Perceptions of Control in Midwifery Assisted Childbirth: A Qualitative Examination of the Midwifery Assisted Experience of Childbearing

This study looks to uncover some of the reasons that the sub-group of women who give birth outside of a hospital setting, and the midwives who serve them, choose to have an alternative birth plan and are willing to undergo social criticism for their decision. This is a qualitative analysis based on interview data with women who utilized midwifery care and midwives themselves. In-depth interview questions focus on the decision to use a midwife, definitions of control in the prenatal and birthing experience, and any kind of facilitation midwifery is seen to give expectant mothers in relation to these concepts. Through analyzing these interview responses, I found an emerging theme work in the midwifery model of care. Women who participated in this model, whether it be mothers or midwives themselves, emphasized ideas of control, autonomy and achievement in the childbirth experience. I also found a heavy emphasis on respect for the mother in this model of care. Furthermore, many of the respondents spoke about the emerging social movement of alternative birthing plans and their relationship with conventional medicine which I feel is worthy of examining through a sociological lens. Finally, an interesting theme regarding masculinity and the role of fathers in the childbirth experience developed from the data

Functional Outcome Measures of Recombinant Tissue Plasminogen Activator–Treated Stroke Patients in the Telestroke Technology

The efficiency of telestroke programs in improving the rates of recombinant tissue plasminogen activator (rtPA) in stroke patients has been reported. Previous studies have reported favorable treatment outcomes with the use of telestroke programs to improve the use of rtPA, but functional outcomes are not fully understood. This study investigated the effect of telestroke technology in the administration of rtPA and related functional outcomes associated with baseline clinical variables. Retrospective data of a telestroke registry were analyzed. Univariate analysis was used to compare demographic and clinical variables in the rtPA group and the no rtPA group and between the improved functional ambulation group and the no improvement group. A stepwise binary logistic regression identified factors associated with improved functional outcome in the total telestroke population and in the subset of the telestroke population who received rtPA. In adjusted analysis and elimination of any multicollinearity for patients who received rtPA in the telestroke setting, obesity (odds ratio [OR] = 2.138, 95% confidence interval [CI], 1.164-3.928, P  < .05), higher systolic blood pressure at the time of presentation (OR = 1.015, 95% CI, 1.003-1.027, P  < .05), and baseline high-density lipoprotein at the time of admission (OR = 1.032, 95% CI, 1.005-1.059, P  < .05) were associated with improved functional outcomes. Increasing age (OR = 0.940, 95% CI, 0.916-0.965, P  < .0001) and higher calculated National Institutes of Health Stroke Scale (OR = 0.903, 95% CI, 0.869-0.937) were associated with a poorer outcome in rtPA-treated patients. Telestroke technology improves functional outcomes at spoke stations where neurological expertise is unavailable. Further studies are necessary to determine how telestroke technology can be optimized, especially to improve contraindications and increase eligibility for thrombolysis therapy