High-tech labor. There are about four million births every year in the United States, and according to the first national survey of women’s pregnancy, labor, and postpartum experiences, entitled Listening to Mothers, an overwhelming number of these are technology-intensive. The study surveyed 1,583 women between the ages of 18 and 44 who had given birth within the 24 months preceding the survey.
The survey reports that 93 percent of the women had electronic fetal monitoring during labor, 86 percent were given an intravenous drip, 63 percent had epidural analgesia, 55 percent experienced artificial rupture of the membranes surrounding the baby, and 53 percent were given oxytocin to artificially strengthen contractions.
“These high rates of intervention raise questions about how often procedures appropriately developed for use on mothers in high-risk situations are now being applied routinely,” says Eugene Declercq, a professor of maternal and child health at the School of Public Health and the lead author of the report.
Almost half of the women said that their caregiver had tried to induce labor, and one-third of those cited a nonmedical factor as at least a partial reason. Almost two-thirds were given epidural analgesia, and gave it high ratings for pain relief, but a significant number were unaware of possible side effects. Also, alternative methods of pain control, including immersion in a tub, showering, and the use of “birth balls,” received high ratings for effectiveness, but were used by 8 percent or fewer of the women.
Almost 3 in 10 mothers said that they had never met or only briefly had met the person who delivered their baby before the birth. Doulas (trained labor assistants) and midwives, who typically develop a long-term relationship with a pregnant woman and stay through labor and birth, were the most highly rated providers of labor support, yet they were used far less frequently than other health-care providers.
The survey also asked the mothers about their postpartum physical and mental health. Five out of six who had undergone a cesarean section reported pain at the incision site in the first two months and 7 percent reported continuing pain at least six months after birth. In terms of mental health, almost one in five was experiencing some degree of postpartum depression in the week prior to the survey, the first time such a figure has been reported at the national level.
The full report is available online at http://www.maternitywise.org/listeningtomothers/.
Hostility hurts. Angry people are likely to hurt not only those around them, but themselves as well, according to a study by Avron Spiro III, a School of Public Health assistant professor of epidemiology, and colleagues at Brown University, the University of Memphis, Harvard Medical School, and the Boston VA Medical Center. Their research revealed that high levels of hostility more accurately predict coronary heart disease (CHD) than do traditional risk factors such as high cholesterol, high blood pressure, smoking, and excessive weight.
The researchers followed nearly 800 men enrolled in the Veterans Administration Normative Aging Study over a three-year period between 1986 and 1989. They measured the hostility levels of the men, who averaged 60 years old, were predominantly Caucasian, had a high school education, and were free of chronic medical conditions, using the Cook-Medley Ho Scale, a widely used personality test. They also examined the results of physical exams and blood tests for factors associated with the metabolic syndrome, a collection of disorders highly correlated with CHD that includes obesity, insulin resistance, hyperglycemia (high blood sugar), high blood cholesterol, and high blood pressure.
Independent of any other risk factors, the men with higher levels of hostility had a higher incidence of CHD. Furthermore, those with the highest levels of hostility were at the greatest risk for heart disease. Level of HDL (the so-called good cholesterol) was the only metabolic measure found to be predictive of CHD -- high levels were associated with lower risk of disease.
The authors caution that there is not yet a clear understanding of the mechanisms behind this relationship -- it may be that a high level of hostility is somehow related to cardiac arrhythmia or to imbalances in the nervous or endocrine systems. They also note that the subjects of this study are a relatively homogeneous group and healthier than average since their health was closely monitored during the 40 years of their participation in the VA Normative Aging Study. They suggest that future studies should include a more general and representative population, including younger people, women, and people of color.
“Still, this study is interesting,” says Spiro, “because it reinforces the body of evidence that personality factors do play a role in health outcomes.”
The research was published in the November issue of Health Psychology and is available online at: http://www.apa.org/journals/hea/press_releases/november_2002/hea216588.html.
Briefs" is written by Joan Schwartz in the Office of the Provost. To read
more about BU research, visit http://www.bu.edu/research.