[Care and Support for same-sex Couples during Pregnancy and Childbirth]. / Versorgung und Betreuung gleichgeschlechtlicher Frauenpaare während Schwangerschaft und Geburt.

INTRODUCTION: Since 2015, same-sex couples in Austria have been able to fulfil their desire to have children with the help of reproductive medicine services. The aim of this study was to determine the needs of women and the special features of care for women in couple relationships during pregnancy and childbirth. METHODOLOGY: Eight interviews were conducted with Austrian women in same-sex relationships using a semi-structured guideline. The women were recruited by means of a convenience sample via an association and word of mouth. The content of the collected data was analysed using the recommended Mayring method. RESULTS: In the obstetric accompaniment of same-sex female couples, it became obvious that the usual use of language was inappropriate and alternatives to the term father, such as the term co-mother, were insufficiently established. Openness, acceptance and understanding as well as being seen as a holistic family were considered important prerequisites for improving the quality of care. In addition, the inclusion of the non-pregnant mother was considered essential. Despite their non-traditional couple relationship, female couples wanted care without special status and prejudice. DISCUSSION AND CONCLUSION: A comprehensive socio-political discourse is still needed to promote the normality of family models beyond heteronormativity. Unbiased, supportive obstetric care can offer rainbow families a framework in which children can develop healthily from the outset.

[Taboo subject of miscarriage? - Anchoring through mechanisms at the medical, social, and organisational level "It broke my heart and that's just the way it is ..."] / Tabuthema Fehlgeburt? ­ Verankerung durch Mechanismen auf medizinischer, sozialer und organisationaler Ebene "Es hat mir mein Herz gebrochen und es ist halt so ...".

INTRODUCTION: Miscarriage is the most common complication of pregnancy. In this work, the experiences associated with miscarriage and their relevance for the women are analysed on different levels. METHOD: In May 2023, 14 guided interviews were conducted with women. The text material obtained will be brought to a higher level of abstraction using Mayring's content analysis approach and then interpreted. RESULTS: The results of the study underpin the significance of a miscarriage as a dramatic experience and the assumption of a broad taboo experienced as stressful. The deliberately chosen exchange among like-minded people, the concealment of the pregnancy and subsequently the miscarriage for reasons of shame, self-protection from professional disadvantages, and the assumption of overburdening the partner do not weigh as heavily as those mechanisms that operate in the health sector: at this level, mistrust, trivialisation and organisational and spatial inadequacies contribute to tabooing. The stressful circumstance of miscarriage is cushioned by people who recognise the grief and offer support. CONCLUSIONS: Based on the results of the study, improvements can be derived primarily in the area of care: Recognition of miscarriage, needs-based support services, improvement of communicative elements and organisational and spatial framework conditions.

Breastfeeding in primiparous women - expectations and reality: a prospective questionnaire survey.

BACKGROUND: Breastfeeding provides the optimal nutrition for infants and offers numerous benefits for both mother and child. The World Health Organisation recommends exclusive breastfeeding during the first 6 months of life and the introduction of complementary feeding between the fifth and seventh months of life. There is a discrepancy between breastfeeding recommendations and the actual duration of breastfeeding. The aim of this study was to analyse breastfeeding behaviour in primiparous women in order to be able to provide support for mothers. METHODS: In this prospective, questionnaire-based study conducted between 2020 and 2022, primiparous women were asked to complete three questionnaires at three defined survey time points (routine prepartum presentation, postpartum hospitalization, completed sixth month of life). RESULTS: A total of 140 women were included and returned all three questionnaires. Fifty-eight percent performed breastfeeding exclusively at least until their baby had reached the age of 6 months, whereas 20% already stopped within the first 6 months. The main reasons given for early cessation were insufficient milk supply and inadequate infant weight gain. A comprehensive level of prepartum knowledge had a significant positive effect on participants' sense of confidence with breastfeeding. Sociodemographic factors such as age and educational level were also associated with breastfeeding behaviour, but significant corresponding differences in the duration of breastfeeding were not observed. Women with postpartum midwifery care breastfed significantly longer (p < 0.05). CONCLUSIONS: Breastfeeding behaviour and duration are influenced by multiple factors. Although certain sociodemographic factors are unalterable, comprehensive prepartum knowledge transfer and postpartum midwifery care have a positive impact on breastfeeding behaviour. TRIAL REGISTRATION: The study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) on 6 December 2022 (DRKS00030763).

[Fathers' Experiences of Pregnancy, Birth and Postpartum During the Covid 19 Pandemic]. / Erfahrungen von Vätern zu Schwangerschaft, Geburt und Wochenbett während der Covid-19 Pandemie.

INTRODUCTION: In order to reduce the possible risk of infection by SARS-CoV-2, access restrictions have been introduced in all areas of public life. In extra- and intramural health care facilities, these measures also affect pregnant women, women giving birth, and women who have recently given birth as well as their partners. The aim of this study is to collect and reflect on the experiences of expectant fathers against the background of pandemic-related restrictions. METHOD: Following a qualitative study design, 11 guided interviews with fathers who experienced a birth during the Covid 19 pandemic were conducted in June 2022. Based on a content analysis according to Mayring, categories were derived, and the results from the interviews were transferred to a higher level of abstraction and interpreted. RESULTS: The fathers felt excluded, stressed and insecure due to the pandemic-related restrictions during pregnancy, birth, and the women's inpatient stay. Although there was understanding for the measures, there was a prevailing fear of not being able to support the partner sufficiently and of not having enough opportunities for bonding with the newborn. CONCLUSION: The results of the study make it clear that during the covid pandemic, the need for structured frameworks for the involvement of accompanying persons in the obstetric setting should receive increased attention. The active participation of partners in antenatal and birth care should be encouraged.

[The Influence of Maternal Obesity on Selected Obstetric Parameters]. / Der Einfluss von mütterlicher Adipositas auf ausgewählte geburtshilfliche Parameter.

INTRODUCTION: In Austria, the percentage of obese people increased by 5.2% between 1999 and 2014; 14.8% of women between the age of 15 to 45 are overweight. An increased body mass index (BMI) of women increases the risk of pathologies and irregularities during pregnancy, childbirth and the puerperium. In this work, the influence of maternal obesity on selected obstetric parameters is analyzed. METHODOLOGY: The data set includes all single births between 1.1.2008 and 31.12.2018 with a predictable BMI (n=640922) from the Austrian birth register. The maternal BMI was compared with the variables of age of the mother, parity, length of pregnancy, induction of labor, birth mode, child's APGAR value, child's umbilical cord pH value, and child's mortality and evaluated by means of a descriptive representation of the frequencies and bivariate analysis methods. RESULTS: A BMI of women ≥30 resulted in an increased rate of premature births, childbirth, Caesarean sections, neonatal APGAR values < 8 and ≤ 4, lower umbilical cord pH values of < 7.2 and increased rates of child mortality. In contrast, vaginal operative birth termination is less common. CONCLUSIONS: Obesity has a negative impact on various obstetric factors. Prevention should promote a healthy lifestyle before the onset of pregnancy.

Health professionals' views on maternity care for women with physical disabilities: a qualitative study.

BACKGROUND: During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS: The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS: Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION: The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.

Experiences of Austrian mothers with mobility or sensory impairments during pregnancy, childbirth and the puerperium: a qualitative study.

BACKGROUND: Approximately 8% of all women of childbearing age in Austria live with permanent impairments. In everyday life, women with disabilities face various challenges and discrimination, among which the issue of pregnancy and motherhood, in particular, is often considered taboo, and their parenting abilities are doubted. Knowledge in the medical field about the experiences of women with disabilities during pregnancy, childbirth and the puerperium is limited. METHODS: To investigate the personal meanings and experiences of women with disabilities in regard to pregnancy, childbirth and the puerperium, in-depth individual, semi-structured interviews were conducted with ten mothers with various mobility or sensory impairments who reside in Austria. The qualitative interview data were analyzed using the qualitative content analysis proposed by Mayring. RESULTS: Three main themes or categories emerged from the inductive content analysis, namely, (i) the social network, (ii) self-efficacy and self-awareness and (iii) communication, transparency and information. Participants reported limited acceptance of their life decisions and experienced an environment of discriminatory attitudes. They experienced a lack of support and lack of confidence in their parenting abilities, which negatively influenced their self-efficacy and self-awareness. Violations of personal borders and a feeling of being watched and controlled were reported. Communication with health care professionals was often characterized by mutual aspects of fear, uncertainty and awkwardness, as perceived by women with disabilities. Adequate information about pregnancy, childbirth and the puerperium, particularly about measures taken and interventions applied, was frequently missing. CONCLUSION: Heath care facilities need to be structured to ensure ease of access for women with disabilities. Education should be offered to health care professionals to improve knowledge about care for women with disabilities and to strengthen communication skills. All necessary information needs to be prepared and provided in an adequate manner. The establishment of a health-promoting environment for mothers, their children and their families requires a sensitive, respectful and non-judgmental attitude of society toward women with disabilities during pregnancy, childbirth and the puerperium.

Effect of nonpersistent pesticides on estrogen receptor, androgen receptor, and aryl hydrocarbon receptor.

Nonpersistent pesticides are considered less harmful for the environment, but their impact as endocrine disruptors has not been fully explored. The pesticide Switch was applied to grape vines, and the maximum residue concentration of its active ingredients was quantified. The transactivation potential of the pesticides Acorit, Frupica, Steward, Reldan, Switch, Cantus, Teldor, and Scala and their active compounds (hexythiazox, mepanipyrim, indoxacarb, chlorpyrifos-methyl, cyprodinil, fludioxonil, boscalid, fenhexamid, and pyrimethanil) were tested on human estrogen receptor α (ERα), androgen receptor (AR) and arylhydrocarbon receptor (AhR) in vitro. Relative binding affinities of the pure pesticide constituents for AR and their effect on human breast cancer and prostate cancer cell lines were evaluated. Residue concentrations of Switch's ingredients were below maximum residue limits. Fludioxonil and fenhexamid were ERα agonists (EC50 -values of 3.7 and 9.0 µM, respectively) and had time-dependent effects on endogenous ERα-target gene expression (cyclin D1, progesterone receptor, and nuclear respiratory factor 1) in MCF-7 human breast cancer cells. Fludioxonil, mepanipyrim, cyprodinil, pyrimethanil, and chlorpyrifos-methyl were AhR-agonists (EC50 s of 0.42, 0.77, 1.4, 4.6, and 5.1 µM, respectively). Weak AR binding was shown for chlorpyrifos-methyl, cyprodinil, fenhexamid, and fludioxonil. Assuming a total uptake which does not take metabolism and clearance rates into account, our in vitro evidence suggests that pesticides could activate pathways affecting hormonal balance, even within permitted limits, thus potentially acting as endocrine disruptors.

Obstetric and Neonatal Outcomes Following Hospital Transfers of Home Births and Births in Midwife-led Units in Austria.

Introduction: Home births and births in midwife-led units and the associated potential risks are still being debated. An analysis of the quality of results of planned home births and births in midwife-led units which require intrapartum transfer of the mother to hospital provides important information on the quality of processes during births which occur outside hospital settings. The aim of this study was to analyze neonatal and maternal outcomes after the initial plan to deliver at home or in a midwife-led unit had to be abandoned and the mother transferred to hospital. Material and Methods: The method used was an analysis of data obtained from the Austrian Birth Registry. The dataset consisted of singleton term pregnancies delivered in the period from 1 January 2017 to 31 December 2021 (n = 286056). For the analysis, two groups were created for comparison (planned hospital births and hospital births recorded in the Registry as births originally planned as home births or births in midwife-led units but which required a transfer to hospital) and assessed with regard to previously defined variables. Data were analyzed using frequency description, bivariate analysis and regression models. Results: In Austria, an average of 19% of planned home births have to be discontinued and the mother transferred to hospital. Home births and births in midwife-led units which require transfer of the mother to hospital are associated with higher intervention rates intrapartum, high rates of vacuum delivery, and higher emergency c-section rates compared to planned hospital births. Multifactorial regression analysis showed significantly higher risks of poorer scores for all neonatal outcome parameters (Apgar score, pH value, transfer rate). Conclusion: If a birth which was planned as a home delivery or as a delivery in a midwife-led unit fails to progress because of (possible) anomalies, the midwife must respond and transfer the mother to hospital. This leads to a higher percentage of clinical interventions occurring in hospital. From the perspective of clinical obstetrics, it is understandable, based on the existing data, that giving birth outside a clinical setting cannot be recommended.

Influence of Maternal Age on Selected Obstetric Parameters.

Introduction In recent decades, there has been a continuous rise in the average age at which women give birth. A maternal age of 35 years and above is considered an independent risk factor in pregnancy and birth, due to higher rates of intervention. This study investigates the influence of maternal age on birth procedure, gestational age, and rate of interventions during delivery. The influence of maternal parity is also analyzed. Material and Methods Data from the Austrian Register of Births was retrospectively collected and evaluated. The collected data was the data of all singleton live births in Austria between January 1, 2008 and December 31, 2016 (n = 686 272). Multiple births and stillbirths were excluded from the study. Maternal age and parity were analyzed in relation to predefined variables (birth procedure, gestational age, episiotomy in cases of vaginal delivery, epidural anesthesia in both vaginal and cesarean deliveries, and intrapartum micro-blood gas analysis). Statistical data was evaluated using (1) descriptive univariate analysis, (2) bivariate analysis, and (3) multinomial regression models. Results The cesarean section rate and the rate of surgically-assisted vaginal deliveries increased with advancing maternal age, especially in primiparous women, while the rate of spontaneous deliveries decreased with increasing maternal age. A parity of ≥ 2 had a protective effect on the cesarean section rate. The rate of premature births also increased with increasing maternal age, particularly among primiparous women. Discussion Although higher maternal age has a negative effect on various obstetric parameters, it was nevertheless not possible to identify a causal connection. Maternal age should not be assessed as an independent risk factor; other factors such as lifestyle or prior chronic disease and parity must be taken into consideration.