Home birth midwifery in the United States: evolutionary origins and modern challenges

Human childbirth is distinct in requiring-or at least strongly profiting from-the assistance of a knowledgeable attendant to support the mother during birth. With economic modernization, the role of that attendant is transformed, and increased access to obstetric interventions may bring biomedicine into conflict with anatomical, physiological, and behavioral adaptations for childbirth. This article provides an overview of the role of midwifery in human evolution and ways in which this evolutionary heritage is reflected in home birth in the contemporary United States. Opportunities remain for evolutionary scholars to apply their knowledge and skills to strengthen culturally consonant, evolutionarily grounded maternity care within a complex, multilevel, pluralistic medical system

Lactation and neonatal nutrition: defining and refining the critical questions.

This paper resulted from a conference entitled "Lactation and Milk: Defining and refining the critical questions" held at the University of Colorado School of Medicine from January 18-20, 2012. The mission of the conference was to identify unresolved questions and set future goals for research into human milk composition, mammary development and lactation. We first outline the unanswered questions regarding the composition of human milk (Section I) and the mechanisms by which milk components affect neonatal development, growth and health and recommend models for future research. Emerging questions about how milk components affect cognitive development and behavioral phenotype of the offspring are presented in Section II. In Section III we outline the important unanswered questions about regulation of mammary gland development, the heritability of defects, the effects of maternal nutrition, disease, metabolic status, and therapeutic drugs upon the subsequent lactation. Questions surrounding breastfeeding practice are also highlighted. In Section IV we describe the specific nutritional challenges faced by three different populations, namely preterm infants, infants born to obese mothers who may or may not have gestational diabetes, and infants born to undernourished mothers. The recognition that multidisciplinary training is critical to advancing the field led us to formulate specific training recommendations in Section V. Our recommendations for research emphasis are summarized in Section VI. In sum, we present a roadmap for multidisciplinary research into all aspects of human lactation, milk and its role in infant nutrition for the next decade and beyond

bFcRn transzgenikus juh előállítása = Generation of the bFcRn transgenic sheep

Munkacsoportunk (ELTE, Immunológiai Tsz) a szarvasmarha neonatalis Fc receptor (bFcRn) szerepét vizsgálja az IgG homeosztázisban (maternális immuntranszport, katabolizmus, humorális immunválasz). Jelen pályázatunk célja az volt, hogy a bFcRn túltermelés hatását a kiskérődző juhban is ellenőrizzük, ill. a kérődzőkre jellemző kérdésekben – tőgy IgG szekréció – pontosítsuk. Terveink szerint egy kollaborációs együttműködés keretében a Roslin Intézettel közösen az ún. lentivírus transzgenezis (tg) révén bFcRn-t túltermelő juhokat hozzunk létre és ezeket az állatokat elemezzük. Az ELTE munkacsoportja ebben a kutatásban vállalta és sikerrel végrehajtotta, hogy a bFcRn promoteréből és cDNS-ből egy olyan konstrukciót készít, amelyet a Roslin Intézetben lentivírusba illeszthetnek. Továbbá, hazai együttműködésben sikerült ebből egy lentivírust is előállítani, amellyel a konstrukciót sikeresen validáltuk (RT-PCR, Western blot). Előállítottunk továbbá olyan ovalbumin specifikus juh szérumot, amellyel a későbbiekben a tg juhok in vivo vizsgálatát tervezzük végrehajtani. A Roslin Intézet munkatársai szintén sikeresen állítottak elő lentivírust az általunk létrehozott konstrikcióból, azt in vitro vizsgálatok során tesztelték, majd bFcRn tg egereket hoztak létre. A konstrukcióval 2008 év elején juh zigótákat fertőztek, de sajnos ezek nem voltak sikeresek. A juh szaporodásának szezonális viszonyai miatt a munkát 2009-ben folytatjuk. | Our group (Dept.Immunology, ELTE) analyze the role of the bovine neonatal Fc receptor (bFcRn) in IgG homeostasis (maternal immune transport, catabolism, humoral immune response). The aim of the current application was to investigate the effect of the bFcRn overexpression in the sheep as small ruminant, especially in ruminant specific functions, such as the IgG secretion in the mammary gland. In order to achieve these goals we intended to generate and analyze transgenic sheep using lentivirus technology that overexpress the bFcRn in a collaborative effort with The Roslin Institute. Our group at ELTE was required and successfully performed to generate a construct composed of the bFcRn promoter and cDNA segments that could be used to create a lentiviral vector at The Roslin Institute. In addition, together with a Hungarian company, we created a lentiviral vector from this construct which we successfully validated (RT-PCR, Western blot). We also generated ovalbumin specific sheep antiserum which can be used later to in vivo analyze the tg sheep. Our colleagues at The Roslin Institute have successfully used our construct to create their own lentiviral vector, which they tested in vitro and generated bFcRn tg mice. They also attempted to create tg sheep by infecting sheep zygotes with these lentiviruses, however these attempts were not successful. Due to the seasonality of the sheep reproduction, we will continue this work in 2009

Gender roles and technological progress

Until the early decades of the 20th century, women spent more than 60% of their prime-age years either pregnant or nursing. Since then, the introduction of infant formula reduced women's comparative advantage in infant care, by providing an effective breast milk substitute. In addition, improved medical knowledge and obstetric practices reduced the time cost associated with women's reproductive role. We explore the hypothesis that these developments enabled married women to increase their participation in the labor force, thus providing the incentive to invest in market skills, which in turn reduced their earnings differential with respect to men. We document these changes and develop a quantitative model that aims to capture their impact. Our results suggest that progress in medical technologies related to motherhood was essential to generate a significant rise in the participation of married women between 1920 and 1950, in particular those with young children

Viviendo la experiencia de la parturición en un modelo asistencial humanizado

That was a qualitative study with phenomenological approach that aimed at understanding women's post-partum experiences in a humanized assistance. Data were collected in a hospital from São Paulo, SP, Brazil. Eight women in post-partum period were interviewed. From data analysis two themes were extracted: Bearing the labor and Having the opportunity rescuing autonomy, being disclosed the phenomenon: Living the ambiguity on the birth process in a humanized assistance model. The reports show feelings like pain, fear and anxiety, however, it allowed a participation and rescuing autonomy. Although the study have been realized in a humanized assistance, the women's experiences reveals that they are far from an effective humanization, according to its principles. This study can be used to guide educative actions target to humanization and to generate managerial changesEste es un estudio cualitativo con abordaje fenomenológica con la finalidad de comprender las experiencias de puerperas que vivieron el trabajo de parto y el parto en la asistencia humanizada. La colecta de los dados ocurrio en un hospital en la ciudad de São Paulo, donde fuera entrevistadas ocho mujeres en el periodo post-partum. De la analisis de los dados surgieron los temas: Soportando el trabajo de parto y Tiendo la oportunidad de rescatar la autonomía, siendo desvelado lo fenómeno Viviendo la ambigüedad de la parturición en un modelo asistencial humanizado. Los relatos evidenciaron sentimientos relacionados a dolor, miedo y ansiedad, pero, posibilitou la participación y rescate de la autonomía. Aunque el estudio tener sido realizad en la asistencia humanizada, las experiencias de las puérperas fueram distantes de los principios de la asistencia humanizada. El actual estudio puede nortear aciones educativas al parto direccionadas para humanización y generar innovación en la asistenciaTratou-se de um estudo qualitativo baseado na abordagem fenomenológica com o objetivo de compreender as experiências de puérperas que vivenciaram o trabalho de parto e o parto em um modelo assistencial humanizado. Os dados foram coletados em um hospital localizado na cidade de São Paulo, onde foram entrevistadas oito puérperas. Da análise dos dados surgiram os temas: Suportando o trabalho de parto e Tendo a oportunidade de resgatar a autonomia, e o fenômeno desvelado foi Vivendo a ambiguidade da parturição em um modelo assistencial humanizado. Os relatos evidenciaram sentimentos como dor, medo e ansiedade, porém, possibilitou a participação e resgate da autonomia. Embora o estudo tenha sido realizado em um modelo assistencial considerado humanizado, as experiências das puérperas revelam que ainda se distanciam de uma efetiva humanização, conforme seus princípios. Este estudo pode ser utilizado para nortear ações educativas voltadas à humanização e gerar mudanças assistenciaisUniversidade Federal de São Paulo (UNIFESP) Departamento de EnfermagemUNIFESP, Depto. de EnfermagemSciEL

Warm shower aspersion, perineal exercises with Swiss ball and pain in labor

OBJECTIVE: To evaluate, in an isolated and combined manner, the use of warm aspersion bath and perineal exercises performed with Swiss ball during labor, facing pain perception. METHODS: This is a clinical or intervention study. We recruited 15 pregnant women at low obstetric risk who accepted the use of non-pharmacological interventions for pain relief and who also accepted being questioned about their perception of pain using a visual analogue scale. RESULTS: When the interventions studied were associated, pain reduction was significant. There was no significant difference in pain scores, when interventions were isolated. CONCLUSION: The results indicate that the associated use of non-pharmacological methods for pain relief, warm aspersion bath and perineal exercises with the Swiss ball during the dilation phase is related to the reduction of pain and promotion of the parturient's comfort when associated.OBJETIVO: Avaliar de forma isolada e combinada a utilização do banho quente de aspersão e exercícios perineais realizados com bola suíça durante o trabalho de parto e a percepção da dor. MÉTODOS: Estudo clínico experimental ou de intervenção, randomizado. Foram recrutadas 15 parturientes de baixo risco obstétrico que aceitaram utilizar intervenções não farmacológicas para alívio da dor e questionadas sobre a percepção dolorosa, utilizando a aplicação da escala analógica visual. RESULTADOS: Quando as intervenções em estudo foram associadas a diminuição da dor foi significativa. Não houve diferença significativa no escore de dor, quando as intervenções foram isoladas. CONCLUSÃO: Os resultados indicam que a utilização associada dos métodos não farmacológicos para alívio da dor, banho quente de aspersão e exercícios perineais com a bola suíça durante a fase de dilatação está relacionada com a redução da dor da parturiente e promoção do conforto materno, quando associados.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de EnfermagemUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaMaternidade Pro Matre PaulistaUNIFESP, Escola Paulista de Enfermagem (EPE)UNIFESP, EPMSciEL

Labor Pain: Perception of the Parturient and Midwife Evaluation

Abstract: Labor pain is an organic response which is important to make a correct assessment. Human evolution brought some modifications to the human body and as a consequence, labor pain is a major concern for women and simultaneously a professional matter for midwives. The aim of this study is to describe the perception of labor pain by the parturient and its evaluation by midwives of these episodes. A quantitative cross-sectional descriptive design was used. Non-parametric methods were applied because the sample obtained was not normal. The study was based on two convenience samples, totaling 164 parturients and 18 nurses. The visual analogue scale (VAS) was applied. Data were collected from 575 pain episodes. The age and parity of the parturient are not associated statistically with the intensity of labor pain at the time of hospital admission, as well as the presence of a companion. The level of pain mentioned by the parturients is significantly higher than indicated by the evaluation of the midwives. Midwives with between 6-10 and 11-15 years in practice assess pain at lower levels than nurses with 1-5 or 16-20 years in practice. Conclusions: The midwives underestimate labor pain. It is important to develop greater accuracy in assessing labor pain. Midwives can provide the stronger support if they do a correct evaluation of parturient’s pain

Förlossningsrummets design. En systematisk litteraturstudie

Background: The environment in labor wards has gradually changed over time. Since women have previously given birth to children in the home, almost all children in Sweden are now born in labour wards with highly specialized care. The birthing room is to a large extent medicalized and there are few opportunities for pregnant women to choose an alternative birthing environment. There is no previous summary of how the design of the birthing room affects women and children's health during childbirth. Aim: To summarise published research on how birthing room design physically and emotionally influence maternal and child outcomes during childbirth and the first two hours after. Method: A systematic literature search was conducted in ten different databases in Dec 2016. All peer reviewed studies who investigated how the design of the birthing room affected health and well-being of mother and child were included. All stages of inclusion and quality assessment have been made by me (LH) and one more person; I have performed data extraction and analysis. Result: Thirteen quantitative studies of different character and quality are reported in this thesis. The result showed that women were positively enrolled in the more comfort- tably furnished birthing rooms, high volume and poor soundproofed birthing rooms were adversely affected and associated with an increased estimated labor pain in one study. The included studies showed minor differences in obstetric outcomes, a rando-mized controlled study reported significantly lower incidence of artificial oxytocin stimulation in the intervention group.Bakgrund: Miljön på förlossningsavdelningar och i förlossningsrummet har gradvis förändrats över tid. Från att kvinnor tidigare födde barn i hemmet föds nu nästan alla barn i Sverige på förlossningsavdelningar med högspecialiserad vård. Förlossningsrummet är i hög utsträckning medicintekniskt utformat och det finns få möjligheter för födande kvinnor att välja en alternativ förlossningsmiljö. Det finns ingen tidigare sammanställning genomförd över hur designen av förlossningsrummet påverkar kvinnor och barns hälsa under förlossning. Syfte: Var att sammanställa publicerad vetenskaplig forskning kring hur designen av förlossningsrummet påverkar kvinnor och barns fysiska och psykiska hälsa under förlossningen och de två första timmarna efter. Metod: En systematisk litteratursökning genomfördes i tio olika databaser i december 2016. Alla vetenskapligt granskade studier inkluderades som undersökte hur förlossningsrummets design påverkade hälsa och välbefinnande hos mor och barn. Alla stadier av inkludering och kvalitetsbedömning har gjorts av mig (LH) och en till person, jag har genomfört dataextraktion och analys. Resultat: Tretton kvantitativa studier av olika karaktär och kvalité redovisas i det här examensarbetet. Resultatet visade att kvinnorna var positivt inställda till de mer komfortabelt inredda förlossningsrummen, hög ljudvolym och bristfälligt ljudisolerade förlossningsrum upplevdes negativt och var kopplat till en ökad skattad förlossningssmärta i en av studierna. De inkluderade studierna visade små skillnader i obstetriskt utfall, en randomiserad kontrollerad studie redovisade signifikant lägre förekomst av artificiell oxytocin stimulering i interventionsgruppen

Comparación de los beneficios de la posición vertical durante el parto frente a otras posiciones

En la actualidad existe evidencia científica que demuestra que la libertad de movimiento y cambio postural durante el parto es primordial para un parto y nacimiento fisiológicos. Este hecho se ha observado en distintas épocas y culturas a lo largo de la historia. Las matronas atendían los partos de manera intuitiva pero hoy en día, la asistencia al parto en España se realiza de manera que sea cómoda para los profesionales sanitarios más que para las propias madres. Se demuestra que los partos en posiciones verticales presentan mayores ventajas que los partos en posiciones horizontales. Debido a esto, las matronas deberían actuar en función de este conocimiento: aumentando su confianza y competencia para la asistencia a las mujeres en cualquier postura que elijan y creando un entorno que favorezca esa libertad de movimientos. Nuestro objetivo es señalar la importancia de la Humanización en la atención al parto normal como proceso natural y fisiológico, no como un proceso patológico o de enfermedad. Hacemos una revisión bibliográfica y análisis crítico para describir cómo ha ido cambiando la posición de las mujeres durante el parto en distintas épocas y culturas, además de describir algunas de las posturas que se pueden adoptar durante el parto, con sus correspondientes ventajas e inconvenientes. La atención al parto vertical conlleva menos complicaciones para la madre y el recién nacido frente a las posiciones horizontales. Por ello se pretende concienciar a los sanitarios para que incorporen la evidencia científica sobre las mejores posiciones y así, realizar una humanización de atención al parto dando la elección a la madre.Grado en Enfermerí