Childbirth News

Background: A fathers experience of the birth of his first child is important not only for their birth-givingpartner but also for the father himself, his relationship with the mother and the newborn. Novalidated questionnaire assessing first-time fathers experiences during childbirth is currentlyavailable. Hence, the aim of this study was to develop and validate an instrument to assessfirst-time fathers experiences of childbirth.MethodDomains and items were initially derived from interviews with first-time fathers, andsupplemented by a literature search and a focus group interview with midwives. Thecomprehensibility, comprehensiveness and relevance of the items were evaluated by fourpaternity research experts and a preliminary questionnaire was pilot tested in eight first-timefathers. A revised questionnaire was completed by 200 first- time fathers (response rate =81%) Exploratory factor analysis using principal component analysis with varimax rotationwas performed and multitrait scaling analysis was used to test scaling assumptions. Externalvalidity was assessed by means of known-groups analysis. Results: Factor analysis yielded four factors comprising 22 items and accounting 48% of the variance.The domains found were Worry, Information, Emotional support and Acceptance. Multitraitanalysis confirmed the convergent and discriminant validity of the domains; however,Cronbachs alpha did not meet conventional reliability standards in two domains. Thequestionnaire was sensitive to differences between groups of fathers hypothesized to differ onimportant socio demographic or clinical variables Conclusions: The questionnaire adequately measures important dimensions of first-time fathers childbirthexperience and may be used to assess aspects of fathers experiences during childbirth. Toobtain the FTFQ and permission for its use, please contact the corresponding author.

Background: Nearly half the worlds babies are born at home. We sought to evaluate the training,knowledge, skills, and access to medical equipment and testing for home birth attendantsacross 7 international sites. Methods: Face-to-face interviews were done by trained interviewers to assess level of training,knowledge and practices regarding care during the antenatal, intrapartum and postpartumperiods. The survey was administered to a sample of birth attendants conducting home or outof-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, DemocraticRepublic of the Congo, Kenya and Zambia). Results: A total of 1226 home birth attendants were surveyed. Less than half the birth attendants wereliterate. Eighty percent had one month or less of formal training. Most home birth attendantsdid not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag andmask manual resuscitator). Reporting of births and maternal and neonatal deaths togovernment agencies was low. Indian auxilliary nurse midwives, who perform some homebut mainly clinic births, were far better trained and differed in many characteristics from thebirth attendants who only performed deliveries at home. Conclusions: Home birth attendants in low-income countries were often illiterate, could not read numbersand had little formal training. Most had few of the skills or access to tests, medications andequipment that are necessary to reduce maternal, fetal or neonatal mortality.

Background: 39% of neonatal deaths in India occur on the first day of life, and 57% during the first threedays of births. However, the association between postnatal care (PNC) for newborns andneonatal mortality has not hitherto been examined. The paper aims to examine the associationof PNC for newborns with neonatal mortality in India. Methods: Data from District Level Household Survey, waive three (DLHS-3) conducted in 2007-08 isutilized in the study. We used conditional logit regression models to examine the associationof PNC with neonatal mortality. The matching variables included birth order and the age ofthe mother at the birth of the newborn. Results: The findings suggest no association between check-up of newborns within 24 hours of birthand neonatal mortality. However, the place where the newborns were examined wassignificantly associated with neonatal mortality. Moreover, findings do reveal that children ofmothers who were advised on keeping baby warm (kangaroo care) after birth during theirantenatal sessions were significantly less likely to die during the neonatal period compared tothose children whose mothers were not advised about the same. Conclusions: The findings are relevant because keeping baby warm is one of the most cost-effective andeasiest interventions to save babies from dying during the neonatal period. Thoughrandomized controlled trials have already demonstrated the effectiveness of keeping babywarm, for the first time this has been found effective in a large-scale population-based study.The findings are of immense value for a country like India where the neonatal mortality ratesare unacceptably high.

Background: When an ultrasound-based estimate of gestational age (GA) is less (greater) than an estimatebased on a definite last menstrual period, the fetus may grow slower (faster) than average.While the association between these discrepancies in GA estimates and adverse perinataloutcomes has been examined extensively, there is scant evidence about long-term effects,such as child neurodevelopment. Methods: Using data from a prospective cohort study titled, NICHD Study of Successive Small-for-Gestational Age Births, we examined if GA discrepancies in early second trimester ofpregnancy (17 weeks gestation) are associated with: (1) impaired motor and mental functionat 13 months (measured using Bayley Scales of Infant Development (Bayley)), and (2)impaired cognitive development at five years (assessed by Wechsler Preschool and PrimaryScale of Intelligence - Revised Intelligence Quotient (WPPSI-R)) in the infant. The studypopulation consisted of 572 (30% of the overall sample of 1,945) women who presented forprenatal care in Norway and Sweden between 1986 and 1988. Results: Our results showed that GA discrepancies in early second trimester are significantlyassociated with birthweight. We found no significant relationship, however, with the Bayleydevelopment scores at 13 months and with the WPPSI-R IQ measures at five years. Conclusions: GA discrepancies at 17 weeks gestation are not associated child neurodevelopment. Thesediscrepancies do, however, relate to birthweights, providing a basis for detecting fetal growthpatterns early in the second trimester of pregnancy. Our study, however, was unable toevaluate the impact of first-trimester discrepancies on impaired neurodevelopment in theinfant.

Background: Maternity services should take into account the needs of all women, including those related to disability. No reliable information, however, exists on the extent and characteristics of disability in this population in the UK. This brief report provides an overview of the prevalence of disability in women giving birth in the UK as measured by the presence of a limiting longstanding illness (LLI). The demographic, socio-economic, lifestyle and pregnancy related characteristics and child health outcomes are summarised to inform maternity and postnatal care service planning, and policy development. Methods: Secondary analysis of data on 18,231 mother-child pairs from the nationally representative UK Millennium Cohort Study. The baseline interviews with families were carried out in 2001-2002. The LLI prevalence in women who had recently delivered was estimated, and relevant characteristics and differences in outcomes compared using descriptive statistics taking into account the study design and non-response. Results: 9.4% (95% CI 8.7-10.0) of women who had recently given birth reported having an LLI. Musculoskeletal, respiratory and mental disorders accounted for most of the health problems. A significantly higher proportion of women with an LLI received means-tested financial benefits, had no educational qualifications and suffered from intimate partner violence compared to women who did not have an LLI (49.3% vs 35.3%, 20.4% vs 15.0%, 6.0% vs 3.3%, respectively). They were also more likely to smoke throughout pregnancy than women without an LLI (29.2% vs 20.8%), have a preterm birth (10.9% vs 6.8%) and be lone parents (19.5% vs 13.9%). Only 25.6% of children of mothers with an LLI were breastfed for more than three months compared to 33.4% of infants of mothers who did not have an LLI. At the age of seven years, 12.0% of children of mothers with an LLI had an activity limiting health problem themselves compared to 6.2% of children of mothers without an LLI. Conclusions: Disability in women who had recently delivered is relatively common. It is associated with social and economic inequalities and worse pregnancy and child related outcomes. Apart from condition-specific support during and after pregnancy, disabled women may require extra help from health professionals to quit smoking, continue breastfeeding, and reduce intimate partner violence.