What Do We Know About Perinatal Sexuality? A Scoping Review on Sexoperinatality - Part II

The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. 

A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. 

Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. 

Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. 

Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.

Purchase full article [in French] at:   http://goo.gl/7zmy9k

By:   de Pierrepont C1, Polomeno V2, Bouchard L3, Reissing E4.

• 1Université d'Ottawa, Ottawa, Canada. Electronic address: catdep@hotmail.com.
• 2École des sciences infirmières, université d'Ottawa, Ottawa, Canada. Electronic address: vpolomen@uottawa.ca.
• 3Département de sociologie, institut de recherche sur la santé des populations, université d'Ottawa, Ottawa, Canada. Electronic address: louise.bouchard@uottawa.ca.
• 4École de psychologie, université d'Ottawa, Ottawa, Canada. Electronic address: reissing@uottawa.ca.
• J Gynecol Obstet Biol Reprod (Paris). 2016 Mar 14. pii: S0368-2315(15)00348-8. doi: 10.1016/j.jgyn.2015.11.001.
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Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District

Background
Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district.

Method

A cross-sectional survey was conducted in 2011 as part of the ‘Response to Accountable priority setting for Trust in health systems’ (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas.

Results

A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71–75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60–2.71%) than in rural areas 0.4% (95% CI 0.27–0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55–8.76).

Conclusions

Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths.

Below:  Distribution of health facilities with and without EmONC in Kapiri Mposhi, 2010

Below:  Basic and Comprehensive Emergency Obstetric and Neonatal Care

Full article at:   http://goo.gl/C4S0Hl

By:  

Selia Ng’anjo Phiri, Knut Fylkesnes, Karen Marie Moland

Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

Selia Ng’anjo Phiri, Knut Fylkesnes

Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia

Jens Byskov

Research Unit for Human Parasitology and the Environment, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 100, DK-1870 Frederiksberg C, Copenhagen, Denmark

Torvid Kiserud

Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway

Torvid Kiserud

Department of Clinical Science, University of Bergen, Bergen, Norway

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“You should go so that others can come”; The Role of Facilities in Determining an Early Departure After Childbirth in Morogoro Region, Tanzania

Background

Tanzania is among ten countries that account for a majority of the world’s newborn deaths. However, data on time-to-discharge after facility delivery, receipt of postpartum messaging by time to discharge and women’s experiences in the time preceding discharge from a facility after childbirth are limited.

Methods

Household survey of 1267 women who delivered in the preceding 2–14 months; in-depth interviews with 24 women, 12 husbands, and 5 community elders.

Results

Two-thirds of women with vaginal, uncomplicated births departed within 12 h; 90 % within 24 h, and 95 % within 48 h. Median departure times varied significantly across facilities (hospital: 23 h, health center: 10 h, dispensary: 7 h, p < 0.001).

Quantitative and qualitative data highlight the importance of type of facility and facility amenities in determining time-to-discharge. In multiple logistic regression, level of facility (hospital, health center, dispensary) was the only significant predictor of early discharge (p = 0.001). However across all types of facilities a majority of women depart before 24 h ranging from hospitals (54 %) to health centers (64 %) to dispensaries (74 %). Most women who experienced a delivery complication (56 %), gave birth by caesarean section (90 %), or gave birth to a pre-term baby (70 %) stayed longer than 24 h. Reasons for early discharge include: facility practices including discharge routines and working hours and facility-based discomforts for women and those who accompany them to facilities. Provision of postpartum counseling was inadequate regardless of time to discharge and regardless of type of facility where delivery occurred.

Conclusion

Our quantitative and qualitative findings indicate that the level of facility care and comforts existing or lacking in a facility have the greatest effect on time to discharge. This suggests that individual or interpersonal characteristics play a limited role in deciding whether a woman would stay for shorter or longer periods. Implementation of a policy of longer stay must incorporate enhanced postpartum counseling and should be sensitive to women’s perceptions that it is safe and beneficial to leave hospitals soon after birth.

Full article at:  http://goo.gl/hCgolx

By:  Shannon A. McMahon^15*, Diwakar Mohan¹, Amnesty E. LeFevre¹, Idda Mosha², Rose Mpembeni³, Rachel P. Chase¹, Abdullah H. Baqui¹⁴ and Peter J. Winch¹

¹Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore 21205-2179, MD, USA

²School of Public Health and Social Sciences, Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania

³School of Public Health and Social Sciences, Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania

⁴International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore 21205-2179, MD, USA

⁵Institute of Public Health, Ruprecht-Karls-Universität, Heidelberg, Germany

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'Birthgasm': A Literary Review of Orgasm as an Alternative Mode of Pain Relief in Childbirth

Childbirth is a fundamental component of a woman's sexual cycle. The sexuality of childbirth is not well recognized in Western society despite research showing that some women experience orgasm(s) during labor and childbirth. 

Current thinking supports the view that labor and childbirth are perceived to be physically painful events, and more women are relying on medical interventions for pain relief in labor. This review explores the potential of orgasm as a mode of pain relief in childbirth and outlines the physiological explanations for its occurrence. Potential barriers to sexual expression during childbirth and labor, including the influence of deeply held cultural beliefs about sexuality, the importance of privacy and intimacy in facilitating orgasmic birth experiences, and the value of including prospective fathers in the birthing experience, are discussed. 

The role of midwives and their perceptions of the use of complementary and alternative therapies for pain relief in labor are examined. While there are indications of widespread use of complementary and alternative therapies such as hydrotherapy, herbal remedies, and breathing techniques for pain relief in childbirth, orgasm was not among those mentioned. 

Lack of recognition of the sexuality of childbirth, despite findings that orgasm can attenuate the effects of labor pain, suggests the need for greater awareness among expectant parents, educators, and health professionals of the potential of orgasm as a means of pain relief in childbirth.

Purchase full article at:   http://goo.gl/V8YDs0

By:  Mayberry L1, Daniel J2.

• 1Curtin University L.Mayberry@curtin.edu.au.
• 2Curtin University. 

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How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania

Maternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access.

Data on health facilities’ location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites.

About half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District). Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours’ walking time.

Our findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services in resource-limited settings.

Below:  Location map of Ludewa and Iringa Districts

Below: Catchment area estimated by raster analysis.

The areas around health facilities represent a 2 hours’ catchment divided in 20 minutes’ intervals. (A) Iringa District current scenario with all delivery sites; (B) Iringa District proposed scenario with reduced number of delivery sites; (C) Ludewa District current scenario with all delivery sites; (D) Ludewa District proposed scenario with reduced number of delivery sites. The grey shades delimit the areas that will loose accessibility within 2 hours by a 40% reduction of delivery sites.

Full article at: http://goo.gl/K7aCF0

By:

Piera Fogliati, Giovanni Putoto

Doctors with Africa–CUAMM, Padua, Italy

Manuela Straneo, Gaetano Azzimonti

Doctors with Africa–CUAMM, Iringa, Tanzania

Cosimo Brogi, Pier Lorenzo Fantozzi

Department of Physical Sciences, Earth and Environment, University of Siena, Siena, Italy

Robert Mahimbo Salim

Regional Medical Office, Iringa Region, Iringa, Tanzania

Hamis Mwendo Msengi

Council Medical Office, Ludewa District Council, Ludewa, Tanzania

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Birth Location Preferences of Mothers and Fathers in Rural Ghana: Implications for Pregnancy, Labor and Birth Outcomes

Below:  Birth location preferences. Number of mothers and fathers who preferred health facility birth compared with those who preferred homebirth

Birth delivery location preferences were split for mothers (home delivery–9; facility delivery–11), and fathers (home delivery–7; facility delivery–11). We identified two patterns of preferences and birth outcomes: 1) preference for homebirth that resulted in delayed care seeking and was likely associated with several cases of stillbirths and postpartum morbidities; 2) Preference for health facility birth that resulted in early care seeking, and possibly enabled women to avoid adverse effects of birth complications.

Safe pregnancy and childbirth interventions should be tailored to the birth location preferences of mothers and fathers, and should include education on the development of birth preparedness plans to access timely delivery related care. Improving access to and the quality of care at health facilities will also be crucial to facilitating use of facility-based delivery care in rural Ghana.

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Cost-effectiveness of a repeat HIV test in pregnancy in India

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Exceptionally Deadly: Death from Childbirth Is Unusually Common in America

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The Color of Risk: U.S. Maternal Mortality Rate

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