Managing heart conditions in pregnancy

Healthcare professionals are encountering more andmore women with cardiac conditions contemplating pregnancyor when pregnant than ever before. Advances insurgical treatment of congenital cardiac anomalies meanmany more women are now reaching childbearing age andcontemplating pregnancy than would hitherto have beenseen.Due to the fact that Irish figures have not been availablethus far on the effects of cardiac disease on pregnancy andvice versa, we have come to rely on statistics from our nearestneighbour the UK. The Centre for Maternal and ChildEnquiries (CMACE) is an independent charity. Its missionis to improve the health of mothers, babies and children bycarrying out confidential enquiries and other related workon a UK wide basis and widely disseminating the results. Itproduces a report every three years into maternal fatalitiesin the previous three-year period. The most recent reportwas published in 2007, reflecting the deaths that occurredin 2002-2005. In the most recent CMACE triennial reportinto maternal mortality (2002-2005) for the first time cardiacdisease was found to be the leading cause of maternaldeath among women in the UK, with a maternal mortalityrate for heart disease of 2.27 per 100,000 maternities

Those who can, teach. 'A teacher affects eternity; she can never tell where her influence stops'

Teachers can have a profound effect on us all, both good and bad. In this paper the effect two individual midwives had on my evolution as a midwife will be examined. They were very different: one was formal and the other informal. The classroom was the setting for one, the clinical area for the other. Each had her own unique style and way of looking at the world. One was very different from the other in manner and in approach. However they each shared a philosophy of women centred, normal birth which they espoused in all aspects of their working lives

Caesarean wound care for midwives

With a rise in caesarean births there is a rise in wound care management issues for midwives and the potential for surgical site infections (SSIs). The burden of SSIs include increases in maternal mortality, morbidity, length of hospital stay and cost. Sepsis is currently the leading cause of maternal mortality, with 50 per cent of the women who die having had a caesarean birth (Centre for Maternal and Child Enquiries (CMACE) 2011). Wound management and the prevention of sepsis are therefore issues of great concern to midwives. This article considers the incidence of wound infections and presents the guidance available to help address this problem

All for Nothing?: Executive Authority and Congressional Evasion on Arms Sales

On August 17, 2018, CNN reported that Lockheed Martin manufactured a bomb that killed dozens of Yemeni schoolchildren in Northern Yemen. Saudi Arabia purchased the bomb in an arms deal authorized under the Arms Export Control Act, the statute in which Congress delegates to the President authority to control the import and export of arms. Under the Act, the President must comply with reporting and waiting periods allowing time for Congress to oppose a sale by enacting a joint resolution. However, the Act allows the President to sell arms in an emergency without notice or waiting periods. President Trump invoked that authority in 2019, to sell arms to Saudi Arabia, a transaction Congress opposed. This raises questions about the efficacy of the Act itself. Specifically, given Supreme Court precedent, past practice, and exceptions to the Act, there is some doubt as to whether Congress would in practice be able to halt a sale. This comment explores that question, and employs Justice Jackson’s Steel Seizure Concurrence as a framework. Although Congress likely possesses authority to halt a sale, I consider the legacy of Congress’ decision to delegate authority, and note the complexities emergency provisions and Supreme Court precedent create

Alien Registration- Richards, Margaret M. (Auburn, Androscoggin County)

https://digitalmaine.com/alien_docs/22677/thumbnail.jp

Born too soon: preterm birth in Europe trends, causes and prevention

It is estimated that 15 million babies annually are born too soon, which is before 37 completed weeks of gestation and that this number is rising (1). Complications of preterm birth are the leading cause of death among children less than 5 years of age and this accounted for nearly one million preventable deaths in 2013 (1). The United Nations Millennium Development Goal (MDG) 4 targeted a two-thirds’ reduction of under five deaths by 2015 and recommended interventions to prevent preterm birth and to improve survival for preterm newborns (2). While infant and maternal mortality rates have witnessed some improvements, the burden of mortality and morbidity in the perinatal period remains a major concern (3). This is due in part to the high number of births per year, the young age of the maternal and infant population harmed by adverse perinatal events and the long-term sequelae of adverse pregnancy events such as very preterm birth or severe hypoxia (4)

Rainbow of hope after the storm: couples' experiences of pregnancy after stillbirth

Despite phenomenal advances in maternity care over the past fifty years babies still die around the time of their birth and the causes may be varied. Pregnancy loss remains the most common complication of pregnancy today with one in five pregnancies ending in loss. These losses can occur at any stage from fertilisation through pregnancy to birth. Stillbirth is when the baby, greater than 24 weeks gestation or weighing more than 500 grams, is born having never shown signs of life. Most of the estimated 2,000,000 stillbirths annually, happen in low and middle resource countries, and occur for a combination of reasons: lack of access to trained healthcare assistance around pregnancy and birth, poor nutrition, and a dearth of resources - to name but a few. Stillbirth remains an issue for high resource countries like Ireland also. In high resource countries, it is expected that one in two hundred pregnancies annually will end in stillbirth. Despite our best efforts these rates have remained static for the past ten years. On average there are three hundred and fifty stillbirths in Ireland every year. To put that into context that is a jumbo jet full of babies who never get to go home with their parents, who never get to fulfill their milestones, but these children are never forgotten about by their parents

Experiences of couples in pregnancy after stillbirth: an interpretative phenomenological analysis

Background: Despite advances in maternity care, 2.6 million babies die at or before their birth each year across the globe. The majority of couples will proceed to a pregnancy after loss, often within a very short timeframe of their index loss. However, little is known about how couples, as a unit, negotiate the experience of pregnancy after loss. Aim: To understand how couples, as a dyad, make sense of a pregnancy after stillbirth. Method: The experiences of eight heterosexual couples, who were pregnant again in the immediate pregnancy after stillbirth, was explored using Interpretive Phenomenological Analysis (IPA). Data were collected by joint, semi-structured, face-to-face interviews with a convenience sample. Interviews were audiotaped, transcribed verbatim and analysed using IPA principles. To ensure both the individual and dyadic experiences were explored an additional layer of data analysis was performed. Findings: Two superordinate themes emerged from the data ‘Hoping for a born alive baby’ and ‘Journey of Loss. The first theme, ‘Hoping for a born alive baby’ was the aim of all of the couples in a pregnancy after stillbirth. The processes of negotiated decision-making and lived experience of a subsequent pregnancy were explored. Couples made sense of their experiences of pregnancy after loss via the lens of the death of their babies. In the second theme, ‘Journey of Loss’, couples spoke about the unexpected death of their babies, their experiences at the time of loss and in its aftermath, and the impact that these events had on them as a couple. Conclusion and Implications: Perinatal loss and pregnancy after loss are common occurrences in maternity services. The original findings of this study adds to the understanding of pregnancy after loss, from a couples’ perspective and will assist in the provision of appropriate support services for couples both at the time of loss and in the pregnancy that follows. How couples negotiate the experiences of loss and subsequent pregnancy will help to inform policy and improve services for future couples pregnant after stillbirth