1988 National Maternal and Infant Health Survey: methods and response characteristics

OBJECTIVES: The 1988 National Maternal and Infant Health Survey (NMIHS) was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications. METHODS: The NMIHS is a nationally representative sample of 11,000 women who had live births, 4,000 who had late fetal deaths, and 6,000 who had infant deaths in 1988. Questionnaires were mailed to mothers based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States. RESULTS: The response rates in all three components of the NMIHS differed according to the mothers' characteristics. Mothers were more likely to respond if they were 20-39 years of age, were white, were married, had fewer than four children, entered prenatal care early, had more prenatal visits, had more years of education, or resided in the Midwest Region. The percent of respondents was lower for teenage mothers, mothers of races other than white, and mothers with four or more children, little prenatal care, or fewer years of education. Mothers whose infants weighed less than 2,500 grams were less likely to respond in the live-birth and infant-death components than mothers whose infants weighed 2,500 grams or more. CONCLUSIONS: The NMIHS will provide an invaluable tool for researchers and practitioners seeking solutions to perinatal and obstetric problems.     

Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women

PURPOSE: To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not. METHOD: A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy. FINDINGS: Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk. CONCLUSIONS: Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.     

Rural and urban differences in physician resource use for low-risk obstetrics

OBJECTIVE: To explore the hypothesis that rural obstetricians (OBs) and family physicians (FPs) utilized fewer resources during the care of the low-risk women who initially booked with them than did their urban counterparts of the same specialties. DATA SOURCES/STUDY DESIGN: A stratified random sample of Washington state rural and urban OBs and FPs was selected during 1989. A participation rate of 89 percent yielded 209 participating physicians. The prenatal and intrapartum medical records of a random sample of the low-risk patients who initiated care with the sampled providers during a one-year period were abstracted in detail and analyzed with the physician as the unit of analysis. Complete data for 1,683 patients were collected. Resource use elements (e.g., urine culture) were combined by standardizing them with average charge data so that aggregate resource use could be analyzed. Intraspecialty comparisons for resource use by category and overall were performed. FINDINGS/CONCLUSIONS: Results show that rural physicians use fewer overall resources in caring for nonreferred low-risk-booking obstetric patients than do their urban colleagues. Resource use unit expenditures showed the hypothesized pattern for both specialties for total, intrapartum, and prenatal care with the exception of FPs for prenatal care. Approximately 80 percent of the resource units used by each physician type were related to hospital care. No differences were shown in patterns of care for most clinically important aspects of care (e.g., cesarean delivery rates), and no evidence suggested that outcomes differed. The overall differences were due to specific components of care (e.g., fewer intrapartum hospital days and less epidural anesthesia).     

Prenatal maternal stress and prematurity: A prospective study of socioeconomically disadvantaged women.

Developed and tested a biopsychosocial model of birth weight and gestational age at delivery using structural equation modeling procedures. The model tested the effects of medical risk and prenatal stress on these indicators of prematurity after controlling for parity. Ss were 130 women (aged 18–42 yrs) of low socioeconomic status (SES) interviewed throughout pregnancy in conjunction with prenatal care visits to a public clinic. Ss also completed an abbreviated version of the Perceived Stress Scale (S. Cohen et al; see record 1984-24885-001) and the State form of the State-Trait Anxiety Inventory. Lower birth weight was predicted by earlier delivery and by prenatal stress. Earlier delivery was predicted by medical risk and by prenatal stress. Parity was not related to time of delivery or to birth weight. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of labor contractions on catecholamine release and breathing frequency in newborn rats.

Plasma catecholamines in newborn rats (0-2 hr old) were analyzed following vaginal birth, cesarean section with simulated labor contractions, or cesarean section without labor contractions. Upon delivery, pups were exposed to key elements of the rat's natural birth process, that is, umbilical cord occlusion, tactile stimulation, and cooling. Only pups exposed to actual or simulated labor showed an immediate rise in norepinephrine and epinephrine. Initial postpartum respiratory frequencies were higher in vaginal than in cesarean delivered pups and, in all groups, inversely correlated with catecholamine titers, suggesting respiratory distress or transient tachypnea at lower catecholamine levels. These findings establish a rat model for analyzing effects of labor on neonatal adaptive response during the transition from prenatal to postnatal life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teenagers' perceptions of barriers to prenatal care

A structured interview conducted during the postpartum hospitalization of 184 patients aged 17 years or younger was used to study teenagers' perceptions of barriers to prenatal care. The interview consisted of more than 100 questions on demographic characteristics, family and social support, desire for the pregnancy, perceptions of the importance of prenatal care, practical obstacles to access to health care (such as lack of transportation, day care, etc), financial problems related to care, problems finding time to obtain health care, knowledge of available prenatal care resources, and perceptions of ease or difficulty in the use of existing clinics. Multiple regression analysis using the Kessner index as the criterion variable showed that major factors related to the adequacy of prenatal care received by these teenagers were perceptions of cost barriers, the gestational age at which the teenager discovered she was pregnant, school enrollment status (those in school received poorer care than those who had dropped out), and the degree of social support experienced by the teenager. These findings suggest that specific changes in the health care system are needed to make prenatal care more accessible for pregnant teenagers. These changes would include enhancing community awareness that Medicaid pays for prenatal care, establishing links between prenatal clinics and school health systems, and scheduling prenatal clinics at times more convenient for teenagers.     

Neonatal medication surveillance by the pharmacist

Data on prenatal, labor and delivery, and postnatal medication exposure to neonates were collected. During an 11-week period, 100 neonates consecutively admitted to a hospital were studied. The pharmacist obtained a social and medication history from the mothers and reviewed maternal anesthesia records and the charts of the neonates. Fifteen definite and possible adverse medication reactions were detected in 13 neonates. The median number of different medications ingested prenatally was 4.7. The four most commonly ingested prenatal medications were vitamins (97%), iron preparations (90%), headache/pain/arthritis medications (68%) and antinausea/vomiting medications (40%). The most commonly used medications during labor and delivery were oxytocin (73%), meperidine (33%) and promazine (25%). The use of strong narcotics during this period produced neonatal respiratory depression in some cases. The four most commonly prescribed postnatal medications were vitamin K1 (100%), gentamicin (10%), ampicillin (8%) and Poly-Vi-Sol (6%). The maternal interview indicated that most mothers were unaware of the influence that many medications can play upon the fetus. It is recommended that the pharmacist conduct a maternal medication interview prior to labor and delivery.     

Ethnic group perceptions of mental health service providers.

Assessed 121 male and 118 female Chicano, 124 male and 123 female Black, and 126 male and 125 female Anglo college students' perceptions of 100 characteristics of 6 service-provider groups and the likelihood that Ss would discuss 9 problem areas with professional groups. Analysis revealed main effects for race, sex, and provider groups; factor analysis of the 9 problem topics revealed personal-social and educational-vocational dimensions. Females were more likely than males to discuss both problem areas with provider groups. Blacks and Chicanos were more likely than Anglos to take personal problems to professionals. Ss preferred to consult psychiatrists and clinical psychologists for the same types of problems more than counseling psychologists, who in turn were preferred more than college counselors, high school counselors, and advisers. For educational-vocational concerns, Ss generally expressed a stronger probability of consulting providers other than psychiatrists and clinical psychologists. Methodological issues, previous findings, and implications for service providers are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forearm blood flow in response to stress.

Examined the relationship between stress, forearm blood flow, and subjective anxiety. In 26 normal male Ss, electric shocks applied to the opposite forearm led to a rapid rise in anxiety and forearm blood flow. With repeated regular shocks, habituation of the vasomotor response occurred and anxiety became less intense. Changes appeared to be related to S's ability to predict accurately the intensity and frequency of the stimulus. Mental arithmetic under harassment produced a more gradual but greater rise in blood flow without an equal rise in anxiety. 23 alcoholic Ss who were judged to have limited motivation and ego strength showed a significantly lower vasomotor response during mental arithmetic. It is concluded that changes in forearm blood flow observed during stress cannot be related only to an increase in anxiety. This response seems to depend also on the significance of the stimulus to S, his psychiatric status, and his level of motivation. (19 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subject characteristics and preferences for different approaches to psychotherapy: A multivariate study.

Examined selected personality variables, sex, age, interpersonal values, and educational level, as antecedents to preferences for a nondirective (Carl Rogers) or directive (Albert Ellis) therapist. Ss were 77 hospitalized psychiatric patients and 77 normal undergraduates. Individual films of the same patient being separately interviewed by the therapists were shown to the Ss on separate days. The Barrett-Lennard Relationship Inventory and an expression of preference for therapists were dependent measures. Ss who preferred the Ellis presentation proved to be more dogmatic (Rokeach Dogmatism Scale, Form E) and externalized (Rotter's Internal–External Locus of Control Scale) than Ss preferring the Rogers presentation. Trait anxiety (Taylor Manifest Anxiety Scale) was only related to therapy preference for the patients. The variables differed in discriminability between preferences, although patients and students were similar in their relative preferences for the 2 therapist orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with gastrointestinal endoscopy: Self-efficacy enhancement and coping style.

48 men scheduled for endoscopy were assessed for preferred coping style and assigned to 1 of 4 preparation conditions: (1) relaxation plus coping self-efficacy (SE) enhancement, (2) relaxation only, (3) procedural information, and (4) no preparation. It was hypothesized that increases in SE would be associated with better behavioral and self-report assessments of coping with endoscopy, and that coping style would moderate effects of SE enhancement. Hypotheses were largely confirmed. Ss in SE enhancement preparation experienced greater increases in coping SE and greater decreases in distress before and during endoscopy than did other Ss. Changes in coping SE were negatively correlated with changes in anticipatory anxiety, and SE ratings were significantly related to distress during endoscopy. Ss classed as monitors fared most poorly with no-preparation, whereas blunters did most poorly with procedural information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Test anxiety, academic performance, and cognitive appraisals.

Investigated the impact of test anxiety on test performance and the cognitive appraisals of test-anxious students. To overcome limitations of previous research, state and dispositional measures of test anxiety were used over repeated performance trials. 62 Ss who were enrolled in an undergraduate statistics course that required multiple examinations were administered the State-Trait Anxiety Inventory and served as Ss. Ss' expectations, thoughts, and performance were assessed at each of the 4 examination occasions. Results indicate that test anxiety was related to poor test performance both early and late in the term. When state anxiety levels were controlled for, the test anxiety–test performance relation was apparent only during the later stages of the course. The pattern of Ss' anxiety and appraisals suggests that test-anxious Ss experienced most doubt and concern early in the term. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recipient and provider perspectives of barriers to rural prenatal care

Barriers to prenatal care have been linked to inappropriate service usage and poor health outcomes of mothers and infants. This study describes barriers to prenatal care, as identified by low-income recipients and providers of prenatal care in a small rural county in the Midwest. A prospective survey design and focus group were used. An unexpected finding occurred. Almost half of the recipients identified no barriers to prenatal care; however, these women still received less than adequate prenatal care. Providers identified the attitudinal barrier of women as not valuing prenatal care, but the women did not. Some women were found to need information about availability and eligibility for Medicaid and other services. Issues surrounding prenatal care for rural women are complex and subtle. Community health nursing can inform and influence community leaders and members about prenatal care services for rural low-income women.     

Colonization with vancomycin-resistant enterococci in chronic hemodialysis patients

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.     

Health care and the poor: Psychological implications of restrictive policies.

Describes a field experiment with 180 women (mean age 25.9 yrs) visiting an urban welfare office to examine the possible effects of 2 aspects of restrictive Medicaid policies: (a) the loss of choice of providers and (b) adverse patient mix (i.e., when the majority of a provider's clients are Medicaid beneficiaries). Results indicate that health care presented within the context of not having a choice was derogated and that choice and patient mix combined to influence intentions to seek care. Ss who did not choose the health plan in a simulated choice, who had fewer choices than expected, and who did not accept restricted choice also had negative perceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care characteristics associated with women's satisfaction with prenatal care

OBJECTIVES: The objective of this study was to explore the relation between prenatal care characteristics and satisfaction among Medicaid recipients. METHODS: African-American (n = 75) and Mexican-American (n = 26) nonadolescent primiparous pregnant women who had at least three prenatal care visits participated in a 25-minute telephone survey that asked them about satisfaction with prenatal care (art of care, technical quality, physical environment, access, availability and efficacy); prenatal care characteristics (practitioner attributes, service availability, and features of the delivery of care); and, personal characteristics (sociodemographics, health status and behaviors, and pregnancy-related variables). Univariate and multivariable analyses were conducted to explore the relations between personal characteristics and satisfaction and between care characteristics and satisfaction. RESULTS: For the overall sample, the following prenatal care characteristics were associated with increased satisfaction: having procedures explained by the provider, short waiting times at the prenatal care site, the availability of ancillary services, and reporting that the prenatal care practitioner was male. When examining the data by ethnicity, whether the provider explained procedures was the most important determinant of satisfaction for both African-American and Mexican-American women. CONCLUSIONS: Knowledge of the care characteristics that impact low-income pregnant women's satisfaction can be utilized to alter service delivery to increase use of prenatal care and ultimately to improve perinatal outcomes.     

Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.

Objective: Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. Design: Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. Main Outcome Measures: Gestational age at delivery, birth weight, preterm delivery (     

Paternal perspectives of the childbirth experience

This study examined the responses given by first-time fathers who were asked to describe their feelings about their childbirth experience. The fathers answered three open-ended questions about their feelings concerning labor and childbirth, and the paternal behaviors believed to be most useful to their wives during labor and delivery. Data from fathers who attended prenatal childbirth education classes were examined separately from fathers who did not attend. The findings indicated that for all fathers, regardless of prenatal preparation, the labor experience evoked generally positive responses in addition to a significant number of negative responses, while perceptions of the birth experience were primarily characterized by positive or very positive feelings. The results also indicated that the fathers perceived that they were most helpful to their partner during labor.