No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The WHO advises against recumbent or supine position for longer periods during labour and birth and states that caregivers should encourage and support the woman to take the position in which she feels most comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births and may thus counterbalance any increase in perineal trauma and blood loss.</p> <p>Methods</p> <p>A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by intention to treat.</p> <p>Results</p> <p>The main findings of this study were that birth on the birth seat did not reduce the number of instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal edema.</p> <p>Conclusions</p> <p>The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a birth seat caused no adverse consequences for perineal outcomes and may even be protective against episiotomies.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov.ID: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01182038">NCT01182038</a></p

A descriptive study of Swedish women with symptoms of breast inflammation during lactation and their perceptions of the quality of care given at a breastfeeding clinic

BACKGROUND: Women's perceptions of quality of care during episodes of breast inflammation have been scantily explored. It was the objective of the present study to describe a cohort of breastfeeding women with inflammatory symptoms of the breast during lactation regarding demographical variables, illness history and symptoms at first contact with a breastfeeding clinic and to explore their physical health status, psychological well-being and perceptions of quality of care received, at a six-week postal follow-up. METHODS: This is a descriptive study set at a midwife-led breastfeeding clinic in Sweden, which included a cohort of women with 210 episodes of breast inflammation. The women had taken part in a RCT of acupuncture and care interventions and were recruited between 2002 and 2004. Of the total cohort, 176 (84 %) responded to a postal questionnaire, six weeks after recovery. RESULTS: Of the 154 women for whom body temperature was recorded at the first visit, 80 (52%) had fever ranging from 38.1°C to 40.7°C. There was no significant difference between those with favourable outcomes (5 or less contact days) and those with less favourable outcomes (6 or more contact days) for having fever or no fever at first contact. Thirty-six percent of women had damaged nipples. Significantly more women with a less favourable outcome (6 or more contact days) had damaged nipples. Most women recovered well from the episode of breast inflammation and 96% considered their physical health and 97% their psychological well-being, to be good, six weeks after the episode. Those whose illness lasted 6 days or more showed less confidence in the midwives and in the care given to them. Twenty-one (12%) women contacted health care services because of recurring symptoms and eight of the 176 responders (4.5%) were prescribed antibiotics for these recurring symptoms. A further 46 women (26% of the responders) reported recurring symptoms that they managed without recourse to health care services. CONCLUSION: Initial fever may not be indicative of outcomes for women with inflammatory breast symptoms and treatment by antibiotic therapy may be necessary less often than has been supposed. Women who are also suffering from damaged nipples may need special attention. Those with protracted symptoms were less satisfied with care and showed less confidence in caregivers. International research collaboration might help us find the optimal level of antibiotic therapy for this group of women. This is an important consideration for the global community

No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The WHO advises against recumbent or supine position for longer periods during labour and birth and states that caregivers should encourage and support the woman to take the position in which she feels most comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births and may thus counterbalance any increase in perineal trauma and blood loss.</p> <p>Methods</p> <p>A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by intention to treat.</p> <p>Results</p> <p>The main findings of this study were that birth on the birth seat did not reduce the number of instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal edema.</p> <p>Conclusions</p> <p>The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a birth seat caused no adverse consequences for perineal outcomes and may even be protective against episiotomies.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov.ID: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01182038">NCT01182038</a></p

First-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period : Implications for early parenthood preparation

Objective to describe first-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period. Design a qualitative study was conducted and data was analysed with a phenomenographical approach. Setting and participants 15 first-time fathers were recruited from three postnatal units in southern Sweden and interviewed approximately one month after their baby was born. Measurements and findings three categories and 14 conceptions about fathers' experiences of their preparation emerged from the data. ‘Acquiring knowledge and forming realistic expectations' was essential for ‘Developing strategies' and ‘Being facilitated and supported' enhanced these processes. Key conclusions and implications for practice supporting fathers to develop strategies for life with a new baby and providing expert guidance to fruitful and accurate information may help the construction of a fatherhood identity and strengthen the fatherhood role. The findings can be used to develop a parental preparation for early parenthood that will correspond to fathers' needs

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

<p>Abstract</p> <p>Background</p> <p>The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.</p> <p>Methods</p> <p>In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.</p> <p>Results</p> <p>Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, <it>Staphylococcus aureus </it>(<it>S. aureus</it>), Group B streptococci (GBS) and <it>Enterococcus faecalis</it>. More women with mastitis had <it>S. aureus </it>and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured <it>S. aureus </it>and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 10⁷cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).</p> <p>Conclusion</p> <p>Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.</p

What's normal? Oligosaccharide concentrations and profiles in milk produced by healthy women vary geographically.

Background: Human milk is a complex fluid comprised of myriad substances, with one of the most abundant substances being a group of complex carbohydrates referred to as human milk oligosaccharides (HMOs). There has been some evidence that HMO profiles differ in populations, but few studies have rigorously explored this variability.Objectives: We tested the hypothesis that HMO profiles differ in diverse populations of healthy women. Next, we examined relations between HMO and maternal anthropometric and reproductive indexes and indirectly examined whether differences were likely related to genetic or environmental variations.Design: In this cross-sectional, observational study, milk was collected from a total of 410 healthy, breastfeeding women in 11 international cohorts and analyzed for HMOs by using high-performance liquid chromatography.Results: There was an effect of the cohort (P 4 times higher in milk collected in Sweden than in milk collected in rural Gambia (mean ± SEM: 473 ± 55 compared with 103 ± 16 nmol/mL, respectively; P < 0.05), and disialyllacto-N-tetraose (DSLNT) concentrations ranged from 216 ± 14 nmol/mL (in Sweden) to 870 ± 68 nmol/mL (in rural Gambia) (P < 0.05). Maternal age, time postpartum, weight, and body mass index were all correlated with several HMOs, and multiple differences in HMOs [e.g., lacto-N-neotetrose and DSLNT] were shown between ethnically similar (and likely genetically similar) populations who were living in different locations, which suggests that the environment may play a role in regulating the synthesis of HMOs.Conclusions: The results of this study support our hypothesis that normal HMO concentrations and profiles vary geographically, even in healthy women. Targeted genomic analyses are required to determine whether these differences are due at least in part to genetic variation. A careful examination of sociocultural, behavioral, and environmental factors is needed to determine their roles in this regard. This study was registered at clinicaltrials.gov as NCT02670278

Swedish high school students' knowledge and attitudes regarding fertility and family building

<p>Abstract</p> <p>Background</p> <p>Infertility is a serious problem for those who suffer. Some of the risks for infertility are preventable and the individual should therefore have knowledge of them. The purposes of this study were to investigate high-school students' knowledge about fertility, plans for family building and to compare views and knowledge between female and male students.</p> <p>Methods</p> <p>A questionnaire containing 34 items was answered by 274 students. Answers from male and female students were compared using student's <it>t</it>-test for normally distributed variables and Mann-Whitney <it>U</it>-test for non-normal distributions. The chi-square test was used to compare proportions of male and female students who answered questions on nominal and ordinal scales. Differences were considered as statistically significant at a <it>p</it>-value of 0.05.</p> <p>Results</p> <p>Analyses showed that 234 (85%) intended to have children. Female students felt parenthood to be significantly more important than male students: <it>p </it>= <it><</it>0.01. The mean age at which the respondents thought they would like to start to build their family was 26 (± 2.9) years. Men believed that women's fertility declined significantly later than women did: <it>p </it>= <it><</it>0.01. Women answered that 30.7% couples were involuntarily infertile and men answered 22.5%: <it>p </it>= <it><</it>0.01. Females thought it significantly more likely that they would consider IVF or adoption than men, <it>p = </it>0.01. Men felt they were more likely to abstain from having children than women: <it>p = <</it>0.01. Women believed that body weight influenced fertility significantly more often than men: <it>p = <</it>0.01 and men believed significantly more often that smoking influenced fertility: <it>p </it>= 0.03. Both female and male students answered that they would like to have more knowledge about the area of fertility.</p> <p>Conclusions</p> <p>Young people plan to start their families when the woman's fertility is already in decline. Improving young people's knowledge about these issues would give them more opportunity to take responsibility for their sexual health and to take an active role in shaping political change to improve conditions for earlier parenthood.</p

Evaluation of changes in postnatal care using the "Parents' Postnatal Sense of Security" instrument and an assessment of the instrument's reliability and validity

<p>Abstract</p> <p>Background</p> <p>A sense of security is important for experiences of parenthood in the early postpartum period. The objectives of this study were to evaluate two models of postnatal care using a questionnaire incorporating the Parents' Postpartum Sense of Security (<it>PPSS</it>) instrument and to test the validity of the <it>PPSS </it>instrument.</p> <p>Methods</p> <p>Postal surveys were sent to 234 mothers who had experienced two different forms of postnatal care (study group and control group) and returned by 86.8%. These two groups of mothers were compared for total scores on the <it>PPSS </it>instrument. Demographic variables and mothers' opinions about care interventions were also compared and these variables were tested for correlations with the total <it>PPSS </it>score. A regression analysis was carried out to assess areas of midwifery care which might affect a sense of security. The internal consistency and concurrent validity of the instrument were tested for the total population.</p> <p>Results</p> <p>there were no significant differences between the groups for scores on the <it>PPSS </it>instrument. A total of three variables predicted 26% of the variability on the <it>PPSS </it>scores for the study group and five variables predicted 37% of the variability in the control group. One variable was common to both: "<it>The midwives on the postnatal ward paid attention to the mother as an individual"</it>. There were significant correlations between the total <it>PPSS </it>scores and scores for postpartum talks and visits to the breastfeeding clinic. There was also a significant correlation between the single question: "<it>I felt secure during the first postpartum week</it>" and the total <it>PPSS </it>score. Tests for internal consistency and concurrent validity were satisfactory.</p> <p>Conclusion</p> <p>The proposed new model of care neither improved nor impaired mothers' feelings of security the week following birth. Being seen as an individual by the midwife who provides postnatal care may be an important variable for mothers' sense of postnatal security. It is possible that postpartum talks may encourage the processing of childbirth experiences in a positive direction. Availability of breastfeeding support may also add to a sense of security postpartum. The <it>PPSS </it>instrument has shown acceptable reliability and validity.</p