Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health.

This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.

Maternal trait personality and childbirth: the role of extraversion and neuroticism.

BACKGROUND: anxiety during pregnancy and childbirth can increase risk of complications and interventions for both mother and infant. Although considerable work has explored fear of childbirth and anxiety during labour and subsequent birth outcomes there has been less consideration of the role of more stable maternal personality upon childbirth. Traits of neuroticism and extraversion are however predictive of health outcomes in other fields potentially through biological, psychological and social mechanisms. The aim of the current research was thus to examine the relationship between trait personality and childbirth experience. METHODS: seven hundred and fifty-five mothers with an infant aged 0-6 months completed a self-report questionnaire including the Ten Item Personality Measure and descriptions of birth experience including mode of birth [vaginal vs. caesarean section] and complications [failure to progress, fetal distress, post-partum haemorrhage, assisted birth and severe tear]. FINDINGS: personality traits were significantly associated with birth experience. Specifically mothers scoring low in extraversion and emotional stability were significantly more likely to have a caesarean section and experience a number of complications during labour and birth including an assisted birth, fetal distress, failure to progress and a severe tear. Findings were independent of maternal age, education and parity. CONCLUSIONS: the personality traits of extraversion and emotional stability appear to facilitate likelihood of normal birth. Potential explanations for this include biological (physiological reactivity, pain thresholds, oxytocin and dopamine release) and psychological (coping mechanisms, social support, self-efficacy) factors. The findings have important implications for antenatal education and support during labour.

Aromatherapy and massage for antenatal anxiety: its effect on the fetus.

Antenatal anxiety has been linked to maternal hypothalamic-pituitary-adrenal axis changes which can affect fetal development and may have lasting effects on the child's psychological development. Treatments for anxiety have hitherto focused on psychotherapy techniques or antidepressant drugs but these do not always effect long term improvement. Aromatherapy and massage have successfully been used to produce significantly greater improvement in reduction of anxiety. Midwives may highlight anxiety in some of the mothers in their care and can incorporate the holistic approach of aromatherapy and massage into their practice. However, further research is required to establish the efficacy and cost-effectiveness of aromatherapy and massage in the antenatal period.

Implementation of new medical techniques: experience from the Swedish randomized controlled trial on fetal ECG during labor.

BACKGROUND: In a large Swedish multicenter randomized controlled trial (RCT) on intra partum fetal monitoring with automatic analysis of fetal ECG waveform (STAN) in combination with cardiotocography (CTG) (4966 parturients, 300 obstetricians and midwives managing the patients), interim analysis revealed protocol violations. By a post hoc analysis of the results over time, factors affecting the acceptance of the new technique were analyzed. METHODS: The rates of primary and secondary outcome measures (fetal outcome, operative deliveries) were compared in the two study groups (CTG + ST and CTG only). Changes over time were statistically evaluated using a test for homogeneity between the two periods. RESULTS: After retraining, the CTG + ST group showed the lowest rates of operative delivery for fetal distress, fetal blood sampling and admissions to neonatal intensive care unit. Operative deliveries (p = 0.02) and the number of fetal blood sampling decreased significantly over time (p = 0.001). CONCLUSIONS: Training and education probably predisposed the clinicians to a change and reinforced it when it occurred as a result of increased personal experience. The audit and feedback together with the influence of opinion leaders and inter-collegial interactions seem to have been of importance for the successively increasing acceptance of the new method during the RCT.

Relación entre analgesia epidural y tipo de parto / The relationship between epidural analgesia and the type of childbirth

Objetivo: Estudiar la relación que existe entre administración de analgesia epidural durante el trabajo de parto y parto instrumentado (con fórceps o ventosa) en el Hospital Materno-Infantil Teresa Herrera de A Coruña para los casos estudiados que tuvieron lugar en 1999. Material y Métodos: Se seleccionaron 380 casos aleatoriamente a partir de la revisión de historias clínicas, de los cuales 190 habían recibido analgesia epidural y el resto (190) no la habían recibido. Resultados: De la asociación aislada entre analgesia epidural y parto instrumentado encontramos que el riesgo de parto instrumentado cuando se administra analgesia epidural es alto (OR de 2,7). Sin embargo, cuando analizamos por efecto confusor de las diferentes variables encontramos que el ser primípara, el peso del recién nacido > de 3500 g y la analgesia epidural por este orden tienen un efecto independiente sobre la presencia de un parto instrumentado. Por otra parte, se registró una frecuencia similar de casos de sufrimiento fetal intraparto para ambos grupos (5,8 por ciento de los partos con analgesia epidural y 5,3 por ciento de los casos sin analgesia epidural); relación no significativa estadísticamente (según p de 3500 g, tendencia a abreviar expulsivo sin sufrimiento fetal…), que a la analgesia en sí misma. El impacto de ésta sobre el desarrollo último del parto podría verse influido por un cambio en la práctica obstétrica (AU)

[Effect of dietary level of vitamin E on protection of fetus against ischemic distress induced by clamping the uterotubal vessels of pregnant rats].

The effect of dietary vitamin E on the fetal ischemic distress induced by clamping the uterotubal vessels of pregnant rats was studied. The fetal heart rate was measured by the pulsed doppler technique as an index of fetal distress induced by ischemia. On reperfusion after clamping the vessels for 9 min., the decreased fetal heart rate was restored to normal rapidly and completely in the E-supplemented group, but slowly and incompletely in the E-deficient and control groups. On reperfusion after ischemia, the amounts of lipid peroxides, measured as thiobarbituric acid (TBA)-reactive substances, were greatly increased in the fetal brain and liver and in the placenta in the E-deficient and control groups, but not in the E-supplemented group. The vitamin E concentrations in fetal tissues were less than 10% of those in the maternal tissues. But a diet containing a large amount of vitamin E induced significantly increased concentrations of vitamin E in fetal brain and liver. These results suggest that vitamin E may have a protective effect on fetal distress by decreasing lipid peroxides.

Protective effect of vitamin E on fetal distress induced by ischemia of the uteroplacental system in pregnant rats.

The effect of dietary vitamin E on the fetal ischemic distress induced by clamping the uterotubal vessels of pregnant rats was studied. The fetal heart rate was measured by the pulsed doppler technique as an index of fetal distress induced by ischemia. On reperfusion after clamping the vessels for 9 min, the decreased fetal heart rate was restored to normal rapidly and completely in the E-supplemented group, but slowly and incompletely in the E-deficient and control groups. On reperfusion after ischemia, the amounts of lipid peroxides, measured as thiobarbituric acid (TBA)-reactive substances, were greatly increased in the fetal brain and liver and in the placenta of in the E-deficient and control groups, but not in the E-supplemented group. The vitamin E concentrations in fetal tissues were less than 10% of those in the maternal tissues. Significant differences were found in the vitamin E concentrations in the maternal serum and liver in the three groups of rats given diet containing different amounts of vitamin E for 2 weeks. No significant differences were found between the vitamin E-deficient and control groups in the levels of vitamin E in the fetal brain and liver and the placenta, but these levels were significantly lower than those in the E-supplemented group.

External cephalic version as an alternative to breech delivery and cesarean section.

External cephalic version (ECV), the transabdominal manipulation of a breech-presenting fetus into a head-down position before birth, is common in traditional ethno -obstetric systems as well as in the modern scientific obstetrics of Europe. In the United States, this practice has fallen out of use and is no longer taught in medical schools or obstetric residencies. The currently standard American management options for breech are either breech delivery or, most frequently, cesarean section. This paper examines the historical and cross cultural distribution of ECV, describes the various methods for effecting version of the fetus, and assesses the risks of the procedure. It is concluded that the data available are inadequate to either condemn the practice or to advocate it without reservation. It is suggested that ECV may constitute an attractive conservative management strategy for breech presentation in scientific obstetric systems as well as in those developing countries where the skill to do versions is part of the traditional inventory of midwifery skills.