Contribution of isolated general practitioner maternity units.

A postal survey of isolated general practitioner maternity units in England and Wales showed that just under 4% of deliveries take place in them. Eight per cent of general practitioners are on the staffs, and in 87% of units midwives are integrated with the community midwifery service. Sixty two per cent of units have visiting consultant cover. Fifty seven per cent of patients are booked and delivered in the unit, 28% are booked and deliberately delivered elsewhere, 5% are transferred in the antenatal period, and 10% transferred as emergencies. The perinatal mortality rate for cases booked and delivered in the units is 1.1 per 1000. The number of emergency transfers was appreciably less for those units that were prepared to do their own operations. Thirty five per cent of these units are liable to be cut off in bad weather, and they will continue to fulfil an essential role in the midwifery services.     

Measures of performance in Scottish maternity hospitals.

OBJECTIVE--To develop measures of hospital performance over time with particular reference to maternal and neonatal care by controlling for case mix. DESIGN--Analysis of computerised records of births. SETTING--Scotland, 1980-7. SUBJECTS--Over half a million singleton live births and stillbirths. MAIN OUTCOME MEASURES--Numbers of perinatal deaths and caesarean sections. RESULTS--Scottish maternity hospitals perform more or less equally with regard to perinatal mortality. When caesarean sections are considered, there is evidence that hospitals differ in their treatment of different groups of women; in two examples one hospital had an increased rate among women of parity 2 or more and another had a reduced rate of repeat caesarean section. CONCLUSIONS--Developing measures of performance over time by controlling for case mix is a valid system for monitoring hospital outcomes and activity, and allows comparison either between hospitals or with data for all Scottish maternity hospitals. Hospital profiles permit identification of differences for particular patient groups after allowance is made for other case mix variables.     

Patterns of multiple paternity and maternity in fishes

The characterization of patterns of multiple mating is a major facet of molecular ecology and is paramount to understanding the evolution of behaviours associated with parental care and mate choice. Over the last 15 years, fishes have been particularly well studied with respect to multiple maternity and paternity thanks to the widespread application of microsatellite markers. The present review focusses on the impressive literature on genetic parentage in fishes. In studies of natural populations, we find that multiple paternity is extremely common across fish species, whereas rates of multiple maternity are much more variable. In species with nest defence, for example, rates of multiple maternity are strongly bimodal, and the occurrence of multiple dams per brood is either rare or the rule. The sex of the care‐giving parent is correlated with the rate of multiple parentage: when males provide uniparental care, rates of multiple paternity are low compared to rates of multiple maternity; when females provide parental care, either alone or assisted by males, rates of multiple paternity are highly variable, whereas rates of multiple maternity are quite low. These patterns may reflect conflicts between the reproductive interests of males and females. We also find that fishes in which females brood the offspring internally display much higher rates of multiple paternity compared to mammals or birds, whereas reptiles are intermediate. Male‐nesting fish species, however, show rates of multiple paternity more similar to those found in other vertebrates. © 2011 The Linnean Society of London, Biological Journal of the Linnean Society, 2011, 103 , 735–760.     

Qualitative study of evidence based leaflets in maternity care

ObjectiveTo examine the use of evidence based leaflets on informed choice in maternity services.DesignNon-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services and health professionals providing antenatal care.SettingWomen''s homes; antenatal and ultrasound clinics in 13 maternity units in Wales.ParticipantsChildbearing women and health professionals who provide antenatal care.InterventionProvision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use.ResultsHealth professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use. Time pressures limited discussion, and choice was often not available in practice. A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of “right” and “wrong” choices rather than “informed” choices. Hierarchical power structures resulted in obstetricians defining the norms of clinical practice and hence which choices were possible. Women''s trust in health professionals ensured their compliance with professionally defined choices, and only rarely were they observed asking questions or making alternative requests. Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy. The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced.ConclusionsThe way in which the leaflets were disseminated affected promotion of informed choice in maternity care. The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice.

What is already known on this topic

Informed Choice leaflets are widely used in maternity care but little is known about their ability to influence informed choice and decision makingHigh quality information is essential for promoting informed choice but is insufficient by itself

What this study adds

Time constraints and other pressures on health professionals resulted in a lack of discussion of the content of the leafletsFear of litigation, power hierarchies, and the technological imperative in maternity care limited the choices availableHealth professionals promoted normative practices rather than choice, and as women valued their opinions this led to the promotion of informed compliance rather than informed choice     

Chinese women in Italy--menarche, pregnancy and maternity

The purpose of this study was to assess the well-being and health status of Chinese immigrant women in Italy. The subjects (mean 29.5 years) frequented the "Health Center for Foreign Women and their Children" in Bologna, Italy. Information on living conditions, biological characteristics and pregnancy or maternity was obtained through interviews of the women in the Center during normal medical visits. Data on menarche age were based on the retrospective method since all the women were in China at the onset of menarche. Social factors influencing the health and behavior of Chinese women in Italian society are discussed. The analysis on children sex ratio at birth indicates that the old cultural Chinese tradition of son preference still continues to exist. These women have achieved a socio-economic improvement and generally good health status in Italy. The difficult living conditions they faced in China are indirectly reflected in their delayed puberty (14.4 +/- 1.4 years). The delayed sexual development was probably due to the same situation of severe poverty that forced them to migrate.     

Behavior of lactating rats in a dual-chambered maternity cage

Videotape sampling of behavior in a dual-chambered apparatus indicates that the continuous monitoring of the amount of time a mother spends in the cage with its litter can be taken as a valid reflection of maternal behavior. Nursing is the principal behavior of lactating females while in the compartment with their litters; lying still, consummatory behavior, and activity occur with greater frequency in the cage away from the litter. Both the time that mothers spend with their litters and nursing behavior displayed a 24-hr rhythm with crest values occurring during the period of light.     

Variation in detection probability of polar bear maternity dens

In surveys recording polar bear maternity dens, the proportion of actual dens in an area detected has usually been unknown. In this study, I evaluate how the proportion of dens that are observable varies with time in spring based on three 3–4 weeks ground surveys and observations of 25, 13, and 5 dens in Svalbard, Norwegian Arctic, during 2009, 2011 and 2012. The data indicate that few dens will be detected in surveys before early April, as few bears will have emerged at that time. Dens became unobservable after periods of drifting snow but are subsequently reopened within one or 2 days by occupying bears. Most bears departed dens by late April, and abandoned dens were quickly concealed by drifting snows. As such, I suggest that the optimal period for conducting an aerial survey is early to mid-April on a day with low winds and good visibility, because about half of the dens could be expected to be observable. Because emergence date, duration at den site, and abandonment dates varied considerably, uncertainty around the proportion of polar bear maternal dens detected during a survey will be large.