Resonance between beginning of life and end of life: an un-trodden path to health in Maternity Services?

This paper presents a secondary analysis and discussion of two research projects, which separately  explored existential aspects of beginning of life (among first time mothers) and end of life (among dying and their relatives) respectively. Findings from two studies conducted in different research designs are discussed through common theoretical understandings of secular, spiritual and religious aspects of life. In the paper we focus in particular on, how becoming a mother can actualize existential considerations and how the resonance to the same actualizations in relation to dying, can potentially inform maternity services. Two summary arguments, the existential-spiritual and the health professional argument substantiate our reason to emphasize how spiritual care might be as relevant at beginning of life, as it is at end of life.Denne artikel er en sekundær analyse og diskussion af to forskningsprojekter, som søgte at udforske eksistentielle karakteristika ved henholdsvis livets begyndelse (blandt nybagte mødre) og livets afslutning (blandt døende og deres pårørende). På baggrund af empiri genereret via forskellige forskningsmetoder diskuteres resultaterne i lyset af en fællesteoretisk forståelse af sekulære, religiøse og spirituelle aspekter i menneskelivet. I artiklen fokuserer vi i særlig grad på, hvordan det at blive mor kan aktualisere eksistentielle overvejelser og hvordan resonansen til samme aktualisering i forbindelse med døden, kan informere sundhedsvæsenets svangreomsorg. Med begrundelse i to sammenfattende argumenter, det eksistentielle/åndelige og det sundhedsfaglige, argumenterer vi for, at eksistentiel og åndelig omsorg potentielt kan være relevant ved livets begyndelse på samme vis som ved livets afslutning

Maternal hormonal milieu influence on fetal brain development

An adverse maternal hormonal environment during pregnancy can be associated with abnormal brain growth. Subtle changes in fetal brain development have been observed even for maternal hormone levels within the currently accepted physiologic ranges. In this review, we provide an update of the research data on maternal hormonal impact on fetal neurodevelopment, giving particular emphasis to thyroid hormones and glucocorticoids. Thyroid hormones are required for normal brain development. Despite serum TSH appearing to be the most accurate indicator of thyroid function in pregnancy, maternal serum free T4 levels in the first trimester of pregnancy are the major determinant of postnatal psychomotor development. Even a transient period of maternal hypothyroxinemia at the beginning of neurogenesis can confer a higher risk of expressive language and nonverbal cognitive delays in offspring. Nevertheless, most recent clinical guidelines advocate for targeted high-risk case finding during first trimester of pregnancy despite universal thyroid function screening. Corticosteroids are determinant in suppressing cell proliferation and stimulating terminal differentiation, a fundamental switch for the maturation of fetal organs. Not surprisingly, intrauterine exposure to stress or high levels of glucocorticoids, endogenous or synthetic, has a molecular and structural impact on brain development and appears to impair cognition and increase anxiety and reactivity to stress. Limbic regions, such as hippocampus and amygdala, are particularly sensitive. Repeated doses of prenatal corticosteroids seem to have short-term benefits of less respiratory distress and fewer serious health problems in offspring. Nevertheless, neurodevelopmental growth in later childhood and adulthood needs further clarification. Future studies should address the relevance of monitoring the level of thyroid hormones and corticosteroids during pregnancy in the risk stratification for impaired postnatal neurodevelopment.This work was supported by the grant "Doutoramento em Medicina Jose de Mello Saude 2014" by Jose de Mello Saude to AM

Ritualisation and Parenthood: Sorgpraksisser hos forældre, der har mistet et spædbarn

When a woman in a Danish maternity ward gives birth to a stillborn baby, it is common practice that the health professionals encourage the parents to see and hold the baby. Within empirical research, one will find a number of qualitative and quantitative studies of the significance of such practices regarding the continuous emotional health for the mothers, but many studies are deficient when it comes to representativity and confounding. This article relates to existing research and replenishes with a cross-disciplinary approach, consisting of sociological and cultural analyses of the paradigmatic shift of grief paradigms and the relations to the dead and the meaning ofritualisations, as well as empirical studies of specific grief and everyday life practices carried out by bereaved parents.The central theme is: what are the interrelations between the practices and interactions initiated by the parents and performed at the maternity wards, in the home and on online memorial sites, on children’s graves and elsewhere and what do they mean to the parents’ grief practices in the life to come?Denne artikel forholder sig til eksisterende forskning om, hvordan forældrenes møde med det døde barn indvirker på deres sorg. Denne forskning suppleres i kraft af en tværvidenskabelig tilgang med sociologiske og kulturanalytiske studier af paradigmatiske skift i forhold til sorgpraksisser og forholdet til den døde samt af ritualers betydning. Endelig inddrages empiriske studier af konkrete sorg- og hverdagspraksisser hos forældre, der mister et barn før, ved eller kort tid efter fødslen. Artiklens hovedfokus er således at analysere de praksisser og interaktioner mellem forældrene og det døde barn, som udfolder sig på fødeafdelingerne, og som efterfølgende foregår i medieret form på f.eks. online mindesider, på børnenes grave og andre steder, samt at reflektere over mulige forbindelser mellem tidlige og senere sorgpraksisser; hvordan de forskellige elementer hænger sammen, og hvad de betyder for forældres sorg og livet efterfølgende

Midwives’ experiences of using the Obstetric Norwegian Early Warning System (ONEWS): A national cross-sectional study

Introduction: Increasing numbers of maternity units are implementing routine and standardized monitoring of all women using a form of Early Warning Score System with the aim to early detect women at risk of developing critical illness or a deterioration of their condition. The implementation in Norway is relatively new. This study aimed to describe Norwegian midwives’ experiences with the Obstetric Norwegian Early Warning System (ONEWS). Methods: We performed a cross-sectional study based on an electronic questionnaire, sent to heads of midwifery at all maternity units in Norway for distribution to their clinically active midwives. Thirty-one of 48 units had implemented ONEWS for over a month. About 1020 midwives received the questionnaire, 232 (23%) responded. Results: Of the participants, 217 (93.5%) reported receiving sufficient training and 230 (99.1%) reported using the same scoring system, including the same vital parameters measured. The criteria for use of ONEWS varied between units regarding inclusion criteria and frequency of scoring. A total of 214 (92.2%) midwives agreed that ONEWS has value in the surveillance of high-risk women, while 152 (65.5%) agreed that ONEWS contributes to medicalization of the care of low-risk women. Some 166 (71.6%) midwives reported that ONEWS was time consuming and 159 (68.5%) that the measures need to be better adapted to childbearing women. Conclusions: Maternity units in Norway implementing ONEWS use an almost identical scoring system but varying criteria for whom to score and how often. Midwives considered ONEWS particularly suited for high-risk women and not for low-risk childbearing women

Fertility treatment and risk of childhood and adolescent mental disorders:register based cohort study

Objective To assess the mental health of children born after fertility treatment by comparing their risk of mental disorders with that of spontaneously conceived children. Design Prospective register based cohort study. Setting Nationwide register based information from Danish National Health Registers cross linked by a unique personal identification number assigned to all citizens in Denmark. Participants All children born in Denmark in 1995-2003 with follow-up in 2012 when the children were aged 8-17; 33 139 children were conceived after fertility treatment and 555 828 children were born after spontaneous conception. Main outcome measures Absolute risks and hazard ratios for overall and specific mental disorders estimated with adjustment for potential confounding variables. Estimated association between the risk of mental disorders and subtypes of procedures, hormone treatments, gamete types, and cause of infertility. Results The risk of mental disorders in children born after in vitro fertilisation or intracytoplasmic sperm injection was low, and was no higher than in spontaneously conceived children, except for a borderline significant increased risk of tic disorders (hazard ratio 1.40, 95% confidence interval 1.01 to 1.95; absolute risk 0.3%). In contrast, children born after ovulation induction with or without insemination had low but significantly increased risks of any mental disorder (1.20, 1.11 to 1.31; absolute risk 4.1%), autism spectrum disorders (1.20, 1.05 to 1.37; 1.5%), hyperkinetic disorders (1.23, 1.08 to 1.40; 1.7%), conduct, emotional, or social disorder (1.21, 1.02 to 1.45; 0.8%), and tic disorders (1.51, 1.16 to 1.96; 0.4%). There was no risk systematically related to any specific type of hormone drug treatment. Conclusions There was a small increase in the incidence of mental disorders in children born after ovulation induction/intrauterine insemination. Children born after in vitro fertilisation/intracytoplasmic sperm injection were found to have overall risk comparable with children conceived spontaneously