Background: Most studies on birth settings investigate the association between planned place of birth at the start of labor and birth outcomes and intervention rates. To optimize maternity care it also is important to pay attention to the entire process of pregnancy and childbirth. This study explores the association between the initial preferred place of birth and model of care, and the course of pregnancy and labor in low-risk nulliparous women in the Netherlands. Methods: As part of a Dutch prospective cohort study (2007–2011), we compared medical indications during pregnancy and birth outcomes of 576 women who initially preferred a home birth (n = 226), a midwife-led hospital birth (n = 168) or an obstetrician-led hospital birth (n = 182). Data were obtained by a questionnaire before 20 weeks of gestation and by medical records. Analyses were performed according to the initial preferred place of birth. Results: Low-risk nulliparous women who preferred a home birth with midwife-led care were less likely to be diagnosed with a medical indication during pregnancy compared to women who preferred a birth with obstetrician-led care (OR 0.41 95% CI 0.25-0.66). Preferring a birth with midwife-led care – both at home and in hospital - was associated with lower odds of induced labor (OR 0.51 95% CI 0.28-0.95 respectively OR 0.42 95% CI 0.21-0.85) and epidural analgesia (OR 0.32 95% CI 0.18-0.56 respectively OR 0.34 95% CI 0.19-0.62) compared to preferring a birth with obstetrician-led care. In addition, women who preferred a home birth were less likely to experience augmentation of labor (OR 0.54 95% CI 0.32-0.93) and narcotic analgesia (OR 0.41 95% CI 0.21-0.79) compared to women who preferred a birth with obstetrician-led care. We observed no significant association between preferred place of birth and mode of birth. Conclusions: Nulliparous women who initially preferred a home birth were less likely to be diagnosed with a medical indication during pregnancy. Women who initially preferred a birth with midwife-led care – both at home and in hospital – experienced lower rates of interventions during labor. Although some differences can be attributed to the model of care, we suggest that characteristics and attitudes of women themselves also play an important role.
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Smoking-behavior during pregnancy and the reliability of an interview were prospectively investigated. The tobacco-exposure was assessed a) by an intake interview b) by a smoking diary and c) by maternal thiocyanate and carboxy-hemoglobin concentrations. Of the 115 nulliparous women, 66 smoked (57.4%). Seventeen women (25.8%) quit and 39 women (59.1%) reduced smoking. Directly after intake, in the first week of the diary, significantly more cigarettes were smoked than stated during the intake interview. According to the diaries, the number of cigarettes increased during the first half of pregnancy. In the 24th week significantly more cigarettes were smoked than in the first week after intake. Also a significant increase of thiocyanate between the measurements at intake and in the 24th of amenorrhea was found. The maternal carboxy-hemoglobin levels did not significantly change during pregnancy. Investigators should be aware of changes in smoking behavior during pregnancy and the potential bias of self reported smoking behavior at the beginning of pregnancy. The tobacco-exposure should be assessed (anamnestic or biochemical) several times during pregnancy, anyway it should include the second half of pregnancy.
This article interrogates platform-specific bias in the contemporary algorithmic media landscape through a comparative study of the representation of pregnancy on the Web and social media. Online visual materials such as social media content related to pregnancy are not void of bias, nor are they very diverse. The case study is a cross-platform analysis of social media imagery for the topic of pregnancy, through which distinct visual platform vernaculars emerge. The authors describe two visualization methods that can support comparative analysis of such visual vernaculars: the image grid and the composite image. While platform-specific perspectives range from lists of pregnancy tips on Pinterest to pregnancy information and social support systems on Twitter, and pregnancy humour on Reddit, each of the platforms presents a predominantly White, able-bodied and heteronormative perspective on pregnancy.
Pre-eclampsia (PE) is a common and severe pregnancy complication and is associated with substantial perinatal morbidity and mortality in mothers and infants. The disease is often characterized by a non-specific presentation which makes it challenging for physician to diagnose PE during regular pregnancy check-ups. To date, there are no diagnostic tests on the market for detection of PE early in pregnancy (first trimester). In this project, we will develop a platform to sensitively analyse calcium-binding proteins (CBPs) which will unlock the full potential of CBPs as predictive PE markers. The technology will also be applicable for other diseases (e.g., dementia and cancer) where CBPs are also known to play a key role in disease pathophysiology. We will develop with phage display antibodies that can recognize calcium binding to specific motifs in proteins. To this end we will synthesize peptide motifs with and without calcium to select antibodies that are specific for calcium bound proteins. These antibodies will be validated for their clinical use. For this goal we will use serum samples from the Improved studie (EU subsidised study) to determine if we can recognize pre-eclampsia in a very early stage. This knowledge can lead to a better treatment of pregnant women suffering from this disease and also will probably increase the well-being for the baby born and the development further in life.
Vulnerable pregnant women are an important and complex theme in daily practice of birth care professionals. Vulnerability is an important risk factor for maternal and perinatal mortality and morbidity. Providing care for these women is often complex. First, because it is not always easy to identify vulnerability. Secondly, vulnerable women more often cancel their appointments with midwives and finally, many professionals are involved while they do not always know each other. Even though professionals are aware of the risks of vulnerability for future mothers and their (unborn) children and the complexity of care for these women, there is no international definition for ‘vulnerable pregnancies’. Therefore, we start this project with defining a mutual definition of vulnerability during pregnancy. In current projects of Rotterdam University of Applied Sciences (RUAS) we define a vulnerable pregnant woman as: a pregnant woman facing psychopathology, psychosocial problems, and/or substance abuse combined with lack of individual and/or social resources (low socioeconomic status, low educational level, limited social network). In the Netherlands, care for vulnerable pregnant women is fragmented and therefore it is unclear for birth care professionals which interventions are available and effective. Therefore, Dutch midwives are convinced that exchanging knowledge and best practices concerning vulnerable pregnancies between midwifery practices throughout Europe could enhance their knowledge and provide midwives (SMB partners in this project) with tools to improve care for vulnerable pregnant women. The aim of this project is to exchange knowledge and best practices concerning vulnerable pregnancies between midwifery practices in several European countries, in order to improve knowledge and skills of midwives. As a result, guidelines will be developed in order to exchange selected best practices which enable midwives to implement this knowledge in their own context. This contributes to improving care for vulnerable pregnant women throughout Europe.
