Outcomes of care in birth centers: demonstration of a durable model.

INTRODUCTION: The safety and effectiveness of birth center care have been demonstrated in previous studies, including the National Birth Center Study and the San Diego Birth Center Study. This study examines outcomes of birth center care in the present maternity care environment. METHODS: This was a prospective cohort study of women receiving care in 79 midwifery-led birth centers in 33 US states from 2007 to 2010. Data were entered into the American Association of Birth Centers Uniform Data Set after obtaining informed consent. Analysis was by intention to treat, with descriptive statistics calculated for maternal and neonatal outcomes for all women presenting to birth centers in labor including those requiring transfer to hospital care. RESULTS: Of 15,574 women who planned and were eligible for birth center birth at the onset of labor, 84% gave birth at the birth center. Four percent were transferred to a hospital prior to birth center admission, and 12% were transferred in labor after admission. Regardless of where they gave birth, 93% of women had a spontaneous vaginal birth, 1% an assisted vaginal birth, and 6% a cesarean birth. Of women giving birth in the birth center, 2.4% required transfer postpartum, whereas 2.6% of newborns were transferred after birth. Most transfers were nonemergent, with 1.9% of mothers or newborns requiring emergent transfer during labor or after birth. There were no maternal deaths. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 excluding anomalies. DISCUSSION: This study demonstrates the safety of the midwifery-led birth center model of collaborative care as well as continued low obstetric intervention rates, similar to previous studies of birth center care. These findings are particularly remarkable in an era characterized by increases in obstetric intervention and cesarean birth nationwide.

Familiarity and face processing.

The results of three experiments explore the role of familiarity in face processing. Using the complete-over-part advantage (Experiment 1) and the chimeric faces task (Experiment 2), the results revealed evidence for what may be termed "holistic processing" of unfamiliar, newly learned, and famous faces. Notably, the extent of holistic processing on both tasks was not moderated by the familiarity of the stimuli. Experiment 3 replicated this pattern using a simultaneous chimeric task to rule out a simple explanation through memory demands. Taken together, these three experiments provide robust and convergent evidence to suggest that all faces regardless of familiarity can be processed in a holistic fashion. On the basis of these results, discussion is presented regarding the value of considering different "types" of facial processing over and above a more simple consideration of task difficulty.

It's not my fault: understanding nursing students' causal attributions in Pathophysiology.

Pathophysiology is a difficult subject matter for many nursing students. This course is also critical for safe clinical practice. However, little research has explored what variables may influence nursing students' success in this course. This study is the first in a forthcoming series that seeks to better understand how to facilitate student success in Pathophysiology. In this study, students' causal attributions for successes and failures were explored as these attributions greatly influence future academic motivation and behavior. Students were asked to respond to two open-ended questions in order to better understand what causal attributions students were making for their successes and failures in Pathophysiology. Seventy-five Bachelor of Science in Nursing students who were enrolled in Pathophysiology returned their responses (92.6% response rate). Content analysis was utilized to determine whether students were making internal or external causal attributions for their successes and failures. Additionally, responses were evaluated in order to identify common themes shared by respondents. The majority of respondents (84%) attributed their academic successes in Pathophysiology in part to internal causes, and the majority of respondents (68%) attributed their academic failures, in part, to external causes. In this study the majority of students attributed their successes to controllable, unstable causes-primarily effort. Research indicates that attributing success to effort may reflect that students' confidence in their abilities is suffering, and that attributing failures to external causes, such as task difficulty, are also detrimental to performance and learning (Siegle et al., 2009). The results of this study are further presented and discussed.

Exploring the influence of students' attributions for success on their self-regulation in pathophysiology.

Pathophysiology is a difficult course both for students to take and for instructors to teach. However, little research has explored learner characteristics that teachers may address through targeted instruction to make both the teaching and learning experience better. This study examined the influence of students' causal attributions for success on their self-regulated learning, which is strongly associated with positive learning outcomes. Results indicated that ability, effort, and luck attributions for success collectively influenced Pathophysiology students' self-regulated learning and that ability was the most potent influence. The findings and the implication for teaching are discussed.

First birth cesarean and risk of antepartum fetal death in a subsequent pregnancy.

INTRODUCTION: To examine the relationship between first birth by cesarean and antepartum fetal death in a subsequent pregnancy in a large, hospital-based population. METHODS: Data for this retrospective cohort study were taken from a database of all women who gave birth at Brigham and Women's Hospital during 4 waves of data collection beginning in 1994 and ending in 2002. We calculated the risk of antepartum fetal death in the subsequent pregnancy for women whose first birth was by cesarean compared to women with a vaginal first birth. Survival analysis was used to examine the influence of gestational age at birth. RESULTS: Of 10,996 women who met inclusion criteria, 22% (n = 2450) had first births by cesarean, and 78% (n = 8546) had vaginal first births. The risk of antepartum fetal death in the subsequent pregnancy for women whose first birth was by cesarean was significantly greater than the risk for women whose first birth was vaginal (odds ratio 2.6; 95% confidence interval, 1.1-6.2). The relationship between first birth cesarean and antepartum fetal death in a subsequent pregnancy differed by gestational age at birth, with no excess risk among women with a previous cesarean birth who gave birth before 34 weeks' gestation but with a substantially increased risk for women who gave birth at 34 or more weeks' gestation (unadjusted hazard ratio = 5.6; 95% confidence interval, 1.6-19.8). Hazard ratio estimates for the association remained significant in bivariate models when adjusted for maternal height, weight, age, hypertension, and diabetes. DISCUSSION: In these data, first birth by cesarean was associated with an increased risk of antepartum fetal death in a subsequent pregnancy. Our findings suggest that antepartum fetal deaths in subsequent pregnancies might be prevented by avoiding primary cesarean birth.

Maternal temperature elevation and occiput posterior position at birth among low-risk women receiving epidural analgesia.

INTRODUCTION: To evaluate the relationship between maternal temperature elevation and occiput posterior position at birth as well as the association of fetal head position and temperature elevation on method of birth among women receiving epidural analgesia. METHODS: We conducted a secondary analysis of data from the Fetal Orientation during Childbirth by Ultrasound Study (FOCUS), which used serial ultrasounds to evaluate the effect of epidural anesthesia on fetal position at birth in low-risk women. The current analysis was limited to the 1428 study participants who received epidural analgesia. RESULTS: In our population, 47% (n = 669) of women had a maximum intrapartum temperature greater than or equal to 99.6°F (37.6°C). The prevalence of fetal occiput posterior position at admission did not differ between women who later developed temperature elevations (24.4%) and those who did not (23.6%, P= .70). Women who developed an elevated temperature greater than or equal to 99.6°F (37.6°C) had an increased risk of occiput posterior fetal head position at birth regardless of the amount of temperature elevation (odds ratio [OR]= 2.0; 95% confidence interval [CI], 1.5-2.8); the association persisted after control for potentially confounding factors (adjusted OR = 1.5; 95% CI, 1.1-2.1). The cesarean birth rate among women with both temperature elevation and occiput posterior position at birth was more than 12 times the rate of women with neither risk factor (adjusted OR = 12.6; 95% CI, 7.5-21.2). DISCUSSION: Intrapartum temperature elevation among women receiving epidural analgesia, even if only to 99.6°F (37.6°C), is associated with approximately a 2-fold increase in the occurrence of occiput posterior fetal head position at birth. Additionally, although this observational study cannot establish causal links, our findings suggest that the relationship between epidural-related intrapartum temperature elevation and occiput posterior position at birth could contribute to an increased cesarean birth rate among women receiving epidural analgesia for pain relief in labor.

Making heads turn: the effect of familiarity and stimulus rotation on a gender-classification task.

Recent work has demonstrated that facial familiarity can moderate the influence of inversion when completing a configural processing task. Here, we examine whether familiarity interacts with intermediate angles of orientation in the same way that it interacts with inversion. Participants were asked to make a gender classification to familiar and unfamiliar faces shown at seven angles of orientation. Speed and accuracy of performance were assessed for stimuli presented (i) as whole faces and (ii) as internal features. When presented as whole faces, the task was easy, as revealed by ceiling levels of accuracy and no effect of familiarity or angle of rotation on response times. However, when stimuli were presented as internal features, an influence of facial familiarity was evident. Unfamiliar faces showed no increase in difficulty across angle of rotation, whereas familiar faces showed a marked increase in difficulty across angle, which was explained by significant linear and cubic trends in the data. Results were interpreted in terms of the benefit gained from a mental representation when face processing was impaired by stimulus rotation.