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.

Effect of percutaneous electrical stimulation at the Baliao point on preventing postpartum urinary retention after labor analgesia

BACKGROUND Anesthetic drugs used in labor analgesia also paralyze the bladder muscle by blocking the sacral plexus,thereby affecting maternal postpartum spontaneous urination and increasing the risk of postpartum urinary retention(PUR).AIM To analyze the effect of percutaneous electrical stimulation at the Baliao point combined with biofeedback therapy for PUR prevention.METHODS We selected 182 pregnant women who received labor analgesia in obstetrics between June 2022 and December 2023.They were divided into the combined therapy group(transcutaneous electrical stimulation of the Baliao point combined with biofeedback therapy)and the control group(biofeedback therapy alone).The first spontaneous urination time,first postpartum urine volume,bladder residual urine volume,postpartum hemorrhage volume,pre-urination waiting time,PUR incidence,adverse reactions,and the intervention’s clinical efficacy were compared between the two groups.RESULTS The first spontaneous urination time after delivery was more delayed(2.92±1.04 h vs 3.61±1.13 h,P<0.001),with fewer initial postpartum urine(163.54±24.67 mL vs 143.72±23.95 mL,P<0.001),more residual bladder urine(54.81±10.78 mL vs 65.25±13.52 mL,P<0.001),more postpartum bleeding(323.15±46.95 mL vs 348.12±45.03 mL,P=0.001),and longer waiting time for urination(0.94±0.31 min vs 1.29±0.42 min,P<0.001),in the control group than in the combined therapy group.The control group also had higher PUR incidence(4.65%vs 15.85%,P=0.016).Both groups had no adverse reactions,but the clinical total efficacy rate of the intervention was significantly higher in the combined therapy group than in the control group(95.35%vs 84.15%,P=0.016).CONCLUSION Percutaneous electrical stimulation of the Baliao point combined with biofeedback can significantly promote postpartum micturition of parturients with labor analgesia,thereby effectively preventing PUR occurrence.

Effects of Maternal Death on Children Living in the Sagnarigu Municipality

Introduction: The greatest effect of maternal mortality is renowned in children aged 2 - 5 months whose mothers had died. Children whose mothers died due to maternal complications were likely to record a higher mortality in infancy compared to children of surviving mothers. Motherless children mostly suffer a lot due to lack of day-to-day care, isolation, lack of motivation as well as economic cost associated with mother’s death. Thus, the purpose of this study was to ascertain the lives of children whose mothers passed away during childbirth at the Sagnarigu Municipality. Methods: This quantitative cross-sectional study was carried out at the Sagnarigu Municipal. The study recruited 297 respondents. To assess the effects of maternal death on the lives of children, families that experienced maternal death were assessed. The number of pregnancies experienced by the deceased woman, pregnancy-related complaints experienced, determinants of maternal death, number of children alive, and their standard of living were assessed with the aid of a structured questionnaire. Results: The data showed that negligence, illiteracy, poor road access, poverty, ignorance, delays in recognizing the problem, delays in making appropriate decisions, delays in the health facility, delays in giving the appropriate treatments, and traditional beliefs were some of the factors that led to maternal death in the Sagnarigu Municipality. Conclusion: The study concluded that determinants of maternal death in the Sagnarigu Municipal included the following;negligence, illiteracy, poverty, and delays in recognizing the problem. The study findings also demonstrated that the effects of maternal death on children are diverse and cut across different areas of a child’s life including livelihood sustenance, healthcare, education, and emotional and psychological development.

Maternal Fetal Prognosis: Pregnancy and Delivery in Women of 40 Years Old and Over in a Second Reference Hospital in Bamako

Introduction: Late pregnancies are considered a public health problem linked to maternal mortality due to their complications. These risks, which worsen with maternal age, should be better known and taken into account in monitoring these pregnancies. Objective: To evaluate the impact of age on the prevalence of obstetric and neonatal complications among parturients of 40 years old and over. Methodology: This was an 11-year retrospective analytical case control study from January 1, 2007 to December 31, 2017. The study population was female patients of 40 years old or older for cases and female patients younger than 40 years of control case. Results: In total, we collected 640 cases of parturients of 40 years old and over out of a total of 84,234 deliveries during the study period;i.e. a frequency of 0.76%. Spontaneous abortion increased in patients of 40 and over with 8.28%. Hypertension and diabetes were higher of women of 40 and over, 52.65%. Concerning the method of admission: 55% of parturients of 40 and over were referrals. Incidents occurring among women of 40 and over were more pronounced than in control cases. Complications during vaginal delivery, cervical tear, perineal tear, uterine dehiscence and uterine rupture are high in our cases, i.e. 11.88%;3.59%;2.19%;2.66. During our study, depending on the type of delivery, the cesarean rate was much higher among women of 40 and over than among control cases, i.e. 54.22% versus 12.24%. Hemorrhages in the 3rd trimester were the main indications for cesarean section. Hemorrhages in the 3rd trimester were more frequent with women of 40 and over, i.e. 10.47%;5.94% versus 1.74% and 0.42%. As for the different types of malformations in parturients, women under 40 years old fetal malformations were absent in 92.29%, on the other hand they were more frequent in patients with 40 years and over, i.e. a normal frequency of 36.72%. Conclusion: Pregnancy at a late age exposes the elderly patient and the newborn to several risks. During this study, an increase in maternal-fetal morbidity was observed with aged women.

How Can China Encourage More Childbirths?

National Bureau of Statistics data show that in 2018, new births in China stood at15.23 million, a 10.9-per-thousand birth rate that was the lowest since 1961.After the two-child policy was put into place in 2015, there were 17.86 million registered new births in 2016. But in 2017 it fell to 17.23million, followed by the 2.63-million drop in2018.

Benefits of Mindfulness Training on the Mental Health of Women During Pregnancy and Early Motherhood:A Randomized Controlled Trial

Objective This study aimed to evaluate the effects of a mindfulness-based psychosomatic intervention on depression,anxiety,fear of childbirth(FOC),and life satisfaction of pregnant women in China.Methods Women experiencing first-time pregnancy(n=104)were randomly allocated to the intervention group or a parallel active control group.We collected data at baseline(T0),postintervention(T1),3 days after delivery(T2),and 42 days after delivery(T3).The participants completed questionnaires for the assessment of the levels of depression,anxiety,FOC,life satisfaction,and mindfulness.Differences between the two groups and changes within the same group were analyzed at four time points using repeated-measures analysis of variance.Results Compared with the active control group,the intervention group reported lower depression levels at T2(P=0.038)and T3(P=0.013);reduced anxiety at T1(P=0.001)and T2(P=0.003);reduced FOC at T1(P<0.001)and T2(P=0.04);increased life satisfaction at T1(P<0.001)and T3(P=0.015);and increased mindfulness at T1(P=0.01)and T2(P=0.006).Conclusion The mindfulness-based psychosomatic intervention effectively increased life satisfaction and reduced perinatal depression,anxiety,and FOC.

Myoma Delivered through the Cervical during Labor: About a Case and Review of the Literature

The authors report the clinical case of a multipara whose intracervical myoma had been diagnosed during the prenatal follow-up and who was delivered into the vagina during labor. Caesarean section was indicated to avoid rupture of the pedicle during fetal expulsion. The myomectomy was performed in a second operation via the vagina, without complications.

Rural-urban differences in distributions and determinants of facility delivery among women in Bangladesh

Introduction:The utilization of facility delivery is crucial to achieve sustainable development goals by reducing maternal and neonatal deaths.This study aimed to compare the distributions and determinants of childbirth in health facilities in urban and rural regions of Bangladesh.Methods:Cross-sectional data from the 2017-2018 Bangladesh Demographic and Health Survey were analyzed.Multilevel logistic regression was applied.Results:A total of 4751 women were included in the analyses.Only 50%of childbirths took place in health facilities,63.4%and 44.6%in urban and rural regions,respectively.Overall,the odds of the association between facility delivery and the studied factors were similar.Multiparous women had significantly lower odds of facility delivery in both rural(adjusted odds ratio[AOR]=0.3,95%confidence interval[CI]:0.2 to 0.5)and urban(AOR=0.2,95%CI:0.1 to 0.5)regions.In both regions,women with higher education levels,highly educated husbands,antenatal care(ANC),and higher wealth indexes had significantly higher odds of facility delivery.Conclusion:Several common associated factors were identified.However,differences were observed regarding distributions of these factors.The differences in facility delivery utilization could result from lower ANC utilization,socioeconomic status,and transportation facilities in rural regions than urban regions;therefore,improving these conditions could increase facility delivery in these regions.

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.

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.

Effect of cognitive behavior therapy training and psychological nursing on the midwifery process in the delivery room

BACKGROUND The severe physical and psychological impact of pain on the physical and mental health of women during labor leads to increased risks and complications during childbirth,presenting a major public health concern.Some studies have shown that cognitive behavioral therapy(CBT)has a positive effect on maternal psychology during delivery,reducing stress and shortening labor time.Thus,CBT training for mothers and delivery room staff may be beneficial in minimizing complications and adverse effects during natural birth.AIM To investigate the clinical effects of CBT training and psychological care during delivery,and their therapeutic effects on women in labor.METHODS This study used a retrospective analysis and included 140 mothers admitted to the maternity ward between January 2021 and January 2023.The study subjects were randomized into two groups:control(n=70)and observation(n=70).Routine care,CBT training,and psychological care were provided to mothers in both groups.Psychological status scores,delivery time,and satisfaction with care pre-and post-delivery were compared,and the incidence of complications after receiving care was analyzed between the two groups.RESULTS Although the psychological state of both groups improved significantly in the late stages of labor,the psychological state scores of the mothers in the observation group were significantly lower than those of the mothers in the control group(P<0.05).The duration of labor and incidence of complications in the observation group were significantly lower than those in the control group(P<0.05).The mothers in the observation group were significantly more satisfied with nursing care during the course of labor than those in the control group(P<0.05).CONCLUSION CBT training and psychological care for mothers in the midwifery process can effectively improve anxiety and depression,shorten labor duration,reduce postnatal complications,and improve nursing satisfaction and nurse-patient relationships.Its clinical application is effective and has popularization value,providing a new way to protect maternal mental health.

Socio-Epidemiological Aspects and Prognosis of Unassisted Deliveries Arriving at Fousseyni Daou Hospital in Kayes

Introduction: The World Health Organization estimates that each year more than 20 million women suffer from the after-effects of unattended childbirth, of which 800 women die every day as a result of obstetric complications. Objective: Study the socio-epidemiological aspects and prognosis of unassisted deliveries arriving at the Fousseyni Daou De Kayes hospital. Materials and Methods: This was a descriptive, cross-sectional study with prospective collection, case-control that took place at the maternity ward of the Fousseyni Daou hospital in Kayes, from 1 January to 31 December 2021. Results: The frequency of unattended birth was 4.1%. The 30 - 35 age group was the most represented with 32.5%. In our study 58.1% of cases were out of school, 19.4% were primigestes and 39.4% were multiparous. In our series 60.6% of cases had given birth at home and 39.4% along the way. The majority of cases regretted having given birth without the assistance of qualified personnel in 45.6%. Maternal complications were dominated by perineal lesions in 14.4% of cases, haemorrhage of delivery in 25% of cases, severe anaemia in 30% of cases;16.7% of newborns were in poor condition, 13.6% were fresh stillbirths, 15.6% of newborns had obstetric trauma. The maternal death rate on arrival was 3%. Conclusion: The frequency of unassisted childbirth is high in the Kayes region. Its complications can be serious for both the mother and the newborn.

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. .

Impact of Traditional Oxytocics on the Course of Labour in Maternity Wards in Parakou (Benin) in 2022

Introduction: The use of oxytocic plants (OPs) to facilitate childbirth is old and it is a common practice in the world, particularly in northern Benin. Objective: To study the effect of oxytocic plants on the progress of labour. Materials and Method: This was a cross-sectional and analytical study with prospective data collection conducted in the public maternity hospitals of Parakou from 15 July 2022 to 15 August 2022. All the parturients admitted to the maternity units were included. Data were entered and processed using Epi Data 3.1fr, Epi info 7.1.3.3 and Excel 2010. The difference was statistically significant for a p-value of less than 0.05. Results: Of 297 parturients surveyed, 109 had used OPs, representing a frequency of use of 36.7%. The average age was 27.5 ± 8.9 years, with extremes of 17 and 45 years. They were in common-law unions (54.1%), housewives (32.1%), from Muslim religion (53.2%), from Bariba ethnic group and related (30.3%) and from a rural area (60.5%). These parturients were pauciparous (37.6%) and primiparous (44.9%). Six OPs were used by the parturients. These were Hybanthus enneaspermus (40.7%), Schrankia leptocarpa (12.0%), Ceratotheca sesamoides (35.2%), Cassytha filiformis (5.6%), Selaginella lepidophylla (5.6%) and Newbouldia leavis (18.5%). The parturients used the leaves (90.6%) and decoction (97.2%). The administration was oral (99.0%) without precise dosage (85.3%) in the third trimester of pregnancy (84.41%) and facilitated delivery (99.1%). Fon and related ethnic groups (p = 0.014), Yoruba and related ethnic groups (p = 0.031), rural background (p = 0.032) and multiparity (p = 0.04) were the factors associated with OPs use. These parturients had a higher risk of caesarean delivery (p = 0.001;OR = 1.8 [1.23 - 2.65]), dynamic dystocia (p = 0.001;OR = 1.3 [1.12 - 1.49]), burnout syndrome (p = 0.002;OR = 1.1 [1.02 - 1.17]), uterine rupture (p = 0.032;OR = 1.1 [0.97 - 1.17]), rapid labour (p = 0.001;OR = 1.6 [1.38 - 2.00]), and risk of postpartum haemorrhage (p = 0.002;OR = 1.15 [1.05 - 1.27]). In contrast, parturients’ use of OPs was found to reduce the risk of their newborns being transferred to neonatology (p = 0.002;OR = 0.50 [0.31 - 0.79]) and dying at birth (p = 0.021;OR = 0.19 [0.03 - 0.94]). Conclusion: The use of OPs is widespread in Parakou. Several factors were associated with it. This use had a protective effect on newborns. This study shows the need to determine the active ingredients of these OPs and emphasise a safer use of them.

Investigation on maternal mortality in Southeast Asia,Europe and Africa using three delays model

Background:Maternal mortality is a prevalent issue in healthcare provision worldwide.It is particularly common in developing and underdeveloped countries,where maternal deaths during childbirth or pregnancy occur frequently.Various internal and external factors contribute to the high maternal mortality rate in specific regions.One model,known as the three delays model approach,examines three distinct causes that contribute to this problem.The first delay is the lack of awareness in seeking timely healthcare,the second delay involves obstacles in reaching healthcare facilities on time,and the third delay relates to poor or inadequate healthcare provision in tertiary care facilities.These delays are responsible for the elevated maternal mortality rates,with the prevalence of each delay varying across regions.Objective:The objective of this literature review is to examine and critically evaluate existing literature on perceptions and investigations regarding maternal mortality in Southeast Asia,Europe and Africa,utilizing the three delays model approach as a categorization framework.Method:This literature review followed BEME guide No.3.A total of 18 articles were included in the sample after conducting a thorough search of various databases and search engines.A Prisma flowchart was created,and the articles were critically appraised.Results:A total of 18 articles focusing on different regions were analyzed.The findings revealed that in countries of Southeast Asia,the primary cause of maternal mortality is the first delay,which refers to the lack of awareness in seeking medical care.On the other hand,in Africa and other European countries,the second and third delays are more prominently associated with maternal mortality.Conclusion:Inadequate care is one of the major causes of maternal mortality in majority of regions acrossthe globe.Multiple factors can hinder access to appropriate healthcare.The three delays model plays a significant role in the higher maternal mortality rate.By raising awareness among women and their families about the importance of seeking healthcare,the risk of fatality can be reduced.Similarly,in developing regions,it is crucial to ensure that healthcare facilities are easily accessible and provide high-quality emergency obstetric care to meet the needs of pregnant women in critical situations.

Could Labor Be Considered Outside of a Medical Environment in Africa? Case of the Maternity Hospital in Yopougon Attié/Abidjan/Ivory Coast/West Africa

Introduction: Developing countries are characterized by a high maternal mortality rate, particulary related to the management of childbirth. The author describes in this work 588 childbirth labors that took place without any medical supervision. Method: All patients who reached the hospital with a full cervix dilation were included in the study. The outcomes of those childbirth labors without medical supervision were evaluated at the maternal and neonatal level. Results and Discussion: The average age of the patients was 28.1 ± 13 years with 47% nulliparous and 30% pauciparous. These patients represented 14% of all births;59% of the patients had had three and five prenatal consultations. 71% of them came straight from home and had meconium-stained amniotic fluid. The APGAR score was greater than 6 in 94% of newborns, and 66.7 of them weighed between 2500 and 3500 g. Only 0.9% of patients coming from home needed a caesarean section. Conclusion: Home birth is not yet possible in Africa because it is not supervised by professionals who know the risks of childbirth, its complications and recognize the warning signs;however, the results of this preliminary study show that the issue of home childbirth in Côte d’Ivoire can be reconsidered subject to greater involvement of medical staffs.

Investigation of the effects of perceived stress on antenatal care behaviors and the labor process during the COVID-19 pandemic

Objective:The aim of this study was to examine of the effects of perceived stress on antenatal care behaviors and the labor process during the COVID-19 pandemic.Methods:This study was conducted with a descriptive design.The data were collected using an“Introductory Information Form”and the“Antenatal Perceived Stress Inventory”.Descriptive statistics were analyzed using Kruskal-Wallis,Mann-Whitney U,and multinomial logistic regression tests.Results:The sample of the study included 487 women.The mean total Antenatal Perceived Stress Inventory score of the participants was found as 2.30±0.80.The mean medical and obstetric risks/fetal health,psychosocial changes during pregnancy,and prospect of childbirth subscale scores of the participants were determined to be 2.29±1.08,2.26±0.87,and 2.34±0.86,respectively.It was determined that as the antenatal perceived stress levels of the participants who frequently attended physical examinations increased,they became 1.535 times more likely to perceive the care they received to be adequate(Odds ratio(OR):1.535;1.045–2.254 Confidence interval(CI);P=0.029).It was found that as the antenatal perceived stress levels of the participants whose clinical tests were frequently analyzed increased,they were 1.518 times more likely to perceive the care they received to be adequate(OR:1.518;1.080–2.135 CI;P=0.016).Moreover,as the antenatal perceived stress levels of the participants who frequently underwent fetal health follow-ups increased,they were 1.573 more likely to perceive the care they received to be adequate(OR:1.573;1.042–2.375 CI;P=0.031).Conclusion:It was concluded that as the antenatal perceived stress levels of the women who frequently underwent physical examinations,clinical test analyses,and fetal health follow-ups increases,they were more likely to consider that they received adequate care.

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.

Birthing ball on promoting cervical ripening and its influence on the labor process and the neonatal blood gas index

BACKGROUND Term pregnancy-induced labor refers to the use of artificial methods to induce uterine contractions and terminate pregnancy after 37 wk.It is a common method to prevent overdue pregnancy and to deal with high-risk pregnancies.In addition,it can alleviate maternal complications and cause the fetus to leave the adverse intrauterine environment early,which is beneficial to the outcome of pregnancy.AIM To explore the effect of a birthing ball on labor by inducing cervical ripening and its influence on labor and the neonatal blood gas index.METHODS Twenty-two women who were scheduled to undergo labor induction and delivery in the obstetrics department of our hospital were randomly divided into two groups:the delivery ball group(childbirth ball combined with COOK balloon induction)and the conventional group(COOK balloon induction alone).The cervical Bishop score before and after intervention,duration of labor at each stage,mode of delivery,neonatal umbilical venous blood pH,oxygen partial pressure(PO_(2)),carbon dioxide partial pressure(PCO_(2)),and the 1-min Apgar score were recorded.RESULTS After the intervention,the cervical Bishop score of the delivery ball group(7.84±1.52)was significantly higher than that of the conventional group(7.32±1.29)(P<0.05),and the cervical Bishop scores of the two groups after intervention were significantly higher than those before intervention(P<0.05).After the intervention,the first stage of labor(510.9±98.7 min),the second stage of labor(43.0±8.5 min),and the total duration of labor(560.0±120.9 min)in the delivery ball group were lower than those in the routine group,with a first stage of labor of 602.1±133.2 min,a second stage of labor of 48.4±9.1 min,and a total duration of labor of 656.8±148.5 min(P<0.05).There was no significant difference in the time of the third stage of labor between the two groups(P>0.05).There was no significant difference in the pH,PO_(2),and PCO_(2) values of newborns between the delivery ball group and the conventional group(P>0.05).The 1-min Apgar score of the delivery ball group was higher than that of the conventional group(9.10±0.38 points vs 8.94±0.31 points,P<0.05).The natural delivery rate of the delivery ball group was higher than that of the conventional group(91.00%vs 78.00%,P<0.05).CONCLUSION The use of a birthing ball combined with a COOK balloon for inducing labor has a better effect on promoting cervical ripening,shortening the time of labor,and improving the Apgar score of newborns.

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.