly L. D'Anna-Hernandez, Randal G. Ross, Crystal L. Natvig, Mark L.

Laudenslager, Hair cortisol levels as a retrospective marker of
hypothalamicpituitary axis activity throughout pregnancy: Comparison to
salivary cortisol, Physiology & Behavior, Volume 104, Issue 2, 3 August
2011, Pages 348-353, ISSN 0031-9384, 10.1016/j.physbeh.2011.02.041.
Abstract: Maternal stress during pregnancy is associated with negative
maternal/child outcomes. One potential biomarker of the maternal stress
response is cortisol, a product of activity of the hypothalamicpituitary
adrenal axis. This study evaluated cortisol levels in hair throughout
pregnancy as a marker of total cortisol release. Cortisol levels in hair
have been shown to be easily quantifiable and may be representative of
total cortisol release more than single saliva or serum measures. Hair
cortisol provides a simple way to monitor total cortisol release over an
extended period of time. Hair cortisol levels were determined from each
trimester (15, 26 and 36 weeks gestation) and 3 months
postpartum. Hair cortisol levels were compared to diurnal salivary cortisol
collected over 3 days (3 times/day) at 14, 18, 23, 29, and
34 weeks gestational age and 6 weeks postpartum from 21 pregnant
women. Both salivary and hair cortisol levels rose during pregnancy as
expected. Hair cortisol and diurnal salivary cortisol area under the curve
with respect to ground (AUCg) were also correlated throughout pregnancy.
Levels of cortisol in hair are a valid and useful tool to measure long-term
cortisol activity. Hair cortisol avoids methodological problems associated
with collection other cortisol measures such as plasma, urine, or saliva
and is a reliable metric of HPA activity throughout pregnancy reflecting
total cortisol release over an extended period.
Keywords: Hypothalamicpituitaryadrenal axis; Stress biomarkers; Thrifty
phenotype; Early programming
H. Shonna Yin, Shalini G. Forbis, Benard P. Dreyer, Health Literacy and

Pediatric Health, Current Problems in Pediatric and Adolescent Health Care,
10.1016/j.cppeds.2007.04.002.
Suzanne Yates, CHAPTER 1 - Western approach to pregnancy, Pregnancy and

Childbirth, Churchill Livingstone, Edinburgh, 2010, Pages 7-61, ISBN
9780702030550, 10.1016/B978-0-7020-3055-0.00001-7.
Shunyue Cheng, Naoji Kondo, Yutaka Aoki, Yumi Kitamura, Yasuhisa Takeda,
Zentaro Yamagata, The effectiveness of early intervention and the factors
related to child behavioural problems at age 2: A randomized controlled
trial, Early Human Development, Volume 83, Issue 10, October 2007, Pages
683-691, ISSN 0378-3782, 10.1016/j.earlhumdev.2007.01.008.
The aim of this study was to assess the effectiveness of early home-based
intervention as a community health service and evaluate the influence of
both early maternal depression and motherinfant relationships on child
behavioral problems at age 2 in a longitudinal setting.
Methods
A randomized controlled trial was conducted in this study. A total of 95
motherinfant pairs were assigned randomly to intervention (48) or control
(47) groups. The intervention group received monthly specific home visits
between the infant ages of 5 and 9 months while the control group received
only routine center-based services. Maternal depression and the mother
infant relationship were assessed by medical checkups at the ages of 4 and
10 months. Child behavioral problems were assessed at age 2.
Results
The intervention had no significant impact on child behavioral problems.
However, for mothers who had a disturbed relationship with their infants,
the rate of improvement in the quality of the relationship was higher in
the intervention group. Disturbed motherinfant relationships at 10 months
and early maternal depression significantly increased the risk of high
scores on the Child Behavior Checklist (CBCL).
Conclusions
These findings indicate that intervention is most likely to have a positive
impact on the quality of motherinfant relationships in cases where the
relationship is disturbed and that a disturbed motherinfant relationship
and maternal depression during infancy are relevant to the future mental
health of the child. To prevent difficulties in child functioning, more
prolonged interventions focusing on disturbed motherinfant relationships
may be required.
Keywords: Motherinfant relationship; Behavioral; Intervention; CBCL; Home
visit; Maternal depression
Catherine d'Arcangues, Family planning needs: new opportunities, emergency

contraception and other new technologies, Reproductive BioMedicine Online,
Volume 3, Issue 1, 2001, Pages 34-41, ISSN 1472-6483, 10.1016/S1472-
6483(10)61962-1.
Abstract: Modern contraception is considered to be one the major advances
of the 20th century. Yet, as the next century begins, it is estimated that
there is still a largely unmet need for contraception, with millions of
couples worldwide who express a wish to limit the number of their children
but do not use or are not satisfied with their contraceptive method. While
the reasons are numerous, it is clear that there is a need for improved and
new methods which are easier to use, under the user's control, with fewer
side-effects and responding to the needs of different groups of users,
including men. To respond to this need, current contraceptive research and
development efforts focus on five main areas: emergency post-coital
methods, user-controlled long-acting methods, dual protection methods
against both pregnancy and sexually transmitted infections, methods for
men, and methods with fewer side-effects including some that are more
targeted to specific reproductive biological events. A number of leads are
presented which are at various stages of development. Concluding remarks
stress the numerous challenges of contraceptive development, not the least
of which is the vision required of what the needs of future generations
will be, since it takes 10-15 years to bring a new contraceptive to the
market. More fundamentally, overall progress towards reducing the unmet
need for contraception will depend on the status of women, specifically
their decision-making power, and access to education and income.
Keywords: contraception; education; family planning; future methods;
pregnancy; side-effects
Elizabeth Anderson, Deborah Dillon McDonald, Ismat Mikky, Thomas Brewer,

Cindy Koscizewski, Sheryl LaCoursiere, Laura Andrews, Colleen Delaney,
Health care implications and space allocation of research published in
nursing journals, Nursing Outlook, Volume 51, Issue 2, April 2003, Pages
70-83, ISSN 0029-6554, 10.1016/S0029-6554(02)05451-9.
Abstract: Publishing research in professional peer-reviewed journals
remains one of the most valuable ways to disseminate research.
Purpose
To examine how research is disseminated through nursing journals and to
examine characteristics of published research.
Design
A cross-sectional descriptive survey was conducted with manuscripts from 78
nursing journals that publish research.
Method
The final issue for 1999 was examined. Pairs of independent raters content-
analyzed all research manuscripts.
Discussion
Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the
journal space. Many empirical studies omitted validity and reliability. Few
manuscripts reported the date for completion of data collection, and fewer
than one third contained the length of time from acceptance to publication.
Conclusions
Enhanced instrumentation reporting, shorter time from data collection to
publication, and an increase in journal space devoted to research might
enable nurses to make more cutting-edge clinical decisions.
Cynthia D. Fair, Taylor E. Morrison, The relationship between prenatal

control, expectations, experienced control, and birth satisfaction among
primiparous women, Midwifery, Volume 28, Issue 1, February 2012, Pages 39-
44, ISSN 0266-6138, 10.1016/j.midw.2010.10.013.
this paper explores the relationship between perceptions of prenatal
control, expectations for childbirth, and experienced control in labour and
birth and how they individually and collectively affect birth satisfaction.
Design
a repeated measures exploratory study was conducted with 31 primiparous
women between 26 and 40 weeks pregnant. Standardised interviews were
conducted prior to birth to assess levels of prenatal control and
expectations for control during childbirth. Six weeks after the birth,
women were interviewed again to assess experiences of control and birth
satisfaction.
Setting
prenatal clinic, North Carolina, USA.
Findings
results show experienced control to be a significant predictor of birth
satisfaction, with high levels of control correlating with high
satisfaction levels. However, no correlations were found between the three
aspects of control, and both prenatal control and birth expectations were
found to have no significant effect on birth satisfaction. Findings also
indicate that women cared for by midwives have significantly higher
experienced control and birth satisfaction than women whose care was
provided by obstetricians, while incidence of caesarean birth did not
affect either measure.
Conclusions
experienced control during labour and birth is an important predictor of
birth satisfaction. Health care providers should collaborate with the women
they care for to use techniques that maximize the experience of control
especially during labour and birth.
Keywords: Birth satisfaction; Childbirth; Control; Expectation
Embry M Howell, Ira J Chasnoff, Perinatal Substance Abuse Treatment:

Findings From Focus Groups With Clients and Providers, Journal of Substance
Abuse Treatment, Volume 17, Issues 12, JulySeptember 1999, Pages 139-148,
ISSN 0740-5472, 10.1016/S0740-5472(98)00069-5.
Abstract: Thirty-three focus groups were conducted with pregnant women in
substance abuse treatment and their providers in order to identify factors
in women's lives that facilitate and hamper their treatment process and
successful program components to address the needs of this high-risk
population. The focus groups were conducted as part of a larger evaluation
of demonstrations funded by the Health Care Financing Administration. From
the 88 women in the focus groups we received a picture of their troubled
lives and the events that led to their participation in the programs. The
women had difficult childhoods, and currently had weak support networks and
difficult relationships with male partners, many of whom were substance
abusers. Most had children, which complicated getting into and staying in
treatment. However, fear of losing custody of children was a major
motivator for treatment. Important components of successful programs
included: (a) the development of interorganizational linkages between
various governmental agencies, especially child protection systems,
prenatal care providers, and substance abuse treatment agencies and
providers; (b) outreach and systems for identifying pregnant substance
abusers through provider education and routine screening; and (c) intensive
case management, necessary to link women to the many services they needed
in order to obtain treatment, such as child care, transportation, and
housing. Published by Elsevier Science Inc.
Keywords: focus groups; pregnancy; Medicaid; substance abuse treatment
Yuanjing Ren, Xinguang Chen, Bonita Stanton, Are Urban Low-Income Children
From Unplanned Pregnancy Exposed to Higher Levels of Environmental Tobacco
Smoke?, Journal of Pediatric Health Care, Volume 26, Issue 3, MayJune
2012, Pages 174-181, ISSN 0891-5245, 10.1016/j.pedhc.2010.07.008.
The negative consequences of environmental tobacco smoke (ETS) in children
have been well documented. Our objective is to assess whether children of
unplanned pregnancies are at increased risk for ETS exposure.
Method
Data were collected through interviews of mothers who accompanied their
children to the Childrens Hospital of Michigan, Detroit, Michigan.
Associations of ETS exposure with unplanned pregnancy were analyzed using
the 2 test and stratified by maternal smoking status. Results from the
bivariate analysis were further verified using a multiple logistic
regression method to control for significant covariates.
Results
Among the sample of 399 children, 125 (31.3%) were born from unplanned
pregnancies; 47.2% of the unplanned children and 25.6% of the planned
children were exposed to ETS (2 = 18.4, p < .01). Unplanned children of
non-smoking mothers also experienced higher levels of exposure to ETS
compared with planned children (22.45% vs. 10.05%, 2 = 5.50, p < .05).
The association remained significant after controlling for covariates
(adjusted odds ratio = 2.45; 95% confidence interval = 1.03, 5.84; p < .
05).
Discussion
Findings of this study suggest the importance of preventing ETS in urban
children, particularly those from unplanned pregnancies.
Keywords: Environmental tobacco smoke; unplanned pregnancy; urban children
, New in review, Journal of the American Dietetic Association, Volume 93,

Issue 4, April 1993, Pages 480-484,486-488,490-492,494,497-502, ISSN 0002-
8223, 10.1016/0002-8223(93)92304-G.
Stergios K. Doumouchtsis, Sabaratnam Arulkumaran, Head Trauma After

Instrumental Births, Clinics in Perinatology, Volume 35, Issue 1, March
2008, Pages 69-83, ISSN 0095-5108, 10.1016/j.clp.2007.11.006.
Abstract: Instrumental vaginal delivery involves the use of the vacuum
extractor or obstetric forceps to facilitate delivery of the fetus. It is
associated with substantial risk of head injury, including hemorrhage,
fractures, and, rarely, brain damage or fetal death. This review article
describes the different types, etiology, pathophysiology, risk factors, and
clinical features of head trauma after instrumental birth, along with their
management and prevention strategies.
Katy Dawley, Helen Varney Burst, The American College of Nurse-Midwives and
its antecedents: A historic time line, Journal of Midwifery & Women's
Health, Volume 50, Issue 1, January 2005, Pages 16-22, ISSN 1526-9523,
10.1016/j.jmwh.2004.09.011.
Abstract: In celebration of the 50th anniversary of the American College of
Nurse-Midwives, this time line presents a chronologic history of the
development of nurse-midwifery in the United States. It places the
introduction of nurse-midwifery in American health care into its historic
context and follows the evolution of the profession through early attempts
at forming a national organization, the eventual formation of the American
College of Nurse-Midwifery, and the subsequent merger with the American
Association of Nurse-Midwives, to create the American College of Nurse-
Midwives. The work of the College between 1955 and the turn of the 21st
century is highlighted.
Keywords: nurse-midwifery; history; public health nursing; American College
of Nurse-Midwives; midwifery; midwifery education
Deborah Davis, Maralyn Foureur, Vanessa Clements, Patricia Brodie, Peter

Herbison, The self reported confidence of newly graduated midwives before
and after their first year of practice in Sydney, Australia, Women and
Birth, Available online 20 April 2011, ISSN 1871-5192,
10.1016/j.wombi.2011.03.005.
Graduates from a new, 3-year Bachelor of Midwifery program joined those
educated through the 1 year, postgraduate route (for those already
qualified as nurses) for the first time in New South Wales (NSW) Australia
in 2007. Many hospitals offer transition support programs for new graduates
during their first year of practice though there is little evidence
available to inform these programs.
Objectives
To establish the new midwife's confidence in working to the 14 National
Competency Standards for the Midwife1 and the International Confederation
of Midwives (ICM) Definition of a Midwife and to explore whether the new
midwife's confidence changed over the new graduate year. In particular the
study set out to determine whether there were any differences in the
confidence of new graduates from undergraduate or postgraduate programs.
Design
Pre and post survey with comparisons longitudinally and within
undergraduate and postgraduate cohorts.
Settings
Three Area Health Services in Sydney and surrounding areas, Australia.
Participants
A convenience sample of all new graduate midwives employed in the three
Area Health Services in the early months of 2008.
Methods
New graduate midwives rated their level of confidence (110) in working to
the 14 National Competency Standards for the Midwife and the ICM Definition
of a Midwife during their first weeks of employment and after the
completion of their first year of practice.
Results
Midwives prepared through the undergraduate and postgraduate routes
commenced their first year of practice with similar levels of confidence.
The confidence of these midwives increased modestly over the first year of
practice. Those from postgraduate programs were significantly more
confident than those from undergraduate programs on four competencies after
the first year of practice. Participant's self reported confidence in
working to the ICM Definition of a Midwife was low.
Conclusions
Our profession and community need strong, confident midwives and it is in
all our interests to look to ways we can best achieve this. While the
findings of this study should be treated with caution, this study suggests
that there is room for improvement in the way we support newly graduated
midwives to build their confidence over their first year of practice.
Further research is needed to identify the needs of newly graduated
midwives and how best we can support them to develop as strong and
confident practitioners through their first year of practice.
Keywords: Midwifery; Health services; Workforce; Confidence
Joan Forns, Nerea Lertxundi, Aritz Aranbarri, Mario Murcia, Mireia Gascon,
David Martinez, James Grellier, Aitana Lertxundi, Jordi Julvez, Eduardo
Fano, Fernando Goi, Joan O. Grimalt, Ferran Ballester, Jordi Sunyer, Jesus
Ibarluzea, Prenatal exposure to organochlorine compounds and
neuropsychological development up to two years of life, Environment
International, Volume 45, 15 September 2012, Pages 72-77, ISSN 0160-4120,
10.1016/j.envint.2012.04.009.
Abstract: Polychlorinated biphenyls (PCB), hexachlorobenzene (HCB), and
dichlorodiphenyl dichloroethylene (ppDDE) are persistent, bioaccumulative,
and toxic environmental pollutants with potential neurotoxic effects.
Despite a growing body of studies investigating the health effects
associated with these compounds, their specific effects on early
neuropsychological development remain unclear. We investigated such
neuropsychological effects in a population-based birth cohort based in
three regions in Spain (Sabadell, Gipuzkoa, and Valencia) derived from the
INMA [Environment and Childhood] Project. The main analyses in this report
were based on 1391 motherchild pairs with complete information on maternal
levels of organochlorine compounds and child neuropsychological assessment
(Bayley Scales of Infant Development) at age 14 months. We found that
prenatal PCB exposure, particularly to congeners 138 and 153, resulted in
impairment of psychomotor development (coefficient = 1.24,
95% confidence interval = 2.41, 0.07), but found no
evidence for effects on cognitive development. Prenatal exposure to ppDDE
or HCB was not associated with early neuropsychological development. The
negative effects of exposure to PCBs on early psychomotor development
suggest that the potential neurotoxic effects of these compounds may be
evident even at low doses.
Keywords: Child development; Organochlorine compounds; Polychlorinated
biphenyls; Hexachlorobenzene; Dichlorodiphenyl dichloroethylene;
Neuropsychology
Gaynor D Maclean, The challenge of preparing and enabling skilled

attendants to promote safer childbirth, Midwifery, Volume 19, Issue 3,
6.
Abstract: The worldwide challenge to reduce maternal mortality is beset by
numerous and complex issues. Currently, there is a special focus on the
role of midwives and others who provide skilled care, their education and
the environment in which they are challenged to practice. A review of some
of the historical evidence highlights and considers some critical lessons
learned in preparing and utilising skilled personnel to attend women at
this vulnerable time in their lives. The importance of providing an
environment that enables care providers to function effectively is
explored. The indispensable merit of political commitment to reducing
maternal mortality becomes evident through consideration of achievements in
various countries both historically and currently. It is apparent that
making childbirth safer is a multifaceted issue that still presents
challenges across much of the globe in the 21st century and that this can
never be taken for granted in any historical phase or geographical
location.
In this paper I embrace a major literature search and share findings

emerging from studies and activities undertaken on behalf of various
national and international organizations, though it does not necessarily
reflect the views of those organizations.
Jeanne Raisler, Against the odds: breastfeeding experiences of low income

mothers, Journal of Midwifery & Women's Health, Volume 45, Issue 3,
MayJune 2000, Pages 253-263, ISSN 1526-9523, 10.1016/S1526-9523(00)00019-
2.
Abstract: This qualitative study asked low income mothers about their
experiences of breastfeeding care in the health system and about
integrating breastfeeding into their daily lives. Focus group interviews
were conducted with urban and rural nursing mothers who participated in the
WIC Program and were supported by breastfeeding peer counselors. Mothers
said that helpful breastfeeding care providers knew correct information,
established supportive personal relationships, referred women to
breastfeeding specialists for problems, showed enthusiasm for nursing, and
facilitated breastfeeding through concrete actions during the prenatal,
intrapartum, and postpartum periods. Unhelpful providers missed
opportunities to discuss breastfeeding, gave misinformation, encouraged
formula supplementation, provided perfunctory or routine breastfeeding
care, and were hard to contact when problems arose. Women valued their
breastfeeding peer counselors for responding promptly to distress calls,
making home visits, being knowledgeable about breastfeeding, providing
hands-on assistance, and acting personal and caring. Incorporating
breastfeeding into daily activities was a challenge for many mothers.
Ambivalence about the physical bond of nursing, personal modesty, and
getting on with life at home, work, or school were identified as important
issues. Listening to the thoughts and experiences of low income nursing
mothers can help health workers to provide more culturally sensitive,
effective breastfeeding care to this population.
Barbara E. Kwast, Midwives' role in safe motherhood, Journal of Nurse-

Midwifery, Volume 36, Issue 6, NovemberDecember 1991, Pages 366-372, ISSN
0091-2182, 10.1016/0091-2182(91)90109-3.
Vicky Newman, Position of the American dietetic association: Promotion and

support of breast-feeding, Journal of the American Dietetic Association,
10.1016/0002-8223(93)92300-M.
(http://www.sciencedirect.com/science/article/pii/000282239392300M)
Kimberly K. Vesco, Njeri Karanja, Janet C. King, Matthew W. Gillman, Nancy

Perrin, Cindy McEvoy, Cara Eckhardt, K. Sabina Smith, Victor J. Stevens,
Healthy Moms, a randomized trial to promote and evaluate weight maintenance
among obese pregnant women: Study design and rationale, Contemporary
Clinical Trials, Volume 33, Issue 4, July 2012, Pages 777-785, ISSN 1551-
7144, 10.1016/j.cct.2012.03.006.
Obesity and excessive weight gain during pregnancy are associated with
adverse pregnancy outcomes. Observational studies suggest that minimal or
no gestational weight gain (GWG) may minimize the risk of adverse pregnancy
outcomes for obese women.
Objective
This report describes the design of Healthy Moms, a randomized trial
testing a weekly, group-based, weight management intervention designed to
help limit GWG to 3% of weight (measured at the time of randomization)
among obese pregnant women (BMI 30 kg/m2). Participants
are randomized at 1020 weeks gestation to either the intervention or
a single dietary advice control condition.
Primary outcomes
The study is powered for the primary outcome of total GWG, yielding a
target sample size of 160 women. Additional secondary outcomes include
weight change between randomization and one-year postpartum and proportion
of infants with birth weight > 90th percentile for gestational
age. Statistical analyses will be based on intention-to-treat.
Methods
Following randomization, all participants receive a 45-minute dietary
consultation. They are encouraged to follow the Dietary Approaches to Stop
Hypertension diet without sodium restriction. Intervention group
participants receive an individualized calorie intake goal, a second
individual counseling session and attend weekly group meetings until they
give birth. Research staff assesses all participants at 34-weeks gestation
and at 2-weeks and one-year postpartum with their infants.
Summary
The Healthy Moms study is testing weight management techniques that have
been used with non-pregnant adults. We aim to help obese women limit GWG to
improve their long-term health and the health of their offspring.
Keywords: Weight gain; Pregnancy; Diet
Leanne Whiteside-Mansell, Cynthia C Crone, Nicola A Conners, The

Development and Evaluation of an Alcohol and Drug Prevention and Treatment
Program for Women and Children: The AR-CARES Program, Journal of Substance
Abuse Treatment, Volume 16, Issue 3, April 1999, Pages 265-275, ISSN 0740-
5472, 10.1016/S0740-5472(98)00049-X.
Abstract: This study examined the evolution of the Arkansas Center for
Addictions Research, Education, and Services (AR-CARES) over a 5-year
period and evaluated its impact on women and children. The program was
designed to provide comprehensive substance use prevention and treatment
services to low-income pregnant and parenting women and their children. The
program changed significantly over this time, based upon input from clients
and staff, as well as in response to changing community resources. The
evaluation suggests that the program had an impact on the substance use of
study participants, birth outcomes, and the growth and development of
children.
Keywords: AOD; program development; program evaluation; substance abuse;
womens AOD prevention and treatment
Prema Ramachandran, Breast-feeding and fertility: Sociocultural factors,

1, 1987, Pages 191-206, ISSN 0020-7292, 10.1016/0020-7292(87)90405-X.
Keywords: Lactation; Fertility; Supplementary feeds; Maternal nutrition
Rebecca Meiksin, Judy C. Chang, Tina Bhargava, Robert Arnold, Diane Dado,
Richard Frankel, Keri L. Rodriguez, Bruce Ling, Susan Zickmund, Now is the
chance: Patientprovider communication about unplanned pregnancy during the
first prenatal visit, Patient Education and Counseling, Volume 81, Issue 3,
December 2010, Pages 462-467, ISSN 0738-3991, 10.1016/j.pec.2010.09.002.
Abstract: Objective
Unplanned pregnancy is associated with psychosocial stress, post-partum
depression, and future unplanned pregnancies. Our study describes how
topics related to unplanned pregnancy were addressed with patients during
the first prenatal visit.
Methods
We audio-recorded and transcribed initial prenatal visits between 48
patients and 16 providers from a clinic serving racially diverse, lower-
socio-economic patients. We conducted a fine-grained thematic analysis of
cases in which the patient's pregnancy was unplanned.
Results
Of the 48 patients, 35 (73%) had unplanned pregnancies. Twenty-nine visits
for unplanned pregnancies (83%) included discussion of the patient's
feelings about the pregnancy. Approximately half (51%) of the visits
touched on partner or other types of social support. Six patients (17%)
were offered referrals to counseling or social services. Only four visits
(11%) touched on future birth control options.
Conclusion
Most initial prenatal visits for unplanned pregnancies included discussion
of patient feelings about the pregnancy. However, opportunities to discuss
future birth control and for more in-depth follow-up regarding social
support and psychological risks associated with unplanned pregnancy were
typically missed.
Obstetrics care providers should be cautious about making assumptions and
should consider discussing pregnancy circumstances and psychosocial issues
in more depth when treating patients facing unplanned pregnancy.
Keywords: Patientprovider relationship; Communication; Prenatal care;
Pregnancy; Unplanned
R. Hermes, J. Saragusty, W. Schaftenaar, F. Gritz, D.L. Schmitt, T.B.

Hildebrandt, Obstetrics in elephants, Theriogenology, Volume 70, Issue 2,
15 July 2008, Pages 131-144, ISSN 0093-691X,
10.1016/j.theriogenology.2008.04.003.
Abstract: Obstetrics, one of the oldest fields in veterinary medicine, is
well described and practiced in domestic and exotic animals. However, when
providing care during elephant birth or dystocia, veterinary intervention
options differ greatly from any domestic species, and are far more limited
due to the dimensions and specific anatomy of the elephant reproductive
tract. In addition, aging of captive elephant populations and advanced age
of primiparous females make active birth management increasingly important.
Intrauterine infection, uterine inertia and urogenital tract pathologies
are emerging as major causes for dystocia, often leading to foetal and dam
death. This paper reviews the current knowledge on elephant birth and the
factors associated with dystocia. It then summarises recommendations for
birth and dystocia management. As Caesarean section, the most common ultima
ratio in domestic animal obstetrics, is lethal and therefore not an option
in the elephant, non-invasive medical treatment, induction of the Fergusson
reflex or the conscious decision to leave a retained foetus until it is
expelled voluntarily, are key elements in elephant obstetrics. Surgical
strategies such as episiotomy and foetotomy are sometimes inevitable in
order to try to save the life of the dam, however, these interventions
result in chronic post-surgical complications or even fatal outcome.
Limited reliable data on serum calcium concentrations, and pharmacokinetics
and effect of exogenous oestrogen, oxytocin, and prostaglandins during
birth provide the scope of future research, necessary to advance scientific
knowledge on obstetrics in elephants.
Keywords: Obstetrics; Dystocia; Parturition; Loxodonta africana; Elephas
maximus
May Loo, Chapter 11 - Select Populations: Children, In: John W. Spencer,

PhD, and Joseph J. Jacobs, MD, MBA, Editor(s), Complementary and
Alternative Medicine (Second Edition), Mosby, Saint Louis, 2003, Pages 409-
457, ISBN 9780323020282, 10.1016/B978-0-323-02028-2.50015-2.
France Galerneau, Silvio E. Inzucchi, Diabetes mellitus in pregnancy,

Obstetrics and Gynecology Clinics of North America, Volume 31, Issue 4,
December 2004, Pages 907-933, ISSN 0889-8545, 10.1016/j.ogc.2004.09.002.
Marianne E. McPherson, Charles J. Homer, Policies to Support Obesity

Prevention for Children: A Focus on of Early Childhood Policies, Pediatric
Clinics of North America, Volume 58, Issue 6, December 2011, Pages 1521-
1541, ISSN 0031-3955, 10.1016/j.pcl.2011.09.001.
Keywords: Childhood obesity prevention; Healthy weight; Policy; Early
childhood; Advocacy; Health care professionals
Chantal Lau, Nancy Hurst, Oral feeding in infants, Current Problems in

Pediatrics, Volume 29, Issue 4, April 1999, Pages 105-124, ISSN 0045-9380,
10.1016/S0045-9380(99)80052-8.
Catherine S. Bradley, Holly E. Richter, Robert E. Gutman, Morton B. Brown,

William E. Whitehead, Paul M. Fine, Christiane Hakim, Frank Harford, Anne
M. Weber, Pelvic Floor Disorders Network, Risk factors for sonographic
internal anal sphincter gaps 6-12 months after delivery complicated by anal
sphincter tear, American Journal of Obstetrics and Gynecology, Volume 197,
Issue 3, September 2007, Pages 310.e1-310.e5, ISSN 0002-9378,
10.1016/j.ajog.2007.06.034.
Abstract: Objective
The objective of the study was to identify risk factors for internal anal
sphincter (IAS) gaps on postpartum endoanal ultrasound in women with
obstetric anal sphincter tear.
Study Design
This prospective study included 106 women from the Childbirth and Pelvic
Symptoms Imaging Supplementary Study who had third- or fourth-degree
perineal laceration at delivery and endoanal ultrasound 6-12 months
postpartum. Data were analyzed using Fishers exact and t tests and
logistic regression.
Results
Mean ( SD) age was 27.7 ( 6.2) years. Seventy-nine women (76%) were white
and 22 (21%) black. Thirty-seven (35%) had sonographic IAS gaps. Risk
factors for gaps included fourth- vs third-degree perineal laceration (odds
ratio [OR] 15.4, 95% confidence interval [CI] 4.8, 50) and episiotomy (OR
3.3, 95% CI 1.2, 9.1). Black race (OR 0.23, 95% CI 0.05, 0.96) was
protective.
Conclusion
In women with obstetric anal sphincter repairs, fourth-degree tears and
episiotomy are associated with more frequent sonographic IAS gaps.
Keywords: anal sphincter laceration; endoanal ultrasound; postpartum fecal
incontinence
Emmalee S Bandstra, Connie E Morrow, April L Vogel, Robert C Fifer, Audrey

Y Ofir, Ana T Dausa, Lihua Xue, James C Anthony, Longitudinal influence of
prenatal cocaine exposure on child language functioning, Neurotoxicology
and Teratology, Volume 24, Issue 3, MayJune 2002, Pages 297-308, ISSN
0892-0362, 10.1016/S0892-0362(02)00192-7.
Abstract: The present study estimates the longitudinal effects of in utero
cocaine exposure on language functioning at 3, 5 and 7 years of age in an
urban sample of 443 full-term children (236 cocaine-exposed and 207
noncocaine-exposed) participating in the Miami Prenatal Cocaine Study. The
sample was enrolled prospectively at birth, with documentation of prenatal
drug exposure status through maternal interview and urine and meconium
toxicology assays. Language functioning was measured at ages 3 and 5 years
using the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P)
and at age 7 years using the Core Language Domain of the NEPSY: A
Developmental Neuropsychological Assessment. Longitudinal Generalized
Linear Model and Generalized Estimating Equations (GLM/GEE) analyses
revealed an association between prenatal cocaine exposure and deficits in
total language functioning after statistically controlling for child sex,
visit age, prenatal exposure to alcohol, marijuana and tobacco and over 20
additional medical and sociodemographic covariates drawn from potentially
confounding influences assessed at birth and follow-up visits (D=0.17; 95%
CI=0.32, 0.03; P=.019). The link from prenatal cocaine exposure to later
language deficits does not appear to be mediated by cocaine-associated
deficits in birth weight, length or head circumference. Overall, the
evidence tends to support an inference of a stable cocaine-specific effect
on indicators of language functioning during early childhood through age 7
years.
Keywords: Prenatal cocaine exposure; Language performance; CELF-P; NEPSY
Thach Duc Tran, Tuan Tran, Jane Fisher, Validation of three psychometric
instruments for screening for perinatal common mental disorders in men in
the north of Vietnam, Journal of Affective Disorders, Volume 136, Issues 1
2, January 2012, Pages 104-109, ISSN 0165-0327, 10.1016/j.jad.2011.08.012.
Perinatal non-psychotic common mental disorders (PCMDs) are less well
recognised in men than in women. However, there are adverse consequences of
PCMD for men, their partners and their infants. There is a need for simple,
readily administered screening tools for use in research and primary health
care for men, including in low income settings. The aim of this study was
to validate three scales for screening PCMDs in men in northern Vietnam.
Methods
Translated and culturally verified versions of the Edinburgh Postnatal
Depression Scale (EPDS), Zung's Self-rated Anxiety Scale (Zung SAS), and
the General Health Questionnaire 12 items (GHQ-12) were validated against a
gold-standard diagnostic tool, the Structured Clinical Interview for DSM IV
diagnoses in a community-based sample of 231 Vietnamese men who were
partners of pregnant women or women who had recently given birth. Post-hoc
analyses, Receiver Operating Characteristic (ROC) analyses, and Cronbach's
alpha were performed to examine the validity and internal reliability of
the three scales.
Results
The prevalence of PCMDs in men was 17.8% (95%CI: 13.322.3). The AUROC of
the EPDS 76.7% (95%CI: 67.985.5), the Zung SAS was 77.5% (95%CI: 68.9
86.0) and the GHQ-12 was 79.2% (95%CI: 71.287.1). The selected cut-off
point to detect clinically significant symptoms in men using the EPDS was
4/5 (Sensitivity (Se) 68.3% and specificity (Sp) 77.4%), the Zung SAS was
35/36 (Se 70.7% and Sp 79.0%) and the GHQ-12 was 0/1 (Se 75.6% and Sp
74.7%).
Conclusions
PCMDs in men are an unrecognised public health problem in northern Vietnam.
Overall the cut off scores to detect clinically significant symptoms are
lower than those reported in high income settings. Cut off scores on the
EPDS and Zung SAS are slightly higher in men than in women in northern
Vietnam, but these scales are suitable for use with men in this setting.
Although not suitable to detect PCMD in women, the GHQ-12 is suitable to
detect PCMD in men.
Keywords: Screening; Common mental disorders; Validation; Men; Developing
countries
, CHAPTER 19 - The First Month of Life, In: Stephen D. Ratcliffe, MD, MSPH,
Elizabeth G. Baxley, MD, Matthew K. Cline, MD, and Ellen L. Sakornbut, MD,
Editor(s), Family Medicine Obstetrics (Third Edition), Mosby, Philadelphia,
2008, Pages 572-617, ISBN 9780323043069, 10.1016/B978-032304306-9.50024-0.
G.J Hofmeyr, Obstructed labor: using better technologies to reduce

mortality, International Journal of Gynecology & Obstetrics, Volume 85,
Supplement 1, June 2004, Pages S62-S72, ISSN 0020-7292,
10.1016/j.ijgo.2004.01.011.
Abstract: Objective: To identify, from the best available evidence,
underutilized and promising technologies that may reduce maternal mortality
from obstructed labor. Methods: The author sought systematic reviews of
randomized trials, individual randomized trials, and, in the absence of
randomized data, non-randomized studies and clinical consensus. Data were
presented according to the level of the evidence. Results: Obstructed labor
causes approximately 8% of maternal deaths, and indirectly contributes to a
greater percentage. Proven or widely accepted technologies that help reduce
mortality from obstructed labor include contraception, external cephalic
version, the partogram, augmentation of labor, selective amniotomy,
selective episiotomy, vacuum extraction, caesarean section, symphysiotomy,
and destructive procedures for non-viable fetuses. Technologies of
uncertain usefulness include maternal height and shoe size, vaginal
cleansing, upright posture for delivery and vaginal lubrication. Unuseful
technologies include pelvimetry, estimating fetal weight, early labor
induction, routine amniotomy and augmentation, routine episiotomy, and
starvation during labor. Conclusion: Access to well-established
technologies, particularly safe caesarean section, can reduce maternal
mortality in resource-poor countries.
Keywords: Obstructed labor; Cephalopelvic disproportion; Cesarean section;
Vacuum delivery; Symphysiotomy
Michael F. Detweiler, Jonathan S. Comer, Anne Marie Albano, Chapter 9 -

Social Anxiety in Children and Adolescents: Biological, Developmental, and
Social Considerations, In: Stefan G. Hofmann and Patricia M. DiBartolo,
Editor(s), Social Anxiety (Second Edition), Academic Press, San Diego,
2010, Pages 223-270, ISBN 9780123750969, 10.1016/B978-0-12-375096-9.00009-
2.
Ewa Andersson, Kyllike Christensson, Ingegerd Hildingsson, Parents'

experiences and perceptions of group-based antenatal care in four clinics
in Sweden, Midwifery, Available online 17 September 2011, ISSN 0266-6138,
10.1016/j.midw.2011.07.006.
group-based antenatal care consists of six to nine two-hour sessions in
which information is shared and discussed during the first hour and
individual examinations are conducted during the second hour. Groups
generally consist of six to eight pregnant women. Parent education is built
into the programme, which originated in the United States and was
introduced in Sweden at the beginning of the year of 2000.
Objective
to investigate parents' experiences of group antenatal care in four
different clinics in Sweden.
Method
a qualitative study was conducted using content analysis five group
interviews and eleven individual interviews with parents who experienced
group-based antenatal care. An interview guide was used.
Settings
the study was set in four antenatal clinics that had offered group-based
antenatal care for at least one year. The clinics were located in three
different areas of Sweden.
Participants
the participants were women and their partners who had experienced group-
based antenatal care during pregnancy. Other criteria for participation
were mastery of the Swedish language and having followed the care
programme.
Findings
three themes emerged, The carecombining individual physical needs with
preparation for parenthood, refers to the context, organisation, and
content of care'. Group antenatal care with inbuilt parent education was
appreciated, but respondents reported that they felt unprepared for the
first few weeks after birth. Their medical needs (for physical assessment
and screening) were, however, fulfilled. The theme, The groupa composed
recipient of care, showed the participants role and experience. The role
could be passive or active in groups or described as sharers. Groups helped
parents normalise their symptoms. The theme, The midwifea controlling
professional, showed midwives are ignorant of gender issues but, for their
medical knowledge, viewed as respectable professionals.
Key conclusions
in the four clinics studied, group-based antenatal care appeared to meet
parents' needs for physical assessment and screening. Parents identified
that the groups helped them prepare for birth but not for parenthood. The
group model created a forum for sharing experiences and helped participants
to normalise their pregnancy symptoms.
Implications for practise
the midwife's role in facilitating group-based antenatal care demands new
pedagogical strategies and approaches.
Keywords: Group-based antenatal care; Parents; Midwife; Experience
Louise M. Howard, Pregnancy in women with psychotic disorders, Clinical

Effectiveness in Nursing, Volume 9, Supplement 2, 2006, Pages e201-e211,
ISSN 1361-9004, 10.1016/j.cein.2006.10.001.
To review the psychiatric and obstetric complications of pregnancy in women
with psychotic disorders and discuss implications for prevention and
treatment of these conditions.
Design
Narrative review.
Results
Many women with psychotic disorders have children but their pregnancies are
at an increased risk of obstetric complications, stillbirths and neonatal
deaths, and psychiatric complications. Women with a history of mood
disorders (affective psychoses) are at high risk of postpartum relapse. A
significant proportion of mothers with psychotic disorders have parenting
difficulties and lose custody of their infant.
Conclusions
Close liaison between all health professionals during pregnancy and
postpartum is essential for optimal management of these high-risk
pregnancies.
Keywords: Obstetric complications; Schizophrenia; Psychotic disorders;
Parenting; Pregnancy
Kathleen R. Beebe, Janice Humphreys, Expectations, Perceptions, and

Management of Labor in Nulliparas Prior to Hospitalization, Journal of
Midwifery & Women's Health, Volume 51, Issue 5, SeptemberOctober 2006,
Pages 347-353, ISSN 1526-9523, 10.1016/j.jmwh.2006.02.013.
Abstract: This ethnographic qualitative study was designed to explore the
phenomenon of prehospitalization labor from the perspective of nulliparous
women. Twenty-three women were interviewed in the early postpartum period
using a semistructured interview guide. The participants recounted their
experiences with labor onset recognition and management before being
admitted to the hospital for birthing. Qualitative analyses included
verbatim transcription of audiotaped interviews, line-by-line coding, and
categorization of data into codes and categories. Interpretive analyses
were validated with a collaborative research team and the participants
themselves. The central theme that emerged from this study was confronting
the relative incongruence between expectations and actual experiences.
Supporting categories included: expectations about the labor experience,
identifying labor onset, managing the physical and emotional responses to
labor, supportive resources, and decision making about hospital admission.
Early labor experiences in nulliparas offer insight into the contributions
of both expectations and environment to adaptation in labor. Midwives and
perinatal nurses are in a unique position to design interventions that
support and reinforce laboring womens activities outside of the hospital
setting.
Keywords: adaptation; decision making; labor onset; life experiences;
nulliparity; pregnant women; sensation; pregnancy; qualitative research;
symptom management
S.K. Lodhi, R. Sohail, F. Zaman, M. Tayyab, T. Bashir, C.N. Hudson, R.L.

Khan, FIGO save the Mothers Initiative: the PakistanUK collaboration,
October 2004, Pages 79-87, ISSN 0020-7292, 10.1016/j.ijgo.2004.07.001.
Abstract: The pilot study in Punjab, Pakistan was one of the five paired
demonstration projects sponsored by FIGO in the Save the Mothers maternal
mortality project. The goal of the project was to bring basic and
comprehensive emergency obstetric care (EmOC) to a semiurban and rural area
some 30 km from Lahore, where effectively there was none. The aim was to
achieve this by using the existing facilities within the rural health
system without the deployment of extra specialist staff other than as
initial facilitators. This report shows trebling of some performance
indicators and an improvement in met need. There is coincidentally a
similar increase in the uptake of general medical services. Reducing
maternal mortality requires building local capacity for EmOC; the essential
components being the premises, trained personnel, equipment, and
availability of drugs and blood. Availability and provision of EmOC coupled
with changes in the attitude of the population resulted in marked
improvement of process indicators.
Keywords: Maternal mortality; EmOC
Roxana Marachi, Robert J. McMahon, Susan J. Spieker, Jeffrey A. Munson,

Longitudinal assessment of the low-end specificity of maternal reports of
depressive symptoms, Behaviour Research and Therapy, Volume 37, Issue 5,
May 1999, Pages 483-501, ISSN 0005-7967, 10.1016/S0005-7967(98)00160-0.
Abstract: Recent studies have raised concerns about the specificity of
self-report measures of depression with respect to low-end scores. Because
of the high face validity of measures such as the Beck Depression
Inventory, it is suspected that extremely low scores may reflect
individuals who may harbor depressive symptoms or other psychological
abnormalities, yet are inclined to `fake-good', or respond in a socially
desirable manner on the BDI. The presence of this phenomenon was tested in
a sample of adolescent mothers who were assessed at four time points over 8
years. It was hypothesized that low-scoring mothers (compared with medium-
and high-scoring mothers) would have more negative outcomes on a variety of
self-report and observational measures of parenting, as well as have
children with more negative outcomes on adjustment and behavior. This study
employed multiple assessments, multiple informants and multiple domains of
functioning. The analyses controlled for the possible effects of social
desirability and demographic differences between the depression groups. The
hypotheses were not supported. The majority of analyses found no
differences between the groups; where differences did exist, there were no
indications that the low-scoring group was at a disadvantage to the medium
or high scoring groups.
Ursula Pauli-Pott, Bettina Mertesacker, Ulla Bade, Claudia Bauer, Dieter

Beckmann, Contexts of relations of infant negative emotionality to
caregivers reactivity/sensitivity, Infant Behavior and Development,
Volume 23, Issue 1, January 2000, Pages 23-39, ISSN 0163-6383,
10.1016/S0163-6383(00)00029-1.
Abstract: The aim of the study was to examine whether and how infant
negative emotionality, depression in the caregiver, and marital emotional
support are related to the caregivers reactivity/sensitivity. The central
question concerned interaction effects between these risk factors.
Furthermore, it was of special interest whether there were interaction
effects of infant positive and negative emotionality on the
reactivity/sensitivity of the caregiver. Participants were 101 mothers and
their healthy 4-month-olds. The infant temperament characteristics were
measured by parent report as well as in the laboratory. Caregiver behavior
was observed during home visits. Hierarchical regression analyses were
computed. Whereas there were no direct associations between either maternal
depression or infant negative emotionality and maternal
reactivity/sensitivity, the interaction of the two risk factors proved
highly significant. Good marital support was directly linked to maternal
reactivity/sensitivity. The relevance of positive infant emotionality could
not be demonstrated.
Keywords: Infant temperament; Maternal depression; Marital support;
Maternal reactivity; sensitivity; Mother-infant interaction
Loraine Bacchus, Gillian Mezey, Susan Bewley, Domestic violence: prevalence

in pregnant women and associations with physical and psychological health,
European Journal of Obstetrics & Gynecology and Reproductive Biology,
Volume 113, Issue 1, 15 March 2004, Pages 6-11, ISSN 0301-2115,
10.1016/S0301-2115(03)00326-9.
Abstract: Objectives: To examine the prevalence of domestic violence (DV)
and its associations with obstetric complications and psychological health
in women on antenatal and postnatal wards. Study design: A cross-sectional
survey conducted in an inner-London teaching hospital. Two hundred English-
speaking women aged 16 and over, were interviewed between July 2001 and
April 2002. The Abuse Assessment Screen was used to assess for experiences
of DV. Depression was assessed using the Edinburgh Postnatal Depression
Scale (EPDS). The analysis of predictors of obstetric complications grouped
together those known to be associated with DV. Results: 23.5% of women had
lifetime experience of DV, 3% during the current pregnancy. Women with a
history of DV were significantly more likely to be single, separated or in
non-cohabiting relationship and to have smoked in the year prior to and/or
during pregnancy. Higher EPDS scores were significantly associated with DV,
single, separated or non-cohabiting status, and obstetric complications.
Both a history of DV and increased EPDS scores were significantly
associated with obstetric complications after controlling for other known
risk factors. Conclusions: Domestic violence is regarded as an important
risk marker for the development of obstetric complications and depressive
symptomatology. This finding of itself justifies training and education of
maternity health professionals to raise awareness.
Keywords: Domestic violence; Obstetric complications; Psychological health;
Prevalence
I. Anna S. Olsson, Karolina Westlund, More than numbers matter: The effect
of social factors on behaviour and welfare of laboratory rodents and non-
human primates, Applied Animal Behaviour Science, Volume 103, Issues 34,
20 March 2007, Pages 229-254, ISSN 0168-1591,
10.1016/j.applanim.2006.05.022.
Abstract: With the development of laboratory animal science, increasing
attention has been given to the possible influence of housing and husbandry
on the behaviour and welfare of laboratory animals as well as on the
scientific integrity. With the present paper, we aim to contribute to this
knowledge by reviewing existing literature on how social factors influence
laboratory rodents and non-human primates. We use social ecology in the
wild as a starting point to understand experimental studies of these social
species. Laboratory studies show that preweaning social experiences, and
lack thereof, affect the development of social skills and capacity to cope
with stressful situations in both primates and rodents. Studies of
deprivation, of preference and of demand indicate that both rodents and
primates are highly motivated to interact with conspecifics. When housed
alone, rodents and primates typically show a more anxious reaction in
behaviour tests, and are more profoundly affected by certain stressors,
although there seem to be some differences in how rodent males and females
react to different social situations. However, for social housing to be
beneficial for the animals, compatible and stable groups are crucial. When
forming groups of monkeys in captivity, the age and sex of individuals and
their relative age difference, the taxonomic membership of the animals as
well as the introductory technique are factors of importance for success.
Kinship is also of importance for the compatibility of both rodent and
primate groups. Social instability through changes of group composition is
apparently stressful, resulting in behavioural and physiological
alterations in both rodents and primates. The effects of social conditions
around testing have been given much less attention, but several studies
show that animals react differently in behaviour tests when tested in group
than when tested individually. Altogether, the most commonly used
laboratory rodents and primates belong to social species, and their
behaviour and welfare are strongly affected by previous and present social
environment. Factors such as group composition and stability, rank and
previous social experience therefore need to be taken into account both
when designing housing systems and when planning experiments and
interpreting results.
Keywords: Group; Individual; Social isolation; Social housing; Rat; Mouse;
Guinea pig; Macaque; Primate; Rodent
M.A. Lumsden, I.M. Symonds, New undergraduate curricula in the UK and

Australia, Best Practice & Research Clinical Obstetrics &
Gynaecology, Volume 24, Issue 6, December 2010, Pages 795-806, ISSN 1521-
6934, 10.1016/j.bpobgyn.2010.05.002.
Abstract: There are many challenges facing undergraduate education in the
smaller specialities such as obstetrics and gynaecology (O&G). These
are similar throughout the world, although the emphasis may vary according
to geography and the approach of those involved in medical education in
general.
The number of medical students has increased because of the greater number
of doctors required, the gender balance and also because it provides
revenue for the universities. This means that strategies must be developed
to include more teaching units in both primary and secondary care as well
as those at a distance from the main teaching provider. Australia and the
UK both have this problem but, obviously, the distances involved in
Australia are much greater.
One of the drivers for the change in undergraduate medical education in the
UK was factual overload and the need to teach basic competencies to the
students. National curricula that take this into account are being
developed and that in the UK has been taken up by a majority of the medical
schools. The opportunities offered by O&G to provide basic skills and
competencies difficult to find elsewhere in the curriculum are
unparalleled. These include issues such as communication in situations
where great sensitivity is required and also the impact of cultural beliefs
and ethnicity on clinical practice. However, factual knowledge of medical
science is also essential and ways of achieving a balance are discussed.
Keywords: undergraduate education; core competencies; national curriculum;
remote and rural
Jill Rips, ESTABLISHING A SUCCESSFUL HIV COUNSELING AND TESTING SERVICE: A

Blueprint for Preventing Pediatric HIV Infections and Translating Research
into Clinical Practice, Obstetrics and Gynecology Clinics of North America,
Volume 24, Issue 4, 1 December 1997, Pages 873-897, ISSN 0889-8545,
10.1016/S0889-8545(05)70349-1.
Abstract: As discussed in more detail elsewhere in this text, clinical
trial ACTG 076,12 designed to study the administration of zidovudine (ZDV)
during pregnancy to prevent mother-to-child transmission of HIV, proved so
effective that researchers discontinued the trial prematurely in early
1994. Because infants born to HIV-positive mothers who took the medication
during pregnancy, labor, and delivery and who received the drug during the
first 6 weeks of life were much less likely to be infected by the virus,
researchers concluded that the experimental agent should be offered to all
pregnant women with HIV. Later in that year, the recommendation was
codified in the journal Morbidity and Mortality Weekly Report,9 and the use
of ZDV during the antepartum, intrapartum, and neonatal period became the
national standard of care.4,11 By almost any measure, trial ACTG 076 has
been a major success, overcoming substantial logistic and scientific
barriers and demonstrating the life-saving potential of the new protocol.
The remaining challenge is to translate this research advance into a
clinical and social triumph.
The results of ACTG 076 have already resulted in local, state, and federal
legislative initiatives designed to ensure the broadest possible
integration of the new intervention protocols into clinical practice. These
initiatives have included a variety of mandates targeted at pregnant and
postpartum women and their newborns. This article advises clinicians and
administrators on setting up successful prenatal HIV counseling and testing
programs for the early detection of HIV infection and for complying with
the burgeoning array of legislative directives. The suggestions are broad
enough to be applicable to a full array of clinical practices ranging from
a private, single provider office to a large hospital-based prenatal
clinic.
Zidovudine is too expensive and perhaps too toxic to be administered

routinely to all pregnant women in the United States, where only 1.5 women
in 1000 are appropriate candidates because of their HIV-positive status.
Therefore, confirmation of HIV status remains a necessary first step to the
prenatal use of ZDV. It is not always a simple first step. Legal, ethical,
and logistic issues swirl around discussions of testing. Each issue must be
confronted if testing is to be successfully implemented. Patient and
provider beliefs and attitudes and the realities of patient flow in offices
and clinics are critical determinants of successful testing programs. Even
after the successful implementation of testing programs, the provider must
act to ensure informed patient decision making about perinatal ZDV therapy
and to provide access to therapy.
These challenges are surmountable. The solutions to the implementation

problems proposed herein are not theoretical. They represent a distillation
of our collective experience in the field. Over the last several years, the
author and her colleagues have attempted to optimize testing programs,
perinatal ZDV counseling, and the administration of ZDV and to link HIV-
infected women with care in a variety of settings. To ensure that the
recommendations are broadly applicable, counseling, testing, and care
programs have been evaluated in academic, community, and municipal
hospitals. It is hoped that these models can be replicated in diverse
clinical situations, and that readers can avoid the pitfalls and barriers
previously encountered. As arduous as developing these programs might seem,
they are achievable and, most important, will help to save lives.
Sheena Currie, Pashtoon Azfar, Rebecca C. Fowler, A bold new beginning for
midwifery in Afghanistan, Midwifery, Volume 23, Issue 3, September 2007,
Pages 226-234, ISSN 0266-6138, 10.1016/j.midw.2007.07.003.
Keywords: Midwifery; Afghanistan; Midwifery education; Professional
association
A.V. Camacho, M.D. Castro, R. Kaufman, Cultural aspects related to the

health of Andean women in Latin America: A key issue for progress toward
the attainment of the Millennium Development Goals, International Journal
of Gynecology & Obstetrics, Volume 94, Issue 3, September 2006, Pages
357-363, ISSN 0020-7292, 10.1016/j.ijgo.2006.04.028.
Abstract: International declarations have affirmed that health is a
universal right. In order for people to exercise their right to health,
their social and cultural contexts need to be acknowledged. However, due to
a number of barriers encountered at different levels of society and
geographically this right is not yet fully exercised by a considerable
number of women in Latin America.
During the last decade progress has been made in the development of public
health policies and programs that integrate and recognize the differences
in culture that should be considered when addressing indigenous women's
health issues.
However, a biomedical health model, which discounts cultural influences,

prevails globally over a more integrated approach. This leads to a lack of
access and use of quality reproductive health services and care among
indigenous people and is one of several important factors contributing to
high levels of maternal mortality and poor reproductive health among
indigenous women.
It is important to ensure that an intercultural approach is included in

health policies, programs and services. An intercultural strategy fosters
dialogue and respect among women, men, and decision-makers and can
contribute to the realization of reproductive health rights and improvement
of health outcomes.
The debate continues on how to accelerate progress in public policies,
health programs and health services. An intercultural approach to assure
the health of indigenous women should be a key part of this discussion.
Specific efforts are critical for obtaining better health outcomes for
indigenous women and other vulnerable populations, if not progress will
stagnate in the middle of the 21st century, jeopardizing the attainment of
the Millennium Development Goal (MDGs).
Keywords: Indigenous; Andean women; Reproductive health; Maternal health;
Intercultural models of care; Maternal mortality
Tiffany Field, Chapter 2 - Pain reduction during painful procedures and

chronic pain syndromes, Touch Therapy, Churchill Livingstone, Burlington,
2000, Pages 45-91, ISBN 9780443057915, 10.1016/B978-044305791-5.50006-3.
Marjorie Beeghly, Deborah A Frank, Ruth Rose-Jacobs, Howard Cabral, Edward

Tronick, Level of prenatal cocaine exposure and infantcaregiver attachment
behavior, Neurotoxicology and Teratology, Volume 25, Issue 1, January
February 2003, Pages 23-38, ISSN 0892-0362, 10.1016/S0892-0362(02)00323-9.
Abstract: The objective of this longitudinal prospective cohort study was
to determine whether level of prenatal cocaine exposure, or the interaction
between level of prenatal cocaine exposure and contextual risk variables,
was associated with a higher rate of infantcaregiver insecure attachment
and disorganized attachment, or with alterations in infant crying or
avoidant behavior, after controlling for prenatal exposure to alcohol,
tobacco, and marijuana, the quality of the proximal caregiving environment,
and other covariates. Subjects were 154 full-term 12-month-old infants (64
unexposed, 61 with lighter cocaine exposure, 29 with heavier cocaine
exposure) and their primary caregivers from low-income, urban backgrounds.
Exposure status was determined in the maternity ward by biologic assay
(infant meconium and/or maternal or infant urine) and maternal self-report.
At the 12-month follow-up visit, infants were videotaped with their primary
caregiver in Ainsworth's Strange Situation. Reliable coders masked to
exposure status scored videotapes for attachment variables, amount of
crying, and level of avoidance. Contrary to popular perceptions, level of
prenatal cocaine exposure was not significantly related to secure/insecure
attachment status, disorganized attachment status, or rated level of felt
security. Foster care status also was not associated with attachment
status. However, heavier prenatal cocaine exposure, in interaction with
maternal contextual variables (public assistance or multiparity) was
associated with alterations in infant socio-affective behavior, including a
higher level of behavioral disorganization, more avoidance of the
caregiver, and less crying.
Keywords: Level of prenatal cocaine exposure; Prenatal exposure to tobacco,
marijuana, and alcohol; Infantcaregiver attachment; Disorganization;
Infant crying; Avoidant behavior; Parity; Foster care
Suzanne Dixon, Edward Tronick, Constance Keefer, T.B. Brazelton, Perinatal

circumstances and newborn outcome among the Gusii of Kenya: Assessment of
risk, Infant Behavior and Development, Volume 5, Issue 1, January 1982,
Pages 11-32, ISSN 0163-6383, 10.1016/S0163-6383(82)80014-3.
Abstract: Twenty-four Kenyan Gusii newborn infants and their mothers were
studied in order to examine the interrelationships of newborn behavioral
organization, and biomedical and biosocial factors as they are affected by
culture. African mothers were found to be of high parity, had low third
trimester weight gains, suffered anemia and parasitic infestation, and
delivered under unmonitored stressful circumstances. Neonatal assessments
of biomedical and behavioral factors were done two or more times during the
first two weeks of life. The infants were large, vigorous, and showed
little behavioral or physiologic signs of stress. They performed in every
assessment within the normal range for American infants born under optimat
conditions. Factors of birth weight, length, gestational age, and
postpartum weight gain were positively related to behaviors demonstrating
good organization in the control of the state of consciousness. Infants
born of older mothers of high parity demonstrated poorer social interactive
skills, particularly in the third exam period.
Diane L. Mohit, Management and care of mentally ill mothers of young

children: An innovative program, Archives of Psychiatric Nursing, Volume
10, Issue 1, February 1996, Pages 49-54, ISSN 0883-9417, 10.1016/S0883-
9417(96)80086-0.
Abstract: The literature identifies seriously mentally ill (SMI) mothers of
young children as being at-risk for frequent psychiatric hospitalization
because of preexisting impairment in adjustment and coping compounded by
the additional strains of motherhood. Economic hardship, lack of
information, and social isolation are some factors that may cause stress in
relation to parenting. This article discusses the nature and extent of
parenting problems experienced by SMI mothers of young children receiving
treatment in a hospital-based, community-focused case management program.
Intervention strategies are described that focus on reducing
rehospitalization by decreasing the intensity and duration of maternal role
strain.
Emily Moye Skuban, Daniel S. Shaw, Frances Gardner, Lauren H. Supplee, Sara
R. Nichols, The correlates of dyadic synchrony in high-risk, low-income
toddler boys, Infant Behavior and Development, Volume 29, Issue 3, July
2006, Pages 423-434, ISSN 0163-6383, 10.1016/j.infbeh.2006.02.004.
Abstract: Synchrony has been broadly conceptualized as the quality of the
parentchild dyadic relationship. Parenting, factors that compromise
caregiving quality, and child characteristics have all been theoretically
linked to synchrony, but little research has been conducted to validate
such associations. The present study examined correlates of synchrony
including parenting, maternal psychological resources and child attributes,
among a sample of 120 motherson dyads who were participating in a
treatment study for children identified as being at risk for developing
early conduct problems. There families participated in an at-home
assessment, which included a series of motherson interactions. Synchrony
was associated with aspects of parenting and child attributes, including
maternal nurturance, and child emotional negativity and language skills.
The findings are discussed in terms of parent and child contributions to
the development of synchrony.
Keywords: Parentchild relations; Mothers; Language development; Risk
factors; At risk populations
, POSTER SESSION I, American Journal of Obstetrics and Gynecology, Volume

187, Issue 6, Supplement 1, December 2002, Pages S81-S111, ISSN 0002-9378,
10.1016/S0002-9378(02)80050-3.
Bo-Eun Lee, Yun-Chul Hong, Hyesook Park, Mina Ha, Ja Hyeong Kim, Namsoo
Chang, Young-Man Roh, Boong-Nyun Kim, Yeni Kim, Se-young Oh, Young Ju Kim,
Eun-Hee Ha, Secondhand smoke exposure during pregnancy and infantile
neurodevelopment, Environmental Research, Volume 111, Issue 4, May 2011,
Pages 539-544, ISSN 0013-9351, 10.1016/j.envres.2011.02.014.
Abstract: During prenatal development, the nervous system may be more
susceptible to environmental toxicants, such as secondhand smoke. The
authors assessed the effects of prenatal and postnatal secondhand smoke
exposure on the neurodevelopment of 6-month infants. The subjects were 414
mother and infant pairs with no medical problems, taken from the Mothers'
and Children's Environmental Health study. Prenatal and postnatal exposures
to secondhand smoke were determined using maternal self-reports. Examiners,
unaware of exposure history, assessed the infants at 6 months of age using
the Bayley Scales of Infant Development. Bayley scores were compared for
secondhand smoke exposed and unexposed groups after adjusting for potential
confounders. Multiple logistic regression analysis was carried out to
estimate the risk of developmental delay posed by SHS exposure. The
multivariate model included residential area, maternal age, pre-pregnancy
body mass index, education, income, infant sex, parity, birth weight, and
type of feeding. After adjusting for covariates, secondhand smoke exposure
during pregnancy was found to be related to a decrease in mental
developmental index score, but not to a decrease in psychomotor
developmental index score. In addition, secondhand smoke exposure during
pregnancy was found to increase the risk of developmental delay (mental
developmental index score 85) at 6 months. This study suggests that the
infants of non-smoking women exposed to secondhand smoke are at risk of
neurodevelopmental delay.
Keywords: Secondhand smoke; Pregnancy; Infant; Neurodevelopment; Cognitive
function
Elizabeth K. Anthony, Bryn King, Michael J. Austin, Reducing child poverty

by promoting child well-being: Identifying best practices in a time of
great need, Children and Youth Services Review, Volume 33, Issue 10,
10.1016/j.childyouth.2011.05.029.
Abstract: Child poverty in the United States persists despite a range of
social services designed to reduce poverty rates and improve the economic
self-sufficiency of families. The economic downturns resulting in job
losses and the housing crisis have converged to create a new group of
families who were managing to remain out of poverty prior to the recession
but are now slipping into poverty, putting additional strain on services.
In light of these pressing issues, this article synthesizes the literature
examining child poverty to take a long-range view of the relationship
between economic strain, system involvement, and impacts on children and
the systems attempting to serve these children. The effectiveness of
various policy and program efforts aimed at reducing child poverty rates
and/or ameliorating the negative effects of living in poverty is reviewed.
The article concludes by suggesting a major shift in focus from reducing
child poverty as a singular goal to a comprehensive approach to promoting
child and family well-being.
Keywords: Child poverty; Child well-being; Policy; Programs; Social
services
Christian M. Pettker, Stephen F. Thung, Errol R. Norwitz, Catalin S.

Buhimschi, Cheryl A. Raab, Joshua A. Copel, Edward Kuczynski, Charles J.
Lockwood, Edmund F. Funai, Impact of a comprehensive patient safety
strategy on obstetric adverse events, American Journal of Obstetrics and
Gynecology, Volume 200, Issue 5, May 2009, Pages 492.e1-492.e8, ISSN 0002-
9378, 10.1016/j.ajog.2009.01.022.
Abstract: Objective
We implemented a comprehensive strategy to track and reduce adverse events.
Study Design
We incrementally introduced multiple patient safety interventions from
September 2004 through November 2006 at a university-based obstetrics
service. This initiative included outside expert review, protocol
standardization, the creation of a patient safety nurse position and
patient safety committee, and training in team skills and fetal heart
monitoring interpretation. We prospectively tracked 10 obstetrics-specific
outcome. The Adverse Outcome Index, an expression of the number of
deliveries with at least 1 of the 10 adverse outcomes per total deliveries,
was analyzed for trend.
Results
Our interventions significantly reduced the Adverse Outcome Index (linear
regression, r2 = 0.50; P = .01) (overall mean, 2.50%). Concurrent with
these improvements, we saw clinically significant improvements in safety
climate as measured by validated safety attitude surveys.
Conclusion
A systematic strategy to decrease obstetric adverse events can have a
significant impact on patient safety.
Keywords: crew resource management; medical errors; obstetric adverse
outcomes; patient safety
Lucy M. Osborn, Effective well-child care, Current Problems in Pediatrics,

10.1016/0045-9380(94)90011-6.
Emily Neuhaus, Theodore P. Beauchaine, Raphael Bernier, Neurobiological

correlates of social functioning in autism, Clinical Psychology Review,
10.1016/j.cpr.2010.05.007.
Abstract: Although autism is defined by deficits in three areas of
functioning (social, communicative, and behavioral), impairments in social
interest and restricted behavioral repertoires are central to the disorder.
As a result, a detailed understanding of the neurobiological systems
subserving social behavior may have implications for prevention, early
identification, and intervention for affected families. In this paper, we
review a number of potential neurobiological mechanismsacross several
levels of analysisthat subserve normative social functioning. These
include neural networks, neurotransmitters, and hormone systems. After
describing the typical functioning of each system, we review available
empirical findings specific to autism. Among the most promising potential
mechanisms of social behavioral deficits in autism are those involving
neural networks including the amygdala, the mesocorticolimbic dopamine
system, and the oxytocin system. Particularly compelling are explanatory
models that integrate mechanisms across biological systems, such as those
linking dopamine and oxytocin with brain regions critical to reward
processing.
Keywords: Autism spectrum disorders; Social neurobiology; Social brain;
Affiliation
J.D. Seffah, Re-laparotomy after Cesarean section, International Journal of

Gynecology & Obstetrics, Volume 88, Issue 3, March 2005, Pages 253-257,
ISSN 0020-7292, 10.1016/j.ijgo.2004.12.014.
Abstract: Objective
The objective of the study was to find out the indications for management
and the outcomes of reopening the abdomen during the puerperium after
Cesarean section.
Patients and methods
This was a retrospective descriptive survey at the Korle Bu Teaching
Hospital in Accra, Ghana.
Results
There were 6120 Cesarean sections (17%) out of a total of 36,010
deliveries. Re-laparotomy was done in 44 patients (0.7%) of the Cesarean
sections. The indications were: hemorrhage from uterine atony, hemorrhage
from placental bed after operation for placenta previa, uterine sepsis with
hemorrhage, hemorrhage after Cesarean section, myomectomy and hemorrhage
from anterior abdominal wound dehiscence. The main surgeries performed
were: hysterectomy, ligation of ascending branches of uterine arteries,
ligation of hypogastric arteries, debridement and re-suturing of the
uterine incision and secondary suturing of anterior abdominal wall. There
were 6 near missed fatalities. There were 4 mortalities caused by excessive
hemorrhage and severe sepsis.
Conclusion
The case fatality rate for re-laparotomy after Cesarean section is high
(9%). Near missed-fatalities are common. To reduce the unfavorable
outcomes, instituting more intensive education on the use of the partograph
should prevent prolonged labor. Centers carrying out Cesarean section
should have efficient blood transfusion service in place.
Keywords: Cesarean section; Re-laparotomy; Near-missed fatality; Mortality
Ann M. Coulston, 69 - Insulin Resistance and Type 2 Diabetes Mellitus:

Gender Differences and Similarities, In: Marianne J. Legato, MD, Editor(s),
Principles of Gender-Specific Medicine, Academic Press, San Diego, 2004,
Pages 752-758, ISBN 9780124409057, 10.1016/B978-012440905-7/50340-6.
Abstract: As the incidence of type 2 diabetes increases so has interest in
understanding the origins of the disease and disease management. In
general, diabetes mellitus (DM) has not been diagnosed more often in men or
women. Consequently, research on disease management and complications has
not focused on men or women specifically, but most often studied mixed
populations. The one exception is gestational diabetes. Obviously, this is
a condition of women only and research on the management, medical and
nutritional, of gestational diabetes is in its infancy. We are only
beginning to understand the medical consequences of insulin resistance,
which is at the root of both type 2 diabetes and gestational diabetes [1].
Consequently, information on nutritional considerations of this condition
is scarce and especially so for potential gender differences. Over the last
few years, insights have been gleaned from cohort epidemiology studies of
women and men, but nutrition intervention studies comparing women and men,
other than weight loss, are essentially nonexistent.
Dominique Behague, Growth monitoring and the promotion of breastfeeding,

Social Science & Medicine, Volume 37, Issue 12, December 1993, Pages
1565-1578, ISSN 0277-9536, 10.1016/0277-9536(93)90191-6.
Abstract: Recent studies evaluating the efficacy of growth monitoring
programs have scrutinized their educational and preventive capabilities.
Advocates claim that growth monitoring can be effective if communities and
mothers are more actively involved in the process of weighing and
measuring, and if the technology is understood by all as an aid for disease
prevention and health promotion rather than as a curative procedure.
Others have argued that this theory is rarely possible to implement. The
ways in which preventive growth monitoring can be made possible are still
under exploration, given that the reasons for such deeply imbedded
curative expectations of growth monitoring are not fully understood. Any
such understanding requires an analysis of growth monitoring within the
context of the GOBI (growth monitoring, oral rehydration therapy,
breastfeeding and immunization) child survival framework.
To attain this type of understanding, a series of qualitative

methodological techniques were used in a population of 50 mothers and
several health care facilities in Pelotas, RS, Brazil, as a complement to
pre-existing epidemiological data from the Center for Epidemiology at the
Federal University of Pelotas. With a subsample of 15 mothers, intensive
interviews and observations were specifically focused on: (1) mothers'
understanding of growth monitoring, (2) breastfeeding practices and
beliefs, (3) doctor-patient communication.
Findings from this study suggest that, even in a program with widespread
attendance and a relatively interactive growth monitoring approach, the
use of growth charts do little to promote duration or frequency of
breastfeeding, and may even pay a role in the factors which deter women
from choosing to breastfeed for longer durations or with greater frequency.
We found that mothers' personal interpretations of the charts were
representative of the larger socio-cultural and economic issues that
affected their lives on a daily basis. Growth charts thus served as one of
the many tangible domains onto which mothers could project their worries
and measure their personal successes and failures.
Keywords: breastfeeding; growth monitoring; weaning; culturally-appropriate
primary health care; Brazil
Claudia Fishman, Robin Evans, Eloise Jenks, Warm bodies, cool milk:
Conflicts in post partum food choice for Indochinese women in California,
Social Science & Medicine, Volume 26, Issue 11, 1988, Pages 1125-1132,
ISSN 0277-9536, 10.1016/0277-9536(88)90188-8.
Abstract: The Federal Special Supplemental Food Program for Women, Infants
and Children provides nutritious foods and dietary counselling to low
income women and children with a medically certified nutritional risk. The
Public Health Foundation, a large WIC agency in Los Angeles, observed
declining breastfeeding rates among Indochinese participants. We
interviewed 110 Cambodian, ethnic Chinese and Vietnamese WIC participants
about their infant feeding decisions and experience. These women believed
that formula was superior to breastmilk for a number of reasons, some
related to the Asian humoral medical system. The women described excessive
cooling during childbirth that they hoped to counter-balance by consuming
humorally hot foods for 100 days post partum. A hot maternal diet was
thought to produce unhealthy breastmilk after 1 month, so the women
preferred using infant formula, perceived to be stable and more nourishing
than breastmilk. The WIC Program is using these and other findings to make
breastfeeding more attractive to Southeast Asians.
Keywords: Southeast Asian; breastfeeding; nutrition; pregnancy
William F. Rayburn, Sharon T. Phelan, Promoting Healthy Habits in

Pregnancy, Obstetrics and Gynecology Clinics of North America, Volume 35,
10.1016/j.ogc.2008.05.001.
Abstract: Most women have an appreciation of what are generally considered
healthy habits including more exercise; eating a healthy diet; avoiding
cigarettes, alcohol, and drugs; using seatbelts; and being current on
preventive care, such as good dental status. Being pregnant can be a strong
motivator to change or modify behavioral choices. This is an optimal time
for a provider to build on this potential motivator to effect change.
Frequent follow-up visits allow re-enforcement of attempted change. This
constant encouragement and support helps to impress on the woman and her
family the importance of change.
Lichun Tian, Jianghong Li, Kaining Zhang, Philip Guest, Women's status,
institutional barriers and reproductive health care: A case study in
Yunnan, China, Health Policy, Volume 84, Issues 23, December 2007, Pages
284-297, ISSN 0168-8510, 10.1016/j.healthpol.2007.04.008.
Yunnan is one of the poorest and most remote provinces in China. The
reproductive health status of the population is poor. The aim of the study
was to identify factors contributing to poor reproductive health and major
barriers in accessing reproductive health information and care and to
inform interventions to increase access to and the quality of care in
service delivery.
Methods
The study was based on qualitative data collected from structured and
unstructured interviews with health program managers, service providers,
clients, and community members in three counties. Focus group discussions,
field observations, reviews of the records of medical facilities and
thematic analysis were used in the study.
Results
Gender inequality and the fragmented health system were some of the
barriers in accessing the services. Incorrect diagnosis, over treatment and
IUD insertion with un-sterilised tools may have contributed to the
persistent high rate of reproductive tract infections (RTI) in the study
settings.
Conclusions
The improvement of reproductive health thus hinges critically upon the
elevation of women's status. All health sectors within China's health
system need to be better integrated and institutionally induced gender
inequality ought to be reduced so that all in the population, particularly
the vulnerable, will have equal and adequate access to reproductive health
care.
Keywords: Yunnan; China; Reproductive health; Gender inequality;
Reproductive culture; Health system; Reproductive tract infections
Joanne K. Gall, Marilyn E. Schima, The role of the midwife in permanent

contraception, Journal of Nurse-Midwifery, Volume 28, Issue 4, JulyAugust
1983, Pages 13-17, ISSN 0091-2182, 10.1016/0091-2182(83)90105-2.
Abstract: This article begins with a historical perspective on the midwife
and oulines the unique role played in family planning. Discussion follows
concerning current trends in the education of professional midwives and the
subsequent training they conduct with traditional birth attendants and
other health providers in family planning. Because permanent contraception
is now included in family planning methods, a new dimension is added to the
responsibility and role of the professional midwife and the traditional
birth attendant.
The midwife plays a key role in the client's acceptance and use of family
planning methods, especially in deciding on permanent contraception.
Presented here are examples of the current counseling role of professional
midwives, a description of how they are being trained to perform permanent
surgical contraception, and discussion of their emerging roles as educators
of traditional birth attendants and coordinators of the health team that
provides quality family planning and permanent contraception services.
, Bibliography, Mosby's Guide to Women's Health, Mosby, Saint Louis, 2007,

Pages 249-275, ISBN 9780323046015, 10.1016/B978-032304601-5.50037-X.
Palma Shaw, Audra Duncan, Ageliki Vouyouka, Kathleen Ozsvath, Radiation

exposure and pregnancy, Journal of Vascular Surgery, Volume 53, Issue 1,
Supplement, January 2011, Pages 28S-34S, ISSN 0741-5214,
10.1016/j.jvs.2010.05.140.
The effect of radiation on the fetus has been derived primarily from animal
studies and human exposures to diagnostic and therapeutic radiation as well
as atomic bomb exposure. Given the variety of sources, there is controversy
over the dose of radiation in addition to the other environmental
conditions that surrounded these events and their relationship to exposure
today.
Methods
The effects of ionizing radiation on the fetus, the prenatal period,
parental exposure, the pregnant clinician, and the pregnant patient are
discussed in the context of their exposure to radiation.
Results
The fetus is most sensitive to radiation effects between 8 and 15 weeks of
pregnancy. Stepping away from the table and using movable shields help
reduce the exposure by a factor of four for every doubling of the distance
between the operator and the radiation source.
Conclusion
Proposed guidelines for pregnancy during vascular residency training
involving fluoroscopic procedures can help bring about awareness, clarify
maximal exposure, and better delineate the role of the pregnant resident.
Richard S. Schottenfeld, Brent Moore, Michael V. Pantalon, Contingency

management with community reinforcement approach or twelve-step
facilitation drug counseling for cocaine dependent pregnant women or women
with young children, Drug and Alcohol Dependence, Volume 118, Issue 1, 1
10.1016/j.drugalcdep.2011.02.019.
Cocaine abuse among women of child-bearing years is a significant public
health problem. This study evaluated the efficacy of contingency management
(CM), the community reinforcement approach (CRA), and twelve-step
facilitation (TSF) for cocaine-dependent pregnant women or women with young
children.
Methods
Using a 2 2 study design, 145 cocaine dependent women were
randomized to 24 weeks of CRA or TSF and to monetary vouchers provided
contingent on cocaine-negative urine tests (CM) or non-contingently but
yoked in value (voucher control, VC). Primary outcome measures included the
longest consecutive period of documented abstinence, proportion of cocaine-
negative urine tests (obtained twice-weekly), and percent days using
cocaine (PDC) during treatment. Documented cocaine abstinence at baseline
and 3, 6, 9 and 12 months following randomization was a secondary outcome.
Findings
CM was associated with significantly greater duration of cocaine abstinence
(p < .01), higher proportion of cocaine-negative urine tests
(p < 0.01), and higher proportion of documented abstinence
across the 3-, 6-, 9- and 12-month assessments (p < 0.05),
compared to VC. The differences between CRA and TSF were not significant
for any of these measures (all p values 0.75). PDC decreased significantly
from baseline during treatment in all four groups (p < 0.001)
but did not differ significantly between CM and VC (p = 0.10) or
between TSF and CRA (p = 0.23).
Interpretation
The study findings support the efficacy of CM for cocaine dependent
pregnant women and women with young children but do not support greater
efficacy of CRA compared to TSF or differential efficacy of CM when paired
with either CRA or TSF.
Keywords: Cocaine dependence; Women; Behavioral treatments; Contingency
management; Randomized clinical trial
Joh Chin Rossiter, Attitudes of Vietnamese women to baby feeding practices

before and after immigration to Sydney, Australia, Midwifery, Volume 8,
Issue 3, September 1992, Pages 103-112, ISSN 0266-6138, 10.1016/S0266-
6138(05)80078-6.
Abstract: The purpose of this study was to explore Vietnamese women's
attitudes, behaviour and beliefs towards baby feeding practices before and
after immigration to Sydney. Findings from 70 questionnaires and 20 in-
depth face-to-face interviews with ethnic Vietnamese women indicated that
Vietnamese women's preference towards baby feeding practices was shaped by
their health beliefs, which in turn were influenced by the social, cultural
and economic environment of the host country. Changing to bottle feeding
was an adaptation process, a bridge between the old and the new
environments. Recommendations have been made regarding ways of promoting
breast feeding among immigrant women.
Karol L. Kumpfer, Melissa A. Fowler, Parenting skills and family support

programs for drug-abusing mothers, Seminars in Fetal and Neonatal Medicine,
Volume 12, Issue 2, April 2007, Pages 134-142, ISSN 1744-165X,
10.1016/j.siny.2007.01.003.
Abstract: Summary
Children born to drug-using mothers can suffer from fetal alcohol or drug
syndrome (FAS/FDS) or fetal alcohol or drug effect (FAE/FDE). Such children
have a greater likelihood of developing acute or chronic physical,
cognitive and behavioral problems. In-utero exposure to tobacco, alcohol or
drugs impact on the developing fetus and, after birth, the family
environment and family system exert effects on the infants and children of
substance-abusing parents. Evidence-based prevention and maternal drug
treatment programs focus on enhancing parental childcaring abilities,
supporting parentchild attachment and encouraging family support systems
to improve children's health and cognitive outcomes. FAS/FDS prevention
programs, as well as selective and indicated prenatal and postnatal
interventions, can improve the support given both to mother and to child,
and evidence-based, in-home parenting and family-skills-training approaches
are particularly useful.
Keywords: Children of substance abusing mothers; Family support; Fetal
alcohol syndrome; Fetal exposure; Parenting programs
Hani Atrash, Brian W. Jack, Kay Johnson, Dean V. Coonrod, Merry-K. Moos,
Phillip G. Stubblefield, Robert Cefalo, Karla Damus, Uma M. Reddy, Where is
the Woman in MCH?, American Journal of Obstetrics and Gynecology, Volume
199, Issue 6, Supplement B, December 2008, Pages S259-S265, ISSN 0002-9378,
10.1016/j.ajog.2008.08.059.
Abstract: Scientific evidence indicates that improving a woman's health
before pregnancy will improve pregnancy outcomes. However, for many years,
our efforts have focused primarily on prenatal care and on caring for
infants after birth. The concept of preconception care has been identified
repeatedly as a priority for improving maternal and infant health.
Preconception care is not something new that is being added to the already
overburdened healthcare provider, but it is a part of routine primary care
for women of reproductive age. Many opportunities exist for preconception
intervention, and much of preconception care involves merely the provider
reframing his or her thinking, counseling, and decisions in light of the
reproductive plans and sexual and contraceptive practices of the patient.
With existing scientific evidence that improving the health of Women will
improve the health of mothers and children, we must focus on improving the
health of Women before pregnancy and put the W in Maternal and Child
Health.
Keywords: maternal and child health; preconception; woman
Vinod K. Paul, The current state of newborn health in low income countries
and the way forward, Seminars in Fetal and Neonatal Medicine, Volume 11,
Issue 1, February 2006, Pages 7-14, ISSN 1744-165X,
10.1016/j.siny.2005.10.005.
Abstract: Summary
Of the 4 million neonatal deaths that occur worldwide each year 99% of
these occur in developing countries. South Asia and sub-Saharan Africa
regions account for two thirds of the global burden. Skilled professionals
attend only 35% deliveries in South Asia and 41% in sub-Saharan Africa.
Known, affordable interventions delivered through a rational mix of
outreach, family/community and clinical services can reduce over 70% of all
neonatal deaths. The Millennium Development Goal of reducing the mortality
of children under 5 years by two thirds by the year 2015 from the 1990
baseline would require a substantial reduction in neonatal mortality in the
next decade. For this, the low and middle-income countries must urgently
review their existing programs, and design and implement improved,
integrated action plans for maternal, newborn and child health.
International community, including the academics, institutions and
professional bodies in developed countries can play a crucial role to make
this mission a success.
Keywords: Neonatal health; Newborn health; Neonatal mortality rate; Newborn
deaths; Neonatal survival; Newborn survival; Maternal; Newborn and child
health (MNCH)
Mario Enrique Rendn-Mac

as, Graciela Castaeda-Mucio, Jos Jess Cruz,
Juan Manuel Mej
a-Arangur, Miguel Angel Villas
s-Keever, Breastfeeding
Among Patients with Congenital Malformations, Archives of Medical Research,
Volume 33, Issue 3, MayJune 2002, Pages 269-275, ISSN 0188-4409,
10.1016/S0188-4409(02)00361-2.
This study was undertaken in order to 1) determine the frequency of infants
with major congenital malformations who are breastfed and 2) identify
factors associated with initiating and early weaning of breastfeeding.
Methods
We conducted a descriptive cohort study at a tertiary-care pediatric
hospital. Subjects included infants <20 days of age with major
congenital malformations. According to the feeding pattern, the following
three groups were identified: exclusively breastfed (EB); alternating
breast and formula (ABF), and exclusively formula (EF).
Follow-up interviews were conducted on a monthly basis until the infants

were 6 months of age. The feeding pattern was determined during each visit.
Reasons for changing the breastfeeding pattern were explored.
Results
A total of 120 newborns were recruited. At the time of the first interview,
29.2% were EF, 47.5% EB, and 23.3% ABF. By 6 months of age, the feeding
patterns were 8.6, 18.1, and 73.3%, respectively. Median length of
breastfeeding was 3 months (range: 16 months). The maternal prenatal
decision to breastfeed (odds ratio [OR] 0.11, 95% confidence interval [95%
CI] 0.020.52) and attendance at prenatal breastfeeding sessions (OR 0.30,
95% CI 0.170.87) were associated with breastfeeding initiation.
Conversely, mother-child separation (OR 3.07, 95% CI 1.367.01) and low
birth weight (OR 2.98, 95% CI 1.366.48) were associated with a lack of
breastfeeding. The mother's sensation of low milk production was the main
reason to change or to stop breastfeeding.
Conclusions
In this study, breastfeeding frequency and length among infants with
congenital malformations during the first 6 months of life were lower than
previously published reports of breastfeeding obtained from healthy
infants. Healthcare professionals must encourage breastfeeding in these
infants.
Keywords: Breastfeeding; Congenital malformations; Risk factors; Cohort
study
K. Gourounti, K. Lykeridou, C. Taskou, K. Kafetsios, J. Sandall, A survey
of worries of pregnant women: Reliability and validity of the Greek version
of the Cambridge Worry Scale, Midwifery, Available online 19 October 2011,
ISSN 0266-6138, 10.1016/j.midw.2011.09.004.
Abstract: Objective
to examine the psychometric properties of the Greek version of the
Cambridge Worry Scale (CWS) and to assess worries during pregnancy.
Setting
public hospital in Athens, Greece.
Design
a cross sectional study.
Participants
one hundred and thirty two pregnant women with a gestational age between 11
and 14 weeks who were booked for antenatal screening.
Methods
CWS was forwardbackward translated from English into Greek. The
translated instrument was pilot-tested and administered to a sample of 132
pregnant women. Principal component analysis with promax rotation was used
to test the factor structure of CWS. Measures of state-trait anxiety (STAI)
and depression (CES-D) were used to assess the convergent validity of CWS.
Cronbach's was used to measure internal consistency of the FPI scales.
Findings
results from exploratory factor analysis suggested the existence of four
factors. Therefore, the Greek version replicated the original factor
structure. Construct validity was confirmed by computing correlations
between the CWS factors and conceptually similar constructions of anxiety,
and depression. Internal consistency reliability was satisfactory. The
major worries that pregnant women referred to were the possibility that
something might be wrong with the baby, the process of giving birth,
financial issues and the possibility of miscarriage.
Conclusion
the CWS was found to have a relatively stable factor structure and
satisfactory reliability and convergent and discriminant validity. CWS may
enable researchers and clinicians to apply a reliable measure that focuses
on worries during pregnancy.
Keywords: Worries; Pregnancy; Anxiety; Factor analysis
SeonAe Yeo, A randomized comparative trial of the efficacy and safety of

exercise during pregnancy: Design and methods, Contemporary Clinical
Trials, Volume 27, Issue 6, December 2006, Pages 531-540, ISSN 1551-7144,
10.1016/j.cct.2006.06.005.
Abstract: Use of an exercise intervention for high-risk and vulnerable
populations, such as pregnant women at risk for gestational hypertension or
preeclampsia, requires special consideration. A comparative trial testing
the effects of two types of physical exercises stretching (a comparator)
and walking (a testing intervention) for sedentary pregnant women at risk
for preeclampsia is presented in this paper. The study was designed to
reduce post-randomization bias and dropout rates from both groups, and
closely to monitor safety of subjects. The strengths of the study design
and methods include use of a run-in phase; use of a stretching exercise as
a comparator; multiple ways to measure daily physical activities and the
exercise intervention; and tailored support to remove barriers to exercise
for subjects.
The intervention consists of 40 min of walking at moderate intensity (i.e.,

5569% of maximum heart rate and rating of perceived exhaustion 1213) five
times a week from 18 weeks gestation until birth. The comparator exercise
consists of 40 min of stretching exercise without increasing heart rate to
more than 10% of resting heart rate, five times a week from 18 weeks
gestation until birth. The primary outcome is the incidence of
preeclampsia. Secondary outcomes include the physiologic effects of the
intervention and birth outcomes.
Keywords: Exercise; Physical activity; Pregnant; Preeclampsia; Randomized
placebo-controlled clinical trial; Oxidative stress
Nicette Sergueef, Chapter 2 - Normal Growth And Development Of The Child,

Cranial Osteopathy for Infants, Children and Adolescents, Churchill
Livingstone, Edinburgh, 2007, Pages 23-39, ISBN 9780443103520,
10.1016/B978-0-443-10352-0.50008-0.
Jo Anne Myers-Ciecko, Evolution and current status of direct-entry

midwifery education, regulation, and practice in the United States, with
examples from Washington State, Journal of Nurse-Midwifery, Volume 44,
Issue 4, JulyAugust 1999, Pages 384-393, ISSN 0091-2182, 10.1016/S0091-
2182(99)00070-1.
Abstract: This paper describes the re-emergence of direct-entry midwifery
in the United States, and focuses specifically on the over 1,000 midwives
nationwide who are licensed in the 16 states where direct-entry midwifery
is legal and regulated, and/or certified by the North American Registry of
Midwives; it does not focus on direct-entry midwives or nurse-midwives who
are certified by the American College of Nurse-Midwives Certification
Council, Inc. Professional developments of direct-entry midwives are
highlighted, including the establishment of core competencies and
articulation of values, the creation of a certification process, and
development of education program accreditation. The current status of
licensed midwives in Washington State, where state policies have supported
the development of direct-entry midwifery and the integration of direct-
entry midwives into managed care systems, is presented as one example of
the evolution of professional direct-entry midwifery in this country.
Additionally, recommendations from the UCSF Center for the Health
Professions Taskforce on Midwifery, which address particular areas of
concern for direct-entry midwives, are discussed.
Jane E Sisk, Ann Lennarson Greer, Martha Wojtowycz, Lani B Pincus, Richard
H Aubry, Implementing evidence-based practice: evaluation of an opinion
leader strategy to improve breast-feeding rates, American Journal of
Obstetrics and Gynecology, Volume 190, Issue 2, February 2004, Pages 413-
421, ISSN 0002-9378, 10.1016/j.ajog.2003.09.014.
Abstract: Objective
The objective was to evaluate the effectiveness of opinion leaders in
raising breast-feeding rates.
Study design
A randomized controlled trial of an opinion leader strategy in 18 hospitals
in Central New York State compared mothers' intention to breast-feed during
baseline and study years. Multivariate logistic regression with a mixed
model analyzed the effects on breast-feeding exclusively and on breast- and
formula-feeding combined.
Results
Obstetric clinicians had a high degree of knowledge about breast-feeding
benefits and of perceived responsibility to recommend breast-feeding.
Obstetricians, family practitioners, and midwives agreed on the person
identified as the opinion leader, in each case an obstetrician who was
chief of obstetrics or obstetrics-gynecology. Breast-feeding rates in
hospitals with the opinion leader intervention did not differ significantly
from those in control-group hospitals during the study year.
Conclusion
The opinion leader strategy in this case did not improve breast-feeding
rates during the study year. Opinion leader strategies may make assumptions
about clinician control that are not justified in situations such as
breast-feeding.
Keywords: Randomized controlled trial; Opinion leaders; Breast-feeding
, Chapter 5 - Measurement of pelvic floor muscle function and strength and

pelvic organ prolapse, In: Kari B, PT, MSc, PhD, Bary Berghmans, PT, MSc,
PhD, Siv Mrkved, PT, MSc, PhD, and Marijke Van Kampen, PT, MSc, PhD,
Editor(s), Evidence-Based Physical Therapy for the Pelvic Floor, Churchill
Livingstone, Edinburgh, 2007, Pages 45-112, ISBN 9780443101465,
10.1016/B978-0-443-10146-5.50011-3.
, Appendix N - Hospital Policy: Sample Hospital Breastfeeding Policy for

Newborns, Breastfeeding (Seventh Edition), W.B. Saunders, Philadelphia,
2011, Pages 963-968, ISBN 9781437707885, 10.1016/B978-1-4377-0788-5.10068-
9.
L Page, Human resources for maternity care: the present system in Brazil,
Japan, North America, Western Europe and New Zealand, International Journal
of Gynecology & Obstetrics, Volume 75, Supplement 1, November 2001,
Pages S81-S88, ISSN 0020-7292, 10.1016/S0020-7292(01)00515-X.
Abstract: This article describes the nature of the humanization of birth
and the overlapping but distinct role of professionals within the maternity
services with an emphasis on the role of the midwife. It describes the
status of midwives in different parts of the world, and the common
characteristics of work undertaken to restore the role of the midwife.
Midwifery is seen as an essential component of effective maternity
services. In addition it is important to recognize the important role that
traditional birth attendants play in many parts of the world. An
appropriate structure including primary and secondary and tertiary care
services are important for professionals to play their full part.
Keywords: Humanization; Midwifery; Traditional birth attendants; Restoring
midwifery
Cecilia S Acuin, Geok Lin Khor, Tippawan Liabsuetrakul, Endang L Achadi,

Thein Thein Htay, Rebecca Firestone, Zulfiqar A Bhutta, Maternal, neonatal,
and child health in southeast Asia: towards greater regional collaboration,
The Lancet, Volume 377, Issue 9764, 511 February 2011, Pages 516-525, ISSN
0140-6736, 10.1016/S0140-6736(10)62049-1.
Abstract: Summary
Although maternal and child mortality are on the decline in southeast Asia,
there are still major disparities, and greater equity is key to achieve the
Millennium Development Goals. We used comparable cross-national data
sources to document mortality trends from 1990 to 2008 and to assess major
causes of maternal and child deaths. We present inequalities in
intervention coverage by two common measures of wealth quintiles and rural
or urban status. Case studies of reduction in mortality in Thailand and
Indonesia indicate the varying extents of success and point to some factors
that accelerate progress. We developed a Lives Saved Tool analysis for the
region and for country subgroups to estimate deaths averted by cause and
intervention. We identified three major patterns of maternal and child
mortality reduction: early, rapid downward trends (Brunei, Singapore,
Malaysia, and Thailand); initially high declines (sustained by Vietnam but
faltering in the Philippines and Indonesia); and high initial rates with a
downward trend (Laos, Cambodia, and Myanmar). Economic development seems to
provide an important context that should be coupled with broader health-
system interventions. Increasing coverage and consideration of the health-
system context is needed, and regional support from the Association of
Southeast Asian Nations can provide increased policy support to achieve
maternal, neonatal, and child health goals.
D. Cohen, C. Lisles, W.R. Williams, C.F. Brunsdon, T. Batstone, Exploratory

study to evaluate the provision of additional midwifery support to teenage
mothers, Public Health, Volume 125, Issue 9, September 2011, Pages 632-638,
ISSN 0033-3506, 10.1016/j.puhe.2011.06.008.
To evaluate the provision of psychosocial interventions of potential
benefit to pregnant teenage women.
Study design
Pre-test/post-test, controlled, experimental design.
Methods
One hundred and sixty-four pregnant teenage women received usual midwifery
care or usual midwifery care plus additional psychosocial support. Four
outcomes were measured at baseline and 4 weeks after delivery: self-esteem
(Rosenberg Self-Esteem Scale), physical activity (International Physical
Activity Questionnaire), social support (Short Form Social Support
Questionnaire) and smoking behaviour (yes/no).
Results
At follow-up, there were no significant differences in any of these
outcomes between the 65 women in the intervention group and the 64 women in
the control group who completed both assessments (mean age 17.5 years).
There was no difference in use of National Health Service (NHS) services,
but the intervention group made greater use of non-NHS services, such as
family planning or help with housing or benefits problems.
Conclusion
The very low self-esteem of the women in the study may indicate that the
intervention was not sufficiently robust to impact on mental health and
lifestyle, although a longer follow-up may be needed to confirm this.
Discrepancy in the evidence provided by formal and informal data suggests
that project benefits may have been more evident if the evaluation had
included a qualitative element to address the complexity of the client
group and intervention.
Keywords: Teenage pregnancy; Midwifery; Social support; Health services;
Self-esteem
Steffen Foerster, Steven L. Monfort, Fecal glucocorticoids as indicators of

metabolic stress in female Sykes' monkeys (Cercopithecus mitis
albogularis), Hormones and Behavior, Volume 58, Issue 4, September 2010,
Pages 685-697, ISSN 0018-506X, 10.1016/j.yhbeh.2010.06.002.
Abstract: Because of their mediating role in the stress response and
potential effects on fitness, glucocorticoid (GC) hormones are increasingly
used to assess the physiological costs of environmental and behavioral
variation among wild vertebrates. Identifying the proximate causes of GC
variation, however, is complicated by simultaneous exposure to multiple
potentially stressful stimuli. Here, we use data from a partially
provisioned social group of Sykes' monkeys to evaluate the effects of
potential psychological and metabolic stressors on temporal and individual
variation in fecal GC (fGC) excretion among 11 adult females. Despite high
rates of agonism over provisioned foods fGCs declined during periods of
high provisioning frequency when fruit availability was dominated by neem
(Azadirachta indica), an item requiring great feeding effort. Provisioned
foods did not prevent fGC increases when availability of the most preferred
main fruit item, tamarind (Tamarindus indica), declined drastically.
Although rank-related differences in access to provisioned foods and rates
of agonism did not lead to an overall effect of rank on fGCs, low-ranking
females excreted more fGCs than high-ranking females during a period of
high provisioning intensity and low fruit availability. The emergence of
this rank effect was associated with elevated feeding effort in all
females, a greater access to provisioned items by high-ranking females, and
a higher proportion of time spent moving in low-ranking females. Our
findings suggest that metabolic stressors were the primary determinants of
both temporal and individual variation in fGCs, indicating potential
fitness benefits for high-ranking females when food availability is
limited.
Keywords: Cercopithecus mitis;
Glucocorticoids; Metabolic stress; Proximate causes; Social behavior;
Feeding ecology; Temporal variation; Individual differences; Rank effects
Nalini Singhal, Zulfiqar Ahmed Bhutta, Newborn resuscitation in resource-

limited settings, Seminars in Fetal and Neonatal Medicine, Volume 13, Issue
6, December 2008, Pages 432-439, ISSN 1744-165X,
10.1016/j.siny.2008.04.013.
Abstract: Summary
Every year, an estimated 4 million newborn infants die worldwide in the
first 4 weeks of life. A large majority of these deaths occurs during the
first day of life. One of the United Nations' eight Millennium Development
Goals is to decrease child mortality; prevention of neonatal deaths by
appropriate resuscitation will have a significant impact on achieving this
goal. Newborn resuscitation needs to be carried out in all the settings
where asphyxiated babies are born, including: community or domiciliary
settings for home births; rural health centers/midwifery stations, where
attendants with basic resuscitation skills might be available; district-
level facilities where staff are available but skills vary; and urban
referral and tertiary care centers. Individuals at all levels require
training and seldomly used skills need to be maintained so that, when
required, resuscitation can be carried out efficiently and effectively.
Simple resuscitation techniques include: positioning, drying, and keeping
the baby warm; assessing the heart rate, color, and respirations;
recognizing the need for, and administering, assisted ventilation with a
bag and mask or tube and mask. These maneuvers can be carried out with
simple equipment and appropriate training. Research in developing countries
remains sparse, with 90% of research being done in more developed parts of
the world, which experience just 10% of the problems. The significant gaps
in our understanding include: failing to agree on a definition of the term
asphyxia, lack of knowledge of the impact of community approaches on the
prevention and management of asphyxia, and a failure to recognize the best
method to determine heart rate.
Keywords: Birth asphyxia; Developing countries; Resource-limited settings;
Resuscitation
Robert M. Malow, Susan J. Ireland, E. Stephen Halpert, Jose Szapocznik,

Robert C. McMahon, Lee Haber, A description of the maternal addiction
program of the University of Miami/Jackson Memorial Medical Center, Journal
of Substance Abuse Treatment, Volume 11, Issue 1, JanuaryFebruary 1994,
Pages 55-60, ISSN 0740-5472, 10.1016/0740-5472(94)90064-7.
Abstract: The MAP of the University of Miami/Jackson Memorial Medical
Center/Highland PArk Pavilion is a comperehensive inpatient and outpatient
chemical dependency rehabilitation program that serves mostly lower
socioeconomic, African-American perinatal substances-abusing women. The
multidisciplinary treatment team incorporates a broad spectrum of group and
individual therapeutic modalities, including 12-step, psychoeducational,
and RP components.
Within MAP programs, significant attention is given to issues and
experiences that are unique to this population and that must be addressed
if rehabilitation is to be successful. These topics include, but are not
limited to, physical, emotional and sexual abuse, empowerment, family and
parenting concerns, and HIV prevention and coping skills for HIV-
seropositive women.
Keywords: HIV; minorities; cocaine; pregnant women
Susan M. Bentley, Jennifer L. Melville, Bianca D. Berry, Wayne J. Katon,

Implementing a clinical and research registry in obstetrics: overcoming the
barriers, General Hospital Psychiatry, Volume 29, Issue 3, MayJune 2007,
Pages 192-198, ISSN 0163-8343, 10.1016/j.genhosppsych.2007.01.011.
Abstract: Objective
This study aimed to describe the obstacles and solutions in developing and
implementing a prospective obstetric database registry that collects
biopsychosocial data on women during pregnancy and postpartum. The clinical
goals of the registry were to improve both diagnosis of mental health and
substance use problems and access to mental health care during pregnancy.
The research goals were to examine the impact of psychiatric illness and
substance use on birth outcomes.
Study Setting and Registry Design
A questionnaire that contained validated instruments for mental health,
substance use and psychosocial stressors was developed and administered to
all pregnant women in an academic medical center obstetric clinic. Results
were incorporated with reminder and decision support systems to ensure
active follow-up of patients with mental health needs. Automated medical
record information was collected for future analysis of outcomes.
Program Implementation
Barriers to program implementation were overcome by a multifaceted
intervention that included educational outreach to patients, providers and
staff; integration of the registry into preexisting clinical protocols;
reminder systems at workstations; provision of mental health decision
support through perinatal social work and psychiatric consultation; and
utilization of a stepped-care model to delivering mental health services.
Conclusion
A mental health registry that merges clinical and research needs can be
successfully integrated into the obstetric clinic setting.
Keywords: Depression; Registry; Women; Pregnancy
Martin W. Dnser, Otgon Bataar, Ganbat Tsenddorj, Ganbold Lundeg, Stefan

Jochberger, Stephan Jakob, for the Helfen Berhrt Study Team, Intensive
care medicine in Mongolia's 3 largest cities: Outlining the needs, Journal
of Critical Care, Volume 24, Issue 3, September 2009, Pages 469.e1-469.e6,
ISSN 0883-9441, 10.1016/j.jcrc.2008.06.014.
Abstract: Purpose
To evaluate intensive care resources, support, and personnel available in
Mongolia's 3 largest cities.
Materials and Methods
This prospective study was performed as a questionnaire-based survey
evaluating intensive care units (ICUs) in Mongolia's 3 main cities.
Results
Twenty-one of 31 ICUs participated in the survey. The median number of beds
per ICU was 7 (interquartile ranges, 6-10) with 0.7 (0.6-0.9) physicians
and 1.5 (0.6-1.8) nurses per bed. A 24-hour physician service was available
in 61.9% of the participating ICUs. A median number of 359 patients (250-
500) with an average age of 39 (30-49) years were treated annually. Oxygen
was available in all ICUs, but only for 60% (17-75) of beds. Pressurized
air was available in 33% of the ICUs for 24% (0-15) of beds. Of the ICUs,
52.4% had a lung ventilator serving 20% (0-23) of beds. The most common
admission diagnoses were sepsis, stroke, cardiac disease, postoperative or
postpartum hemorrhage, and intoxication. Availability of medical equipment,
disposables, and drugs was inadequate in all ICUs.
Conclusions
Intensive care medicine in Mongolia's 3 largest cities is an under-
resourced and underdeveloped medical specialty. The main problems
encountered are insufficient training of staff as well as lack of medical
equipment, disposables, and drugs.
Keywords: Intensive care medicine; Mongolia; Less developed countries
Simon Attard Montalto, Helen Borg, Mary Buttigieg-Said, Edward J Clemmer,

Incorrect advice: the most significant negative determinant on breast
feeding in Malta, Midwifery, Volume 26, Issue 1, February 2010, Pages e6-
e13, ISSN 0266-6138, 10.1016/j.midw.2008.06.002.
Abstract: Objective
this study reviewed breast-feeding rates in Malta for the first six months
of life and identified reasons why mothers discontinue breast feeding in
this small island state.
Design and participants
a random sample of 405 new mothers who chose to breast feed in the only
major state hospital were contacted by phone one week postnatally and again
each month up to six months, and presented with a questionnaire relating to
their feeding experience.
Findings
breast-feeding attrition rates were high with just 152 (38%) of 403
analysable babies still breast feeding at six months. The reasons for
stopping breast feeding were categorised by: maternal choice; medical
reasons; lack of information; social reasons, incorrect advice and no
reason provided. 200 (50%) of the total cohort stopped breast feeding
following incorrect advice from health professionals. Just 14 (3.5%) and 17
(4.2%) mothers stopped as a result of their own choice or a medical
problem, respectively. Of the total of 403, 77 (19%) mothers introduced
supplementary bottle feeds in hospital; of these, 70 (91%) stopped breast
feeding altogether soon afterwards. This compared with just 180 (55%) of
326 women who did not introduce bottle feeds in hospital yet subsequently
discontinued breast feeding (p<0.001).
Key conclusions
many health professionals in Malta are not sufficiently committed to
supporting breast-feeding mothers, and artificial feeds are widely
recommended without any scientific-based rationale. Incorrect advice on
breast feeding is often given early prior to discharge from hospital. As a
result, many Maltese mothers introduce supplementary artificial milk feeds
in hospital, and this is significantly associated with subsequent cessation
of breast feeding within six months of discharge.
the introduction of a clear hospital breast-feeding policy and appropriate
education for all health professionals involved in maternity care is
strongly recommended.
Keywords: Incorrect advice; Breast feeding
Beverley Lloyd, Penelope Hawe, Solutions forgone? How health professionals

frame the problem of postnatal depression, Social Science & Medicine,
10.1016/S0277-9536(03)00061-3.
Abstract: Our interest is in how particular solutions in postnatal
depression have a tendency to be adopted at the expense of alternative
solutions. One aspect of the answer may lie in how people in positions of
authority think about problems. Framing refers to the way particular
causalities, consequences and moralities are contained within the ways in
which people communicate concepts, in particular in language and in
metaphor. Naming the way problems are framed and identifying alternative
frames, (i.e., reframing) may provide an opportunity to set problems more
effectively and to identify solutions that will solve the problem more
effectively. A framing analysis was conducted, drawing on interviews with
senior researchers, policy makers and practitioners in the field of
postnatal depression. Seven principal ways in which the problem of
postnatal depression was framed were illuminated. These fitted into three
broad approaches to the problem: individual therapeutic approaches, social
competence approaches and societal approaches. Participants in our study
were comfortable and articulate in describing the problem of postnatal
depressionwhether they were focused on the individual or societal levels
of analysis. However, they were less well versed and comfortable in
discussing what they felt might be important social or societal-level
solutions, lacking in both language and schema to do so. The history and
hierarchy that is carried by people from the helping professions may be
hindering new avenues to help mothers with new babies.
Keywords: Postnatal depression; Problem framing; Maternal health policy;
Australia
Joanne Motino Bailey, Patricia Crane, Clark E. Nugent, Childbirth Education

and Birth Plans, Obstetrics and Gynecology Clinics of North America, Volume
10.1016/j.ogc.2008.04.005.
Abstract: Childbirth education is considered a key component to prenatal
care, although many women do not receive any formalized preparation. There
are multiple models of childbirth education for both within health care
settings, including Centering Pregnancy, and external programs, such as
Lamaze and Bradley. As a component of childbirth preparation, a birth plan
can be a medium to improve patient-provider communication regarding a
desired labor and birth experience and improve satisfaction with care.
Anne Scupholme, Nurse-midwives and physicians: A team approach to

obstetrical care in a prenatal care, Journal of Nurse-Midwifery, Volume 27,
Issue 1, JanuaryFebruary 1982, Pages 21-27, ISSN 0091-2182, 10.1016/0091-
2182(82)90130-6.
Abstract: Controversy exists concerning the role of nurse-midwives in
tertiary care centers. By tradition, preparation, and practice, nurse-
midwives have not sought to work in the areas of high-risk obstetrics.
However with the advent of modem technology and the prevailing economic and
legal climate, many more women are finding themselves referred to high-risk
centers for obstetrical care. All of these factors contributed to the
formation of the nurse-midwifery service at the University of Miami,
Jackson Memorial Hospital, Miami, Florida in January 1977. The service is
described as it evolved over four and a half years. The success of the
model led to the expansion of the philosophy and the development of the
three principles of practice-independent management, comanagement, and
collaborative management. The nurse-midwives have performed 8,145
deliveries. Selected data is reviewed and the continued role of nurse-
midwives in perinatal centers is discussed.
Jennifer Percival, Stella Aguinaga Bialous, Sophia Chan, Linda Sarna,

International efforts in tobacco control, Seminars in Oncology Nursing,
10.1053/j.soncn.2003.08.008.
To review international nursing involvement in tobacco control and discuss
opportunities and challenges to enhance nurses participation in decreasing
tobacco-related morbidity and mortality.
Data sources
Published literature and published and unpublished material developed by
nurses in their tobacco control initiatives.
Conclusion
Worldwide, nurses have been involved in tobacco control. However, many
opportunities remain for involvement in the areas of education, research,
and practice.
Implications for nursing practice
There are numerous opportunities for nurses throughout the world to enhance
their involvement in tobacco control.
Mark E. Deutchman, Ricardo Hahn, OBSTETRIC ULTRASONOGRAPHY, Primary Care:

Clinics in Office Practice, Volume 24, Issue 2, 1 June 1997, Pages 407-431,
ISSN 0095-4543, 10.1016/S0095-4543(05)70400-0.
Abstract: Diagnostic ultrasonography is an imaging technique widely used in
modern perinatal care. In some European countries pregnant women receive
one or more ultrasound scans as a matter of routine during pregnancy, but
in the United States the standard of care is for ultrasound to be used for
specific medical indications.3,4 Nonetheless, the majority of low-risk
patients in the United States eventually develop an indication for
ultrasonography during pregnancy.16,23
The radiology model for the performance of obstetric ultrasound scans is

for sonographers, who are not physicians, to perform the ultrasound scan,
to record representative images, and to collect fetal biometric data. A
radiologist then reviews the images and validates the information collected
and generates a report to be sent to the referring physician. Practicing
clinicians such as obstetricians, family physicians, and advanced practice
nurses, however, often perform, record, interpret, and report the
ultrasound scan themselves. The clinician's clinical information and
familiarity with the patient strongly complement the examination process
and the clinical application of information obtained.
Terminology describing obstetric ultrasound examinations has undergone

evolution and is discussed briefly. An old terminology categorizes
obstetric ultrasound scans as level I or level II and so forth.6 This
terminology arose from the British maternal serum alphafetoprotein
(MSAFP)screening program in which patients with an abnormal MSAFP had a
level I scan performed by a nonphysician that included only fetal biometry
to verify gestational age. If the patient's dates were confirmed,
indicating that her abnormal MSAFP was a true abnormal instead of false-
positive, a level II scan then was performed by a physician, directed at
fetal anatomy, primarily to rule out anomalies that would cause the
elevated MSAFP. Modern practice dictates that essentially all obstetric
ultrasound scans adhere to standard examination content that includes fetal
biometry and an anatomic survey. The content of this examination has been
agreed on widely by the American Institute of Ultrasound in Medicine, 4 the
American College of Obstetricians and Gynecologists,3 and the American
College of Radiology. If the standard examination yields questions
requiring further analysis, a consultative or targeted examination may be
performed by a subspecialist, often using more sophisticated equipment.
Under specific circumstances, a limited examination might be appropriate,
such as a scan in labor and delivery to clarify the fetal lie or to assess
amniotic fluid or placental location. In this article, the modern
terminology is adopted, and the types of obstetric ultrasound scans
described include limited labor and delivery scans and the standard
antepartum obstetric ultrasound examination as described by the American
Institute of Ultrasound in Medicine/American College of Obstetricians and
Gynecologists/American College of Radiology guidelines.
Howard C. Taylor Jr., Objectives and principles in the training of the

obstetrician-gynecologist: Training for surgical virtuosity and versatility
or for public service, The American Journal of Surgery, Volume 110, Issue
1, July 1965, Pages 35-42, ISSN 0002-9610, 10.1016/0002-9610(65)90148-0.
Simone G Diniz, Alessandra S Chacham, The Cut Above and the Cut Below:
The Abuse of Caesareans and Episiotomy in So Paulo, Brazil, Reproductive
Health Matters, Volume 12, Issue 23, May 2004, Pages 100-110, ISSN 0968-
8080, 10.1016/S0968-8080(04)23112-3.
Abstract: In the last 50 years, a rapid increase in the use of technology
to start, augment, accelerate, regulate and monitor the process of birth
has frequently led to the adoption of inadequate, unnecessary and sometimes
dangerous interventions. Although research has shown that the least amount
of interference compatible with safety is the paradigm to follow, vaginal
birth is still being treated as if it carries a high risk to women's health
and sexual life in Brazil. This paper describes the impact of the
intervention model on women's birth experience, and discusses how the
organisation of public and private maternity services in Brazil influences
the quality of obstetric care. Brazil is known for high rates of
unnecessary caesarean section (the cut above), performed in over two-
thirds of births in the private sector, where 30% of women give birth. The
94.2% rate of episiotomy (the cut below) in women who give birth
vaginally, affecting the 70% of poor women using the public sector most,
receives less attention. A change in the understanding of women's bodies is
required before a change in the procedures themselves can be expected.
Since 1993, inspired by campaigns against female genital mutilation, a
national movement of providers, feminists and consumer groups has been
promoting evidence-based care and humanisation of childbirth in Brazil, to
reduce unnecessary surgical procedures.
Keywords: evidence-based medicine; caesarean section; episiotomy;
medicalisation of childbirth; humanisation of childbirth; Brazil
Ellen M.H. Mitchell, Amata Kwizera, Momade Usta, Hailemichael

Gebreselassie, Choosing early pregnancy termination methods in Urban
Mozambique, Social Science & Medicine, Volume 71, Issue 1, July 2010,
Pages 62-70, ISSN 0277-9536, 10.1016/j.socscimed.2010.03.025.
Abstract: Little is known about who chooses medication abortion with
misoprostol and why. Women seeking early abortion in 5 public hospitals in
Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-
making strategies, method preferences and experiences with misoprostol and
vacuum aspiration for early abortion. Client screenings
(n = 1799), structured clinical surveys (n = 837), in-
depth exit interviews (n = 70), and nurse focus groups
(n = 2) were conducted. Triangulation of qualitative and
quantative data revealed seemingly contradictory findings. Choice of method
reflected womens heightened concerns about privacy, pain, quality of home
support, HIV infection risk, sexuality, and safety of research
participation. Urban Mozambican women are highly motivated to find early
pregnancy termination techniques that they deem socially and clinically
low-risk. Although 42% found vaginal misoprostol self-administration
challenging and 25% delayed care for over a week to amass funds for user
fees, almost all (96%) reported adequate preparation and comfort with home
management. Women reported satisfaction with all methods and quality of
care, even if the initial method failed or pain management or postabortion
contraception were not offered. A more nuanced understanding of what women
value most can yield service delivery models that are responsive and
effective in reducing maternal death and disability from unsafe abortion.
Keywords: Mozambique; Abortion; Privacy; Misoprostol; Satisfaction; Nurses;
Decision making; Mixed-methods
Mark N. Lobato, Joe Goldenson, Chapter 17 - Tuberculosis in the

Correctional Facility, In: Michael Puisis, D.O., Editor(s), Clinical
Practice in Correctional Medicine (Second Edition), Mosby, Philadelphia,
2006, Pages 259-281, ISBN 9780323032650, 10.1016/B978-0-323-03265-0.50022-
1.
, Position of the American Dietetic Association and Dietitians of Canada:

Nutrition and Womens Health, Journal of the American Dietetic Association,
10.1016/j.jada.2004.04.010.
Abstract: It is the position of the American Dietetic Association (ADA) and
Dietitians of Canada (DC) that women have specific nutritional needs and
vulnerabilities and, as such, are at unique risk for various nutrition-
related diseases and conditions. Therefore, the ADA and the DC strongly
support research, health promotion activities, health services, and
advocacy efforts that will enable women to adopt desirable nutrition
practices for optimal health. Women are at risk for numerous chronic
diseases and conditions that affect the duration and quality of their
lives. Although womens health-related issues are multifaceted, nutrition
has been shown to influence significantly the risk of chronic disease and
to assist in maintaining optimal health status. Dietetics professionals
strongly support research, health promotion activities, health services,
and advocacy efforts that will enable women to adopt desirable nutrition
practices for optimal health.
Melissa D Avery, Diabetes in pregnancy: the midwifery role in management,

Journal of Midwifery & Women's Health, Volume 45, Issue 6, November
December 2000, Pages 472-480, ISSN 1526-9523, 10.1016/S1526-9523(00)00078-
7.
Abstract: Although the primary focus of midwifery is on uncomplicated
pregnancy, all midwives must screen for and, in some cases, comanage the
care of women with diabetes mellitus and gestational diabetes. This article
will review the types of diabetes, implications for preconceptional and
pregnancy care, the changing recommendations relative to diabetes in
pregnancy, and the role of the midwife in providing antepartal and
intrapartal care for women with diabetes in collaboration with other health
care professionals and in accordance with the philosophy and standards of
the American College of Nurse-Midwives. A specific case study will
highlight the role of the midwife, with an overall focus on medical
consultation, collaboration, and referral, as well as client involvement in
the planning of care.
, References, Introduction to Forensic Psychology (Third Edition), Academic

Press, San Diego, 2012, Pages 615-679, ISBN 9780123821690, 10.1016/B978-0-
12-382169-0.16001-3.
Jeffrey S. Stevenson, Reproductive Management of Dairy Cows in High Milk-

Producing Herds, Journal of Dairy Science, Volume 84, Supplement, June
2001, Pages E128-E143, ISSN 0022-0302, 10.3168/jds.S0022-0302(01)70207-X.
Abstract: Challenges limiting reproductive efficiency of high milk-
producing cows include interrelationships among body condition, dry matter
intake, transition from the dry period to lactation, onset of normal
estrous cycles, detection of estrus, and embryonic survival. Attention is
required to details associated with diet formulation; feed bunk management;
cow comfort in free stalls, holding pen, and milking parlor during extremes
of temperature and humidity; proper hoof care; milking management and
mastitis prevention; control of ovulation and estrus; and early
nonpregnancy diagnosis. Intensive management of transition cows should
involve monitoring key metabolic markers using hand-held devices. This
should allow early detection of illnesses that can be followed by proven
interventions to alleviate their residual effects. Body condition should be
monitored more closely to reduce dry cow and transition problems and
prevent prolonged anestrus by maximizing early postpartum dry matter
intakes. Cow comfort should be monitored more closely to minimize standing
time for milking, maximize standing time for estrus and feed intake, and
maximize resting time for rumination and more efficient milk synthesis.
Estrus may be detected using automated techniques such as pedometry, rump-
mounted pressure-sensitive radio-telemetric devices, and in-line parlor
tests for milk progesterone or estrogen. More highly fertile heifers may be
impregnated using sexed semen, sexed embryos, or clones to provide more
replacement heifers because of declining fertility of lactating cows.
Strategies to impregnate high-producing cows will require more ovulation
control before first and subsequent services without detection of estrus.
Because of high rates of embryonic death, more pregnancies may be achieved
by using sexed or cloned embryos. Many reproductive technologies used
today, including programmed breeding, will be refined and incorporated into
the management of cows on fewer dairy farms with more cows per farm.
Despite trends for longer lactations associated with bST and lesser
pregnancy rates, renewed lactations following parturition will continue to
be essential for herd longevity of cows.
Keywords: management; reproduction; dairy cattle; milk production
Dorothy Shaw, The FIGO initiative for the prevention of unsafe abortion,
International Journal of Gynecology & Obstetrics, Volume 110,
Supplement, July 2010, Pages S17-S19, ISSN 0020-7292,
10.1016/j.ijgo.2010.04.004.
Abstract: Unsafe abortion is a recognized public health problem that
contributes significantly to maternal mortality. At least 13% of maternal
mortality is caused by unsafe abortion, mostly in poor and marginalized
women. The International Federation of Gynecology and Obstetrics (FIGO)
launched an initiative in 2007 to prevent unsafe abortion and its
consequences, building on its work on other major causes of maternal
mortality. A Working Group was identified with collaborators from many
international organizations and terms of reference provided direction from
the FIGO Executive Board as to possible evidence-based interventions. A
total of 54 member associations of FIGO, representing almost half its
member societies, requested participation in the initiative, with 43
subsequently producing action plans that are country specific and involve
the national government and multiple collaborators.
Obstetrician/gynecologists have demonstrated the importance of the
initiative by an unprecedented level of engagement in efforts to reduce
maternal mortality and morbidity in country and by sharing experiences
regionally.
Keywords: Contraception; Maternal mortality; Reproductive health;
Unintended/unwanted pregnancy; Unsafe abortion
Georgina Sosa, Kenda Crozier, Jill Robinson, What is meant by one-to-one

support in labour: Analysing the concept, Midwifery, Available online 9
September 2011, ISSN 0266-6138, 10.1016/j.midw.2011.07.001.
the term one-to-one support in labour is used in a range of research
reports and policy documents internationally without a clear consensus on
definition.
Aim
the aim of this paper is to examine the variety of meanings and to clarify
the concept of one-to-one support in labour.
Method
Walker and Avant provide a useful guide for the analysis of concepts and
this has been used as a starting point from which to build our discussion.
We systematically examined the literature to answer the who, what, when,
where, and how for providing one-to-one support in labour.
Findings
our paper examines the evidence for one-to-one support in the light of the
range of meanings that have been attributed to the concept. Multiple
meanings for the concept have created confusion and there is a need for
greater clarity, which may be used in directing research, practice, and
policy.
Conclusions
in spite of strong evidence for the benefits of one-to-one support in
labour, the utility of the evidence base is limited by the failure to
specify what is meant by one-to-one support leading to a lack of
comparability/applicability. There is a need for research that focuses more
clearly on articulating what happens during labour between the woman and
the range of people who support her, in services that are deemed to offer
one-to-one support.
Keywords: One-to-one; Labour support; 1:1; Continuous support
M. El-Shafei, Lessons learned from maternal mortality study to reduce

deaths in Egypt, International Journal of Gynecology & Obstetrics,
Volume 50, Supplement 2, October 1995, Pages S109-S111, ISSN 0020-7292,
10.1016/0020-7292(95)02497-Z.
(http://www.sciencedirect.com/science/article/pii/002072929502497Z)
Abstract: To identify causes of maternal death in Egypt and with that
knowledge to effect its reduction, the Ministry of Health launched a study,
a unique aspect of which was exploration of avoidable factory at home, in
medical facilities, and during transportation from one to the other. The
country must make better use of existing personnel and buildings.
Keywords: Preventable mortality; Egyptian maternal mortality
Virginia Hight Laukaran, The effects of contraceptive use on the initiation

and duration of lactation, International Journal of Gynecology &
Obstetrics, Volume 25, Supplement 1, 1987, Pages 129-142, ISSN 0020-7292,
10.1016/0020-7292(87)90402-4.
Keywords: Breastfeeding; Contraception; Postpartum family planning; Methods
Kerstin Nyberg, Inger Lindberg, Kerstin hrling, Midwives experience of

encountering women with posttraumatic stress symptoms after childbirth,
Sexual & Reproductive Healthcare, Volume 1, Issue 2, April 2010, Pages
55-60, ISSN 1877-5756, 10.1016/j.srhc.2010.01.003.
Abstract: Objective
To describe midwives experience of encountering women with posttraumatic
stress symptoms after childbirth.
Study design
Semi-structured interviews with eight midwives with experiences of
encountering women with posttraumatic stress symptoms after childbirth.
Data were analyzed using thematic content analysis.
Result
The midwives encountered women with severe experiences after a childbirth,
which had affected their lives. The midwives thought that they had to
reflect on their own attitude and use their gentleness as they responded to
the womens stories. By listening to and enabling the women to express
their feelings and tell their stories, the midwives thought that they could
confirm the womens experience. The midwives thought that they could
support women who had lost confidence to give birth but also thought that
cesarean section did not solve the womens problems.
Conclusion
Training of midwives is necessary to increase awareness of the cause of
womens posttraumatic stress symptoms. It is urgent to optimize the
implementation of new research into practical reality to raise the quality
of care of women with fear of childbirth. Childbirth is an important
experience that can influence a womans well-being and her connection to
the child. Posttraumatic stress symptoms should be identified in an early
stage/pregnancy to allow early treatment on the right level of care.
Keywords: Posttraumatic stress symptoms; Childbirth; Midwife; Experience;
Interview; Thematic content analysis
Janet A. DiPietro, Kathleen A. Costigan, Eva K. Pressman, Fetal state

concordance predicts infant state regulation, Early Human Development,
Volume 68, Issue 1, June 2002, Pages 1-13, ISSN 0378-3782, 10.1016/S0378-
3782(02)00006-3.
Abstract: Fetal state organization reflects the development of the central
nervous system but may also portend individual differences in postnatal
state organization. The goal of the present study was to determine the
extent to which fetal state regulation, defined as the percentage of an
observation period in which fetal heart rate and movement concordance was
displayed, is associated with neonatal state regulation. Neonatal state
regulation was evaluated through a standard neurobehavioral assessment at 2
weeks postpartum. Biobehavioral concordance was measured in 52 normally
developing fetuses at 24, 30 and 36 weeks gestation using an
actocardiograph; the neonatal assessment was administered to 41 of these as
infants. Intrafetal stability in biobehavioral concordance did not emerge
prior to 36 weeks. Fetuses with higher concordance at 36 weeks were infants
that displayed better state regulation during the exam, including more
alertness and orientation (r(35)=0.29), less cost of maintaining attention
(r=0.36), less irritability (r=0.41), better regulatory capacity (r=0.47),
a greater range of available states (r=0.34), and were significantly more
likely to maintain control during the most aversive portions of the exam
F(1,31)=4.63, p<0.05). These results support fetal state as a stable
individual attribute that is conserved across the prenatal and neonatal
periods.
Keywords: Fetal state concordance; Infant state regulation; Central nervous
system
Susan M. Blake, Kennan D. Murray, M. Nabil El-Khorazaty, Marie G. Gantz,

Michele Kiely, Dana Best, Jill G. Joseph, Ayman A.E. El-Mohandes,
Environmental Tobacco Smoke Avoidance Among Pregnant African-American
Nonsmokers, American Journal of Preventive Medicine, Volume 36, Issue 3,
March 2009, Pages 225-234, ISSN 0749-3797, 10.1016/j.amepre.2008.10.012.
Environmental tobacco smoke (ETS) exposure during pregnancy contributes to
adverse infant health outcomes. Limited previous research has focused on
identifying correlates of ETS avoidance. This study sought to identify
proximal and more distal correlates of ETS avoidance early in pregnancy
among African-American women.
Methods
From a sample of low-income, black women (n=1044) recruited in six urban,
prenatal care clinics (July 2001October 2003), cotinine-confirmed
nonsmokers with partners, household/family members, or friends who smoked
(n=450) were identified and divided into two groups: any past-7-day ETS
exposure and cotinine-confirmed ETS avoidance. Bivariate and multivariate
logistic regression analyses identified factors associated with ETS
avoidance. Data were initially analyzed in 2004. Final models were reviewed
and revised in 2007 and 2008.
Results
Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders.
In multivariate logistic regression analysis, the odds of ETS avoidance
were increased among women who reported household smoking bans (OR=2.96;
95% CI=1.83, 4.77; p<0.0001), that the father wanted the baby (OR=2.70;
CI=1.26, 5.76; p=0.01), and that no/few family members/friends smoked
(OR=3.15; 95% CI=1.58, 6.29; p<0.001). The odds were decreased among
women who had a current partner (OR=0.42; 95% CI=0.23, 0.76; p<0.01),
reported any intimate partner violence during pregnancy (OR=0.43; 95%
CI=0.19, 0.95; p<0.05), and reported little social support to prevent
ETS exposure (OR=0.50; 95% CI=0.30, 0.85; p=0.01). Parity, emotional coping
strategies, substance use during pregnancy, partner/household member
smoking status, and self-confidence in avoiding ETS were significant in
bivariate, but not multivariate analyses.
Conclusions
Social contextual factors were the strongest determinants of ETS avoidance
during pregnancy. Results highlight the importance of prenatal screening to
identify pregnant nonsmokers at risk, encouraging household smoking bans,
gaining support from significant others, and fully understanding the
interpersonal context of a woman's pregnancy before providing behavioral
counseling and advice to prevent ETS exposure.
Catherine Lewis, Treating Incarcerated Women: Gender Matters, Psychiatric

Clinics of North America, Volume 29, Issue 3, September 2006, Pages 773-
789, ISSN 0193-953X, 10.1016/j.psc.2006.04.013.
Martha H Roper, Jos H Vandelaer, Franois L Gasse, Maternal and neonatal

tetanus, The Lancet, Volume 370, Issue 9603, 814 December 2007, Pages
1947-1959, ISSN 0140-6736, 10.1016/S0140-6736(07)61261-6.
Abstract: Summary
Maternal and neonatal tetanus are important causes of maternal and neonatal
mortality, claiming about 180000 lives worldwide every year, almost
exclusively in developing countries. Although easily prevented by maternal
immunisation with tetanus toxoid vaccine, and aseptic obstetric and
postnatal umbilical-cord care practices, maternal and neonatal tetanus
persist as public-health problems in 48 countries, mainly in Asia and
Africa. Survival of tetanus patients has improved substantially for those
treated in hospitals with modern intensive-care facilities; however, such
facilities are often unavailable where the tetanus burden is highest. The
Maternal and Neonatal Tetanus Elimination Initiative assists countries in
which maternal and neonatal tetanus has not been eliminated to provide
immunisation with tetanus toxoid to women of childbearing age. The ultimate
goal of this initiative is the worldwide elimination of maternal and
neonatal tetanus. Since tetanus spores cannot be removed from the
environment, sustaining elimination will require improvements to presently
inadequate immunisation and health-service infrastructures, and universal
access to those services. The renewed worldwide commitment to the reduction
of maternal and child mortality, if translated into effective action, could
help to provide the systemic changes needed for long-term elimination of
maternal and neonatal tetanus.
L Jamisse, F Songane, A Libombo, C Bique, A Fandes, Reducing maternal

mortality in Mozambique: challenges, failures, successes and lessons
learned, International Journal of Gynecology & Obstetrics, Volume 85,
10.1016/j.ijgo.2004.01.005.
Abstract: The aim of this paper is to describe different approaches to make
emergency obstetric care (EmOC) accessible to women in Mozambique. The
definitions of basic (BEmOC) and comprehensive EmOC (CEmOC), proposed by
the UN agencies, were adopted by FIGO and by the Mozambican Ministry of
Health as a general strategy to reduce maternal mortality. Four projects
are presented: (1) Jos Macamo and (2) Mavalane Hospitals in Maputo city,
(3) Manhia District in Maputo Province and (4) Sofala Province. Jos
Macamo was staffed by physicians 24 h a day; other hospitals by non-
physicians trained in surgical and anesthesiology techniques, as well as
nurse-midwives. Jos Macamo Hospital provided CEmOC to the city of Maputo
and the southern area of Maputo Province. In 2001, this hospital attended
32% of deliveries and 38% of cesarean sections in the city, up from 14 and
2.5%, respectively, in 1998. The Mavalane Hospital failed to provide CEmOC;
however, the number of deliveries per year almost doubled. The Manhia
hospital carried out 31% of the District's C-sections in 2001, up from 9%
in 1998. In Sofala Province, one additional CEmOC and four BEmOCs were
installed and case fatality rates decreased. In conclusion, the strategy
for ensuring provision of EmOC is feasible even in countries with minimal
resources and a scarcity of physicians, such as Mozambique.
Keywords: Maternal mortality; Emergency obstetric care; Developing
countries
Sharon Bernecki DeJoy, Midwives Are Nice, But . . .: Perceptions of

Midwifery and Childbirth in an Undergraduate Class, Journal of Midwifery
& Women's Health, Volume 55, Issue 2, MarchApril 2010, Pages 117-123,
ISSN 1526-9523, 10.1016/j.jmwh.2009.05.009.
The purpose of this study was to explore college students' beliefs about
childbirth and midwifery.
Methods
A critical qualitative analysis was used to identify common themes that
occurred in an online class discussion about midwifery.
Results
This population of 459 college students drew on the larger social discourse
of the medical model of childbirth to frame their discussion of childbirth
and midwives. Common beliefs that emerged from class discussions included
the perceived dangerous nature of childbirth, the necessity for technologic
interventions in childbirth, and doubts about the quality of midwifery
training and practice.
Discussion
To promote midwifery among this population, advocates should continue
public education efforts through a variety of media and communication
strategies, with an emphasis on the safety of midwifery care.
Keywords: midwifery; qualitative research; public opinion; students
Judith T Fullerton, Peter Johnson, Sachiko Oshio, The 1999 ACC task
analysis of nurse-midwifery/midwifery practice phase I: the instrument
development study, Journal of Midwifery & Women's Health, Volume 45,
Issue 2, MarchApril 2000, Pages 150-156, ISSN 1526-9523, 10.1016/S1526-
9523(99)00043-4.
Abstract: The national certification examination (NCE) in nurse-midwifery
and midwifery is developed, administered, and evaluated by the ACNM
Certification Council (ACC). The blueprint for the NCE is based upon a
comprehensive list of tasks that describe the knowledge, skills, and
abilities expected of the midwifery practitioner at entry into the
profession. In 1999, the ACC initiated the third in a series of task
analysis studies to ensure the currency and relevance of the task list.
This study was considered particularly timely, given that the professional
organization, the American College of Nurse-Midwives, had approved pathways
to midwifery for individuals whose first degree was not in nursing (the
certified midwife) and also had expanded the core competencies for
midwifery practice to include responsibilities in the domain of primary
care. This manuscript reports the results of the pilot study, in which the
specific list of tasks was developed. Three hundred and six ACNM members
responded to a preliminary list of tasks, indicating their opinion about
whether each specific task was relevant to entry-level midwifery practice.
The task list finally derived consists of 219 tasks and 177 clinical
conditions, dispersed among seven domains of practice (antepartum,
intrapartum, newborn, postpartum, well-woman/gynecology, primary
care/health assessment, and professional issues.) The task list represents
a comprehensive profile of entry-level practice for nurse-midwives and
midwives certified by the ACC.
Omur Elcioglu, Nurdan Kirimlioglu, Zeki Yildiz, How do the accounts of the
patients on pregnancy and birth process enlighten medical team in terms of
narrative ethics?, Patient Education and Counseling, Volume 61, Issue 2,
May 2006, Pages 253-261, ISSN 0738-3991, 10.1016/j.pec.2005.04.003.
Abstract: Objective
The aim of this study is to evaluate the relationship between the patient
and the physician, midwife and nurse during the process of pregnancy and
birth, and to ascertain the importance of communication within this
relationship; find out the experiences of patients about the communication
process.
Methods
Three hundred eighty-eight people were interviewed about the pregnancy and
birth process. Chi square (2) and t-tests were used for the statistical
evaluation of the data. Forty-nine pregnant women, who were participating
in any pregnancy training program, were asked to write down their
experiences related to the pregnancy and birth process in a notebook.
Thirty-two (65.3%) of these notebooks were taken back 3 months after the
delivery, and these notebooks were evaluated within the framework of
narrative ethics and common themes were found out in order to be
discussed in this paper.
Results
It is found out that communication skills of doctors and midwives/nurses
were of primary importance for all the participants.
Conclusion
Pregnancy and birth are special processes and being informed is of great
importance in this process. Every woman has a story to tell about her
pregnancy and birth processes.
Practice implication
These findings may contribute to the development of new hypotheses. Hence,
similar research projects should be conducted, and the findings should be
compared.
Keywords: Narrative; Ethics; Communication
Alexandra Pacheco, Brbara Figueiredo, Mother's depression at childbirth

does not contribute to the effects of antenatal depression on neonate's
behavioral development, Infant Behavior and Development, Volume 35, Issue
3, June 2012, Pages 513-522, ISSN 0163-6383, 10.1016/j.infbeh.2012.02.001.
Maternal depression is a worldwide phenomenon that has been linked to
adverse developmental outcomes in neonates.
Aims
To study the effect of antenatal depression (during the third trimester of
pregnancy) on neonate behavior, preference, and habituation to both the
mother and a stranger's face/voice. To analyze mother's depression at
childbirth as a potential mediator or moderator of the relationship between
antenatal depression and neonate behavioral development.
Method
A sample of 110 pregnant women was divided in 2 groups according to their
scores on the Edinburgh Postnatal Depression Scale during pregnancy (EPDS;
10, depressed; <10, non-depressed). In the first 5 days after
birth, neonatal performance on the Neonatal Behavioral Assessment Scale
(NBAS) and in the Preference and habituation to the mother's face/voice
versus stranger paradigm was assessed; each mother filled out an EPDS.
Results
Neonates of depressed pregnant women, achieved lower scores on the NBASs
(regulation of state, range of state, and habituation); did not show a
visual/auditory preference for the mother's face/voice; required more
trials to become habituated to the mother's face/voice; and showed a higher
visual/auditory preference for the stranger's face/voice after habituation
compared to neonates of non-depressed pregnant women. Depression at
childbirth does not contribute to the effect of antenatal depression on
neonatal behavioral development.
Conclusion
Depression even before childbirth compromises the neonatal behavioral
development. Depression is a relevant issue and should be addressed as a
routine part of prenatal health care.
Keywords: Childbirth; Depression; Face/voice preference; Habituation;
Neonate; pregnancy
Eileen R. O'Shea, Michael Pagano, Suzanne H. Campbell, Gregory Caso, A

Descriptive Analysis of Nursing Student Communication Behaviors, Clinical
Simulation in Nursing, Available online 10 September 2011, ISSN 1876-1399,
10.1016/j.ecns.2011.05.013.
Abstract: This article describes a pilot study to examine communication
behaviors in nursing simulations. The nursing and communication faculty
researchers used an interdisciplinary descriptive approach to examine 55
student nurses in 19 video recordings of patient simulations. The results
demonstrated that using an interdisciplinary process can lead to a more
diverse and thorough assessment of communication skills. This study
supports the need for psychometrically sound evaluation tools for the
measurement of communication behaviors of nursing students during
simulation scenarios.
Keywords: health communication; human patient simulators;
interdisciplinary; leadership; nursing pedagogy; team communication
Sally Vivrette, Chapter 11 - Drugs acting on the reproductive system, In:

Joseph J. Bertone, DVM MS Diplomate ACVIM, and Linda J.I. Horspool, BVMS
PhD Diplomate ECVPT MRCVS, Editor(s), Equine Clinical Pharmacology, W.B.
Saunders, Oxford, 2004, Pages 177-191, ISBN 9780702024849, 10.1016/B978-0-
7020-2484-9.50015-8.
Charlene Thornton, Annemarie Hennessy, William A. Grobman, Benchmarking and

patient safety in hypertensive disorders of pregnancy, Best Practice &
Research Clinical Obstetrics & Gynaecology, Volume 25, Issue 4, August
2011, Pages 509-521, ISSN 1521-6934, 10.1016/j.bpobgyn.2011.03.002.
Abstract: Hypertensive disorders of pregnancy are a major cause of
morbidity and mortality worldwide. Reliable, published individual patient
data from units and countries are lacking. Without these data, clinicians
are unable to benchmark their incidence, treatments and outcomes, and
patient safety is unable to be routinely assessed. Available data suggest
that a notable proportion of the adverse events that occur with
hypertensive disease of pregnancy may be preventable. Theory and practice
indicate several methods that can offer the possibility of averting these
preventable adverse events. These methods include benchmarking outcomes,
standardisation of care processes, simulation, and enhancement of patient
knowledge. However, data on optimal methods to enhance patient safety and
quality of care of pregnant women with hypertensive disease remain limited,
and further research is required.
Keywords: benchmarking; patient safety; quality of care; preventable
adverse events
Catherine A. McMahon, Elizabeth Meins, Mind-mindedness, parenting stress,

and emotional availability in mothers of preschoolers, Early Childhood
Research Quarterly, Volume 27, Issue 2, 2nd Quarter 2012, Pages 245-252,
ISSN 0885-2006, 10.1016/j.ecresq.2011.08.002.
Abstract: Negative perceptions about the child and child behavior are
implicit in parenting stress, a construct associated with suboptimal
parenting and child outcomes. We examined the extent to which individual
differences in mothers mental representations of their children (mind-
mindedness) were related to parenting stress and observed parenting
behavior. Participants were 86 Australian mothers and their 4-year-olds who
were enrolled in a prospective study. Mind-mindedness was coded from
mothers descriptions of their child, mothers completed a self-report
measure of parenting stress, and maternal behavior during free-play was
videotaped and coded using the Emotional Availability (EA) Scales, Version
3. Mothers who used more mental state words when describing their child
reported lower parenting stress and showed less hostility when interacting
with their children. Mothers who used more positive mental state
descriptors were rated as more sensitive during interaction. The relation
between mind-mindedness and negative maternal behavior was indirect, and
mediated through parenting stress. Clinical implications of the findings
for families and childcare settings are discussed.
Keywords: Emotional availability; Mind-mindedness; Parenting stress
Einat Harf-Kashdaei, Marsha Kaitz, Antenatal moods regarding self, baby,

and spouse among women who conceived by in vitro fertilization, Fertility
and Sterility, Volume 87, Issue 6, June 2007, Pages 1306-1313, ISSN 0015-
0282, 10.1016/j.fertnstert.2006.11.035.
Abstract: Objective
To evaluate the antenatal feelings of women who conceived by IVF, with a
focus on their moods regarding self, baby, and spouse.
Design
Controlled, prospective study.
Setting
Outpatient clinics.
Patient(s)
Thirty women who conceived by IVF and 30 demographically matched women who
conceived naturally.
Intervention(s)
Validated interview and standardized questionnaires.
Main Outcome Measure(s)
Emotionality; positive affect; negative affect; moods regarding self,
spouse, and baby; and global anxiety and depression.
Result(s)
Compared with controls, the IVF group scored lower on negative affect and
higher on measures of (positive) mood regarding self, baby, and spouse. No
differences between groups were found on measures of positive affect,
depression, or anxiety. Women who had undergone two to three IVF cycles had
lower negative affect scores than women who had conceived after the first
treatment cycle, and mood regarding spouse depended on whether or not he
had been the sole source of the couples infertility.
Conclusion(s)
Women who conceived by IVF experienced more positive moods during pregnancy
than did the controls, and lingering effects of the womens history of
infertility were still in evidence.
Keywords: Affect; mood; IVF; pregnancy
Aye Grol, Sevin Polat, The Effects of Baby Massage on Attachment between
Mother and their Infants, Asian Nursing Research, Volume 6, Issue 1, March
2012, Pages 35-41, ISSN 1976-1317, 10.1016/j.anr.2012.02.006.
This study was conducted to examine the effect of baby massage on
attachment between mothers and their newborns.
Methods
This study was carried out from June 2008 to February 2010 in a quasi-
experimental design (57 in the experimental group, 60 in the control
group). Between the dates of the study, all healthy primipara mothers and
their healthy babies were included. Data were collected regarding their
demographic characteristics and by using the Maternal Attachment Inventory
(MAI). All mothers were assessed on the first and the last days of the 38-
day study period. In the experimental group, the babies received a 15-
minute massage therapy session everyday during the 38 days.
Results
There was no significant difference found in the pretest mean value
baseline of the MAI score in both groups. The posttest mean values of the
MAI of the experimental group mothers (90.87 10.76) were significantly
higher than those of control group (85.10 15.50). There was a significant
difference between groups (p < .05).
Conclusion
The results of the study have shown that baby massage is effective in
increasing the motherinfant attachment.
Keywords: complementary therapies; house calls; nursing
Ronnie Lichtman, Helen Varney Burst, Nancy Campau, Betty Carrington, Elaine
K. Diegmann, Lily Hsia, Joyce E. Thompson, Pearls of wisdom for clinical
teaching: expert educators reflect, Journal of Midwifery & Women's
Health, Volume 48, Issue 6, NovemberDecember 2003, Pages 455-463, ISSN
1526-9523, 10.1016/j.jmwh.2003.09.002.
Abstract: A group of expert educators, each with more than 20 years of
experience in midwifery education, was asked to contribute a pearl (or
pearls) of wisdom for clinical teaching. Despite minimal instructions
regarding what type of wisdom was being solicited, remarkable similarities
emerged from the educators' contributions. Themes included the need for
self-evaluation to become a competent preceptor, the role-modeling function
of the preceptor, the development of critical thinking in students, the
need to appreciate students' varying learning styles and individual ways of
functioning, and the use of positive reinforcement. Although these may seem
like universally accepted concepts in clinical teaching, one contributor
related stories she heard from students about hazing behaviors that have
a negative impact on learning. This points to the need for ongoing
education about being an educator, another theme echoed in several of the
contributions.
Keywords: clinical teaching; midwifery education
Cindy Belew, Herbs and the childbearing woman: Guidelines for midwives,
252, ISSN 0091-2182, 10.1016/S0091-2182(99)00043-9.
Abstract: The use of herbs to promote health or treat disease has become
popular, and midwives increasingly encounter questions from childbearing
clients regarding herbs. This article provides an overview of key concepts
regarding the incorporation of herbs into clinical practice and discusses
the preparation and administration of herbal treatments for common concerns
of pregnancy. Safety issues are emphasized throughout.
Mary Lloyd Ireland, Susan M Ott, Special concerns of the female athlete,
Clinics in Sports Medicine, Volume 23, Issue 2, April 2004, Pages 281-298,
ISSN 0278-5919, 10.1016/j.csm.2004.04.003.
Lorraine Namyniuk, Christiane Brems, Sheila Carson, Southcentral foundation

Dena A Coy: A model program for the treatment of pregnant substance-
abusing women, Journal of Substance Abuse Treatment, Volume 14, Issue 3,
MayJune 1997, Pages 285-295, ISSN 0740-5472, 10.1016/S0740-5472(96)00059-
1.
Abstract: This article discusses the societal implications of substance
abuse by pregnant women and women of child-bearing age and reviews their
treatment needs as documented in the literature. It then provides a
treatment model for pregnant women, using the Southcentral Foundation-Dena
A Coy Residential Treatment Program as a model program. It outlines a
number of components that are critical to successful substance abuse
treatment of these women; specifically, medical interventions, social
service provision, educational/vocational services, psychoeducational
programs, psychotherapy, substance abuse interventions, and family
preservation and involvement. These components are superimposed on a
therapeutic community model that stresses gender and cultural relevance, as
well as supportive structure and direction.
Keywords: pregnant women; child-bearing age women; model program
Zafarullah Gill, Martha Carlough, Do mission hospitals have a role in

achieving Millennium Development Goal 5?, International Journal of
Gynecology & Obstetrics, Volume 102, Issue 2, August 2008, Pages 198-
202, ISSN 0020-7292, 10.1016/j.ijgo.2008.04.003.
It is unlikely that some low-income countries will achieve Millennium
Development Goal 5 (MDG5) unless governments find new approaches. One
possibility is through government partnerships with mission hospitals and
other faith-based organizations (FBOs), but this would require overcoming
historic reservations.
Methods
We review the limited literature on mission hospitals and other FBO health
services providing maternity care.
Conclusion
The management and the clinical care provided by FBOs are often of higher
quality than that provided by government hospitals. Mission hospitals have
several advantages including more resources (especially foreign exchange),
greater access to expatriate staff especially for training, and more
flexibility in hiring and managing staff and in procuring and managing
medicines and supplies.
Recommendation
Increased collaboration between governments and mission hospitals,
particularly in underserved and rural areas, could improve availability and
quality of obstetric services enough to meet MDG5 targets. Delegating
responsibilities to mission hospitals, exchanging information, and
collaboration in projects and training could accelerate progress toward
MDG5. Bilateral and multilateral funding institutions and International
NGOs should encourage more effective partnerships between governments and
FBOs.
Keywords: Emergency obstetric care; Faith-based organizations; Millennium
Development Goal 5; Mission hospitals; Nongovernmental organizations
T.K. Sundari Ravindran, Women and the politics of population and

development in India, Reproductive Health Matters, Volume 1, Issue 1, May
1993, Pages 26-38, ISSN 0968-8080, 10.1016/0968-8080(93)90059-3.
Gunilla Lindmark, Jens Langhoff-Roos, Regional quality assessment in

perinatal care, Seminars in Neonatology, Volume 9, Issue 2, April 2004,
Pages 145-153, ISSN 1084-2756, 10.1016/j.siny.2003.08.013.
Abstract: Quality assessment is essential in every sector of health care
and, in modern regionalized perinatal care, continuous data should be
collected at all levels to give a stable basis for this activity. The
discussion of definitions and choice of indicators is in itself an activity
that will increase awareness of quality. Modern computer facilities will
simplify data storage and analysis, but do not change the need to use a
limited number of well-validated and appropriate variables.
Keywords: Quality assessment; Perinatal care
P. Bailey, E. de Bocaletti, G. Barrios, Y. de Cross, Monitoring utilization

and need for obstetric care in the highlands of Guatemala, International
Journal of Gynecology & Obstetrics, Volume 89, Issue 2, May 2005, Pages
209-217, ISSN 0020-7292, 10.1016/j.ijgo.2004.11.038.
Abstract: Objective
To monitor changes in the utilization and need for obstetric care between
1995 and 1998 at three hospitals in the highlands of Guatemala.
Methods
We collected data on 5300 obstetric admissions from maternity registries
and selected 10 indicators to measure intermediate outcomes.
Results
Utilization of services increased at some or all hospitals as measured by
the number of obstetric admissions, proportion of births in facilities, and
cesarean deliveries as a proportion of all births. We observed increases in
the proportion of women expected to have obstetric complications who were
treated at each hospital and in the proportion of women with obstetric
complications who were referrals. The changes in patient profile reflect
increased service utilization and accessibility among women who
traditionally used the health system the least.
Conclusions
Positive changes in these indicators are likely to be associated with a
reduction in maternal mortality. Without a control area, we cannot be sure
of a cause and effect relationship between outcomes and interventions,
nevertheless, maternity registry data offer an inexpensive source of
information for facilities to monitor changes.
Keywords: Essential and emergency obstetric care; Maternity registry;
Monitoring and evaluation; Guatemala
Theodore J. Gaensbauer, Robert J. Harmon, Anne M. Culp, Leola A. Schultz,

William J. van Doorninck, Peter Dawson, Relationships between attachment
behavior in the laboratory and the caretaking environment, Infant Behavior
and Development, Volume 8, Issue 4, OctoberDecember 1985, Pages 355-369,
ISSN 0163-6383, 10.1016/0163-6383(85)90001-3.
Abstract: How useful are observations of patterns of attachment behavior in
a structured laboratory setting for making inferences about the quality of
caretaking received by an infant in the home environment? To address this
question a sample of 107 12-month-old infants who had participated in a
longitudinal intervention project beginning before birth through 14 months
of age were observed in a structured laboratory setting. Patterns of
attachment behavior were compared to maternal caretaking variables observed
in the home environment as well as to ratings of the quality of the
infants' play. The results indicated that attachment behavior in the
laboratory can be used to make inferences about the quality of caretaking
in the home environment with confidence when a consistent and unambiguous
pattern of either optimal or problematical attachment behavior is present,
but not when the attachment behavior pattern is inconsistent or ambiguous.
Keywords: affect; attachment; development; free play; home visitor;
insecure; intervention; mother-child relationship; secure
Vallerie V. McLaughlin, Melinda Davis, William Cornwell, Pulmonary Arterial

Hypertension, Current Problems in Cardiology, Volume 36, Issue 12, December
2011, Pages 461-517, ISSN 0146-2806, 10.1016/j.cpcardiol.2011.08.002.
Abstract: Pulmonary hypertension is a complex and multidisciplinary
disorder. The classification of pulmonary hypertension includes 5 groups.
Pulmonary arterial hypertension is a rare disorder that can be idiopathic
or heritable in nature, or associated with other conditions, such as
scleroderma or congenital heart disease. The recent decades have realized
advances in the treatment of this once devastating disease. More commonly,
pulmonary hypertension is associated with other disorders, such as those
that elevate left heart filling pressures and hypoxemic lung disease.
Chronic thromboembolic disease can result in pulmonary hypertension. To
determine the etiology, a thorough and methodical evaluation must be
completed. Often, an echocardiogram is the first test to suggest the
diagnosis of pulmonary hypertension. Studies to identify potential
associated causes are important. The diagnostic evaluation culminates in
right heart catheterization. Over recent years, advances in therapies,
including the prostacyclins, the endothelin receptor antagonists, and the
phosphodiesterase type 5 inhibitors, have resulted in an improved quality
of life and outlook for patients with what is often a progressive disease.
, REFERENCES, Botanical Medicine for Women's Health, Churchill Livingstone,

Saint Louis, 2010, Pages 616-664, ISBN 9780443072772, 10.1016/B978-
044307277-2.00048-9.
Ian M. Paul, Cynthia J. Bartok, Danielle S. Downs, Cynthia A. Stifter,

Alison K. Ventura, Leann L. Birch, Opportunities for the Primary Prevention
of Obesity during Infancy, Advances in Pediatrics, Volume 56, Issue 1,
2009, Pages 107-133, ISSN 0065-3101, 10.1016/j.yapd.2009.08.012.
Melissa Whitworth, Ruth Cockerill, Antenatal management of teenage

pregnancy, Obstetrics, Gynaecology & Reproductive Medicine, Volume 20,
10.1016/j.ogrm.2010.08.003.
Abstract: The incidence of both the under-18 conception rate and birth rate
is falling. Despite this however, the United Kingdom has the highest rate
of teenage pregnancy in Western Europe. Young mothers and their babies have
poorer access to maternity care and experience worse obstetric outcomes
than older mothers. It is likely that the risks associated with teenage
pregnancy reflect a significant interplay between the socio-demographic
status of many of these teenagers, their nutritional status and their
uptake of antenatal care. This review looks at the complications associated
with teenage pregnancy and how the implementation of specialized antenatal
care aims to achieve similar obstetric outcomes to those of the older
mother. It also looks at additional factors required in the provision of
healthcare to this group of young women. In providing this care, the
quality of life and outcome for both mother and her child can be improved.
Luke Fortney, Dave Rakel, J. Adam Rindfleisch, Jill Mallory, Introduction

to Integrative Primary Care: The Health-Oriented Clinic, Primary Care:
Clinics in Office Practice, Volume 37, Issue 1, March 2010, Pages 1-12,
ISSN 0095-4543, 10.1016/j.pop.2009.09.003.
Keywords: Integrative medicine; Primary care; Prevention; Wellness
Laura R. Stroud, Rachel L. Paster, George D. Papandonatos, Raymond Niaura,

Amy L. Salisbury, Cynthia Battle, Linda L. Lagasse, Barry Lester, Maternal
Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27
Days, The Journal of Pediatrics, Volume 154, Issue 1, January 2009, Pages
10-16, ISSN 0022-3476, 10.1016/j.jpeds.2008.07.048.
Abstract: Objective
To examine effects of maternal smoking during pregnancy on newborn
neurobehavior at 10 to 27 days.
Study design
Participants were 56 healthy infants (28 smoking-exposed, 28 unexposed)
matched on maternal social class, age, and alcohol use. Maternal smoking
during pregnancy was determined by maternal interview and maternal saliva
cotinine. Postnatal smoke exposure was quantified by infant saliva
cotinine. Infant neurobehavior was assessed through the NICU Network
Neurobehavioral Scale.
Results
Smoking-exposed infants showed greater need for handling and worse self-
regulation (P < .05) and trended toward greater excitability and arousal
(P < .10) relative to matched, unexposed infants (all moderate effect
sizes). In contrast to prior studies of days 0 to 5, no effects of smoking-
exposure on signs of stress/abstinence or muscle tone emerged. In
stratified, adjusted analyses, only effects on need for handling remained
significant (P < .05, large effect size).
Conclusions
Effects of maternal smoking during pregnancy at 10 to 27 days are subtle
and consistent with increased need for external intervention and poorer
self-regulation. Along with parenting deficits, these effects may represent
early precursors for long-term adverse outcomes from maternal smoking
during pregnancy. That signs of abstinence shown in prior studies of 0- to
5-day-old newborns did not emerge in older newborns provides further
evidence for the possibility of a withdrawal process in exposed infants.
L Lewis Wall, Obstetric vesicovaginal fistula as an international public-

health problem, The Lancet, Volume 368, Issue 9542, 30 September6 October
2006, Pages 1201-1209, ISSN 0140-6736, 10.1016/S0140-6736(06)69476-2.
Abstract: Summary
Vesicovaginal fistula is a devastating injury in which an abnormal opening
forms between a woman's bladder and vagina, resulting in urinary
incontinence. This condition is rare in developed countries, but in
developing countries it is a common complication of childbirth resulting
from prolonged obstructed labour. Estimates suggest that at least 3 million
women in poor countries have unrepaired vesicovaginal fistulas, and that
30000130000 new cases develop each year in Africa alone. The general
public and the world medical community remain largely unaware of this
problem. In this article I review the pathophysiology of vesicovaginal
fistula in obstructed labour and describe the effect of this condition on
the lives of women in developing countries. Policy recommendations to
combat this problem include enhancing public awareness, raising the
priority of women's reproductive health for developing countries and aid
agencies, expanding access to emergency obstetric services, and creation of
fistula repair centres.
Colin Francome, Wendy Savage, Caesarean section in Britain and the United
States 12% or 24%: Is either the right rate?, Social Science &
Medicine, Volume 37, Issue 10, November 1993, Pages 1199-1218, ISSN 0277-
9536, 10.1016/0277-9536(93)90332-X.
Abstract: The rate of caesarean section (CSR) in Great Britain (GB) and the
U.S.A., 12% in England in 1989 ascertained from a survey performed by the
authors, and 24% according to official U.S. figures, is higher than
warranted by the known and agreed obstetric indications for this operation,
which suggest a rate of 68% would be adequate.
It is argued that the fall in perinatal mortality which has occurred over
the period during which the CS rate has risen is not the main reason for
this fall. The training of obstetricians to deal with anxiety, provision of
primary maternity care by appropriately trained midwives and general or
family practitioners, and changes in management protocols could cut the
CSR. The number of women undergoing surgery every year in the U.K. could be
reduced by 20,000 and in the U.S.A. by 470,000 if the rate of 6% were
achieved.
In studies of midwifery care the CSR is even lower and it is possible that
labour proceeds more efficiently if the woman knows her caregivers and
labours at home, as in The Netherlands. Although CS is much safer than in
the past it is still more likely to result in the death of the woman and
has significant morbidity for the woman and economic costs for society.
Keywords: caesarean section rate; reduction; anxiety; midwifery
Sydney A Spangler, Assessing skilled birth attendants and emergency

obstetric care in rural Tanzania: the inadequacy of using global standards
and indicators to measure local realities, Reproductive Health Matters,
10.1016/S0968-8080(12)39603-4.
Abstract: Current efforts to reduce maternal mortality and morbidity in
low-resource settings often depend on global standards and indicators to
assess obstetric care, particularly skilled birth attendants and emergency
obstetric care. This paper describes challenges in using these standards to
assess obstetric services in the Kilombero Valley of Tanzania. A health
facility survey and extensive participant observation showed existing
services to be complicated and fluid, involving a wide array of skills,
resources, and improvisations. Attempts to measure these services against
established standards and indicators were not successful. Some aspects of
care were over-valued while others were under-valued, with significant
neglect of context and quality. This paper discusses the implications of
these findings for ongoing maternal health care efforts in unique and
complex settings, questioning the current reliance on generic (and often
obscure) archetypes of obstetric care in policy and programming. It
suggests that current indicators may be insufficient to assess services in
low-resource settings, but not that these settings should settle for lower
standards of care. In addition to global benchmarks, assessment approaches
that emphasize quality of care and recognize available resources might
better account for local realities, leading to more effective, more
sustainable service delivery.
Keywords: midwifery; skilled birth attendants; emergency obstetric care;
monitoring and evaluation; Millennium Development Goals; Tanzania
Astrid M Tenter, Anja R Heckeroth, Louis M Weiss, Toxoplasma gondii: from
animals to humans, International Journal for Parasitology, Volume 30,
Issues 1213, November 2000, Pages 1217-1258, ISSN 0020-7519,
10.1016/S0020-7519(00)00124-7.
Abstract: Toxoplasmosis is one of the more common parasitic zoonoses world-
wide. Its causative agent, Toxoplasma gondii, is a facultatively
heteroxenous, polyxenous protozoon that has developed several potential
routes of transmission within and between different host species. If first
contracted during pregnancy, T. gondii may be transmitted vertically by
tachyzoites that are passed to the foetus via the placenta. Horizontal
transmission of T. gondii may involve three life-cycle stages, i.e.
ingesting infectious oocysts from the environment or ingesting tissue cysts
or tachyzoites which are contained in meat or primary offal (viscera) of
many different animals. Transmission may also occur via tachyzoites
contained in blood products, tissue transplants, or unpasteurised milk.
However, it is not known which of these routes is more important
epidemiologically. In the past, the consumption of raw or undercooked meat,
in particular of pigs and sheep, has been regarded as a major route of
transmission to humans. However, recent studies showed that the prevalence
of T. gondii in meat-producing animals decreased considerably over the past
20 years in areas with intensive farm management. For example, in several
countries of the European Union prevalences of T. gondii in fattening pigs
are now <1%. Considering these data it is unlikely that pork is still a
major source of infection for humans in these countries. However, it is
likely that the major routes of transmission are different in human
populations with differences in culture and eating habits. In the Americas,
recent outbreaks of acute toxoplasmosis in humans have been associated with
oocyst contamination of the environment. Therefore, future epidemiological
studies on T. gondii infections should consider the role of oocysts as
potential sources of infection for humans, and methods to monitor these are
currently being developed. This review presents recent epidemiological data
on T. gondii, hypotheses on the major routes of transmission to humans in
different populations, and preventive measures that may reduce the risk of
contracting a primary infection during pregnancy.
R.H.M de Groot, J Adam, J Jolles, Hornstra, Alpha-linolenic acid

supplementation during human pregnancy does not effect cognitive
functioning, Prostaglandins, Leukotrienes and Essential Fatty Acids, Volume
70, Issue 1, January 2004, Pages 41-47, ISSN 0952-3278,
10.1016/j.plefa.2003.08.004.
Abstract: Increasing evidence suggests a positive association between
docosahexaenoic acid (DHA, 22:6n-3) and cognitive performance. In addition,
pregnancy is associated with a reduction of the DHA status and cognitive
deficits. In the current study, cognition was assessed in pregnant women
receiving a margarine enriched with alpha-linolenic acid (ALA, 18:3n-3, the
ultimate dietary precursor of DHA) and some linoleic acid (LA, 18:2n-6, to
prevent a possible reduction in n-6 fatty acids). A control group received
a margarine enriched with LA only.
ALA supplementation hardly affected the maternal DHA status and no

significant differences were found in cognitive performance between the two
groups. This indicates that ALA supplementation during pregnancy does not
affect cognitive performance during and 32 weeks after gestation. At week
14 of pregnancy and 32 weeks after delivery, higher plasma DHA levels were
associated with lower cognitive performance as indicated by longer reaction
times on the finger precuing task (partial correlation coefficients 0.3705
and 0.4633, respectively, P<0.01). Since this could imply an unexpected
adverse association between DHA and certain aspects of cognitive
functioning this certainly needs further investigation.
Keywords: Cognitive functioning; Pregnancy; Docosahexaenoic acid; Fatty
acids
Zivanit Ergaz, Meytal Avgil, Asher Ornoy, Intrauterine growth restriction

etiology and consequences: What do we know about the human situation and
experimental animal models?, Reproductive Toxicology, Volume 20, Issue 3,
10.1016/j.reprotox.2005.04.007.
Abstract: Embryonic and fetal growth depend on genetic and environmental
factors, and the process is the result of the interaction between these
factors. About 79% of live-born infants have a birth weight below normal
(below the 10th percentile). The rate and extent of intrauterine growth
restriction (IUGR) varies by ethnicity and socio-economic status. Some of
the suspected causes of IUGR are as follows. (1) Maternal factors such as
inadequate or severe malnutrition, chronic maternal diseases, birth order,
multiple births, and parental genetic factors. (2) Placental pathology,
mainly placental vascular damage that may lead to placental insufficiency.
This is often found in maternal diseases such as pre-eclampsia, and
Thrombophilia. (3) Intrauterine infections and specific fetal syndromes,
including chromosomal aberrations. (4) Non-classified causes such as
adolescent's pregnancy, maternal smoking and alcohol drinking, living at
high altitudes. Several existing animal models for IUGR, including uterine
artery ligation or gene knock out models, although insightful of potential
mechanism(s) underlying intrauterine growth restriction, are limited in
that they do not reflect human causality. As the ultimate goal is
prevention, we seem still to be distant from achieving this goal.
Keywords: IUGR; SGA; Human; Etiology; Animal models
V.C.W. Taam Wong, Ethical considerations in safe motherhood (SM) programs

in developing countries, Early Human Development, Volume 29, Issues 13,
JuneJuly 1992, Pages 397-401, ISSN 0378-3782, 10.1016/0378-3782(92)90199-
Q.
Abstract: There are still many maternal deaths in the world each year and
over 98% are in developing countries. A program of safe motherhood is
needed to make certain that every woman has the right of basic maternity
care.
Keywords: safe motherhood maternal death
HOOVER ADGER JR., HAROLYN M.E. BELCHER, CHAPTER 19 - The Effect of

Substance Use Disorders on Children and Adolescents, In: Mark L. Wolraich,
MD, Dennis D. Drotar, PhD, Paul H. Dworkin, MD, and Ellen C. Perrin, MA,
MD, Editor(s), Developmental-Behavioral Pediatrics, Mosby, Philadelphia,
2008, Pages 669-698, ISBN 9780323040259, 10.1016/B978-0-323-04025-9.50022-
2.
Thomas Murphy Goodwin, Odinaka A. Nwankwo, Linda Davis O'Leary, Dennis

O'Leary, Roberto Romero, Lisa M. Korst, The first demonstration that a
subset of women with hyperemesis gravidarum has abnormalities in the
vestibuloocular reflex pathway, American Journal of Obstetrics and
Gynecology, Volume 199, Issue 4, October 2008, Pages 417.e1-417.e9, ISSN
0002-9378, 10.1016/j.ajog.2008.07.003.
Abstract: Objective
The vestibular system is a major pathway to nausea and vomiting, and the
vestibuloocular reflex (VOR) is a central component; its function can be
studied using the vestibular autorotation test (VAT). We hypothesize that
women with hyperemesis gravidarum (HG) may have VOR abnormalities.
Study Design
Women with HG were compared with women without HG using the VAT. Horizontal
and vertical VOR gains and phases were evaluated at 3 frequency ranges: low
(2.0 to 3.5 Hz), medium (greater than 3.5 to 5.0 Hz), and high (greater
than 5.0 to 6.0 Hz) during pregnancy and postpartum.
Results
Twenty women with HG and 48 unaffected women were evaluated in early
pregnancy. Women with HG had higher horizontal gains at all 3 frequency
ranges. Horizontal phase differences were also observed at medium
frequencies. No VAT differences were noted postpartum.
Conclusion
Women experiencing HG had a higher mean VOR horizontal gain and lower
horizontal phase when compared with unaffected women.
Keywords: autorotation; hyperemesis gravidarum; nausea; vestibular;
vestibuloocular reflex; vomiting
Mark E. Anderson, Gregory M. Bogdan, Environments, Indoor Air Quality, and

Children, Pediatric Clinics of North America, Volume 54, Issue 2, April
2007, Pages 295-307, ISSN 0031-3955, 10.1016/j.pcl.2007.01.003.
Abstract: This article addresses air-quality science in the indoor
environments in which children and adolescents find themselves, including
the home, the school, and other environments such as work and recreational
situations. The home arena is covered extensively, presenting an analysis
of the usual exposures such as environmental tobacco smoke and bioaerosols
and also touching on discrete issues such as sudden infant death syndrome,
carbon monoxide, and public housing. Recreation and work environments are
covered as well.
Jane Clatworthy, The effectiveness of antenatal interventions to prevent

postnatal depression in high-risk women, Journal of Affective Disorders,
Volume 137, Issues 13, March 2012, Pages 25-34, ISSN 0165-0327,
10.1016/j.jad.2011.02.029.
Postnatal depression can have a major impact on the lives of women affected
and on those around them. While effective treatments are available, it
would be preferable to prevent the condition. The aim of this review was to
examine the effectiveness of antenatal interventions designed to prevent
postnatal depression in high-risk women.
Methods
Randomised controlled trials of interventions to prevent postnatal
depression delivered to high-risk women in pregnancy were identified
through an electronic database search and a reference list search.
Information regarding the selection criteria, content and delivery of the
interventions was extracted and synthesised.
Results
Eleven studies met the review inclusion criteria. Six described
interventions that were significantly more effective in reducing the
incidence and/or symptoms of postnatal depression than a control condition.
Interventions were most likely to be effective when delivered to women who
were depressed during pregnancy and when incorporating evidence-based
psychological treatments for depression and addressing interpersonal
difficulties.
Limitations
It is possible that unpublished trials of antenatal interventions to
prevent postnatal depression exist that were not detected. Due to the
recognised publication bias, these studies may have been less likely to
find a significant effect of antenatal interventions on postnatal
depression.
Conclusions
There is evidence to suggest that interventions delivered in pregnancy can
be effective in preventing postnatal depression. However, these
interventions may be better conceptualised as treatment than prevention as
they were delivered to women experiencing antenatal depression. There is a
need to identify pregnant women experiencing depression and deliver
evidence-based psychological interventions.
Keywords: Postnatal depression; Prevention; Antenatal; Intervention; Review
Catherine M. Nichols, Marie Nam, Viswanathan Ramakrishnan, Elizabeth H.

Lamb, Nancy Currie, Anal sphincter defects and bowel symptoms in women with
and without recognized anal sphincter trauma, American Journal of
Obstetrics and Gynecology, Volume 194, Issue 5, May 2006, Pages 1450-1454,
ISSN 0002-9378, 10.1016/j.ajog.2006.01.059.
Abstract: Objective
The purpose of this study was to determine the rate of new bowel symptoms
and anal sphincter defects in primiparous women with and without recognized
anal sphincter (AS) injury.
Study design
One hundred seventeen primiparous women classified with increasing degrees
of perineal trauma and 21 controls delivered by cesarean section were
enrolled immediately postpartum and demographic and delivery data were
collected. At 6 weeks' postpartum, subjects completed a bowel function
questionnaire and endoanal ultrasonography was performed. Logistic
regression, chi-square, and 2-sample t tests were used for statistical
analysis.
Results
A significant difference in new bowel symptoms was reported in women with
(39%) and without (11%) recognized AS injury (P = .002). AS defects were
present in 0%, 15%, 23%, 37%, and 67% of women with C/S, first-, second-,
third-, and fourth-degree lacerations, respectively. Combined defects of
the internal and external AS were associated with the greatest risk of new
bowel symptoms (OR 32.1 [95% CI 9.6-107], P < .001).
Conclusion
In women with and without recognized AS trauma, new bowel symptoms were
strongly correlated with the presence of anatomic AS defects postpartum.
Keywords: Perineal laceration; Anal sphincter injury; Anal incontinence;
Endoanal ultrasonography; Bowel symptoms
Lisa Espinosa, Kathryn Osborne, Domestic violence during pregnancy:

implications for practice, Journal of Midwifery & Women's Health,
Volume 47, Issue 5, SeptemberOctober 2002, Pages 305-317, ISSN 1526-9523,
10.1016/S1526-9523(02)00287-8.
Abstract: Domestic violence affects many women and their families. Although
estimates of the prevalence of domestic violence during pregnancy vary, it
is likely that most providers of womens health care will encounter
pregnant women who experience domestic violence. The purpose of this
article is to review research that has investigated associations between
domestic violence during pregnancy and other demographic and lifestyle
variables, as well as the literature regarding clinical assessment and
intervention strategies.
Maida Beth Taylor, CHAPTER 19 - Women in Diving, In: Alfred A. Bove, M.D.,
Ph.D., Editor(s), Bove and Davis' Diving Medicine (Fourth Edition), W.B.
10.1016/B978-0-7216-9424-5.50025-3.
Stanley A. Plotkin, Susan E. Reef, Louis Z. Cooper, Charles A. Alford Jr.,

CHAPTER 28 - Rubella, Infectious Diseases of the Fetus and Newborn (Seventh
Edition), W.B. Saunders, Philadelphia, 2011, Pages 861-898, ISBN
9781416064008, 10.1016/B978-1-4160-6400-8.00028-6.
Marjorie S. Rosenthal, Joseph S. Ross, RoseAnne Bilodeau, Rosemary S.

Richter, Jane E. Palley, Elizabeth H. Bradley, Economic Evaluation of a
Comprehensive Teenage Pregnancy Prevention Program: Pilot Program, American
Journal of Preventive Medicine, Volume 37, Issue 6, Supplement 1, December
2009, Pages S280-S287, ISSN 0749-3797, 10.1016/j.amepre.2009.08.014.
Previous research has suggested that comprehensive teenage pregnancy
prevention programs that address sexual education and life skills
development and provide academic support are effective in reducing births
among enrolled teenagers. However, there have been limited data on the
costs and cost effectiveness of such programs.
Purpose
The study used a community-based participatory research approach to develop
estimates of the costbenefit of the Pathways/Senderos Center, a
comprehensive neighborhood-based program to prevent unintended pregnancies
and promote positive development for adolescents.
Methods
Using data from 19972003, an in-time intervention analysis was conducted
to determine program costbenefit while teenagers were enrolled; an
extrapolation analysis was then used to estimate accrued economic benefits
and costbenefit up to age 30 years.
Results
The program operating costs totaled $3,228,152.59 and reduced the teenage
childbearing rate from 94.10 to 40.00 per 1000 teenage girls, averting
$52,297.84 in total societal costs, with an economic benefit to society
from program participation of $2,673,153.11. Therefore, total costs to
society exceeded economic benefits by $559,677.05, or $1599.08 per
adolescent per year. In an extrapolation analysis, benefits to society
exceed costs by $10,474.77 per adolescent per year by age 30 years on
average, with social benefits outweighing total social costs by age 20.1
years.
Conclusions
This comprehensive teenage pregnancy prevention program is estimated to
provide societal economic benefits once participants are young adults,
suggesting the need to expand beyond pilot demonstrations and evaluate the
long-range cost effectiveness of similarly comprehensive programs when they
are implemented more widely in high-risk neighborhoods.
Zulfiqar A Bhutta, Mickey Chopra, Henrik Axelson, Peter Berman, Ties

Boerma, Jennifer Bryce, Flavia Bustreo, Eleonora Cavagnero, Giorgio
Cometto, Bernadette Daelmans, Andres de Francisco, Helga Fogstad, Neeru
Gupta, Laura Laski, Joy Lawn, Blerta Maliqi, Elizabeth Mason, Catherine
Pitt, Jennifer Requejo, Ann Starrs, Cesar G Victora, Tessa Wardlaw,
Countdown to 2015 decade report (200010): taking stock of maternal,
newborn, and child survival, The Lancet, Volume 375, Issue 9730, 511 June
2010, Pages 2032-2044, ISSN 0140-6736, 10.1016/S0140-6736(10)60678-2.
Abstract: Summary
The Countdown to 2015 for Maternal, Newborn, and Child Survival monitors
coverage of priority interventions to achieve the Millennium Development
Goals (MDGs) for child mortality and maternal health. We reviewed progress
between 1990 and 2010 in coverage of 26 key interventions in 68 Countdown
priority countries accounting for more than 90% of maternal and child
deaths worldwide. 19 countries studied were on track to meet MDG 4, in 47
we noted acceleration in the yearly rate of reduction in mortality of
children younger than 5 years, and in 12 countries progress had decelerated
since 2000. Progress towards reduction of neonatal deaths has been slow,
and maternal mortality remains high in most Countdown countries, with
little evidence of progress. Wide and persistent disparities exist in the
coverage of interventions between and within countries, but some regions
have successfully reduced longstanding inequities. Coverage of
interventions delivered directly in the community on scheduled occasions
was higher than for interventions relying on functional health systems.
Although overseas development assistance for maternal, newborn, and child
health has increased, funding for this sector accounted for only 31% of all
development assistance for health in 2007. We provide evidence from several
countries showing that rapid progress is possible and that focused and
targeted interventions can reduce inequities related to socioeconomic
status and sex. However, much more can and should be done to address
maternal and newborn health and improve coverage of interventions related
to family planning, care around childbirth, and case management of
childhood illnesses.
, Position of the American Dietetic Association: Child and adolescent food

and nutrition programs, Journal of the American Dietetic Association,
Volume 103, Issue 7, July 2003, Pages 887-893, ISSN 0002-8223.
Abstract: It is the position of the American Dietetic Association that all
children and adolescents, regardless of age; gender; socioeconomic status;
racial, ethnic, or linguistic diversity; or health status should have
access to food and nutrition programs that ensure the availability of a
safe and adequate food supply that promotes optimal physical, cognitive,
and social growth and development. Appropriate food and nutrition programs
include food assistance and meal programs, nutrition education initiatives,
nutrition screening and assessment followed by appropriate nutrition
intervention, and anticipatory guidance to promote optimal nutrition
status. Malnutrition has been linked to delayed physical, psychosocial, and
cognitive development and is now recognized as a major contributor to the
growing problem of overweight and obesity in the child and adolescent
population. Food and nutrition programs create a safety net that ensures
that children and adolescents at risk for poor nutritional intakes have
access to a safe, adequate, and nutritious food supply and nutrition
screening, assessment evaluation, and intervention. It is important that
continued funding be provided for these programs, which have been
consistently shown to have a positive impact on child and adolescent well-
being. Food and nutrition programs will continue to serve not only as a
means to combat hunger and food insecurity but also as a vehicle for
nutrition education and promotion of physical activity designed to combat
overweight and prevent chronic disease. It is the role of the credentialed
dietetics professional to support permanent, adequate funding to food and
nutrition programs, universal health-care reimbursement for nutrition
services, and the use of research and surveillance programs to justify,
evaluate, and improve these programs. In addition, the dietetics
professional is responsible for serving as a nutrition resource to all
groups and individuals working with children and adolescents, acting as an
advocate for the establishment of child-care, school, and community
settings conducive to the development of good nutrition habits. J Am Diet
Assoc. 2003;103:887-893.
Miho Nagasawa, Takefumi Kikusui, Tatsushi Onaka, Mitsuaki Ohta, Dog's gaze
at its owner increases owner's urinary oxytocin during social interaction,
Hormones and Behavior, Volume 55, Issue 3, March 2009, Pages 434-441, ISSN
0018-506X, 10.1016/j.yhbeh.2008.12.002.
Abstract: Oxytocin (OT) has been shown to play an important role in social
bonding in animals. However, it is unclear whether OT is related to inter-
species social bonding. In this study, to examine the possibility that
urinary OT concentrations of owners were increased by their dog's gaze,
perhaps representing social attachment to their owners, we measured urinary
OT concentrations of owners before and after interaction with their dogs.
Dog owners interacted with their dogs as usual for 30 min (interaction
experiment) or were instructed not to look at their dogs directly (control
experiment). We observed the behaviors of owners and their dogs during the
experiments, and measured OT concentrations by radioimmunoassay in urine
samples from the owners collected just before and 20 min after interaction
with their dogs. Using a cluster analysis, owners could be divided into two
groups: one received a longer duration of gaze from their dogs and reported
a higher degree of relationship with their dogs (LG); the other received a
shorter duration of gaze and reported a lower degree of relationship (SG).
Urinary OT was higher in LG than SG after usual interaction with their
dogs, but not in the control experiment. In the interaction experiment, a
high correlation was found in LG between the frequency of behavioral
exchanges initiated by the dog's gaze and the increase in urinary OT. We
conclude that interactions with dogs, especially those initiated by the
dog's gaze, can increase the urinary OT concentrations of their owners as a
manifestation of attachment behavior.
Keywords: Dog; Gaze; Attachment behavior; Urinary oxytocin
Phillipa Lupton, Amanda Whelan, Promoting successful breast feeding among

women with a low income, Midwifery, Volume 14, Issue 2, June 1998, Pages
94-100, ISSN 0266-6138, 10.1016/S0266-6138(98)90004-3.
Abstract: Objective: to identify those factors which promote or discourage
successful breast feeding in a sample of women with a low income.
Design: qualitative research using in-depth, semi-structured interviews.
Sample: all women with a low income who were identified as having breast
fed their latest baby at least once and who had delivered at a district
general hospital in the south west of England from 17 September 1996 to 5
February 1997.
Findings: three behavioural areas which determined whether or not women

with a low income continued to breast feed were identified: individual and
social environmental, baby and midwifery practice factors. In terms of
individual and social environmental factors those women who continued to
breast feed were more likely to have: positive attitudes; realistic
expectations; greater levels of self-esteem; a supportive mother/friend; a
partner who was not against breast feeding; and the ability to cope with
the perceived temporary social isolation. In terms of baby factors those
women who continued to breast feed had babies who were more likely to: have
three- or four-hourly feeds; be perceived as a contented baby; and have
gained weight. And finally, in terms of midwifery practice factors, those
women who continued to breast feed were more likely to have: not been
separated from their baby; not been given supplementary or complementary
feeds; received good advice, especially with regard to positioning the baby
at the breast; had greater continuity of midwifery input; had sufficient
quality time with a midwife; and had the opportunity to solve problems with
a community midwife's help.
Implications for practice: midwifery practice can be improved to promote

successful breast feeding among women with a low income by: I) creating
realistic expectations and increasing women's confidence/desire to succeed
in breast feeding; 2) providing good quality advice and support to mothers
of newborn babies, particularly with regard to positioning the baby at the
breast; 3) improving social-support networks available to breast-feeding
mothers, perhaps through educating grandmothers (or partners) in breast-
feeding matters.
Cyndi Brannen, Debbie Johnson Emberly, Patrick McGrath, Stress in rural
Canada: A structured review of context, stress levels, and sources of
stress, Health & Place, Volume 15, Issue 1, March 2009, Pages 219-227,
ISSN 1353-8292, 10.1016/j.healthplace.2008.05.001.
Abstract: We conducted this review to organize studies on stressors,
stress, and health of rural Canadians. An organizing framework of the
pathway from psychosocial stressors (i.e., determinants of health) through
perceived stress and physiological impacts to health outcomes was used (1)
to situate the rural experience of stress within the individual using the
existing reports on community and societal stressors and (2) to synthesize
existing research on individual stress for rural residents. The emergent
themes from the review indicated that stressors can be grouped as
individual factors, relationship characteristics, health, work and
education, community, finances, and the environment. We conclude by
proposing that research measuring stressors of rural Canadians needs to be
undertaken in order to understand the connections between health and stress
for this population.
Keywords: Stress; Rural; Health; Canada
Susanne Steinberg, Childbearing research: A transcultural review, Social

Science & Medicine, Volume 43, Issue 12, December 1996, Pages 1765-
1784, ISSN 0277-9536, 10.1016/S0277-9536(96)00071-8.
Abstract: This article provides an examination of the keynote and current
literature concerning traditional beliefs and practices pertinent to
childbearing. Toward this aim, investigations implemented in western and
non-western societies spanning 35 years are discussed. Each study is
summarized in a table indicating the characteristics of the population, the
methodology and the results. The key issues identified for study in
developing countries are: poverty, illiteracy, malnutrition, prostitution,
substance abuse, family disruption, lack of child care, high rates of
maternal and infant mortality and the patterns of utilization of health
services. Industrialized societies are faced with different problems:
isolation of the nuclear family, economic pressure for mothers to work,
deficiency of child care facilities, ambiguity in the definition of
parental roles, marital instability and impersonal, medicalized health
care. These reported results provide the basis for culturally-sensitive
suggestions to improve social welfare schemes, health prevention and
treatment programs. Dominant themes and changing trends in research content
and methodology have been drawn from this literature review. These trends
indicate that future investigations will: (a) focus upon populations-at-
risk; (b) involve large representative samples; (c) address prominant
social and health problems; (d) challenge currently held assumptions; (e)
and use interdisciplinary methods, ethnographic, epidemiologic and
intervention approaches in concert to produce vital and culturally-informed
data for research development, policy decisions and program implementation.
Keywords: childbearing; transcultural; research methodology; review
Marcy Boroff, Patricia O'Campo, Baltimore City Healthy Start Medical Reform
for reducing infant mortality, Patient Education and Counseling, Volume 27,
Issue 1, January 1996, Pages 41-52, ISSN 0738-3991, 10.1016/0738-
3991(95)00788-1.
Abstract: This paper describes the Medical Reform Component of Baltimore
City's Healthy Start Program and how it works toward the goals of reducing
infant mortality (IMR) and improving infant health by making services more
user-friendly and family-oriented.
Keywords: Maternal health; Infant health; Infant mortality; Medical care;
Patient satisfaction
Vincent Boama, Overcoming barriers to pain relief in labor through
education, International Journal of Gynecology & Obstetrics, Volume
10.1016/j.ijgo.2011.06.004.
Christian M. Pettker, Stephen F. Thung, Cheryl A. Raab, Katie P. Donohue,

Joshua A. Copel, Charles J. Lockwood, Edmund F. Funai, A comprehensive
obstetrics patient safety program improves safety climate and culture,
American Journal of Obstetrics and Gynecology, Volume 204, Issue 3, March
2011, Pages 216.e1-216.e6, ISSN 0002-9378, 10.1016/j.ajog.2010.11.004.
Abstract: Objective
The purpose of this study was to determine the effect of an obstetrics
patient safety program on staff safety culture.
Study Design
We implemented (1) obstetrics patient safety nurse, (2) protocol-based
standardization of practice, (3) crew resource management training, (4)
oversight by a patient safety committee, (5) 24-hour obstetrics
hospitalist, and (6) an anonymous event reporting system. We administered
the Safety Attitude Questionnaire on 4 occasions over 5 years (2004-2009)
to all staff members that assessed teamwork and safety cultures, job
satisfaction, working conditions, stress recognition, and perceptions of
management.
Results
We observed significant improvements in the proportion of staff members
with favorable perceptions of teamwork culture (39% in 2004 to 63% in
2009), safety culture (33% to 63%), job satisfaction (39% to 53%), and
management (10% to 37%). Individual roles (obstetrics providers, residents,
and nurses) also experienced improvements in safety and teamwork, with
significantly better congruence between doctors and nurses.
Conclusion
Safety programs can improve workforce perceptions of safety and an improved
safety climate.
Keywords: patient safety; quality improvement; safety attitude
questionnaire; safety culture
Scott Jacob MD, Lois Bloebaum RN, Gulzar Shah PhD, Michael W Varner MD,
Maternal Mortality in Utah, Obstetrics & Gynecology, Volume 91, Issue
2, February 1998, Pages 187-191, ISSN 0029-7844, 10.1016/S0029-
7844(97)00664-9.
Abstract: Objective: To determine trends in maternal deaths in Utah,
identify opportunities for preventive intervention, and analyze the
mechanism of reporting maternal deaths.
Methods: A retrospective review was performed of maternal death

certificates and medical records in Utah from January 1, 1982, through
December 31, 1994.
Results: Sixty-two maternal deaths were identified. The risk of maternal

death increased with maternal age and parity. The classic triad of
hemorrhage (n = 8), infection (n = 5), and preeclampsia-eclampsia (n = 3)
remains an important contributor (16 of 62 or 25.8%). However, trauma (n =
10), pulmonary embolism (n = 10), and maternal cardiac disease (n = 9) now
account for 46.8% (29 of 62) of maternal deaths. A greater number of direct
obstetric causes of maternal death (n = 20) were deemed preventable than
indirect obstetric causes (n = 1) or nonobstetric causes (n = 4).
Conclusion: Trauma, pulmonary embolism, and maternal cardiac disease have
emerged as the most common identifiable causes of maternal death.
Improvements in prevention, earlier diagnosis, and aggressive treatment of
these conditions are necessary to achieve the Public Health Service year
2000 objective of a 50% reduction in maternal mortality ratios (using the
1987 ratio as a baseline).
Ian Askew, Marge Berer, The Contribution of Sexual and Reproductive Health
Services to the Fight against HIV/AIDS: A Review, Reproductive Health
Matters, Volume 11, Issue 22, November 2003, Pages 51-73, ISSN 0968-8080,
10.1016/S0968-8080(03)22101-7.
Abstract: Approximately 80% of HIV cases are transmitted sexually and a
further 10% perinatally or during breastfeeding. Hence, the health sector
has looked to sexual and reproductive health programmes for leadership and
guidance in providing information and counselling to prevent these forms of
transmission, and more recently to undertake some aspects of treatment.
This paper reviews and assesses the contributions made to date by sexual
and reproductive health services to HIV/AIDS prevention and treatment,
mainly by services for family planning, sexually transmitted infections and
antenatal and delivery care. It also describes other sexual and
reproductive health problems experienced by HIV-positive women, such as the
need for abortion services, infertility services and cervical cancer
screening and treatment. This paper shows that sexual and reproductive
health programmes can make an important contribution to HIV prevention and
treatment, and that STI control is important both for sexual and
reproductive health and HIV/AIDS control. It concludes that more integrated
programmes of sexual and reproductive health care and STI/HIV/AIDS control
should be developed which jointly offer certain services, expand outreach
to new population groups, and create well-functioning referral links to
optimize the outreach and impact of what are to date essentially vertical
programmes.
Keywords: HIV/AIDS; sexual and reproductive health services; sexually
transmitted infections; health policies and programmes; integration of
services
Hoosen M Coovadia, Nigel C Rollins, Ruth M Bland, Kirsty Little, Anna

Coutsoudis, Michael L Bennish, Marie-Louise Newell, Mother-to-child
transmission of HIV-1 infection during exclusive breastfeeding in the first
6 months of life: an intervention cohort study, The Lancet, Volume 369,
Issue 9567, 31 March6 April 2007, Pages 1107-1116, ISSN 0140-6736,
10.1016/S0140-6736(07)60283-9.
Exclusive breastfeeding, though better than other forms of infant feeding
and associated with improved child survival, is uncommon. We assessed the
HIV-1 transmission risks and survival associated with exclusive
breastfeeding and other types of infant feeding.
Methods
2722 HIV-infected and uninfected pregnant women attending antenatal clinics
in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban),
were enrolled into a non-randomised intervention cohort study. Infant
feeding data were obtained every week from mothers, and blood samples from
infants were taken monthly at clinics to establish HIV infection status.
Kaplan-Meier analyses conditional on exclusive breastfeeding were used to
estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's
proportional hazard was used to quantify associations with maternal and
infant factors.
Findings
1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive
breastfeeding from birth. Of 1276 infants with complete feeding data,
median duration of cumulative exclusive breastfeeding was 159 days (first
quartile [Q1] to third quartile [Q3], 122174 days). 141% (95% CI 120
164) of exclusively breastfed infants were infected with HIV-1 by age 6
weeks and 195% (170224) by 6 months; risk was significantly associated
with maternal CD4-cell counts below 200 cells per L (adjusted hazard ratio
[HR] 379; 235612) and birthweight less than 2500 g (181, 107306).
Kaplan-Meier estimated risk of acquisition of infection at 6 months of age
was 404% (229576). Breastfed infants who also received solids were
significantly more likely to acquire infection than were exclusively
breastfed children (HR 1087, 1517800, p=0018), as were infants who at
12 weeks received both breastmilk and formula milk (182, 098336,
p=0057). Cumulative 3-month mortality in exclusively breastfed infants was
61% (474792) versus 151% (7632873) in infants given replacement
feeds (HR 206, 100427, p=0051).
Interpretation
The association between mixed breastfeeding and increased HIV transmission
risk, together with evidence that exclusive breastfeeding can be
successfully supported in HIV-infected women, warrant revision of the
present UNICEF, WHO, and UNAIDS infant feeding guidelines.
Kang Yue, Carolyn ODonnell, Paul L. Sparks, The effect of spousal

communication on contraceptive use in Central Terai, Nepal, Patient
Education and Counseling, Volume 81, Issue 3, December 2010, Pages 402-408,
ISSN 0738-3991, 10.1016/j.pec.2010.07.018.
Abstract: Objective
Family planning has several social and health benefits; it can reduce
maternal mortality and the number of unplanned pregnancies, as well as
increase educational and economic opportunities [1,2]. Utilizing
quantitative data from an endline household survey (July 2009) and data
from focus group discussions, the Centre for Development and Population
Activities (CEDPA) seeks to determine whether spousal communication
increases contraceptive use among married women of child-bearing age in
Nepal's Central Terai region.
Methods
Quantitative household survey and qualitative focus group discussions.
Results
Women who discuss family planning with their husbands
(OR = 7.254), perceive husband approval on family planning
(OR = 5.558) and have born a son (OR = 2.239) are more
likely to use a modern contraceptive method. Qualitative data show that
several other considerations can be motivating factors for contraceptive
uptake.
Conclusion
While results do not explain the direction of causality, it is clear that
spousal discussion and partner approval are significant in a woman's
decision to use modern contraceptives in the Central Terai region of Nepal.
More research needs to be conducted on the effect of spousal communication
and contraceptive use, in particular, the role of frequency, quality, and
content of spousal communication, as well as individual motivations.
Keywords: Spousal communication; Family planning; Community-based health;
Nepal
Narbada Thapa, Virasakdi Chongsuvivatwong, Alan F Geater, Magnar Ulstein,

Gregory A Bechtel, Infant death rates and animal-shed delivery in remote
rural areas of Nepal, Social Science & Medicine, Volume 51, Issue 10,
16 November 2000, Pages 1447-1456, ISSN 0277-9536, 10.1016/S0277-
9536(00)00045-9.
Abstract: This article outlines a community-based retrospective study in a
remote area of Nepal and describes local birth practices and their impact
on infant mortality. Data collection was carried out in two steps, a
household survey from September to October 1996 and a qualitative research
phase. Data collected include socio-economic background, reproductive
history, birth practices and child survival. Among 3007 live-born children,
660 (22%) died before their first birthday. In keeping with local customs,
approximately half of the children were delivered in an animal shed and the
other half in the home. Children born in an animal shed were at
significantly higher risk of dying than were those born in the home even
after adjusting for socio-economic status and biological variables. The
association was stronger in the neonatal period (OR=2.8, 95% CI 1.94.1)
than during the post-neonatal period (OR=1.3, 95% CI 1.021.6). The
preparation of the delivery place was inadequate and thereby facilitated
infection of both the newborn and the mother. Traditional norms and animal-
shed delivery practices are common in the Jumla community. The reasons
addressed for giving birth in the animal shed included (1) Household
Deitys anger if delivery takes place in the home and (2) easy to clean the
shed following the birth.
Keywords: Birth practices; Animal-shed delivery; Neonatal death; Post-
neonatal death; Nepal
, Academy of Psychosomatic Medicine: Proceedings of the 48th Annual Meeting

November 1518, 2001, San Antonio, Texas, Psychosomatics, Volume 43, Issue
2, MarchApril 2002, Pages 132-168, ISSN 0033-3182,
10.1176/appi.psy.43.2.132.
A.B. Dessens, M.B.C.M. Cools, A. Richter-Unruh, L.H.J. Looijenga, J.A.

Grootegoed, S.L.S. Drop, 101 - Genetic Defects of Female Sexual
Differentiation, In: Editors-in-Chief: Donald W. Pfaff, Arthur P. Arnold,
Susan E. Fahrbach, Anne M. Etgen and Robert T. Rubin, Editor(s)-in-Chief,
Hormones, Brain and Behavior (Second Edition), Academic Press, San Diego,
2009, Pages 3207-3238, ISBN 9780080887838, 10.1016/B978-008088783-8.00101-
7.
Abstract: This chapter provides an outline of what is known about ovarian
and female development. Specifically, the question is addressed if there
are any known genes which are specifically required for differentiation of
the bipotential gonads to become ovaries. In addition, defects in female
differentiation as a result of sex chromosomal mosaicism are discussed.
Subsequently, various causes of maternal and fetal androgen excess
syndromes are reviewed as well as agenesis syndromes of uterus and vagina
forming a separate entity within the 46,XX disorders of sex development
category. Finally, relevant points regarding the independent effects of
genetic factors and androgens on brain and behavior are summarized.
Keywords: AMH (anti-Mllerian hormone); Androgens; Aromatase deficiency;
Bardel Biedl Syndrome (BBS); Cognition; Congenital adrenal hyperplasia
(CAH); Disorders of sex development (DSD); Estrogens; Gender identity;
Gender role behavior; Germ cell tumor; Glucocorticoid resistance (GRe);
Gonadal dysgenesis; Gonadal hormones; Gonadal tumor risk; Gonadoblastoma;
Inhibin B; Luteoma; MayerRokitanskiKsterHauser syndrome (MRKH);
McKusickKaufman syndrome (MKKS); Mosaicism; Mllerian agenesis/hypoplasia
syndrome; Mllerian duct aplasia, renal aplasia, and cervicothoracic somite
dysplasia (MURCS); Ovarian-determining genes; Ovarian development; Sex
chromosome mosaicism; Sex determination; Sexual functioning; Sexual
orientation; Steroidogenesis
William A. Ramirez-Cacho, Lisa Strickland, Cristina Beraun, Chen Meng,

William F. Rayburn, Medical students attitudes toward pregnant women with
substance use disorders, American Journal of Obstetrics and Gynecology,
Volume 196, Issue 1, January 2007, Pages 86.e1-86.e5, ISSN 0002-9378,
10.1016/j.ajog.2006.06.092.
Abstract: Objective
The objective of this study was to determine whether medical students
attendance at a clinic designed for pregnant substance users would yield
changes in their attitudes toward the special needs of this population.
Study design
This prospective study involved 104 consecutive third-year students
rotating on our obstetrics-gynecology clerkship. Students were assigned to
attend either a half day prenatal clinic designed specifically for women
with substance use disorders during the first 4 weeks (study group) or
during the second 4 weeks (control group). Each answered a confidential 24-
question survey (using a 5-point scale from strongly agree to strongly
disagree), dealing with comfort levels and attitudes, at the beginning and
midway points of the 8-week clerkship. Student t tests were used for
comparisons of averaged scores.
Results
At the beginning of the clerkship, no differences were found between the
study (n = 52) and control groups (n = 52) in their responses to the
survey. Regardless of gender, students who attended the clinic reported
they became more comfortable in talking with patients about their substance
use (P < .001) and more nonjudgmental in treating these patients (P <
.02). Compared with before the clerkship, the control group became less
comfortable in talking with these patients about their habits (P < .01),
less aware about the prevalence of substance abuse during pregnancy (P <
.02), and less aware about the efficacy of counselors (P < .05).
Conclusion
Medical students became more comfortable and better informed about pregnant
women with substance use disorders after attending a clinic dedicated
toward this populations special needs.
Keywords: education; medical student; prenatal care; substance use
Koheleth Winani, Maternal and newborn health in Tanzania, International

Journal of Gynecology & Obstetrics, Volume 112, Issue 1, January 2011,
Pages 6-7, ISSN 0020-7292, 10.1016/j.ijgo.2010.10.001.
Keywords: Maternal health; Newborn health; Tanzania
K.M. Andrews, D.B. Brouillette, R.T. Brouillette, Mortality, Infant, In:

Editors-in-Chief: Marshall M. Haith and Janette B. Benson, Editor(s)-in-
Chief, Encyclopedia of Infant and Early Childhood Development, Academic
Press, San Diego, 2008, Pages 343-359, ISBN 9780123708779, 10.1016/B978-
012370877-9.00084-0.
Abstract: Over 10 million infants and children under 5 years of
age die each year. Over 99% of these deaths occur in the developing
countries and the least developed countries. Under-5 mortality rates range
from 3 deaths per 1000 live births in Iceland and Sweden to over 250 deaths
per 1000 live births in Afghanistan, Niger, Angola, and Sierra Leone. In
2000, the United Nations Millennium Declaration established a goal of a
two-thirds reduction in under-5 mortality rate between 1990 and 2015. With
only 10 years left the rate had been reduced from 95 deaths per 1000
live births to 76 deaths per 1000 live births in 2005, a 20% reduction.
Latin American and East Asian countries have shown a 43% decline; the
Middle East and North African countries and South Asia have had declines of
3335%; by contrast, sub-Saharan Africa has had a decrease of only 10%.
Most infant and early childhood deaths can be prevented by inexpensive

measures such as nutritional support to the pregnant mother, access to
clean water, immunization against childhood infectious diseases, provision
of a skilled attendant at birth, treatment of diarrhea and dehydration with
oral rehydration fluid, and implementation of malarial control measures
including insecticide treated bed nets. Improvement in socioeconomic status
results in improvement in infant in childhood mortality but just as
important is the political will within a nation to provide support for
women and children. Conversely, war, sociopolitical deterioration, and the
HIV/AIDS epidemic have increased infant and childhood mortality from 1990
to 2005 as exemplified by Iraq, Zimbabwe, and Botswana.
Historically, infant mortality in developed countries first improved when

standards of living increased and infectious disease mortality decreased.
More recently, advances in obstetric and neonatal care for high-risk
pregnancies and premature infants have reduced neonatal mortality rates to
as low as 3 per 1000 live births. Back to sleep and other risk reduction
strategies have cut the incidence of sudden infant death syndrome by 50%
and more since 1990. Despite these advances, even in developed countries
there remain disadvantaged subgroups and at-risk populations with
significantly higher infant and child mortality rates.
Keywords: AIDS/HIV; Breastfeeding; Congenital malformations; Demographic
factors; Environmental health; Failure to thrive; Female education;
Infectious diseases; Low birth weight; Malnutrition; Newborn infant;
Neonatal mortality; Postneonatal mortality; Prematurity; Sudden infant
death syndrome
Neil B Guterman, Enrollment strategies in early home visitation to prevent

physical child abuse and neglect and the universal versus targeted
debate: a meta-analysis of population-based and screening-based programs,
Child Abuse & Neglect, Volume 23, Issue 9, September 1999, Pages 863-
890, ISSN 0145-2134, 10.1016/S0145-2134(99)00062-9.
Abstract: Objective: Seeking to discern optimal programmatic strategies and
inform the universal versus targeted debate in early home visitation
services to prevent physical child abuse and neglect, a meta-analysis was
conducted examining enrollment approaches in early home visitation studies
and their reported outcomes.
Method: Quantitative meta-analytic techniques were used to compare effect

sizes from 19 controlled outcome studies across screening-based and
population-based enrollment strategies. Effect sizes were calculated on
protective services data and on child maltreatment related measures of
parenting.
Results: On protective services report data, population-based studies

reported a weighted mean effect size attributable to early home visitation
of + 3.72%, in comparison to .07% for screening-based studies. On child
maltreatment related measures of parenting, population-based studies
reported a weighted mean effect size (r) attributable to early home
visitation of + .092, in comparison to + .020 for screening-based studies.
Conclusions: The findings indicate that population-based enrollment

strategies appear favorable to screening-based ones in early home
visitation programs seeking to prevent physical child abuse and neglect. It
may be that psychosocial risk screens serve to enroll higher proportions of
families for which early home visitation services are less likely to
leverage change, and to exacerbate a mismatch between early home visitation
service aims and family needs.
Keywords: Child maltreatment; Home visitation; Prevention; Program
enrollment
D. Shaw, Women's right to health and the Millennium Development Goals:

Promoting partnerships to improve access, International Journal of
Gynecology & Obstetrics, Volume 94, Issue 3, September 2006, Pages 207-
215, ISSN 0020-7292, 10.1016/j.ijgo.2006.04.029.
Abstract: The Millennium Development Goals (MGD) represent a commitment of
189 member states that adopted them during the Millennium Summit in
September 2000. This UN General Assembly recognized that gender equality
and women's empowerment are both central to achieving sustainable
development by means of combating poverty, hunger and disease. Neither
reproductive nor sexual health was explicitly articulated in the original
MDGs and indicatorsa critical omission, as globally women are more
disadvantaged than men. However, a clear link exists between all of the
MDGs and the reproductive and sexual health of women, who cannot contribute
to sustainable development, unless their right to health is met through
improved access. The FIGO 2006 World Report on Women's Health addresses
many issues critical to the success of the MDGs, with a focus on how
partnerships have become a crucial vehicle to improve access to health for
women.
Keywords: Millennium Development Goals; Sexual and reproductive health;
Gender equality; Sexual and reproductive rights; Access; Partnerships;
Maternal mortality; Infant and child mortality

(Training and (Quality of Life) ) and Education) and Maternal) and Postpartum

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

(Training and (Quality of Life) ) and Education) and Maternal) and Postpartum

Uploaded by

Copyright:

Available Formats

Carlos Zubaran, Katia Foresti, Investigating quality of life and depressive

Kalpana Upadhyay, Helen Scholefield, Risk management and medicolegal issues

Hawley E. Montgomery-Downs, Salvatore P. Insana, Megan M. Clegg-Kraynok,

Cindy-Lee Dennis, Postpartum depression peer support: Maternal perceptions

Caroline Homer, Vanessa Clements, Nolan McDonnell, Michael Peek, Elizabeth

Obstetric haemorrhage remains a leading cause of maternal death

Lynn Sibley, Leila Caleb-Varkey, Jayant Upadhyay, Rajendra Prasad, Ekta

Louise Seimyr, Barbara Welles-Nystrm, Eva Nissen, A history of mental

Corinna Reck, Daniela Noe, Jakob Gerstenlauer, Eva Stehle, Effects of

S.E.K. Bradley, N. Prata, N. Young-Lin, D.M. Bishai, Cost-effectiveness of

Ayfer Tezel, Sebahat Gzm, Comparison of effects of nursing care to

Terri L. Liberto, Screening for Depression and Help-Seeking in Postpartum

Laura J. Miller, Elizabeth M. LaRusso, Preventing Postpartum Depression,

Nelli Fisher, Lewis A. Eisen, Jyothshna V. Bayya, Alina Dulu, Peter S.

Kimberly Campbell-Voytal, Judith Fry McComish, Joan M. Visger, Carolynn A.

Suellen Miller, Hilarie B. Martin, Jessica L. Morris, Anti-shock garment in

J. Swain, H.G. Dahlen, Putting evidence into practice: A quality activity

Pamela Andreatta, Florence Gans-Larty, Domitilla Debpuur, Anthony Ofosu,

Lisa M. Bodnar, Mary E. Cogswell, Thad McDonald, Have we forgotten the

Barbara E. Kwast, Quality of care in reproductive health programmes:

Education in its broadest sense is required at all levels and sectors of

This paper is the second in series of three which addresses quality of

Lynn M. Sibley, Lauren S. Blum, Nahid Kalim, Daniel Hruschka, Joyce K.

Zeelha Abdool, Ranee Thakar, Abdul H. Sultan, Postpartum female sexual

Piyanee Klainin, David Gordon Arthur, Postpartum depression in Asian

Andrea Gonzalez, Jennifer M. Jenkins, Meir Steiner, Alison S. Fleming, The

Barbara E Kwast, Postpartum haemorrhage: its contribution to maternal

Deborah F. Perry, Anna K. Ettinger, Tamar Mendelson, Huynh-Nhu Le, Prenatal

Marion Righetti-Veltema, Elisabeth Conne-Perrard, Arnaud Bousquet, Juan

N.M.-C. Glangeaud-Freudenthal, A.-L. Sutter, A.-C. Thieulin, V. Dagens-

Wolfgang Hannver, Jochen Ren Thyrian, Kathrin Rske, Julia Grempler,

Ann Starrs, Beverly Winikoff, Misoprostol for postpartum hemorrhage: Moving

Veena Jirapaet, Effects of an Empowerment Program on Coping, Quality of

Katherine Turner, Ada Piazzini, Albertina Franza, Cristina Fumarola,

Zulfiqar A. Bhutta, Zohra S. Lassi, Ann Blanc, France Donnay, Linkages

Dwenda Gjerdingen, Wayne Katon, Deborah E. Rich, Stepped Care Treatment of

M.F. Chersich, S.M. Luchters, E. Yard, J.M. Othigo, N. Kley, M. Temmerman,

Jemima Petch, W. Kim Halford, Psycho-education to enhance couples'

Yann Le Strat, Caroline Dubertret, Bernard Le Foll, Prevalence and

Bridget O. Akin-Otiko, Busisiwe R. Bhengu, Client education experiences and

Helen I Lugina, Kyllike Christensson, Siriel Massawe, Lennarth Nystrom,

Paloma Toledo, Robert J. McCarthy, Carol A. Burke, Kristopher Goetz,

A. Lalonde, B.A. Daviss, A. Acosta, K. Herschderfer, Postpartum hemorrhage

John A. Yozwiak, Postpartum Depression and Adolescent Mothers: A Review of

Sarah Salway, Sufia Nurani, Uptake of contraception during postpartum

Truls stbye, Nancy L. Zucker, Katrina M. Krause, Cheryl A. Lovelady, Kelly

Robert T. Ammerman, Frank W. Putnam, Nicole R. Bosse, Angelique R. Teeters,

Bobbie Posmontier, The Role of Midwives in Facilitating Recovery in

K. Doyle, J. Heron, G. Berrisford, J. Whitmore, L. Jones, G. Wainscott, F.

Ana Victoria Montoya Arizabaleta, Lorena Orozco Buitrago, Ana Cecilia

Lynn Sibley, Deborah Armbruster, Obstetric first aid in the community

Marion Righetti-Veltema, Elisabeth Conne-Perrard, Arnaud Bousquet, Juan

Tara L. Hicks, Susan Forester Goodall, Evelyn M. Quattrone, Mona T. Lydon-

Colleen Keller, Kathie Records, Barbara Ainsworth, Michael Belyea, Paska

Columba K. Mbekenga, Helen I. Lugina, Kyllike Christensson, Pia Olsson,

Vanessa Reid, Mikki Meadows-Oliver, Postpartum Depression in Adolescent

Isobel R. Contento, Jill S. Randell, Charles E. Basch, Review and Analysis

Sheela Saravanan, Gavin Turrell, Helen Johnson, Jennifer Fraser, Carla

We draw on Jordan's concept of authoritative knowledge to assess the

Brian E. Vaugn, Leslie Crichton, Bryon Egeland, Individual differences in

Sheela Saravanan, Gavin Turrell, Helen Johnson, Jenny Fraser, Carla

Jennifer Foster, Angela Anderson, Jennifer Houston, Maya Doe-Simkins, A

Eleni Tsigas, Laura A. Magee, Advocacy organisations as partners in pre-