Maternal vaginal microbiome composition does not affect development of the infant gut microbiome in early life.

Birth mode has been implicated as a major factor influencing neonatal gut microbiome development, and it has been assumed that lack of exposure to the maternal vaginal microbiome is responsible for gut dysbiosis among caesarean-delivered infants. Consequently, practices to correct dysbiotic gut microbiomes, such as vaginal seeding, have arisen while the effect of the maternal vaginal microbiome on that of the infant gut remains unknown. We conducted a longitudinal, prospective cohort study of 621 Canadian pregnant women and their newborn infants and collected pre-delivery maternal vaginal swabs and infant stool samples at 10-days and 3-months of life. Using cpn60-based amplicon sequencing, we defined vaginal and stool microbiome profiles and evaluated the effect of maternal vaginal microbiome composition and various clinical variables on the development of the infant stool microbiome. Infant stool microbiomes showed significant differences in composition by delivery mode at 10-days postpartum; however, this effect could not be explained by maternal vaginal microbiome composition and was vastly reduced by 3 months. Vaginal microbiome clusters were distributed across infant stool clusters in proportion to their frequency in the overall maternal population, indicating independence of the two communities. Intrapartum antibiotic administration was identified as a confounder of infant stool microbiome differences and was associated with lower abundances of Escherichia coli, Bacteroides vulgatus, Bifidobacterium longum and Parabacteroides distasonis. Our findings demonstrate that maternal vaginal microbiome composition at delivery does not affect infant stool microbiome composition and development, suggesting that practices to amend infant stool microbiome composition focus factors other than maternal vaginal microbes.

Canadian Registered Midwives' Experiences With Nipple Stimulation: An Exploratory Survey in British Columbia and Ontario.

OBJECTIVE: The objective of our study was to explore Canadian registered midwives' (RMs') experiences with nipple stimulation. METHODS: An online survey was distributed to practising RMs in British Columbia and Ontario. RESULTS: In total 350 RMs completed the survey. Of these, 154 (44%) practised in British Columbia and 196 (56%) practised in Ontario. This represents a response rate of 53.3% and 20.6% in B.C. and Ontario, respectively. Ninety-six percent of those surveyed (337 RMs) reported having advised clients to use nipple stimulation as a means of releasing oxytocin, and 80% (267 RMs) considered nipple stimulation to be effective. Respondents reported 926 protocols for nipple stimulation. The most common indication for nipple stimulation was for labour augmentation, used by 92% of respondents. CONCLUSION: Nipple stimulation is widely used by RMs practising in British Columbia and Ontario. Survey respondents believed it to be effective and beneficial in mitigating the need for synthetic oxytocin. Survey results showed that the most common indication for nipple stimulation is labour augmentation. Future research should prospectively address the safety and effectiveness of this non-medical method of labour augmentation.

Water Birth and Perinatal Outcomes in British Columbia: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to quantify adverse neonatal outcomes in a cohort of registered midwife (RM)-attended conventional and water births in British Columbia. METHODS: The study included all term singleton births in British Columbia between January 1, 2005 and March 31, 2016 attended by RMs. Births were allocated to a conventional birth cohort or a water birth cohort according to where the actual birth of the neonate took place. The primary outcome was a composite adverse neonatal outcome (Apgar <7 at 5 minutes, resuscitation need, neonatal intensive care unit admission). Secondary outcomes included individual components of the primary outcome, maternal length of labour, and degree of perineal laceration (Canadian Task Force Classification Level II-2). RESULTS: The population included 25 798 births. Of these, 23 201 were conventional, and 2567 were water births. The rate of the composite adverse neonatal outcome was not higher in water births compared with conventional births (hospital conventional, 5.0%; hospital water, 4.2%; home conventional, 3.4%; and home water, 2.9%). Rates of individual components of the composite adverse neonatal score were not greater in the water birth cohort. Maternal outcomes included statistically shorter labours in the water birth cohort and no difference between the cohorts in incidence of third- and fourth-degree lacerations. CONCLUSION: Water births attended by RMs in British Columbia are not associated with higher rates of adverse neonatal outcomes than conventional births attended by midwives.

An evaluation of Interprofessional group antenatal care: a prospective comparative study.

BACKGROUND: Maternal and neonatal outcomes are influenced by the nature of antenatal care. Standard pregnancy care is provided on an individual basis, with one-on-one appointments between a client and family doctor, midwife or obstetrician. A novel, group-based antenatal care delivery model was developed in the United States in the 1990s and is growing in popularity beyond the borders of the USA. The purpose of this study was to evaluate outcomes in clients receiving interprofessional group perinatal care versus interprofessional individual care in a Canadian setting. METHODS: Clients attending the South Community Birth Program (SCBP), an interprofessional, collaborative, primary care maternity program, offering both individual and group care, were invited to participate in the study. Pregnancy knowledge and satisfaction scores, and perinatal outcomes were compared between those receiving group versus individual care. Chi-square tests, general linear models and logistic regression were used to compare the questionnaire scores and perinatal outcomes between cohorts. RESULTS: Three hundred three clients participated in the study. Group care was comparable to individual care in terms of mode of birth, gestational age at birth, infant birth weight, breastfeeding rates, pregnancy knowledge, preparedness for labour and baby care, and client satisfaction. The rates of adverse perinatal outcomes were extremely low amongst SCBP clients, regardless of the type of care received (preterm birth rates ~5%). Breastfeeding rates were very high amongst all study participants (> 78% exclusive breastfeeding), as were measures of pregnancy knowledge and satisfaction. CONCLUSIONS: This is the first Canadian study to compare outcomes in clients receiving interprofessional group care versus individual care. Our observation that interprofessional group care outcomes and satisfaction were as good as interprofessional individual care has important implications for the antenatal care of clients and for addressing the projected maternity provider crisis facing Canada, particularly in small and rural communities. Further study of group-based care including not only client satisfaction, but also provider satisfaction, is needed. In addition, research into the role of interprofessional care in meeting the needs and improving perinatal outcomes of different populations is necessary.

Breast Cancer and Mammography Screening: Knowledge, Beliefs and Predictors for Asian Immigrant Women Attending a Specialized Clinic in British Columbia, Canada.

Screening mammography (MMG) reduces breast cancer mortality; however, Asian immigrant women underutilize MMG. The Asian Women's Health Clinic (AWHC) was established to promote women's cancer screening amongst this population. This study evaluated the rate, and predictors, of MMG amongst women attending the AWHC. Women (N = 98) attending the AWHC completed a questionnaire. Descriptive statistics and multivariable logistic regression evaluated rate and predictors of MMG. Most participants (87 %, n = 85) reported having had a mammogram. Significant MMG predictors were: lower perceived MMG barriers [lifetime: OR (CI) 1.19 (1.01-1.49); past 2 years: OR (CI) 1.11 (1.01-1.25)], and knowing someone with breast cancer [past year: OR (CI) 3.42 (1.25-9.85); past 2 years: OR (CI) 4.91 (1.32-2.13)]. Even amongst women using preventive medicine, 13 % report never having had a mammogram. More research is needed into innovative interventions, e.g. the AWHC, and breast cancer-related outcomes amongst Asian immigrant women.

A rooming-in program to mitigate the need to treat for opiate withdrawal in the newborn.

OBJECTIVE: The purpose of this study was to explore the effect of our rooming-in protocol on the need to treat withdrawal in the opiate-exposed newborn. METHODS: We reviewed the medical records of mother-infant dyads born between October 1, 2003, and December 31, 2006, who received care in our rooming-in program. Data on the type of drug used by the mother, maternal methadone dose at delivery, morphine treatment of the baby, and perinatal outcome were considered. RESULTS: We found a significant positive relationship between maternal methadone dose at delivery, "other opiate" use, and breastfeeding and the need to treat the neonate for withdrawal. We also found the maternal methadone dose at delivery to be related to the duration of pharmacological treatment of the neonate. CONCLUSION: Our findings suggest a role for our rooming-in program in mitigating the relationship between maternal methadone dosage and the need to treat opiate withdrawal in the newborn. Consideration of the role played by the mother-infant dyad model of care needs to be considered in future studies.

A Canadian urban early pregnancy assessment clinic: a review of the first year of operation.

OBJECTIVE: To review the services provided by an early pregnancy assessment clinic (EPAC) in Vancouver, British Columbia, and to assess the characteristics of the women accessing their services and their satisfaction with the care provided. METHODS: The EPAC at BC Women's Hospital and Health Centre was opened in September 2007 to offer assessment of early pregnancy complications and management of early pregnancy loss. We conducted a review of the records of all patients who accessed the clinic in its first year of operation to review the origin of referrals, patient assessments, diagnoses, treatment, complications, and follow-up. Additionally, we distributed satisfaction surveys to patients. RESULTS: A total of 411 patients were referred to the EPAC in its first year of operation. Most referrals were from family physicians (38%), and the primary reason for referral was most commonly cramping and/or spotting (57%). The mean wait time for patients to be seen was 2.02 working days, and the majority of women (91%) were given a diagnosis at their first clinic visit. After assessment, 48% of women had manual vacuum aspiration or dilatation and curettage arranged, 21% had expectant management, and 17% required no treatment, because of complete miscarriage. While 94% of patients with non-viable pregnancies were treated at EPAC, 6% were referred to other health care agencies. In the satisfaction surveys completed, comments about the EPAC were largely positive and primarily focused on the emotional support and level of care received. CONCLUSION: In its first year of operation, the EPAC was well used and provided efficient and compassionate care. Patients reported high satisfaction with the quality of care received from staff, and showed particular appreciation for the emotional care received.

Social support in the post-abortion recovery room: evidence from patients, support persons and nurses in a Vancouver clinic.

BACKGROUND: The benefits of social support in post-surgical recovery are well documented; social support decreases preoperative stress and postoperative recovery time. However, a paucity of studies have examined the effect of social support in the context of pregnancy termination. This study is the first to examine the effect of postoperative accompaniment from the patient, support person and nurses' perspective. STUDY DESIGN: This study was carried out in two phases. In Phase I, no accompaniment was allowed in the post-anesthesia recovery room (PAR); in Phase II, accompaniment was permitted. All participants completed pre- and postoperative questionnaires. RESULTS: The perception of accompaniment was overwhelmingly positive in patients and support people. Patients in Phase II demonstrated a high (over 95%) acceptance of accompaniment in the recovery room. It was found that 96.8% reported they would choose to be accompanied in the recovery room again if they had to have another abortion. Support persons felt very strongly that their presence was helpful to the patient. The decrease in pre- to postoperative anxiety levels was significantly greater in those women who were accompanied. However, overall, nurses demonstrated a negative attitude towards accompaniment in the recovery room. CONCLUSION: In summary, the presence of a support person in the PAR was perceived in a positive manner by patients and support people. However, the reasoning behind the negative opinion of nurses requires further study before PAR accompaniment can be considered a possibility in the context of pregnancy termination.

An evaluation of rooming-in among substance-exposed newborns in British Columbia.

OBJECTIVE: Rooming-in, the practice of caring for mother and newborn together in the same room immediately from birth, is preferred for the general postpartum population but is not yet standard practice of care for newborns of substance-using women. Such newborns are usually separated from their mothers and admitted to a neonatal intensive care unit and treated for substance withdrawal if necessary. We compared clinical and psychosocial outcomes associated with traditional standard care models versus an interdisciplinary rooming-in model of care for substance-exposed newborns. METHODS: We conducted a retrospective comparative review of a cohort of substance-exposed newborns. Data were extracted from the British Columbia Perinatal Health Program database to populate the standard care and rooming-in groups. The main study outcomes were neonatal admission to NICU, breastfeeding, presence of neonatal withdrawal, length of stay, and custody status at discharge. RESULTS: Rooming-in was associated with a significant decrease in admissions to NICU and a shorter NICU length of stay for term infants, increased likelihood of breastfeeding (either exclusively or in combination with formula) during the hospital stay, and increased odds of the baby being discharged home with the mother. There were no significant differences between groups with respect to the presence of neonatal substance withdrawal or breastfeeding status at discharge. CONCLUSION: Rooming-in may facilitate a smooth transition to extrauterine life for substance-exposed newborns by decreasing NICU admissions and NICU length of stay for term infants, encouraging breastfeeding, and increasing maternal custody of infants at discharge. This review supports the finding that rooming-in is both safe and beneficial for substance-exposed babies.

A review of physician anaesthesia prescribing practices in an abortion clinic in British Columbia.

OBJECTIVE: The primary purpose of this study was to review the standard prescribing practices of physicians providing local anaesthesia in a major abortion clinic in British Columbia. METHODS: We conducted a retrospective review of patients who underwent a first trimester surgical abortion at the Comprehensive Abortion and Reproductive Education (CARE) Program at BC Women's Hospital and Health Centre during 2004 (n = 1546). Patients' demographics and reproductive history including age, weight, gestational age, and gravidity were recorded. Main outcomes recorded were dosage of lidocaine administered and amount of conscious sedation (midazolam and fentanyl) administered for pain management. Incidence of toxicity was also recorded. RESULTS: Almost one half (49.9%) of the patients received 20 mL of 0.5% lidocaine, and the remainder received 20 mL of 1.0% lidocaine. The volume of conscious sedation did not differ between groups. There was a positive correlation computed between midazolam and fentanyl dosages (r = 0.583, P < 0.01). Neither was significantly associated with gravidity. Gestational age was associated with both midazolam and fentanyl dose (r = 0.05, P = 0.047; r = 0.06, P = 0.024). There was no reported incidence of toxicity. CONCLUSION: Similar doses of midazolam and fentanyl were administered to patients regardless of the amount of lidocaine given (20 mL of either 0.5% or 1.0%). Further investigation is required to assess whether fentanyl and midazolam doses used during procedures can be used as surrogate measurements of pain. Our findings suggest it would be reasonable to consider using a lower dose of local anaesthetic for first trimester abortions to further reduce the risk of toxicity.

Influence of sex steroid hormones on spatial memory in a songbird.

In mammals, sex steroid hormones influence spatial learning and memory abilities but there are few data regarding such effects in birds. We investigated whether non-invasive sex steroid hormone treatment would affect spatial memory task performance of great tits (Parus major). For five consecutive days, birds were fed wax moth larvae injected with either 80 microg testosterone or 80 microg estradiol carried in peanut oil immediately prior to behavioral testing. During the 5 days prior to and the 5 days following hormone treatment, birds were fed vehicle-injected larvae. Both hormone manipulations resulted in an elevation of circulating hormone levels within 5 min of larva ingestion. This elevation was sustained for at least 30 min but had no short-term (<1 day) effect on spatial memory performance. However, performance tended to increase during the first 5 days of vehicle treatment and during both sex steroid treatments whereas it decreased during the 5 days of vehicle treatment following either hormone treatment. These results suggest that both hormones led to some improvement in spatial memory that declined once treatment ended. The great tit hippocampus was found to express androgen and estrogen receptors which would provide a direct site of sex steroid action.

Spatial ability is impaired and hippocampal mineralocorticoid receptor mRNA expression reduced in zebra finches (Taeniopygia guttata) selected for acute high corticosterone response to stress.

In mammals, stress hormones have profound influences on spatial learning and memory. Here, we investigated whether glucocorticoids influence cognitive abilities in birds by testing a line of zebra finches selectively bred to respond to an acute stressor with high plasma corticosterone (CORT) levels. Cognitive performance was assessed by spatial and visual one-trial associative memory tasks. Task performance in the high CORT birds was compared with that of the random-bred birds from a control breeding line. The birds selected for high CORT in response to an acute stressor performed less well than the controls in the spatial task, but there were no significant differences between the lines in performance during the visual task. The birds from the two lines did not differ in their plasma CORT levels immediately after the performance of the memory tasks; nevertheless, there were significant differences in peak plasma CORT between the lines. The high CORT birds also had significantly lower mineralocorticoid receptor mRNA expression in the hippocampus than the control birds. There was no measurable difference between the lines in glucocorticoid receptor mRNA density in either the hippocampus or the paraventricular nucleus. Together, these findings provide evidence to suggest that stress hormones have important regulatory roles in avian spatial cognition.

Preference for spatial cues in a non-storing songbird species.

Male mammals typically outperform their conspecific females on spatial tasks. A sex difference in cues used to solve the task could underlie this performance difference as spatial ability is reliant on appropriate cue use. Although comparative studies of memory in food-storing and non-storing birds have examined species differences in cue preference, few studies have investigated differences in cue use within a species. In this study, we used a one-trial associative food-finding task to test for sex differences in cue use in the great tit, Parus major. Birds were trained to locate a food reward hidden in a well covered by a coloured cloth. To determine whether the colour of the cloth or the location of the well was learned during training, the birds were presented with three wells in the test phase: one in the original location, but covered by a cloth of a novel colour, a second in a new location covered with the original cloth and a third in a new location covered by a differently coloured cloth. Both sexes preferentially visited the well in the training location rather than either alternative. As great tits prefer colour cues over spatial cues in one-trial associative conditioning tasks, cue preference appears to be related to the task type rather than being species dependent.