Breastfeeding, baby friendliness and birth in transition in North Western Russia: a study of women's perceptions of the care they receive when giving birth in six maternity homes in the cities of Archangelsk and Murmansk, 1999.

UNLABELLED: Women's own views on the quality of the birthing care they received were recorded in a small study in the cities of Archangelsk and Murmansk in February 1999. Six maternity wards took part; one hospital had already been designated as a Baby Friendly Hospital (BFH) according to the strict global criteria of the WHO/UNICEF-recommended Baby Friendly Hospital Initiative (BFHI). Two of the hospitals had made profound changes in feeding routines and were by their own reckoning close to achieving this distinction, and were included in the BFH group. Three maternity wards were far from being in compliance with the BFHI approach and were grouped as the Non-Baby-Friendly Hospitals (NBFH). A total of 180 newly delivered mothers answered a 60-item questionnaire about their birthing and breastfeeding experiences. The questions were chosen from an existing protocol, the WEB (Women's Experiences of Birth) developed by one of the authors (BC). The study was part of an informal evaluation of five years of BFHI activities in the Barents Region, supported by Norway, and also aimed at recording any positive carry-over effect of the BFHI into obstetric routines as a whole. CONCLUSION: It was found that the project definitely had had an impact; feeding practices at the BFH were markedly closer to the international BFHI recommendations than at the NBFH. BFH mothers, however, reported suffering from breastfeeding problems just as often or more so than NBFH mothers. Possible explanations are discussed; it is concluded that this cross-sectional study may depict a transitory situation in the BFH. At the two hospitals not yet assessed, although staff felt that they had made profound changes, they may not yet have grasped the full extent and stringency of the changes required. The study shows that, despite good will, some practical details had not yet been worked out, resulting in a mixed outcome for the mothers. There was no noticeable carry-over of the attitudes and basic ideas of the project into obstetric care, either in the BFH or in the NBFH, so changes in this area may require separate strategies.

Labor experience, maternal mood and cortisol and catecholamine levels in low-risk primiparous women.

This exploratory, prospective study was set up to determine the relationship between cortisol and catecholamine levels and labor experience and postpartum maternal mood. It was performed at the Coronation Hospital, which serves a low-income urban population in Johannesburg. Blood samples were taken from 189 low-risk primiparous women in active first stage of labor and analyzed for cortisol, norepinephrine, epinephrine and dopamine. The stress hormone levels were then correlated with maternal anxiety, depression and self-esteem scores, and changes associated with mothers' labor experience and pain. Patients who were distressed and required analgesia had higher cortisol levels. Those who described a more positive labor experience at 24 hours also had higher cortisol levels. There were no significant correlations between psychological test scores and stress hormone levels. Both labor pain at the time and a more positive recollected labor experience were associated with high cortisol levels. Cortisol and catecholamine levels in labor did not correlate with postpartum psychological test scores.

Integrating psychology and obstetrics for medical students: shared labour ward teaching.

Two studies relating to the inclusion of psycho-social issues in the training of obstetricians are reported here. The first reports on the extent to which currently practising obstetricians have received training in these aspects. The second explored the value of an innovative teaching approach combining psychological and obstetric training for medical students in the labour ward. A postal survey with responses from 220 obstetricians and paediatricians revealed that little information on psychological aspects of obstetric practice had been included in their undergraduate or postgraduate training or obtained from voluntary continuing education programmes. Experience was the primary source of training in these subjects. The second study explored the impact of joint psychological and obstetric teaching ward rounds for medical students. Students attending these integrated sessions reported being better prepared for the psycho-social aspects of obstetrics and showed a greater awareness of cross-cultural differences in needs of women during birth.

South African obstetricians' views on caesarean section.

The widespread increase in the rate of caesarean sections performed in the Western world has become a cause for concern. In this country, two systems of health care exist, one provided by the State and the other based on private practice. A high incidence of caesarean sections has been reported, especially among private practitioners. This study investigated doctors' perceptions of caesarean section practices and explored the availability of facilities which could help to reduce the high caesarean section rate. Questionnaires were mailed to all registered obstetricians. Of these 45.2% (233) responded. Findings indicate that private obstetricians are more likely to perform caesarean sections even though they do have good facilities available to monitor or assess difficult deliveries. Other factors influencing their practice are also explored.

Individual perceptions of stress by dentists.

This paper is concerned with individual responses of four dental practitioners to stress. The subjects were chosen on the basis of age, sex, length of time in practice and whether or not they practised solo or in a group. Responses were measured against ten stressor variables that were previously found to have occurred commonly among dentists. From these responses stressor ratings of the four subjects were obtained and compared. These ratings, which seem to be idiosyncratic and unpredictable, reflect wide differences between the respondents. The findings suggest the possibility that these differences may be attributable to personality factors and differences in coping styles, and tend to support the hypothesis that stress is a unique, perceptual and experimental phenomenon.

Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding.

OBJECTIVE: To measure the effects of supportive companionship on labour and various aspects of adaptation to parenthood, and thus by inference the adverse effects of a clinically orientated labour environment on these processes. DESIGN: Randomized controlled trial. SETTING: A community hospital familiar to most of the participants, with a conventional, clinically-orientated labour ward. SUBJECTS: Nulliparous women in uncomplicated labour. INTERVENTION: Supportive companionship from volunteers from the community with no medical nor nursing experience, concentrating on comfort, reassurance and praise. MAIN OUTCOME MEASURES: Duration of labour, use of analgesia, perceptions of labour and breastfeeding success. RESULTS: Companionship had no measurable effect on the progress of labour. Diastolic blood pressure and use of analgesia were modestly but significantly reduced. The support group were more likely to report that they felt that they had coped well during labour (60 vs 24%, P less than 0.00001). Their mean labour pain scores (26.0 vs 44.2, P less than 0.00001) and state anxiety scores (28.2 vs 37.8, P less than 0.00001) were lower than those of the control group. Compared with the control group (n = 75), at 6 weeks women in the support group (n = 74) were more likely to be breastfeeding exclusively (51 vs 29%, P less than 0.01); and to be feeding at flexible intervals (81 vs 47%, P less than 0.0001). CONCLUSIONS: Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. These effects may be reduced by the provision of additional companionship during labour aimed to promote self-esteem.

Age differences in the stress patterns of dentists.

The present study is a comparison of the stress patterns of older and younger dentists in private practice. Dentists responded to a questionnaire which sought to elicit their responses to a number of situations and events that typically occur in their professional lives. These included financial difficulties, patient-management problems, time issues and uncertainty about their professional status. The groups compared were dentists over 54 years (n = 36) with dentists below the age of 35 years (n = 41), where both the frequency and intensity of their responses were measured. The findings suggested that overall, the older dentists are less stressed than their younger counterparts. Some issues, those concerned with finance and patient-management, appear to affect both groups more or less equally, which suggests that these issues are of global, rather than specific concern. From a theoretical point of view, the findings tend to contradict the generally-held belief that getting older is automatically accompanied by degeneration and problems of adaptation to life changes. On the contrary, seemingly favourable adaptation and low levels of stress are evident in most of the older respondents.

Apartheid, stress and illness: the demographic context of distress reported by South African Africans.

This study examines the relationships between apartheid and the distress experienced by adult urban-dwelling Africans in South Africa. The effects of apartheid are conceptualised and measured as social and economic disadvantage, and this operational definition is justified by a review of the socioeconomic and health aspects of apartheid policies and practices. Distress is conceptualised and measured as (1) exposure to stressors and (2) experiences of ill health. Data was collected from 147 subjects. Analyses indicate that the effects of apartheid (represented by socio-economic disadvantage) are significantly related to the experience of distress (represented by stress and illness) for black South Africans. Multivariate analyses suggest also that the relationships between disadvantage and distress are more complex than a simple and direct relationship between two variables.

The way we teach: behavioural sciences.

This paper describes a new approach to teaching human behavioural science to medical students. Designed to overcome the problems of large student numbers, limited staff resources and a minimum of student-staff contact time, the course follows a group-orientated teaching approach, with students being allocated self-contained work units taking approximately one week to complete and be assessed. Standards achieved by students are as high, and in some cases much higher, than would have been expected following a traditional lecture course. Student feedback has generally been favourable.