Japanese women's experiences from pregnancy through early postpartum period

In Utero Exposure to Metals and Birth Outcomes in an Artisanal and Small-Scale Gold Mining Birth Cohort in Madre de Dios, Peru

BACKGROUND

Few birth cohorts in South America evaluate the joint effect of minerals and toxic metals on neonatal health. In Madre de Dios, Peru, mercury exposure is prevalent owing to artisanal gold mining, yet its effect on neonatal health is unknown.

OBJECTIVES

We aimed to determine whether toxic metals are associated with lower birth weight and shorter gestational age independently of antenatal care and other maternal well-being factors.

METHODS

Data are from the COhorte de NAcimiento de MAdre de Dios (CONAMAD) birth cohort, which enrolled pregnant women in Madre de Dios prior to their third trimester and obtained maternal and cord blood samples at birth. We use structural equation models (SEMs) to construct latent variables for the maternal metals environment (ME) and the fetal environment (FE) using concentrations of calcium, iron, selenium, zinc, magnesium, mercury, lead, and arsenic measured in maternal and cord blood, respectively. We then assessed the relationship between the latent variables ME and FE, toxic metals, prenatal visits, hypertension, and their effect on gestational age and birth weight.

RESULTS

Among 198 mothers successfully enrolled and followed at birth, 29% had blood mercury levels that exceeded the U.S. Centers for Disease Control and Prevention threshold of 5.8 μ g / L and 2 mothers surpassed the former 5 - μ g / dL threshold for blood lead. The current threshold value is 3.5 μ g / dL . Minerals and toxic metals loaded onto ME and FE latent variables. ME was associated with FE (β = 0.24; 95% CI: 0.05, 0.45). FE was associated with longer gestational age (β = 2.31; 95% CI: - 0.3 , 4.51) and heavier birth weight. Mercury exposure was not directly associated with health outcomes. A 1% increase in maternal blood lead shortened gestational age by 0.05 d (β = - 0.75 ; 95% CI: - 1.51 , - 0.13 ), which at the 5 - μ g / dL threshold resulted in a loss of 3.6 gestational days and 76.5 g in birth weight for newborns. Prenatal care visits were associated with improved birth outcomes, with a doubling of visits from 6 to 12 associated with 5.5 more gestational days (95% CI: 1.6, 9.4) and 319 g of birth weight (95% CI: 287.6, 350.7).

DISCUSSION

Maternal lead, even at low exposures, was associated with shorter gestation and lower birth weight. Studies that focus only on harmful exposures or nutrition may mischaracterize the dynamic maternal ME and FE. SEMs provide a framework to evaluate these complex relationships during pregnancy and reduce overcontrolling that can occur with linear regression. https://doi.org/10.1289/EHP10557.

Factors affecting the provision of analgesia during childbirth, Japan

Japan’s universal health-care system means that it is a very safe country in which to give birth. Perinatal outcomes in Japan are excellent, with low infant mortality and neonatal mortality. However, childbirth remains a challenge for many Japanese women, who are faced with a scarcity of places to give birth, limited availability of analgesia and social norms that favour natural birth. The number of birth facilities in Japan continues to decrease as fewer children are born. The numbers of qualified medical staff remain inadequate, with a continuing lack of female physicians, perpetuated by a pervasive negative gender bias. Recruitment efforts are underway, but few doctors want to specialize in obstetrics or gynaecology. Furthermore, around half of female obstetricians and gynaecologists in Japan’s male-dominated medical system stop practising when they have their own children. The difficulty of obtaining analgesia during labour is another problem. Although low uptake of labour pain relief in Japan is said to be due to cultural influences, the root of the problem is a lack of qualified anaesthesiologists and the inflexibility of a system that will not allow other staff to be trained to administer labour analgesia. Problems with labour anaesthesia have been linked to 14 maternal deaths since 2010. Japanese policy-makers need to act to renovate the nation’s obstetric facilities, reorganize regional perinatal care systems, train more obstetricians and anaesthesiologists, promote task-shifting and better integrate biomedical and traditional, non-medical care for pregnant women.

Mother's Beliefs, Attitudes, and Decision Making Related to Infant Feeding Choices

All mothers at some point make a decision about whether to breast- or formula feed their infant. Marital status, education, age, culture, and confidence have all been identified as variables affecting this decision. Previous research has concentrated on the decision-making process in breastfeeding mothers. This qualitative descriptive study investigated the beliefs, attitudes, and decisions of both breast- and formula-feeding mothers. Four categories were identified influencing maternal decision making: (a) infant nutritional benefits, (b) maternal benefits, (c) knowledge about infant feeding, and (d) personal and professional support. Analysis of the data indicated that mothers differed in their choice depending on whether they were infant- or maternal-centered and that most women combine both methods of feeding.

Pregnancy and after: what women want from their partners - listening to women in Uyo, Nigeria

BACKGROUND

A qualitative survey was conducted among childbearing women at three public health facilities in Uyo, Nigeria. We aimed to determine (i) women's expectations of partner support during pregnancy and the postpartum period; (ii) predictors of partner presence during childbirth.

METHODS

From May to mid-July 2011, 387 eligible women were recruited serially during visits to the child welfare clinic at each facility. Interviews were conducted using semistructured questionnaires. Responses were extracted and categorized into eight distinct themes with corresponding examples.

RESULTS AND DISCUSSION

The most desired form of partner support was assistance with domestic chores during and after pregnancy; followed by financial support during pregnancy and providing/caring for the baby in the postpartum period. Partner support during pregnancy was high 98.0% (351). While 73% of respondents expected partner presence during childbirth, 69.4% reported actual partner presence. Women with no experience of pregnancy before marriage, a husband in formal employment, and regular assistance at home had a two- to three-fold likelihood of expecting partner presence at childbirth compared to those without these attributes. Expecting partner presence increased the likelihood of partner presence at childbirth. Results suggest that women have specific expectations of partner involvement during and after pregnancy.

Global and cultural perinatal nursing research: improving clinical practice

High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.