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B Chalmers

Publications and source records attributed to B Chalmers.

At least 19 recordsLinked to original sources
PubMed2006

Why do women go along with this stuff?

PREFACE: Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early mother-infant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidence-based obstetrics, but do not practice it consistently, if at all. Why do women go along with this stuff? In this Roundtable Discussion, Part 1, we asked some maternity care professionals and advocates to discuss this question.

Analgesia, Epidural↗
PubMed2004

A report of women's birth experiences in Baku, Azerbaijan.

The findings from a survey exploring women's perceptions of their care during pregnancy, birth and the postpartum period in Baku, Azerbaijan, initiated by the Ministry of Health and UNICEF, are reported here. In the former Soviet Union, on which the perinatal health care systems of Azerbaijan are based, care for women during the perinatal period was based on using available technology and on a physician-centred model of care. Women's perceptions of their care were infrequently if ever sought or heeded. As healthcare systems are being strengthened in these countries, there is an increasing interest in providing a woman-centered or family-centered approach to care as well as offering appropriate medical care birthing procedures. This study explores the progress made in Azerbaijan in implementing such changes since the introduction of a perinatal reform process a few years ago. Findings indicate some significant deviations from traditional maternity care practices in Baku since the breakdown of the Soviet Union. A more humanistic and evidence-based approach to care is being introduced. It is evident that maternity houses in Baku are also providing better support for infant feeding than many of their former Soviet Union counterparts indicating the effective implementation of the principles of breastfeeding encouraged through the WHO/UNICEF Baby Friendly Hospital Initiative program in that country.

Adolescent↗
PubMed2004

Does previous infection protect against atopic eczema and recurrent wheeze in infancy?

BACKGROUND: Frequent infection in infancy and early childhood has been hypothesized to explain the low prevalence of asthma and other atopic disease among children in developing countries (the so-called 'hygiene hypothesis'), but the low prevalence in Eastern Europe remains unexplained. OBJECTIVE: To test the hygiene hypothesis in the Republic of Belarus by examining the relationship between gastrointestinal (GI) and respiratory infection and two potentially atopic outcomes in the first 12 months of life: atopic eczema and recurrent wheeze. METHODS; We carried out two case-control studies nested within a large (n=17 046) randomized trial in Belarus, with cases defined as (1) first occurrence of atopic eczema (n=819) and (2) second episode of wheezing (n=112). Incidence density sampling was used to select four matched controls born within 1 month at the same hospital as the case. Exposure was defined as one or more episodes of GI or respiratory infection (examined separately) with onset >7 days before onset of the case's atopic outcome. Analyses controlled for family atopic history, duration of exclusive breastfeeding, sex, birth weight, maternal education, and (for recurrent wheeze) maternal smoking. RESULTS: For atopic eczema, prior GI infection occurred in 7.4% of cases vs. 6.0% of controls [adjusted OR=1.27 (0.94-1.72)] and prior respiratory infection in 35.2% vs. 32.6% [adjusted OR=1.14 (95% CI=0.94-1.37)]. For recurrent wheeze, prior GI infection occurred in 9.8% of cases vs. 7.4% of controls [adjusted OR=1.30 (0.60-2.82)]. CONCLUSION: Our results do not support the hypothesis that infection protects against atopic eczema or recurrent wheezing in the first 12 months of life.

Adult↗
PubMed2001

Assessing effective care in normal labor: the Bologna score.

The intention of the "Bologna score" is to quantify, both in an individual labor and in a wider population, the extent to which labors have been managed as if they are normal as opposed to complicated. In this way it may be possible to assess both attitudes and practices within a maternity service toward the effective care of normal labor. A scoring system for normal labor was proposed at the World Health Organization (Regional Office for Europe) Task Force Meeting on Monitoring and Evaluation of Perinatal Care, held in Bologna in January 2000. This paper describes conceptual development of the scale. Recommendations for future evaluation of the Bologna score's validity and potential include field testing globally, comparison with the Apgar score, and evaluation of the relative weight contributed by each of the five measures comprising the Bologna score.

Female↗
PubMed2001

WHO principles of perinatal care: the essential antenatal, perinatal, and postpartum care course.

World Health Organization (WHO) recommendations and meta-analyses of controlled trials have concluded that inappropriate perinatal care and technology continue to be practiced widely throughout the world, despite the acceptance of evidence-based principles and care. The WHO Regional Office for Europe, in consultation with policy makers and reproductive health experts recently proposed ten "Principles of Perinatal Care," which have been endorsed by the reproductive health units of most member states. A comprehensive training program, based on the principles, is now being offered throughout the European region. This paper describes the development of the WHO principles and the WHO training course "Essential Antenatal, Perinatal and Postpartum Care." Together they provide an innovative model of evidence-based and psychosocially sensitive care for the future guidance of perinatal policy makers and caregivers worldwide.

Female↗
PubMed2000

432 Somali women's birth experiences in Canada after earlier female genital mutilation.

BACKGROUND: Women with previous female genital mutilation (sometimes referred to as circumcision) are migrating, with increasing frequency, to countries where this practice is uncommon. Many health care professionals in these countries lack experience in assisting women with female genital mutilation during pregnancy and birth, and they are usually untrained in this aspect of care. Somali women who customarily practice the most extensive form of female mutilation, who were resident in Ontario and had recently given birth to a baby in Canada, were surveyed to explore their perceptions of perinatal care and their earlier genital mutilation experiences. METHOD: Interviews of 432 Somali women with previous female genital mutilation, who had given birth to a baby in Canada in the past five years, were conducted at their homes by a Somali woman interviewer. RESULTS: Findings suggested that women's needs are not always adequately met during their pregnancy and birth care. Women reported unhappiness with both clinical practice and quality of care. CONCLUSIONS: Changes in clinical obstetric practice are necessary to incorporate women's perceptions and needs, to use fewer interventions, and to demonstrate greater sensitivity for cross-cultural practices and more respectful treatment than is currently available in the present system of care.

Canada↗
PubMed2000

Promotion of breastfeeding intervention trial (PROBIT): a cluster-randomized trial in the Republic of Belarus. Design, follow-up, and data validation.

This paper summarizes the objectives, design, follow-up, and data validation of a cluster-randomized trial of a breastfeeding promotion intervention modeled on the WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI). Thirty-four hospitals and their affiliated polyclinics in the Republic of Belarus were randomized to receive BFHI training of medical, midwifery, and nursing staffs (experimental group) or to continue their routine practices (control group). All breastfeeding mother-infant dyads were considered eligible for inclusion in the study if the infant was singleton, born at > or = 37 weeks gestation, weighed > or = 2500 grams at birth, and had a 5-minute Apgar score > or = 5, and neither mother nor infant had a medical condition for which breastfeeding was contraindicated. One experimental and one control site refused to accept their randomized allocation and dropped out of the trial. A total of 17,795 mothers were recruited at the 32 remaining sites, and their infants were followed up at 1, 2, 3, 6, 9, and 12 months of age. To our knowledge, this is the largest randomized trial ever undertaken in area of human milk and lactation. Monitoring visits of all experimental and control maternity hospitals and polyclinics were undertaken prior to recruitment and twice more during recruitment and follow-up to ensure compliance with the randomized allocation. Major study outcomes include the occurrence of > or = 1 episode of gastrointestinal infection, > or = 2 respiratory infections, and the duration of breastfeeding, and are analyzed according to randomized allocation ("intention to treat"). One of the 32 remaining study sites was dropped from the trial because of apparently falsified follow-up data, as suggested by an unrealistically low incidence of infection and unrealistically long duration of breastfeeding, and as confirmed by subsequent data audit of polyclinic charts and interviews with mothers of 64 randomly-selected study infants at the site. Smaller random audits at each of the remaining sites showed extremely high concordance between the PROBIT data forms and both the polyclinic charts and maternal interviews, with no evident difference in under- or over-reporting in experimental vs control sites. Of the 17,046 infants recruited from the 31 participating study sites, 16,491 (96.7%) completed the study and only 555 (3.3%) were lost to follow-up. PROBIT's results should help inform decision-making for clinicians, hospitals, industry, and governments concerning the support, protection, and promotion of breastfeeding.

Adult↗
PubMed1999

What women say about antenatal care in St Petersburg, Russian Federation.

A capacity building program for professionals in maternal and child health care in St Petersburg, Russian Federation, commenced in 1994. The program was designed to provide 12 workshops in evidence-based antenatal and intrapartum care, as well as appropriate preparation of parents for pregnancy, birth and parenthood, for health care professionals in the city. As part of this program women's observations on the quality of their maternity care services during their transition to parenthood were explored. These reports reflect maternity care practices in the former Soviet Union.

Adult↗
PubMed1998

Using the ALPHA form in practice to assess antenatal psychosocial health. Antenatal Psychosocial Health Assessment.

BACKGROUND: The assessment of the psychosocial health of pregnant women and their families, although recommended, is not carried out by most practitioners. One reason is the lack of a practical and evidence-based tool. In response, a multidisciplinary group created the Antenatal Psychosocial Health Assessment (ALPHA) form. This article describes the development of this tool and experience with it in an initial field trial. METHODS: A systematic literature review revealed 15 antenatal psychosocial risk factors associated with poor postpartum family outcomes of woman abuse, child abuse, postpartum depression, marital/couple dysfunction and increased physical illness. The ALPHA form, incorporating these risk factors, was developed and refined through several focus groups. It was then used by 5 obstetricians, 10 family physicians, 7 midwives and 4 antenatal clinic nurses in various urban, rural and culturally diverse locations across Ontario. After 3 months, these health care providers met in focus groups to discuss their experiences. A sample of pregnant women assessed using the ALPHA form were interviewed about their experience as well. Results were analysed according to qualitative methods. RESULTS: The final version of the ALPHA form grouped the 15 risk factors into 4 categories--family factors, maternal factors, substance abuse and family violence--with suggested questions for each area of enquiry. The health care providers uniformly reported that the form helped them to uncover new and often surprising information, even when the women were well known to them. Incorporating the form into practice was usually accomplished after a period of familiarization. Most of the providers said the form was useful and would continue to use it if it became part of standard care. The pregnant women in the sample said they valued the enquiry and felt comfortable with the process, unless there were large cultural barriers. INTERPRETATION: The ALPHA form appears to be an important tool in assessing psychosocial health in pregnancy and to be readily integrated into practice. More study is required to quantify the number of risks identified and resources used, to determine the form's reliability and validity and, ultimately, to assess the effect of its use on postpartum outcomes.

Domestic Violence↗
PubMed1998

Women's experiences of birth in St. Petersburg, Russian Federation, following a maternal and child health intervention program.

BACKGROUND: An educational program for professionals in maternal and child health care in St. Petersburg, Russian Federation, was conducted between 1994 and 1997. METHODS: The program was designed to provide 12 workshops in evidence-based antenatal and intrapartum care, and appropriate preparation of parents for pregnancy, birth, and parenthood for health care professionals in the city. RESULTS: Observations on the quality of maternity care service provided for women at the start and after the completion of the intervention program are reported. Significant changes occurred in maternity care practices during the period in which training programs were offered in St. Petersburg. In particular, more family centered care services were introduced, and breastfeeding practices improved. Significant reductions in maternal and perinatal mortality occurred. CONCLUSIONS: Most maternity hospitals showed a reduction in the use of interventions in delivery over the period of study, although one or two showed tendencies to follow in their Western counterparts' footsteps, including the emergence of a high cesarean delivery rate. This is not yet a cause for concern, but is worth future monitoring by local authorities.

Adult↗
PubMed1998

Psychosomatic obstetrics and gynecology in the next millennium: some thoughts and observations.

While the importance of psychosocial and cultural issues inobstetric care has been increasingly acknowledged in recent decades there is still neglect and misunderstanding of what women want during pregnancy, birth and the postpartum period with regard to their care by health care providers. This paper highlights significant issues of concern which should be of value for caregivers, educators and health service planners as we move into the next millenium.

Female↗
PubMed1998

[Dietary intake of different forms of iron and other factors of anemia epidemiology in women of childbearing age in S. Petersburg].

Actual nutritional status and dietary intake of different iron forms of the women in Sankt-Peterburg were investigated. The concentration of blood hemoglobin was studied. Signs of deficiency of nutrition of the investigated women were not found both by analysis of foodstuffs and energy intake and by anthropometric estimation of nutritional status.

Abortion, Induced↗
PubMed1997

Childbirth in eastern Europe.

Women's experiences of pregnancy and childbirth in the countries of central and eastern Europe are explored in this paper. A capacity building intervention programme in St Petersburg, Russia, which attempts to reform practices within the city, is described. The difficulties inherent in integrating differing cultural approaches to childbirth are highlighted.

Cultural Characteristics↗
PubMed1997

Reducing maternal mortality in St Petersburg.

Following the entry of St Petersburg into Europe's Healthy Cities Project in 1991 it was decided that the highest priority should be given to reducing the city's maternal mortality ratio, then standing at approximately 70 deaths per 100,000 live births. Preventing deaths from unsafe, illegal abortion became the main focus of attention. The use of modern contraceptive methods was promoted, information was disseminated to improve the utilization of family planning services, special outreach services for teenagers were established, and providers were given opportunities for education and training. The maternal mortality ratio and the abortion rate have now declined and contraceptive use appears to be increasing. These achievements are attributable in large measure to the commitment of a broad spectrum of St Petersburg society as well as to outside support.

Adolescent↗
PubMed1996

What men say about pregnancy, birth and parenthood.

Fathers' experiences during their transition to parenthood have been less well documented than those of mothers. This study explored the perceptions of three groups of fathers: fathers were asked to complete a questionnaire covering their experiences during their partner's pregnancy, during antenatal preparation programs or during birth. Fathers in all three groups were asked to respond to a follow-up questionnaire about parenthood. Their views are reported.

Adolescent↗