MATERNAL SUPPORT IN THE DELIVERY ROOM: RESULTS

5 Dec
2009

Three-hundred-twelve African-American women were interviewed. These included 104 cases, mothers of VLBW infants, and 208 controls, whose infants were of NBW. Approximately 5% of women approached as potential controls declined to participate. The refusal rate among potential cases was less than 2%.

Table 1. Characteristics of the African-American Mothers of Very-Low-Birth weight

Variable                      Percent of 104 VLBW Cases

Percent of 208 NBW Controls  OR

95% CI

Maternal Age

Less than 19 (vs all older)

27

31

0.8

0.5-1.4

30 or older (vs all younger)

28

17

1.9*

1.0-3.3

Maternal Education <12 years

31

39

0.7

0.4-1.2

Not married or living together

59

64

0.9

0.6-1.5

Late or no prenatal care

31

39

0.7

0.4-1.7

Parity

First pregnancy vs all others

48

49

0.9

0.6-1.5

Fourth or higher pregnancy vs less

14

15

0.9

0.4-1.7

Cigarette smoking

30

21

1.6

0.9-2.8

Alcohol use

18

15

1.2

0.7-2.3

Income <$11,000

42

49

0.8

0.4-1.4

Did not want the pregnancy

35

43

0.7

0.4-1.1

Undesirable timing ot pregnancy

63

65

0.9

0.5-1.6

Stressful life events

One or more vs none

83

74

1.7

0.9-3.2

Exposure to racial discrimination

1 or more domain vs none

56

40

1.9*

1.2-3.0

3 or more domains vs none

19

8

2.7*

1.3-5.4

No companion in delivery room

56

27

3.5*

2.1-5.8

*P<0.05

Table 1 presents the characteristics of the African-American mothers of VLBW and NBW infants. Several risk factors that have been associated with increased risk of preterm birth in previous studies were found to have odds ratios (OR) for VLBW close to or less than 1.0. These included maternal age of 19 or younger, education of 11 years or less, low income, being unmarried, receiv­ing late or no prenatal care, being of first or of very high parity, and having an undesired pregnancy. Maternal age of 30 or above was associated with a significant increased risk. Alcohol use, cigarette smoking, and experiencing one or more stressful life events during pregnancy were associated with moderate but not statistically significant increased odds of birthweight below 1,500 g.
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In contrast, exposure to perceived racial discrimination in one or more areas of experience and being alone in the delivery room—that is, not having a family member or other support person present at the time of birth—were associated with a two- and three-and-a-half-fold increase in the odds of VLBW, respectively. Among women with a companion in the delivery room, the baby’s father was the only support person present for 35% of the mothers of NBW infants and 21% of the mothers of VLBW infants. The maternal grandmother was the sole support person present for 17% of the mothers of NBW infants, compared to 13% of the mothers of VLBW infants. Both father and grandmother were present for 4% of the mothers with NBW and 2% for the mothers of VLB W infants.

Table 2. Relation Among Social Environment Religion, and Birth weight

Variable                                                          Percent of 104

VLBW Cases

Percent of 208 NBW Controls

OR

95% CI

Lived in your neighborhood less than two years35

30

1.30.8 -2.0
Mother alone in the home versus with one or more adults19

15

1.40.7- 2.6
Where do most family live out of town versus in town72

63

1.50.9-2.5
Relatives other than children seen daily (0 or 1 versus >1)16

10

1.70.8-3.4
People to take care of children if needed for few hours (0 or 1 versus >1)13

20

0.70.4-1.4
Get a car ride in few hours (no versus yes)11

12

0.80.3-2.1
Number of people to count on in times of need (0 or 1 versus >1)12

11

1.10.6-2.4
Satisfaction with how partner let her know how he feels (not satisfied vs satisfied)21

20

1.10.6-2.0
Other adults with whom mother has regular talks (no versus yes)10

16

0.60.3-1.2
Satisfaction with these talks (not satisfied versus satisfied)5

2

3.20.8-13.8
Religious denomination (none versus Baptist and others)18

26

0.60.4-1.1
How religious are you? (not very versus very)How often attend religious services (rarely versus often)31 5042 500.6 0.90.4-1.0 0.6-1.6

Social Support and Religion

To further explore the role of social and cultural context in VLBW, we analyzed responses to 11 questions about social support from friends and family and three questions concerning religion. Results are reported in Table 2. No OR, whether for tangible or emotional support, was significantly different from unity, and only two exceeded 1.5. Thus, none is likely to be a significant predictor of VLBW. Of all the questions considered, mothers “not satisfied with the talks with an adult support person” yielded the highest OR at 3.2. The point estimate would suggest a strong effect, but the prevalence was very low—5% and 2% for mothers of VLBW and NBW, respectively. Therefore, the confidence interval (CI) was quite wide. The second highest OR (1.7) was for “no relatives seen daily” and was somewhat more common. As shown in Table 2, the majority of the mothers of VLBW and NBW infants did belong to a religious denomination. However, half of the mothers in each group rarely attended religious services. All ORs for religious variables were less than 1, and none reached statistical significance.
Analysis of Support in the Delivery Room

Since the mothers of VLBW and NBW infants appeared similar in regard to social support with the exception of their support in the delivery room, we considered the characteristics of the mothers who were alone in the delivery room versus those accompanied by a companion, looking for possible confounding factors. One possibility was the existence of administrative or medical circumstances separating the mother from her family, such as emergency transport to another hospital. Omitting the transferred women did not change the result; however, (OR for VLBW among nontransported ‘alone’ women was 3.5 [2.0-6.4]). Also, we did observe that women in one of our two hospitals were, on average, 60% more likely to be without a support person in the delivery room than women delivering at the other facility, possibly reflecting differences in hospital policies or in the populations served. However, when we looked at the association between VLBW and ‘alone’ at the two hospitals, it was nearly identical (3.0 and 3.5, respectively).

Table 3. Characteristics of African-American Mothers Alone and Not Alone in the Delivery Room

Variable

Percent of ‘Alone’ MothersPercent of ‘Not Alone’ Mothers

OR

95% CI

Maternal Age

Less than 20 years

2432

0.7

0.4-1.1

30 or older

2718

1.7

0.9-3.0

Maternal education <12 years

3934

1.2

0.7-1.9

Not married or living together

6665

1.0

0.6-1.7

Late or no prenatal care

4531

1.8*

1.1-3.0

Parity

First pregnancy versus all others

3655

0.5*

0.3-0.7

Fourth or higher pregnancy versus less

2112

1.9*

1.0-3.8

Cigarette smoking

2823

1.3

0.8-2.3

Alcohol use

1717

1.0

0.6-2.0

Income <$11,000

4747

0.9

0.5-1.8

Did not want the pregnancy?

5434

2.4*

1.5-3.8

Undesirable timing of pregnancy

5464

0.7

0.3-1.3

Stressful life events (one or more versus none)    86

73

2.1*

1.1-4.1

Exposure to racial discrimination

One or more domain versus none

4845

1.1

0.7-1.8

Three or more domains versus none

1212

0.9

0.5-2.0

*P<0.05

Another potential source of confounding could be variables known to be associated with VLBW, which may have been unevenly distributed between women with and without delivery room support. Indeed, Table 3 shows that the mothers without a support person in the delivery room were significantly more likely to have had late to no prenatal care, to be 30 years or more of age, of high parity, to have an unwanted pregnancy, or to have experienced one or more stressful life events during pregnancy. pharmacy uk

Confounding by the factors noted above was ruled out, however. When we looked at the VLBW odds for mothers with and without delivery room support at each level of the potential confounding factors, we found that most values were similar to the crude OR of 3.5 found in the unstratified sample.

Table 4. Modifications of the Effects of Stress Variables on VLBW Risk by the Presence or Absence of a Delivery Room Support Person

VariableAll subjects (N=312) OR             95% CIAlone in DR (N=111) OR             95% CINot Alone in DR (N=194) OR                   95% CI
Stressful life events (one or more)1.70.9-3.20.70.2-2.01.90.8-4.8
Perceived racism (one or more)1.9*1.2-3.01.70.8-3.71.9*1.0-3.9
Perceived racism (three or more)2.7*1.3-5.41.60.5-5.22.2*1.0-4.8
*p<0.05

As a final aspect of the analysis of delivery room support, we looked for a moderating impact of social support on the VLBW risk associated with other factors. These results appear in Table 4. Theoretically, one benefit of social support should be to reduce the impact by buffering its adverse psychophysiologic effects. If this were the case, we might expect the increased risk of VLBW associated with stressful life events, for example, to be lessened for individuals with a strong social support system in place. Our data did not support this theory. Thus, when VLBW ORs for the two strata of women (‘alone’ and ‘not alone’) were compared to the unstratified group OR for two such stressors—stressful life events and racial discrimination—the VLBW risk for the women with social support was higher than for the women without support. However, because of the small sample size, most OR values fall within the CIs of the other strata.

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