Healthy Mothers and Babies: Recent Research:

Maternal Risk Entity

Is there anything more important to a family -- and to the community of interest around that family -- than the safe and healthy delivery of the brand new baby and its mother? Modern medicine has provided technologies and training to alleviate many of the risks vis-a-vis mother and infant, however there is never going to be a situation absolutely free of potential risks surrounding pregnancy, childbirth, and the post-pregnancy period. Hence, nurses and physicians and other healthcare professionals must stay informed and be fully prepared to come up with solutions when risky situations occur. This paper presents the peer-reviewed literature on several maternal risks and there possible remedies.

Infants' Risks in Late Preterm Births

In the peer-reviewed journal Birth, the authors point out that the preterm birth rate has risen from 10.6 births in 1990 to 12.8% in 2006 -- a twenty percent increase (Kirby, et al., 2010). Meanwhile there has been an increase of 26% in late preterm births (34-36 weeks) between 1990 and 2006; and while it is well-known that babies born before the 34th week of gestation are at risk "for life-long morbidity and early mortality," only recently, the authors assert, have healthcare researchers noted that there are also risks for late preterm babies (Kirby, 169).

What are the risks for late preterm babies, and why is this issue an important topic for a nurse to delve into? The infant born in the late preterm is at an "increased risk" of the following complications: a) respiratory disease; b) brain injuries which result in "long-term neurodevelopmental disorders"; and c) possible "death before the first birthday"; and d) an increased risk of "intensive and prolonged hospitalization" which means high medical bills (Kirby, 169).

The authors want readers to understand that what they are reporting goes against "conventional wisdom" when it comes to pediatric and obstetric practices. Why? Because previously those two above mentioned groups viewed children born late preterm and at term to be "medically similar" -- but Kirby and colleague are suggesting they are not similar vis-a-vis risks to their health. Kirby and colleague don't offer an intervention theory but they do say on page 171 that a more accurate gauge measuring gestational age should be developed. Moreover, they suggest that a new definition for "preterm birth" might be more accurately listed at any birth short of 39 weeks of gestation (171).

Postpartum Negative Moods Present Risks to the Mother and Baby

Postpartum experiences have long been a subject of study in the medical field, and it has been known that the postpartum experience "interferes with maternal-infant bonding" and also can carry with it "long-term negative consequences" (Weisman, et al., 2010). The article in the journal Archives of Women's Mental Health researched a "community cohort of 1,844 low-risk women" who had delivered a singleton term baby.

The research involved a very intense assessment of: a) the quality of the delivery; b) "emotions during labor"; c) attitudes toward the pregnancy and the infant; d) "mood regulation"; and e) postpartum "anxiety and depression" (Weisman, 505). The results of this research, which involved conditions of low risk for the mother and baby, included the following: 20.5% of parturient (those about to give birth) women "reported high levels of depressive symptoms" (Weisman, 505).

For women at low risk -- among the 1,844 who were part of the study -- who had Cesarean Section Delivery, 23% reported that they had high levels of depressive symptoms; for women who had normal vaginal deliveries 19% had depressive symptoms; and for women who had assisted vaginal deliveries, the percentage having high levels of depressive symptoms (Weisman, 505).

When anxiety was measured, it was the highest in Cesarean Delivery and it was the lowest in normal vaginal delivery of the child, Weisman continues. Mothers who went through Cesarean Deliveries reported that their labor experience was the "most negative" and they had the highest somatic symptoms during their last trimester; moreover the Cesarean mothers were "the least efficient" when it came to dealing with their negative mood (Weisman, 505).

This research into postpartum experiences -- which, as mentioned, brings risk for the child and the ability of mother and child to bond in a normal way -- found that the higher the maternal age the greater the chances of: postpartum depression; labor pain; "inefficient mood regulation; somatic symptoms; and moreover, the older the woman the more negative "and less positive perception" of the fetus during the last trimester (Weisman, 505).

What are the clinical implications of this research? Weisman notes that since rates of Cesarean Delivery are on the rise in the West (U.S., UK, Canada, and Mexico) and in Europe and parts of Asia, based on the survey referenced above, there are greater risks in Cesarean deliveries. Why? Because without strong mother-child bonding children can suffer later in life.

Midwives Should be Trained to Work with Mentally Challenged Expectant Mothers

An article in the Journal of Psychiatric and Mental Health Nursing posits that very few midwives have received training or meaningful education regarding the mental health of the women they work with who are delivering babies. The authors surveyed midwives across 19 maternity sites in the state of Victoria, Australia and learned that most midwives "lack mental health skills and knowledge" and hence they lack self-confidence and feel uncomfortable around expectant mothers in the midst of mental illness (McCauley, et al., 2011). Part of the reason that the authors chose this topic to research is that psychiatric disorders "have the highest prevalence in women during the childbearing year," and in fact the peak prevalence "for depression" is when a woman is between 25 and 44 years of age (McCauley, 787). For women suffering from schizophrenia, are known to not inform their doctor until they are six to eight weeks pregnant, and if they continue to take medications for schizophrenia (antipsychotic medications) that can negatively impact the unborn child, McCauley explains.

So what is the solution, according to this article? They surveyed 160 midwives (most of whom were female) and 60% of them had "negative responses" toward the expectant mothers who were mentally ill in some form (McCauley, 791). The bottom line, given the lack of training by midwives, is simple: it is "essential that all midwives have appropriate mental health knowledge and skills" so that the well-being of the pregnant mother is protected and secured (McCauley, 794).

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