A birth with fatal outcome for both the mother and the foetus was reported in the Danish medical journal, Bibliothek for Læger in 1868. Here, the article with its two illustrations is summarised because of the vivid description of the course together with the therapeutic considerations expressed by the obstetrician. Due to an earlier osteomyelitis the pregnant woman's spine was deformed and her pelvis was narrowed. The birth came to a standstill, and it became necessary to reduce the circumference of the foetus' cranium by perforation, after which the dead foetus could be delivered. The woman died of infection some days later. Afterwards her deformed lumbar spine and pelvis was removed, preserved and depicted in two lithographs. The preserved pelvis is still extant in the Saxtorphian obstetric collection in Medical Museion, Copenhagen.
To gain a deeper understanding of women's thoughts and experiences regarding informed choices during childbirth.
A qualitative approach with individual in-depth interviews was chosen for data collection. Ten women were interviewed three to four weeks after the birth of their first child. The transcribed interviews were analysed using systematic text condensation.
Two main themes emerged based on the analysis: "women's resources and coping abilities" and "women's abilities to make informed choices during birth". Women's resources and coping abilities influenced how they retrieved information and made their own choices. Their abilities to make informed choices during birth were influenced by the course of the birth process and the fact that they were patients and submitted to the hospitals' routines.
Instead of using the term "informed choice", women in this study discussed involvement, participation and being heard and seen as individuals. How receptive women are to information during birth varies, and midwives play an important role during pregnancy in informing and encouraging them. The relationship between women and midwives influences women's abilities to make informed choices during birth. Women need individual care and should be encouraged to have realistic expectations and to gain knowledge and confidence in their ability to give birth. A model of care in which women experience greater continuity will have an impact on their expectations, decision-making and experience of birth.
Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Copenhagen DK-2100 Ø, Denmark. phom@rh.dk
Source
Int J Pediatr Otorhinolaryngol. 2005 Apr;69(4):487-91
INTRODUCTION: This study examines the question whether season of birth is associated with acute otitis media (AOM) and recurrent AOM (rAOM) and whether season of birth is associated with early age of AOM onset. METHODS: This was done in a population-based survey of 591 unselected Greenlandic children aged 3-5 and 8 years, living in the two largest towns in Greenland. The overall attendance rate was 86%. Information of AOM episodes was obtained from the parents and cross-checked in medical records available for 95% of the children. In total, 67% reported AOM at least once and 30% of those had rAOM. RESULTS: According to season of birth, the frequency of history of AOM in general varied between 63% and 70% lowest for birth in the autumn and highest for birth in the spring but without any significant statistical difference (p=0.51). The similar variation in rAOM according to season of birth was between 21% and 35%, highest for children born in autumn and winter and lowest for children born in the spring (p=0.09). Additionally, there was no difference in age at onset of the first AOM episode according to season of birth. However, AOM children born in the summer and autumn periods have a significantly higher relative risk (RR=1.44, CI=1.04-1.99) of attracting rAOM than AOM children born in the winter and spring periods. This may be due to a higher risk of being quickly reinfected in the late autumn and winter period with another episode of upper respiratory tract infection. CONCLUSION: Season of birth do not seem to be a predictor of AOM episodes or early onset of AOM but children born in the summer and autumn periods who attracts AOM have a higher risk of developing rAOM.
The 10-item Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) is a widely used instrument to assess and identify pregnancy-specific anxiety in nulliparous women. It has good psychometric values and predictive validity for birth and childhood outcomes. Nonetheless, the PRAQ-R is not designed for use in parous women, as particularly one item of the questionnaire is not relevant for women who gave birth before. We tested the factorial and scalar invariance of a modified PRAQ-R2 across nulliparous and parous women with an adapted item to fit both groups of pregnant women. A longitudinal study among 1144 pregnant women (n = 608 nulliparous and n = 536 parous) with two repeated measures of the PRAQ-R2 was used to test for measurement invariance of the instrument. Results show metric and scalar invariance, indicating that the PRAQ-R2 measures similar constructs on the same scale for all pregnant women at two different times during pregnancy. We conclude that the PRAQ-R2 can be used, compared, or combined in a sample of nulliparous and parous women.
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Cites: J Am Acad Child Adolesc Psychiatry. 2002 Sep;41(9):1078-8512218429
Institution of Clinical Sciences Malmö, Department of Surgery, Skåne University Hospital Malmo, Lund University, 205 02, Malmö, Sweden. johannaeaurin@gmail.com.
Late age at first childbirth is a well-established risk factor for breast cancer. Previous studies have, however, shown conflicting results to whether late age at first childbirth also influences the prognosis of breast cancer survival. The aim of this study was to examine age at first birth in relation to survival after breast cancer diagnosis.
We used information from the Malmö Diet and Cancer study. At baseline 17,035 women were included. All women were followed from the year they developed breast cancer until they either died or until the end of follow-up. All women were asked how many children they had given birth to and were then divided into different groups, =?20, >?20 to ?=?25, >?25 to ?=?30 and >?30. Nulliparous women form a separate group. Survival analyses were then performed using Cox proportional hazard survival analysis. Women in all age groups had a lower risk of breast cancer specific death as compared to the reference group?=?20, however non-significantly. Nulliparous women had a higher risk of breast cancer specific death as compared to the same reference group, however these results were not statistically significant. We could not see any negative effect of late first childbirth on breast cancer specific survival.
Division of Womens and Childrens Health, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. per.holmqvist@lvn.se
The aim of this study was to evaluate whether age of onset of multiple sclerosis is related to use of combined oral contraceptives and/or timing of childbirth. The results showed that use of combined oral contraceptives and childbirth before the first multiple sclerosis symptom was correlated to a higher mean age at the onset of the disease.
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; FinnBrain Birth Cohort Study, University of Turku, Finland. Electronic address: jani.kajanoja@utu.fi.
Overweight, obesity, and associated problems in metabolic health are an increasing public health concern. Personality traits and emotional processing styles may play a role in the regulation of food intake and reward. Alexithymia is a personality construct involving difficulties in identifying and expressing emotions and has been previously associated with eating disorders and metabolic problems. We examined associations between alexithymia dimensions, Body Mass Index (BMI) and gestational diabetes in pregnant women.
The participants were 1660 pregnant women living in Finland from the FinnBrain Birth Cohort Study. We investigated the associations between alexithymia and its dimensions as measured by the Toronto Alexithymia Scale (TAS-20), overweight, and gestational diabetes. The effects of age, education, and depressive symptoms were controlled for using hierarchical regression analysis.
Alexithymic individuals had a higher prevalence of overweight compared to those with low or moderate levels of alexithymia (66.0% vs. 34.8%, OR 3.6, adjusted OR 3.6, CI95% 1.9-6.8, p?
Department of Pediatrics, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States of America.
Coordination of fetal maturation with birth timing is essential for mammalian reproduction. In humans, preterm birth is a disorder of profound global health significance. The signals initiating parturition in humans have remained elusive, due to divergence in physiological mechanisms between humans and model organisms typically studied. Because of relatively large human head size and narrow birth canal cross-sectional area compared to other primates, we hypothesized that genes involved in parturition would display accelerated evolution along the human and/or higher primate phylogenetic lineages to decrease the length of gestation and promote delivery of a smaller fetus that transits the birth canal more readily. Further, we tested whether current variation in such accelerated genes contributes to preterm birth risk. Evidence from allometric scaling of gestational age suggests human gestation has been shortened relative to other primates. Consistent with our hypothesis, many genes involved in reproduction show human acceleration in their coding or adjacent noncoding regions. We screened >8,400 SNPs in 150 human accelerated genes in 165 Finnish preterm and 163 control mothers for association with preterm birth. In this cohort, the most significant association was in FSHR, and 8 of the 10 most significant SNPs were in this gene. Further evidence for association of a linkage disequilibrium block of SNPs in FSHR, rs11686474, rs11680730, rs12473870, and rs1247381 was found in African Americans. By considering human acceleration, we identified a novel gene that may be associated with preterm birth, FSHR. We anticipate other human accelerated genes will similarly be associated with preterm birth risk and elucidate essential pathways for human parturition.
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Cites: Am J Epidemiol. 2008 Feb 15;167(4):474-918048376
Cites: Genome Biol. 2007;8(6):R11817578567
Cites: Lancet. 2008 Aug 30;372(9640):737-4318674812
Cites: BMC Genet. 2008;9:4418611258
Cites: Am J Obstet Gynecol. 2008 Jul;199(1):43.e1-518295169
