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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.
"Research
Briefs" is written by Joan Schwartz in the Office of the Provost. To read
more about BU research, visit http://www.bu.edu/research.
6
December 2002
Boston University
Office of University Relations