Antenatal and perinatal care in southern Italy. I. The mothers' reports

Enteric neuroimmune interactions coordinate intestinal responses in health and disease

The enteric nervous system (ENS) of the gastrointestinal (GI) tract interacts with the local immune system bidirectionally. Recent publications have demonstrated that such interactions can maintain normal GI functions during homeostasis and contribute to pathological symptoms during infection and inflammation. Infection can also induce long-term changes of the ENS resulting in the development of post-infectious GI disturbances. In this review, we discuss how the ENS can regulate and be regulated by immune responses and how such interactions control whole tissue physiology. We also address the requirements for the proper regeneration of the ENS and restoration of GI function following the resolution of infection.

Views on involving a social support person during labor in Zambian maternities

Because social support persons are excluded from modern obstetric care in Zambia, the aim of this study was to explore the views of 84 mothers and 40 health staff about allowing women to be attended by a supportive companion during labor in Zambian urban and rural maternities. Most of the mothers wanted a companion present to provide emotional and practical support. Those who were opposed to the idea had nobody to ask to be with them, or they had relatives who would interfere with the care provided. All health staff cited hospital policy as the principal reason for prohibiting social support persons from staying with laboring women. They also said that the health staff's role is to care for laboring women, and they worried that social support persons could interfere with their work by giving the laboring women traditional medicine. However, most health staff also said that a social support person could help the laboring women and give her a sense of security. The study concludes that Zambian maternity staff should be exposed to new research findings about the benefits of social support during childbirth and that this practice should be encouraged in Zambia. Ultimately, it should be the laboring woman who decides whether she wants to bring a social support person to the labor ward.

Antenatal care in Europe: varying ways of providing high-coverage services

OBJECTIVES

To describe the organizational characteristics of antenatal care and their relation to the utilization of health services and perinatal mortality in 13 European countries.

METHODS

The main data source was a questionnaire on the organization and financing of antenatal care, filled out in 1995 by country representatives of a European Concerted Action.

RESULTS

Thirteen systems for providing antenatal care were found. No clear grouping by organizational characteristics (uniformity, main care providers, integration, continuity of care, physical site, financing) emerged. Organizational characteristics and the utilization of antenatal services or perinatal mortality did not relate to each other.

CONCLUSIONS

There is no single way to provide high-coverage services. Further studies are needed to relate organization characteristics to health impact, costs, and patient satisfaction.

Factors associated with high risk of perinatal and neonatal mortality: an interim report on a prospective community-based study in rural Sudan

In a community-based prospective study, 6275 deliveries resulting in 6084 livebirths, 150 stillbirths (SB) and 167 neonatal deaths (NND) were monitored over a period of 3 years. The risk of an unfavourable outcome (SB or NND) in multiple pregnancies was more than ninefold that of singletons. Teenage mothers and those over 34 years of age ran nearly twice the risk of having an unfavourable outcome of pregnancy compared with mothers aged 20-29 years. First pregnancy and grand-multiparity (greater than eight previous pregnancies) carried a similar risk of an unfavourable outcome compared with mothers with 1-4 previous pregnancies. The most serious risk factor was the adverse outcome of the previous pregnancy. Compared with mothers whose last outcome had resulted in a livebirth surviving at least 30 days, mothers with a previous SB had seven times the risk (adjusted for age and parity) of SB and more than twice the risk of NND in the current pregnancy. Maternal illiteracy was associated with significantly higher risk of NND, and this rate decreased with increasing years of education. Frequency of antenatal visits had a marginally significant effect on the SB rate. Socioeconomic factors, diet and iron supplementation during pregnancy did not seem to affect the outcome.

Social history of a research project: a study on early post-partum discharge

This paper has a two-fold aim: first we report the results of a study in which 66 recently-delivered women were asked their opinion about a possible program of early post-partum discharge, and about their recent experience of birth and hospital stay. The data show that, while most of the mothers were critical of a number of aspects related to personnel behaviour and hospital organization, only a minority would have appreciated early post-partum discharge. The second aim was to present and discuss the social history of this research project: the reasons why the authors carried out the study, the difficulties in interpreting the results and, above all, the obstacles encountered in trying to have them circulated, discussed and applied. It was felt that these problems were not specific to this study, and that it was therefore worthwhile to discuss them openly.

Antenatal and perinatal care in southern Italy. II. The clinicians' reactions

One hundred obstetricians and 50 paediatricians engaged in public antenatal and perinatal care in southern Italy were interviewed about the provision of care in their facilities: 93% of the obstetricians judged the coverage of the target population to be insufficient and 53% of them considered the use of the risk approach to be unsatisfactory in public clinics. For example, no initiative was taken by 60% of public clinics when a woman at high risk failed to attend a booked antenatal visit. Bed rest during labour was prescribed by 72% of the obstetricians, a supporting relative was admitted to only 18% of the births and routine episiotomy was performed in 77% of primigravidae. Only 56% of the paediatricians interviewed allowed early contact between mother and baby. In public hospitals, 80% of paediatricians were present in the delivery room for the births. Screening for congenital hypothyroidism and phenylketonuria was executed in only 37% of the public hospitals. Newborn transport system adequate to national standards was available in only 33% of the hospitals. Antenatal and perinatal care need to be rapidly improved to meet population needs in southern Italy.