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PURPOSE: Our study aim was to identify factors that may contribute to the racial disparity in pregnancy-related mortality. METHODS: We examined differences in severity of disease, comorbidities, and receipt of care among 608 (304 African-American and 304 white) consecutive patients of non-Hispanic ethnicity with one of three pregnancy-related morbidities (pregnancy-related hypertension, puerperal infection, and hemorrhage) from hospitals selected at random from a statewide region. RESULTS: African-American women had more severe hypertension, lower hemoglobin concentrations preceding hemorrhage, more antepartum hospital admissions, and a higher rate of obesity. The rate of surgical intervention for hemorrhage was lower among African-Americans, although the severity of hemorrhage did not differ between the two racial groups. More African-American women received eclampsia prophylaxis. After stratifying by severity of hypertension, we found that more African-Americans received antihypertensive therapy. The rate of enrollment for prenatal care was lower in the African-American group. Among women receiving prenatal care, African-American women enrolled significantly later in their pregnancies. CONCLUSIONS: We have identified racial differences in severity of disease, comorbidities, and care status among women with pregnancy-related complications that would place African-Americans at disadvantage to survive pregnancy. These differences are potentially modifiable.
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Background: In the context of rising rates of postpartum hemorrhage and little data about its effect on women, this study aimed to describe the experiences of care, and the concerns and needs of women after a significant postpartum hemorrhage.
Methods: A cohort of 206 women with a primary postpartum hemorrhage of 1,500 mL or more and/or a peripartum fall in hemoglobin concentration to 7 g â dL or less and â or of 4 g â dL or more was recruited from 17 major hospitals in Australasia. Women rated their satisfaction with care and provided written responses to questions in postpartum questionnaires completed in the first
week and at 2 and 4 months postpartum. Results: In relation to care in hospital, consistently over 20 percent women responded that their needs for information, acknowledgment, and reassurance were only met sometimes, rarely, or never. Sixty-two percent reported that they were given adequate information about their likely physical recovery, and 48 percent about their likely emotional recovery. Four major themes were identified in response to the open-ended questions: adequacy of care, emotional responses to the experience, implications for the future, and concerns for their baby. Conclusions: This study is an important step in identifying the negative impact of experiencing a significant postpartum hemorrhage during childbirth for women who survive. Our results suggest that health professionals should pay greater attention to these womenâs informational and emotional needs.
Introduction. The experience of normal pregnancy is often disrupted for women with preeclampsia (PE). Materials and Methods. Postal survey of the 112 members of the consumer group, Australian Action on Pre-Eclampsia (AAPEC). Results. Surveys were returned by 68 women (61% response rate) and from 64 (57%) partners, close relatives or friends. Respondents reported experiencing pre-eclampsia (ð=53), eclampsia (ð=5), and/or Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP syndrome) (ð=26). Many women had no knowledge of PE prior to diagnosis (77%) and, once diagnosed, did not appreciate how serious or life threatening it was (50%). Women wanted access to information about PE. Their experience contributed substantial anxiety towards future pregnancies. Partners/friends/relatives expressed fear for the woman and/or her baby and had no prior understanding of PE. Conclusions. The PE experience had a substantial effect on women, their confidants, and their babies and affected their approach to future pregnancies. Access to information about PE was viewed as very important.
Nursing 66(10), 2142â2153. doi: 10.1111/j.1365-2648.2010.05391.x
Aim. This study presents the findings a meta-ethnographic study reporting womenâs perceptions and experiences of traumatic birth.
Background. Childbirth is viewed by many as a life transition that can bring a sense of accomplishment. However, for some women, birth is experienced as a traumatic event with a minority experiencing post-traumatic stress. A traumatic birth experience can have a significant impact on the physical and emotional well-being of a woman, her infant and family.
Data source. The CINAHL, MEDLINE, Scopus and PubMed databases were searched
for the period January 1994 to October 2009 using the keywords birth trauma,
traumatic birth, qualitative research, birth narrative and birth stories.
Review methods. A meta-ethnographic approach was used. Quality appraisal was
carried out. An index paper served as a guide in identifying particular findings and comparing them with other findings. This âreciprocal translationâ process started witha search for common themes, phrases and metaphors.
Results. Ten qualitative studies were included in the final sample. Six major themes were identified: âfeeling invisible and out of controlâ, âto be treated humanelyâ, âfeeling trapped: the reoccurring nightmare of my childbirth experienceâ, âa rollercoaster of emotionsâ, âdisrupted relationshipsâ and âstrength of purpose: a way to succeed as a motherâ.
Conclusions. It is evident that a small percentage of women experience a traumatic birth. Although some women who experience a traumatic birth do not necessarily have physical or psychological adverse outcomes, others identify a significant personal impact. Healthcare professionals must recognize womenâs need to be involved in decision-making and to be fully informed about all aspects of their labour and birth to increase their sense of control.
Keywords: childbirth, meta-ethnography, midwifery, nursing, qualitative study,