Pregnancy, Childbirth, and Childcare during the COVID-19 Pandemic for Parents Raising a 4-Month-Old Child

This study examined the situation of raising a four-month-old baby after pregnancy and childbirth during the COVID-19 pandemic. A fact-finding survey was conducted using an anonymous self-administered questionnaire for mothers and their husbands (hereinafter referred to as fathers) who came to A City, Osaka Prefecture, for health checkups of their four-month-old infants. The questionnaire was distributed to 733 mothers (252 responses). Valid responses were received from 247 participants (33.7%). The questionnaire was distributed to 733 fathers (191 responses). Valid responses were received from 184 participants (25.1%). Most participants belonged to nuclear family households. Sixty percent parents were primiparous. More than 90% parents did not participate in online parenting classes or attend childbirth. In addition, more than 80% mothers did not participate in face-to-face or online maternity classes, postpartum face-to-face visits from grandparents in the hospital, online home visits, telephone conversations, or support from non-relatives. Parents could not obtain information about childcare due to COVID-19. There were restrictions on prenatal checkups, visits, and use of facilities. Most of them resolved these problems via social media platforms, cooperating and communicating with their respective partners and relatives, and devising ways to play with their child. Health of nearly 30% mothers was affected by childcare stress and the pandemic, and they were either depressed or despondent. Approximately 70% experienced positive changes in family relationships and mindsets, such as time spent with family and cooperation received in childcare. During the COVID-19 pandemic, parents coped with various changes and problems they experienced during pregnancy, childbirth, and childcare by devising solutions based on their personal perspectives.

Circadian Rhythm of Childbirths and Maternal and Neonatal Prognosis at the YaoundéCentral Hospital

Background: The circadian variation of childbirths has been described by several authors around the globe. De Graaf showed that hospital childbirths at night were associated with increased perinatal mortality and adverse perinatal outcome. To improve obstetric care, we carried out this study to evaluate the circadian rhythm of childbirths and to assess the outcome following variations in the time of childbirths during the day. Methods: It was a cross-sectional descriptive study at the Yaoundé Central Hospital (YCH), over a two years period. We collected data from files of women who delivered from the 1st of January 2017 to 31st December 2018. We included files of women who delivered at least at 28 weeks of pregnancy. We excluded files of those who delivered by elective caesarean section, those whose hour of delivery was not noted and those who delivered before reaching the hospital. Sociodemographic, obstetrical characteristics, and immediate prognosis were recorded. Data were entered into excel, then analysed with SPSS v23 software. Tools used to appreciate our results were means, median, number, percentage, P, and OR with its 95% confidence interval. The difference in p is significant if p is less than 5%. Results: We analyzed 6041 files bearing the time of birth. Childbirths took place at all hours of the day, but the times of the day where the highest numbers of births were recorded were 10, 11, 12, 13 (that’s 1pm), 14 (that’s 2 pm), 15 (that’s 3 pm), 16 (that’s 4 pm), 17 (that’s 5 pm) and 23 (that’s 11 pm) hours, with respectively 224 (3.7%), 277 (4.6%), 256 (4.2%), 265 (4.4%), 207 (3.4%), 255 (4.2%), 228 (3.8%), 216 (3.6%) and 226 (3.7%) births. The peak of births was at 11 am while the time of day where the lowest number of births was recorded was 6 pm, with 175 (2.9%) births. The mean age of participants was 27.34 ± 6.03 years with extremes of 13 and 49, with 87.6% between 20 to 39 years. Sociodemographic characteristics of participants, prematurity and bleeding during delivery, had no dependence on the time of delivery. Perineal tear, duration of observation, Apgar score of the newborn, birthweight, delivery mode, health personnel who performed the delivery, and episiotomyseemed to be influenced by the time of delivery. Daily shifts were not independently associated with the poor Apgar score (0 - 6) at 5 mins, when adjusted for all other factors (p = 0.109). Conclusion: Childbirths were more frequent between 10 am and 5 pm. The period where episiotomy was most performed is the same as when there was macrosomia childbirth. Tears of the perineum are more frequent between 2 pm and 10 pm. There was no independent association between Daily shifts and poor Apgar score. The poor APGAR score would be more related to low birth weight.

Influence of cultural factors on choice of childbirth place among women in Oyigbo Local Government Area,Rivers State,Nigeria

Objectives:This study aims to ascertain if cultural factors influence the childbirth place choice of women in Oyigbo.Materials and Methods:The study used a cross‑sectional study design using a self‑structured questionnaire as the instrument to collect data from 384 volunteers through simple random sampling,and these data were analyzed using frequency and percentage for descriptive statistics while Chi‑square was used for inferential statistics at 0.05 level of significance.Results:The influence of cultural factors such as family traditions(χ^(2)=12.56,P=0.006),beliefs(χ^(2)=70.66,P=0.000),lack of confidence in health facilities(χ^(2)=367.83,P=0.000),and the presence of male skilled birth attendants(χ^(2)=50.85,P=0.000)were statistically significant to the choice of childbirth place,while patriarchal system(χ^(2)=2.99,P=0.393)was not statistically significant to the choices of childbirth places of women in Oyigbo.Religion had a statistically significant influence on childbirth place(χ^(2)=125.46,P=0.000).Conclusion:This study shows that religious and cultural factors have a significant influence on the childbirth place choices of women in Oyigbo Local Government Area of Rivers State.

Psychometric Properties among Japanese Women Based on the Multidimensional Assessment of Women’s Experience of Childbirth

Aims/Background: Perceived experiences of childbirth are important for mothers as they affect their self-esteem, mother-child interactions, subsequent mother-child bonding, and their desire for another child. This study examined the factor structure and construct validity of Salmon and Drew’s Multidimensional Assessment of Women’s Experience of Childbirth (MAWEC) in Japanese. Design/Methods: This study conducted a questionnaire survey using the Japanese version of the MAWEC and other variables with 759 women with infants in Japan. The participants’ mean (standard deviation [SD], range) age was 31.9 (5.3, 18 - 46) years. A total of 353 (46.5%) participants were primiparous and 384 (50.6%) were multiparous, and 22 (2.9%) did not answer. The data were randomly divided into two groups for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and separately analyzed the positive- and negative-worded items. I conducted EFA using the maximum-likelihood method with PROMAX rotation from one-through two- and three-factor structures. Different factor structure models were compared in terms of CFAs using, as indicator of goodness-of-fit, chi-square/df, comparative fit index (CFI), and root mean square of error approximation (RMSEA). Results: This study showed that a bifactor model for the MAWEC with four subscales (positive emotion, positive coping, negative emotion, and negative coping) fit the data the best. These four subscales were associated with demographic, obstetric, neonatal, and feeding characteristics. For example, primiparas were more vulnerable to coping aspects of perceived childbirth experiences, including sense of mastery over the delivery process and ability to enjoy the delivery. Gestational age at birth was associated with emotional aspects of perceived childbirth experiences. Conclusion: The Japanese version of the MAWEC consists of four aspects regarding perceived childbirth experience. Perinatal health professionals may examine women’s childbirth experiences from these four perspectives. .

Does Antenatal Fear of Childbirth Predict Postnatal Fear of Childbirth? A Study of Japanese Women

The study aimed to determine whether antenatal fear of childbirth (expectation) could predict postnatal fear of childbirth (experience) by taking account of other antenatal psychological variables (anxiety and depression) as well as birth outcomes in Japanese women. A longitudinal observational study was conducted at a clinic in Tokyo, Japan, in 2011. Self-report questionnaires were distributed to 240 Japanese women at 37 gestational weeks (Time 1) and on the second day after delivery (Time 2). Regression analyses by means of structural equation modelling were conducted in both the primiparous and the multiparous group. The models exhibited good fit (chisquare value/degree of freedom = 1.10 - 1.62, comparative fit index = 0.92 - 0.99 and root mean square error of approximation = 0.03 - 0.07). Antenatal fear of childbirth was the most predictive variable of postnatal fear of childbirth in both the primiparous (β = 0.58, p = 0.002) and the multiparous group (β = 0.62, p < 0.001). In conclusion, antenatal fear of childbirth was a significant predictor of postnatal fear of childbirth when other antenatal psychological variables and birth outcomes were taken into account. Pregnant women who are strongly afraid of childbirth need special attention before and after delivery.

Psycho-Social Predictors of Childbirth Fear in Pregnant Women: An Australian Study

Background: Around 20% of birthing women report high levels of childbirth fear. Fear potentially impacts women’s emotional health, preparation for birth, and birth outcomes. Evidence suggests that personal and external factors contribute to childbirth fear, however results vary. Aim: To identify pyscho-social factors associated with childbirth fear and possible antenatal predictors of childbirth fear according to women’s parity. Method: 1410 women in second trimester and attending one of three public hospitals in south-east Queensland were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Other measures included the Edinburgh Depression Scale (EPDS), Decisional Conflict Scale (DCS) and items from the EuroQol (EQ-5D) targeting Anxiety/Depression and Pain/Discomfort. In addition items measuring a previous mental health condition, social support and knowledge were used. Preferred mode of birth was also collected. Psycho-social factors were analysed to determine associations with childbirth fear. Multivariate analysis was used to determine predictors of fear. Results: Thirty-one percent (n = 190/604) of nulliparous and 18% (n = 143/782) of multiparous women reported high fear levels. Having a mental health history, desiring a caesarean section, reporting moderate to high pain during pregnancy, having a non-supportive partner and perceiving less childbirth knowledge than peers, were associated with childbirth fear. Standard multiple regression analyses by parity determined that depression, decisional conflict, low social support and less perceived knowledge predicted levels of childbirth fear. The model explained 32.4% of variance in childbirth fear for nulliparous and 29.4% for multiparous women. Conclusion: Psychosocial factors are significantly associated with childbirth fear. The identification of predictive psychosocial factors for childbirth fear indicates the importance of observing, assessing, and developing support strategies for women. Such strategies are required to decrease anxiety and depression for women during pregnancy, promote normal birth, and build social support to improve women’s feelings and positive expectations of birth.

Assessment of the Socio-Demographic Factors Associated with the Satisfaction Related to the Childbirth Experience

Assessment of the socio-demographic factors associated with the satisfaction is related to the childbirth experience. Objective: A mother’s satisfaction with the childbirth experience may have instant and lasting effects on her wellbeing, and on the bonding with her infant. The main aim of the study was to assess which socio-demographic factors are associated with this satisfaction. Most factors that authors agree on are: Pain intensity, personal control, self-efficacy, length of labor, method of delivery and numerous other demographic factors. Design: A cross-sectional study. Data was collected using a self-reported survey. Settings: The sample consisted of 100 women, selected from St Georges Hospital and CHU-NDS, who had to speak Arabic and had given birth in the past three days prior to interview. Methods: The multiple linear regressions and the mean test were used to assess which factors were associated with a positive childbirth experience. The Mackey childbirth satisfaction scale, three items from the Wijma delivery Expectancy/Experience questionnaire, a seven item mastery scale developed by Pearlin and Schooler and a background questionnaire were filled by women. Findings: Factors that were linked to a positive birth experience were: Higher age, multiparous women, higher education, high monthly income, unemployment, childbirth preparation, high personal control and self-efficacy, high childbirth and labor pain, fulfilled expectations, shorter period of labor and instrumented delivery. Conclusion: This study demonstrates that satisfaction with the childbirth experience is multi-dimensional with diverse factors foreseeing diverse dimensions of satisfaction.

Voices of Mother's Interaction with Midwives in Natural Childbirth: A Qualitative Study

Interaction between mothers and midwives during natural childbirth is one of the important factors in relationship between mothers and midwives in natural childbirth. In this qualitative study we explored experiences of mothers and midwives in interaction with each other in natural childbirth. This study was a part of a larger study which was carried out in Iran in 2013-2014. A total of 23 participants participated in this study. 12 primiparous and multiparous women planned to have natural deliveries and 11 midwives were purposefully included for semi-structured in-depth interviews in this study. For analysis and interpretation of mothers’ and midwives’ experience, conventional content analysis was used. Data were coded in MAXqda software (version 2). Interaction between mothers and midwives could be organized and categorized in one theme “relationship”. This theme consists of two subthemes: “respect for the mother” and “interaction” and five categories: “Feeling confidence, Feeling satisfaction, Associated with sensory relationship, Understanding mother’s situation, Understanding the meaning of interaction”. Good relationship between mothers and midwives in natural childbirth could improve the experience of natural childbirth for mothers. This experience could increase woman’s tendency toward natural birth instead of cesarean section in future pregnancies. Findings of this study can be seen as a challenge for health care professionals and policy makers to upgrade care of natural childbirth based on women’s preferences and needs.

The Effect of Reflective Learning on Childbirth Care Competence of Midwifery Students

Background: The skills of midwives in childbirth care competence are still inadequate. This problem is influenced by limitation experience of midwifery students of childbirth care in the field of practice area. That condition related to the proportion of midwifery students and case of childbirth woman was an imbalance. Midwifery students must prepare this competence in an education with childbirth care experience from practice in the laboratory and in the field of practice. Reflective learning is an appropriate learning method that uses experience as the basis of learning to improve childbirth care competence of midwifery students. Objective: This study is to analyze the effect of reflective learning implementation in childbirth care practice to improve students’ competence. Method: This research uses quasi-experimental design with non-equivalent control group design. The respondents were midwifery students in the fourth semester who had experienced the theory of childbirth care. There were totally 64 samples, 34 samples for treatment group and 30 samples for control group. Data were analyzed by using unpaired t test, Mann Whitney U and linear regression. Results: The respondents were homogeny in motivation and grade point of average (GPA). The improvement of childbirth care competency is influenced by treatment of 19.064 with R2 = 57.7%. Conclusion: The implementation of reflective learning in childbirth care practice affected the improvement of students’ competence.

Women’s Motivation and Associated Factors for Herbal Medicine Use during Pregnancy and Childbirth: A Systematic Review

Background: Herbal medicines use has prevailed over the past decades in both low-middle-income and high-income countries over the years. The use among women has increased with increased risks of ill-health. There is extensive literature on herbal medicine use among women in pre/pregnancy, labour, and the postpartum periods. Therefore, this study aimed to understand women’s purposes, experiences, and motivation for using herbal medicines during pregnancy, childbirth and postpartum, and the experiences associated with the use. Methods: Four critical databases were predetermined and searched: CINAHL, Medline, Web of Science, and EMBASE. These databases were chosen for their comprehensiveness and relevance to the review aims. We considered peer-reviewed published articles from January 2000 to December 2018. We chose these databases because we found that they are dominant in the medical and healthcare-related literature. All references were pooled to Endnote reference management software for screening. Quality appraisal of articles was conducted using the Mixed-Method Assessment Tool (MMAT). Content analysis approach was used to extra the data from the articles. Globally, twenty-one articles met the inclusion criteria, and thus, formed the dataset for this review. Results: Most articles (n = 10, 47.6%) reported solely HM uses on only pregnancy whiles the rest evaluated HM uses in labour, pre-pregnancy, and the postpartum periods. The results have shown that the majority of women received information about HM from friends, family, the “black markets,” and drug outlets. Overall, the results were presented in seven broad themes: 1) sociodemographic characteristics of HM users, 2) perceived threat of health problem, 3) sources and quality of the information received, 4) susceptibility to health complications, 5) potential limitations to the use of HM, 6) the motivation for HM utilization, 7) concerns on the combined use of herbal and allopathic medicines. Conclusion: The study recommends the further research into the toxicity of herbal products, to ensure that accurate information can be provided to women before use.

“At Least Your Baby Is Healthy” Obstetric Violence or Disrespect and Abuse in Childbirth Occurrence Worldwide: A Literature Review

Obstetric violence or disrespect and abuse in childbirth is a worldwide phenomenon that takes on various forms, from absence of informed consent to physical harm. The objective of this review is to assess prevalence and root causes of obstetric violence in different countries, and potential solutions to address disrespect and abuse in childbirth. The review finds that obstetric violence is rooted in a patriarchal understanding of gender stereotypes and is exacerbated by power dynamics between health professionals and patients, especially for minorities. Obstetric violence has a long-lasting impact on women’s lives and can jeopardize subsequent decisions to access healthcare services.

Childbirth expectations and correlates at the final stage of pregnancy in Chinese expectant parents

Purpose:To explore the childbirth expectations of Chinese expectant parents during their transition to parenthood.Methods:A cross-sectional descriptive survey was used through the Chinese version of the Childbirth Expectations Questionnaire.A total of 240 expectant parents were recruited when they were admitted to the obstetric units waiting for delivery at a large Maternal and Child Health care Center in Beijing,and 210 couples completed the questionnaires,yielding a response rate of 87.5%.Results:The expectant parents had a high level of childbirth expectations towards caregiving environment,spousal support,control and participation and medical support.Conversely,their expectations toward labor pain and their own ability to cope with the pain were relatively low.Expectant fathers’childbirth expectations and preference of partner’s accompany were two significant predictors of expectant mothers’childbirth expectations,explaining 18.9%and 3.3%of the total variance,respectively.While expectant mothers’childbirth expectations was the only significant predictor of expectant fathers’childbirth expectations.Conclusion:This study adds to understanding of the childbirth expectations of Chinese expectant parents.It is suggested that maternity healthcare providers pay close attention to the childbirth expectations of expectant parents,and improve the nursing care service to promote positive childbirth experiences and satisfaction of expectant parents.

Women with Fear of Childbirth Perceived Large Accumulated Labor Pain in Japan

Background: To improve negative birth experiences among women who experience intense labor pain during labor, it is important to examine the relationship between fear of childbirth immediately after vaginal delivery and the actual intensity of labor pain. However, previous studies have generally evaluated labor pain in a retrospective setting. Purpose: This study examined the relationship between fear of childbirth immediately after vaginal delivery and the actual labor pain intensity and accumulated labor pain intensity without pharmacological pain relief during labor in Japan. Methods: A prospective observational study was conducted between July 2015 and April 2016. Forty-seven pregnant Japanese women were available for analysis. Fear of childbirth was measured by the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version B on the third day after vaginal delivery. Participants with scores of 85 or higher were categorized in the high JW-DEQ group, having severe fear of childbirth. Labor pain intensity was examined chronologically in real time with stepwise usage of two types of Numeric Rating Scale (NRS). Accumulated labor pain intensity was calculated using the area under the curve (AUC). Results: Nine participants were in the high JW-DEQ group and eight of the nine were primiparae. Primiparae in the high JW-DEQ group experienced significantly longer duration and larger accumulated labor pain intensity between the onset of labor and 4 to 6 cm of cervical dilatation than those in the low JW-DEQ group (P = 0.024 and P = 0.021, respectively). Conclusions/Implications for Practice: The latent phase of labor was a key stage to improve fear of childbirth immediately after vaginal delivery without pharmacological pain relief among Japanese primiparae. Midwives should give assistance in the latent phase of labor by focusing on progressing labor smoothly and relieving labor pain to improve negative birth experiences.

Professional’s skills in assessment of perineal tears after childbirth—A systematic review

Perineal tears are one of the most common complications of vaginal births and may cause discomfort and pain long time after childbirth. Visual and digital examination of perineal tears is the most common way to assess and classify a perineal tear. Recent research indicates that many tears diagnosed are misclassified. The aim of this systematic literature review was to outline research that investigates healthcare professionals’ clinical knowledge in assessment and classification of perineal tears in connection with childbirth. Searches were performed in PubMed and CINAHL. Six studies on the topic were identified and ?used to collect data for questionnaires. An integrative review was used in the analysis. Poor knowledge in perineal anatomy and lack of training in clinical assessment and classification of perineal trauma was evident among both physicians and midwives. These findings indicate that healthcare providers lack adequate knowledge and that they make incorrect assessments and errors in classification of perineal tears. The training in assessment and classification is crucial. Midwives are in a unique position to improve the standard of care in this field since they are often the first and many times the only to assess the injury.

Childbirth in the Adolescent Female at the General Hospital of Loandjili (Congo)

Objective: To contribute to the knowledge of the characteristics of teenage birth. Patients and Methods: Retrospective, descriptive and comparative studies, from February 1st 2014 to April 31st 2015, carried out in the Obstetrics and Gynecology Department General Hospital of Loandjili. Included were births of less than 18 years of age at the end of a pregnancy of at least 22 weeks of amenorrhea on the one hand, and adults aged 18 and over, who had given birth at the same end of the pregnancy immediately after the teenager. Thus two populations consisted of 170 cases each. The parameters studied were: Sociodemographic, clinical and prognostic characteristics. Results: During this period, 4190 patients had given birth to 4341 births. Among them, 170 teenage girls are 4%. The average age of teenagers in our study was 16.2 years with a 17-year-age, versus 28.2 years for adults. The average parity was 1.19. While in adults, multiparity was represented at 45.89% with an average parity of 3.19. The average number of prenatal consultations (ANC) was 2.89 for adolescent girls and 31.2% had not been performed. By cons in adults, it was 4.23. These ANCs were started in teenage girls with an average of 22 weeks at the first ANC, while adults started on average at 18 weeks. The average delivery time was 38 weeks of amenorrhea for both populations. Thirty-four cases of premature newborns from adolescent mothers were observed, compared with 14 in adult mothers (p 0.05). The delivery mode was low in 66% of adolescent girls versus 75% of adults. Indications for caesarean section in adolescents were represented by complications of arterial hypertension (38.59%), followed by mechanical dystocia. While in adults, cervical dystocia and scar uteri were the most represented. During this study period, no maternal deaths were recorded among adolescent girls. Characteristics of the newborn: the condition of the newborn at birth was good according to the rating of Apgar among teenagers in 91%, and in adults in 96.5% and, with a birth weight at teenage girls normal in 74% versus 88% in adults. Low birth weight and prematurity were reported with a statistically significant difference in adolescent girls.

Childbearing or Working?——Impact of Childbirth on Rural Women's Interruption of Off-farm Employment

To assess the work interruption information and examine the correlation between childbirth and the off-farm employment interruption of rural women,this article collected 3 820 women's childbirth and employment information over the past 18 years( 1998-2015),using multivariate regression to explore the impact of female individual,family and employment characteristics on probability of employment interruption and duration of interruption. Results indicated that overall,40% of women got interrupted after childbirth in rural areas and the average duration of interruption was about four years. Human capital factors,such as their work experience,first childbirth age and education experience,influence the probability of employment interruption,but these factors do not extend the duration of interruption for women who got interrupted.It is concluded that increasing the human capital of rural women is helpful to increasing their labor force participation rate after childbirth.

Childbirth Complications among Adolescent Mothers at Mbala General Hospital in Mbala District, Zambia

Aim: The study aim was to explore childbirth complications among adolescent mothers at Mbala General Hospital, Zambia. Method: A descriptive cross-sectional study design of 138 adolescent mothers aged between 10-19 years was carried out over a period of five months at a referral hospital (Mbala General Hospital) in Mbala District, in the Northern Province of Zambia, Central Africa. Results: Maternal age prevalence was 31.1% for all admissions. The childbirth complications identified on admission were prolonged labour (42%);during Labour-Cephalopelvic Disproportion (CPD) (59.7%), prolonged labour (20%), in the post-partum period, Post-Partum Hemorrhage (PPH) due atonic uterus at 20%. The most prevalent co-morbidity was Anemia (55.6%). A statistically significant association was observed between childbirth complications and parity with a P-value of 0.001. Conclusion: Our study demonstrates an association between childbirth complications and parity while the childbirth complications of prolonged labour, Contracted Pelvic Disproportion, premature rupture of membrane and PPH were observed.

Birthing Systems, Bio-medicine and Gender-Based PowerRelationships: Patrilinearity and Childbirth in Amed(Est Bali, Indonesia)

This article offers an anthropological overview about birth processes in a small village in Bali.I would like to investigate how the naturalization of this event is often used to justify control over the physical and social body of women,their descendants and social group.Central focus of the analysis will be the consideration of how women’s position within society is determined by a complex system of rules,values,and medical practices deeply conditioning childbirth sphere that legitimates hierarchical divisions and gender inequality.

Epidemiology, the Main Reasons and Maternal-Fetal Complications of Unassisted Childbirth in the Health District of V Bamako Commune, Mali

Objective: To describe the epidemiological aspects, to determine the reasons leading women to give birth outside of health facilities and to determine the maternal prognosis. Patients and Methods: This was a cross-sectional, analytical, quantitative and qualitative descriptive study over a period from 1 June to 31 December 2016 (7 months) on unassisted childbirth in the health district of commune V of Bamako. Results: We recorded 70 unsured deliveries, a frequency of 1.04% out of a total of 6719 deliveries. The extreme ages were 15 years and 41 years with an average age of 28 years. 90% of the birth attendants were married and 10% were single. The women's profession: 48% were housewives, 11% saleswomen, 13% hairdressers, 4% female teachers. Education level: 71% were uneducated and 29% educated. Among those who are educated, their level was primary in 50%, secondary in 32% and higher in 18%. 42% had done antenatal consultation. The main reasons: ignorance of work 44.3%;religious beliefs and societal burdens 10.0%;fear of caesarean section 4.3%;late-night birth labour 5.7%;lack of financial and/or transport means 17.1%; distance from the locality 2.9%;insecurity 2.9%. Maternal and perinatal prognosis: complications were mostly hemorrhagic and concerned 27 (39%) patients. These included uterine atony (13 cases), placental retention (8 cases), soft part lesions (6 cases). We have not recorded any maternal deaths. For the condition of newborns at the time of admission: 88% of newborns were alive, 11% were stillborn fresh and 1% stillborn macerated. Conclusion: The reasons are multifactorial and seem to be a reflection of our society.

Sexuality after childbirth: Gaps and needs

Childbirth is a stressful event for a majority of women and can have many consequences one of which is female sexual dysfunction. The main aim of pre- and postnatal health services is to fulfl physical and emo-tional needs of mothers and babies but not sexual function of women. Also, the fact that sexual satisfaction is part of general well being and mental health is generally neglected. Sexual function of women not only is affected by childbirth, but also is infuenced by many other factors. One of these factors is culture and religion. Women’s sexual life after childbirth has different meaning in different cultures. In many conservative so-cieties with certain cultural and religious beliefs women are prohibited from having sex after childbirth. In these societies, women hear conflicting stories about risks and benefts of having sexual intercourse during post-partum period the majority of which may not be true. It has been reported that some women may be at greater risk of postpartum sexual dysfunction as neurobiologi-cal factors and genetics have been recently suggested to impact female sexual functioning. Considering the multidimensional nature of female sexual dysfunction, this problem cannot be resolved by a simple solution and not all postpartum women can be treated by the same protocol. Various treatment options, such as the use of medications, behavioural interventions and psy-chotherapy have been investigated in research studies and there is still controversy over the issue. Regarding the fact that sexually satisfed women are more men-tally healthy, routine screening during prenatal, ante-natal and postnatal visits are suggested to uncover hid-den diffculties with sexual functioning of women and improve their quality of life.