Childbirth - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

CHILDBIRTH A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Childbirth: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83861-5 1. Childbirth-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on childbirth. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CHILDBIRTH .............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Childbirth...................................................................................... 5 E-Journals: PubMed Central ....................................................................................................... 24 The National Library of Medicine: PubMed ................................................................................ 25 CHAPTER 2. NUTRITION AND CHILDBIRTH .................................................................................... 61 Overview...................................................................................................................................... 61 Finding Nutrition Studies on Childbirth..................................................................................... 61 Federal Resources on Nutrition ................................................................................................... 64 Additional Web Resources ........................................................................................................... 64 CHAPTER 3. ALTERNATIVE MEDICINE AND CHILDBIRTH .............................................................. 67 Overview...................................................................................................................................... 67 The Combined Health Information Database............................................................................... 67 National Center for Complementary and Alternative Medicine.................................................. 68 Additional Web Resources ........................................................................................................... 78 General References ....................................................................................................................... 81 CHAPTER 4. DISSERTATIONS ON CHILDBIRTH ................................................................................ 83 Overview...................................................................................................................................... 83 Dissertations on Childbirth.......................................................................................................... 83 Keeping Current .......................................................................................................................... 92 CHAPTER 5. CLINICAL TRIALS AND CHILDBIRTH .......................................................................... 93 Overview...................................................................................................................................... 93 Recent Trials on Childbirth.......................................................................................................... 93 Keeping Current on Clinical Trials ............................................................................................. 94 CHAPTER 6. PATENTS ON CHILDBIRTH .......................................................................................... 97 Overview...................................................................................................................................... 97 Patents on Childbirth................................................................................................................... 97 Patent Applications on Childbirth ............................................................................................. 124 Keeping Current ........................................................................................................................ 129 CHAPTER 7. BOOKS ON CHILDBIRTH ............................................................................................ 131 Overview.................................................................................................................................... 131 Book Summaries: Federal Agencies............................................................................................ 131 Book Summaries: Online Booksellers......................................................................................... 132 The National Library of Medicine Book Index ........................................................................... 132 Chapters on Childbirth............................................................................................................... 134 Directories.................................................................................................................................. 135 CHAPTER 8. MULTIMEDIA ON CHILDBIRTH ................................................................................. 137 Overview.................................................................................................................................... 137 Video Recordings ....................................................................................................................... 137 Audio Recordings....................................................................................................................... 140 Bibliography: Multimedia on Childbirth ................................................................................... 140 CHAPTER 9. PERIODICALS AND NEWS ON CHILDBIRTH .............................................................. 143 Overview.................................................................................................................................... 143 News Services and Press Releases.............................................................................................. 143 Newsletters on Childbirth .......................................................................................................... 146 Newsletter Articles .................................................................................................................... 147 Academic Periodicals covering Childbirth ................................................................................. 150 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 153 Overview.................................................................................................................................... 153

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NIH Guidelines.......................................................................................................................... 153 NIH Databases........................................................................................................................... 155 Other Commercial Databases..................................................................................................... 159 APPENDIX B. PATIENT RESOURCES ............................................................................................... 161 Overview.................................................................................................................................... 161 Patient Guideline Sources.......................................................................................................... 161 Finding Associations.................................................................................................................. 167 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 169 Overview.................................................................................................................................... 169 Preparation................................................................................................................................. 169 Finding a Local Medical Library................................................................................................ 169 Medical Libraries in the U.S. and Canada ................................................................................. 169 ONLINE GLOSSARIES................................................................................................................ 175 Online Dictionary Directories ................................................................................................... 176 CHILDBIRTH DICTIONARY..................................................................................................... 177 INDEX .............................................................................................................................................. 221

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with childbirth is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about childbirth, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to childbirth, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on childbirth. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to childbirth, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on childbirth. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CHILDBIRTH Overview In this chapter, we will show you how to locate peer-reviewed references and studies on childbirth.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and childbirth, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “childbirth” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Gene Linked to Weight Retention After Childbirth Source: Healthy Weight Journal. p.51. July/August 2000. Contact: B.C. Decker, Inc. 4 Hughson St. South, O.O. Box 620, LCD1, Hamilton, Ontario L8N 3K7, Canada. 800-568-7281. 905-522-7017. [email protected]. Summary: A single gene may be involved in both high body weight in women after childbirth and in low birth weight of infants. Research in Germany based on genotyping of 792 women found that those who are homozygous carriers of the 825T allele of the gene encoding the beta-3 subunit of heterotrimeric G proteins (also called GNB3) have a high risk of retaining much of the weight gained during their first pregnancy. Highly active women with the gene avoid this risk. The same gene appears to be associated with low birth weight in infants who are otherwise not at high risk. According to an

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accompanying editorial, these results are consistent with the idea that the GNB3 825T allele is a marker of adverse metabolic phenotypes. •

Changes in Pelvic Muscle Strength and Stress Urinary Incontinence Associated With Childbirth Source: Journal of Obstetric, Gynecological, and Neonatal Nursing. 19(5): 371-377. September-October 1990. Summary: This article reports on a study in which pelvic muscle strength and stress urinary incontinence were studied in 20 nulliparous women at 32 to 36 antepartum weeks and 6 postpartum weeks. Measures used included a digital muscle strength score, observed incontinence, and urine flow interruption. Pelvic muscle strength declined from the antepartum to postpartum periods in women with vaginal births; however, women with greater antepartal pelvic muscle strength tended to preserve a higher level of strength during the postpartum period. In general, less pelvic muscle strength was found in women who demonstrated stress urinary incontinence. 2 figures. 2 tables. 25 references. (AA).

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Prevalent Urinary Incontinence as a Correlate of Pregnancy, Vaginal Childbirth, and Obstetric Techniques Source: American Journal of Public Health. 89(2): 209-212. February 1999. Summary: This article reports on a study that examined the association between pregnancy, vaginal childbirth, and obstetric techniques, and the prevalence of urinary incontinence among adult women aged 20 to 59 years. The cross sectional survey enrolled a random sample of 6,240 women aged 20 to 59 years who were mailed a self administered questionnaire focusing on urinary incontinence (UI) and other health variables. More than 75 percent of the women responded. The present analysis includes 4,345 women who were not pregnant and did not experience a vaginal childbirth during 1994. Results showed increases in relation to UI during pregnancy, UI immediately after a vaginal childbirth, and age of 30 years or more at the second vaginal childbirth. No multivariate associations were found for forceps delivery or vacuum extraction delivery, episiotomy, or perineal suturing. The authors conclude that not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent UI. 1 figure. 3 tables. 19 references. (AA-M).

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Look at Childbirth Post-Transplant Source: Stadtlanders Lifetimes. Issue 3: p. 28, 29. 1998. Contact: Available from Stadtlanders Lifetimes. Stadtlanders Pharmacy, 600 Penn Center Boulevard, Pittsburgh, PA 15235-5810. E-mail: [email protected]. Summary: This article, from a magazine for kidney transplant patients, tells the story of the author's experience of pregnancy, childbirth, and breastfeeding. The author received her first kidney transplant at age 28, which she lived with for three years. During this time, she began to plan for pregnancy, including researching and adjusting medications to support this plan. Unfortunately, the transplanted kidney was lost to infection and previously undetected chronic rejection. She received a second kidney a year later, at age 32, and experienced fewer postoperative complications with this kidney. However, her blood pressure remained elevated, so she underwent removal of her native kidneys (bilateral nephrectomy) in an effort to reduce her dependence on blood pressure medications. The surgery enabled her to be taken off all blood pressure drugs. The

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author was then successful in becoming pregnant and had a relatively uneventful pregnancy, culminating in the birth of her daughter. During her pregnancy, she and her husband began to explore the option of breastfeeding. Eventually, they decided that the benefits seemed to outweigh the risks. At the time of writing the article, the baby was seven months old, happy and healthy, and still breastfeeding. The author concludes that for her, this child is the most powerful sign of her own rebirth and life renewal. A sidebar reviews the decision regarding breastfeeding for women on immunosuppressant drugs. The sidebar contends that researching the potential effects of each medication the woman is taking is the only way to make an educated decision about breastfeeding. 1 figure. •

Anorectal Complications of Pregnancy and Childbirth Source: Practical Gastroenterology. 20(2): 24, 29-30, 33-34, 37-38. February 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, one in a series on gastrointestinal (GI) disorders during pregnancy, addresses the anorectal complications of pregnancy and childbirth. Fecal incontinence is the major functional impairment that results from anorectal damage and is the focus of this review. Vaginal delivery may cause fecal incontinence by direct anal sphincter injury, by pudendal nerve damage, or by weakening the pelvic floor and allowing gradual stretching and deterioration of the pudendal nerves over many years. Risk factors for incontinence include episiotomy, anal sphincter tears, forceps delivery, multiparity, a prolonged second stage of labor, and high birth weight. A careful history and examination, anorectal manometry, and possibly electromyography and anal endosonography are necessary to evaluate postdelivery incontinence. The author notes that none of these measures are possible unless the patient seeks medical attention for her incontinence. Treatment for incontinence, including drugs, diet, exercises, biofeedback training, or surgery, is usually helpful. 5 figures. 2 tables. 22 references. (AA-M).

Federally Funded Research on Childbirth The U.S. Government supports a variety of research studies relating to childbirth. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to childbirth. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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animals or simulated models to explore childbirth. The following is typical of the type of information found when searching the CRISP database for childbirth: •

Project Title: OBESITY

BETA-ADRENOCEPTOR

GENETIC

POLYMORPHISMS

AND

Principal Investigator & Institution: Johnson, Julie A.; Professor of Pharmacy Practice & Medicin; Pharmacy Practice; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: (Provided by Applicant) Obesity is increasing in prevalence in Western societies, and it represents a major health concern because it increases the risk of cardiovascular disease, metabolic disorders and some forms of cancer. It is estimated that 40% to 70% of the variability in body weight is genetically mediated. A number of genes have been studied as candidate genes for obesity. In the proposed analysis of the Women's Ischemic Syndrome Evaluation Study (WISE) database, we will test the hypothesis that the beta- adrenergic receptor (betaAR) genes and certain G protein genes are associated obesity. Specifically, we will be studying the association between obesity and genes of the beta1AR (ADRB1), the beta2AR (ADRB2), the beta3AR (ADRB3), the Gs protein alpha subunit (GNAS1) (all three betaARs couple with Gs) and the G protein beta3 subunit (GNB3) (a component of Gi, to which beta3ARs couple). We will also examine the multivariate contributions to obesity of genotype, demographic (e.g., age, region) and environmental (e.g., exercise, childbirth history) factors and their possible interactions. Data for the proposed analysis will derive from the database of the WISE study, a four center NHLBI-funded study of ischemic heart disease in women. Genotypes will be assessed by a high through-put genetic bit analysis method. Analyses on approximately 590 white women and 130 black women will be performed separately, and will include multiple regression analysis to test for impact of the various genes, and various demographic and behavioral factors on body mass index. The proposed analyses are important and novel because they will: a) provide the first information on the relationship between ADRB1 and GNAS1 and obesity, b) provide the first information on the ADRB2 and obesity when assessed by haplotype, c) provide information on potential additive or synergistic effects of the genes under study with respect to obesity, d) for some of the genes, provide the first data on the gene-obesity associations in blacks, e) assess the gene-obesity association with respect to certain environmental/behavioral factors such as physical activity and previous childbirth, and f) utilize a state-of-the-art high throughput method for genetic analysis. The information generated from this study should help identify candidate genes that are worthy of further, extensive investigation. Knowledge about genes that are associated with obesity is important as this information may aid in the drug discovery process for anti-obesity drugs. Additionally, genotyping individuals early in age may help to identify those at increased risk of obesity prior to them becoming obese so that they may take appropriate preventive measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILD NEGLECT: SERVICE PATHS AND YOUNG ADULT OUTCOMES Principal Investigator & Institution: Jonson-Reid, Melissa A.; Assistant Professor; None; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2004; Project Start 30-SEP-2000; Project End 30-NOV-2008

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Summary: (provided by applicant): Children reported for neglect and abuse are heavily represented in multiple public service sectors (Jonson-Reid, Drake, Kim, & colleagues, 2003) and are at risk of poor adult outcomes (Widom, 2000), yet cross-sector service research to help us understand how services are associated with these adult outcomes is rare. This application "Child Neglect: Service Paths and Young Adult Outcomes" will extend a currently funded child neglect study (5 R01 MH61733-03) that tracks neglected, abused and poor comparison children to age 18 to follow those children through young adulthood. The study will model early adult mental health service use and violent criminal behavior for poor individuals with and without histories of maltreatment, with an emphasis on modeling these outcomes as a function of childhood service patterns across child welfare, mental health, special education and juvenile justice systems. A secondary aim is to describe rates of other key outcomes (death, young adult poverty or childbirth) for subjects in our study according to neglect, abuse or poverty only history. Prior findings suggest that both special education status and child welfare services are key factors in models of outcomes. The proposed study augments data from these systems with manual review (approximately 1200 case files) to better assess services provided to and outcomes for these subjects as we look at the link between childhood services and young adult outcomes. This continuation extends our current panel (now followed from birth through 17years), using multiple imputation techniques to follow them to age 25. The large sample (N=23,981) includes an AFDC/maltreated group (n=11,866) with a report of abuse or neglect in 1993-94 and a randomly selected AFDC only group (n=12,115) matched by age and region, excluding those who died in childhood. A supplementary comparison includes 4,304 individuals reported for maltreatment and not in families on AFDC. The proposed work will be the only known study, extant or planned, combining broad cross-sector service coverage across maltreated and poverty only children through young adulthood, with sufficient sample size to capture rare, but important, outcomes (e.g., death, homelessness) and model complex service patterns. Supported by a multidisciplinary research team with expertise in child and adult research, close ties to the participating agencies, expertise in administrative and case file data collection and analysis, this study will provide unique, timely and policy-relevant information regarding the transition to adulthood for some of society's most vulnerable children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDBIRTH-RELATED PELVIC FLOOR INJURY Principal Investigator & Institution: Leveno, Kenneth J.; Professor; Obstetrics and Gynecology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapated from Applicant's Description): This proposal is submitted in response to RFA HD-99-003 "Basic Science Research on Female Pelvic Floor Disorders." Described in this application is a comprehensive multidisciplinary basic and clinical science research program focused specifically on the relationship of childbirth to pelvic floor injury. Three research components are presented to include (1) a prospective analysis of the relationship between precise obstetrical events and subsequent pelvic floor dysfunction in 11,000 primiparous women; (2) a randomized trial of the effects of coached maternal pushing during the second stage of labor on postpartum pelvic floor function; and (3) utilization of a novel animal model to study the effects of vaginal trauma during pregnancy on lower urinary tract smooth muscle contractility and contractile protein gene expression. Sample sizes for the aims described in this application are based upon ad hoc power analyses. This proposal also describes the

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qualifications and experience of basic and clinical investigators at the University of Texas Southwestern Medical Center and Parkland Hospital who are committed to the study of childbirth related pelvic floor injury. Included are individuals with expertise in maternal-fetal medicine, urogynecology, and smooth muscle physiology. Existing resources include operational laboratories to support the basic science research described, a well functioning computerized perinatal database to support analysis of precise obstetrical events related to pelvic floor injury and an established, wellfunctioning infrastructure capable of completing randomized clinical trials. Integral to this infrastructure is a well-functioning state-of-the-art urogynecologic clinical laboratory. The major focus of this application is on its theme of multidisciplinary basic and clinical research focused specifically on childbirth which is the singular most important, predisposing factor to pelvic floor injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL MEASURES TO LOWER GENITAL TRACT TRAUMA AT BIRTH Principal Investigator & Institution: Albers, Leah L.; None; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 30-APR-2005 Summary: (provided by applicant): Over 3 million women deliver vaginally each year in the United States, and most experience trauma to the genital tract with birth. This trauma can cause short and long term problems for new mothers, including pain and other functional impairments. Although lowering the rate of childbirth trauma would benefit many women, preventive measures have not been fully explicated. One factor, which may influence rates of childbirth trauma, is the hand maneuvers used by the birth attendant for perineal management late in the second stage of labor (the pushing or expulsive phase). Beyond limiting the routine use of episiotomies, no evidence supports any specific recommendations or perineal management immediately prior to vaginal birth. This study will assess the effects of techniques used by nurse-midwives on rates of spontaneous lacerations to the birth canal. A randomized trial of 1200 low-risk women will compare three strategies on the likelihood of an intact perineum after birth, with control for confounding variables (maternal age and parity, birth position, style of pushing, size and position of baby at birth, length of second stage, and epidural analgesia). The perineal care measures are 1) warm compresses to the perineum, 2) perineal massage with lubricants, and 3) no touching, that is hands off the perineum until crowning and expulsion of the baby. Patients will be recruited in six ambulatory clinics staffed by certified nurse midwives in Albuquerque, NM. Healthy gravidas at term will be randomized in labor. In second stage labor a staff midwife will perform one of the three-perineal management techniques (list above) prior to vaginal birth. After birth all perineal trauma will be documented by physical exam, and other clinical data recorded. Medical records will also be reviewed at hospital discharge and at the 4-6 weeks office visit to identify any complications/ adverse experiences. This study will identify whether any technique is superior for trauma reduction, and will generate evidence to inform the practice of all clinicians who work with childbearing women: nurses, nurse-midwives, family physicians, and obstetricians. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

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Project Title: INFECTION

CTL-MEDIATED

CONTROL--PEDIATRIC/ADULT

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C-CLADE

Principal Investigator & Institution: Goulder, Philip J.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-MAY-2005 Summary: A rational approach to vaccine design would be, first, to understand what constitutes protective immunity in natural infection; then, to generate the same protective responses by means of vaccine. Determination of the correlates of protective immunity in HIV infection has proved elusive. However, data have accumulated over the past decade, which point to the importance of anti-HIV cellular immunity in this regard. More recently, very strong support for the critical role of T helper and, especially, cytotoxic T lymphocytes (CTL) has emerged from work both on HIV-infected humans and SIV-infected macaques. These recent data have leant heavily upon newly available peptide MHC tetrameric reagents to reveal the close interdependence of CTL numbers and control of viremia in HIV and SIV infection. Together with Elispot assays, the peptide-MHC tetramers have transformed the scope of work on CTL responses , increasing the sensitivity and the rapidity of the assays each approximately 50-fold. Most work, however, has neither focused upon the populations most affected by the global epidemic, nor upon C clade infection which predominates worldwide. Current estimates are that two-thirds of the global burden of HIV infection is borne in subSaharan Africa. This is where vaccine-directed research urgently needs to be applied. Understanding the CTL responses which can be expected to exert control of HIV infection, and which would be incorporated into candidate vaccine, requires study of the HLA class I molecules characteristic of these populations, and precise definition of the important C clade-specific CTL epitopes. The two demographic groups most critically affected by the global epidemic are infants and young adult females. This proposal therefore specifically concentrates upon establishing a cohort of C clade infected mothers from pregnancy with the aim of studying these mothers and their children from childbirth onwards. These study subjects will be recruited from an antenatal clinic in Durban, South Africa, where the HIV seroprevalence is presently 4050 percent. The specific aims of the proposed study are a) to define the immunodominant C clade epitopes targeted by CTL, restricted by HLA class I molecules prevalent in this population; b) to compare CTL responses observed in infected mothers and children to defined epitopes, with the purpose of determining the circumstances in which CTL are effective in controlling viremia; and c) to address the relevance of epitope sequence variation to vaccine design. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPILEPSY AND CHILDBIRTH: PK/PD MODELING OF AEDS Principal Investigator & Institution: Pennell, Page; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Approximately 1.1 million women with epilepsy are of childbearing age in the United States and give birth to over 20,000 babies each year. Pregnancy in women with epilepsy is accompanied by increased adverse neonatal outcomes, and approximately 28% of women will experience increased seizures. Serum concentrations of most of the AEDs decline during pregnancy, but findings from previous studies are too inconsistent to provide guidelines for management of AEDs during pregnancy. The primary objectives of Project 1 are: 1) pharmacokinetic/pharmacodynamic (PK/PD)

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modeling of antiepileptic drugs (AEDs) during pregnancy and lactation in women with epilepsy to define fetal/neonatal exposure; 2) identifying the predictors of seizure worsening during pregnancy and postpartum. Given that both AEDs and maternal seizures have been identified as having deleterious effects on the developing fetus and neonate, the PK/PD modeling combined with the course and predictors of illness will provide the foundation to propose guidelines to reduce exposure to both seizure activity and medication. PK/PD modeling of each of the AEDs encountered will be performed in Core A. Both a traditional, two-stage approach and population PK modeling will be employed. The influence of gestational age and other demographic, genetic, and environmental factors (covariates) will be analyzed. Frequency of seizures by type will be documented throughout pregnancy and first postpartum year and compared to each woman's preconception baseline. Worsening of seizure frequency will be correlated with potential predictors, including change in serum AED concentrations, hormonal status, stress, and altered sleep patterns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAMILY STRUCTURE, NEIGHBORHOODS AND CHILD WELL BEING Principal Investigator & Institution: Crowder, Kyle D.; Sociology and Anthropology; Western Washington University 516 High St Bellingham, Wa 98225 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-MAR-2003 Summary: Strong research has documented strong effects of childhood living arrangements on a variety of social, economic, and demographic risk factors for children and adolescents. However, this research provides limited information about the mechanisms through which these effects operate. Paralleling this research, but developing separately, is a growing body of research documenting the impacts of neighborhood social and economic conditions on the same adolescent outcomes. Yet despite the fact that childhood living arrangements, and changes therein, are important determinants of residential mobility and location, the joint impact of these factors has yet to be fully explored. The proposed project offers a reexamination of these dynamics, focusing on the joint effects of childhood living arrangements, residential mobility, and neighborhood context on the risk of two adolescent outcomes closely linked to family formation and economic stability later in life: premarital childbearing and dropping out of high school. The research is designed to address four main questions: 1) To what extent do childhood living arrangements and neighborhood context exert independent effects on the likelihood of dropping out of high school and of experiencing a premarital birth?; 2) Do residential mobility and neighborhood characteristics moderate the effects of childhood living arrangements?; 3) Do neighborhood characteristics and residential mobility mediate the effects of childhood living arrangements?; and 4) To what extent can racial differences in the effects of childhood living arrangements be explained by racial differences in residential outcomes following a change in family composition? To address these questions, the project will utilize data from the Panel Study of Income Dynamics linked with census data describing the socioeconomic and demographic conditions of census tracts and other geographic units. Logistic regression techniques and discrete-time event history analysis will be used to examine the annual risk of experiencing a premarital childbirth, the annual hazard of dropping out of high school, and the likelihood of completing high school prior to age 20. In predicting these outcomes, childhood living arrangements, mobility, and neighborhood conditions are treated as time-varying covariates during adolescence and are also summarized across

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all childhood years, thereby avoiding the potential bias introduced to previous research by the use of measures taken from a single point in time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTION AND MORPHOLOGY OF THE PELVIC FLOOR MUSCULATURE Principal Investigator & Institution: Johnson, Vicki; None; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): The purpose of this study is to describe the pelvic floor musculature (PFM) characteristics in women with genuine stress urinary incontinence (GSUI) as compared to a control group of normal, health nulliparous women with no history of GSUI. The following aims will be tested: Aim 1: To describe the characteristics of pelvic bone structure (geometry) in women with GSUI as compared to nulliparous women with no history of genuine stress urinary incontinence (GSUI). Aim 2: To describe the differences in the structural anatomy (morphology) of the PFM including muscles, fascia and ligamentous structures at rest in women with GSUI as compared to healthy, normal nulliparous women. Aim 3: To describe the differences in function and contractility of the PFM in women with GSUI as compared to healthy, normal nulliparous women. Aim 4: To describe the effects of controlled PFM relaxation following contraction in regard to regress of strain subsequent to PFM contraction in women with GSUI as compared to healthy, normal nulliparous women. Background and Significance: Urinary incontinence (UI) affects approximately 14 million individuals in the United States; the majority of these are women. Genuine stress urinary incontinence is involuntary urine leakage during coughing, sneezing, or other physical activities that increase intra-abdominal pressure. Development of GSUI in women is multi-factorial including childbirth, increased age, and genetic influences. The mechanism(s) of improvement induced by rehabilitative exercises of the PFM have not been adequately described. Method: A descriptive study design will be used to describe pelvic bone structure (CT scan) and pelvic muscle structure and dynamic function (NMRI) in women with GSUI compared to nulliparous controls. Statistical Analysis: Descriptive statistical analysis will be used to obtain frequencies and percents (nominal-level variables), and means and standard deviations (interval/ratio level variables). This analysis will provide an estimate of effect sizes and sample size requirements for testing differences in future studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HISTORY OF HORMONE REPLACEMENT THERAPY, 1960-2000 Principal Investigator & Institution: Watkins, Elizabeth S.; Individual Award--Watkins, Elizabeth Sie 6516 Northumberland St Pittsburgh, Pa 15217 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): The goal of this project is to produce the first sociocultural historical study of the changing rationales for prescribing hormone replacement therapy (HRT) for menopausal and post-menopausal women from the 1960s to the present. The resulting book will provide a historical perspective for contemporary debates about the health care and health policy implications of menopause, aging, and HRT. The study is driven by three main questions. 1) How and where do physicians and patients get their information about menopause, aging, and medical treatments? This project investigates the interactions among scientists, physicians, drug companies,

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government agencies, feminist health activists, the media, and the public in the construction, dissemination, and translation of medical information for midlife and older women. 2) In what ways have the phenomena of menopause and aging been both medicalized and de-medicalized? While menopause and its sequence, like other aspects of women's health (e.g., childbirth, birth control), have increasingly come under medical control in the 20th century, there has also been a parallel trend in recent decades to re-define menopause as a "natural" event. This project will analyze the differences and similarities between these two views and set them in the larger context of health policy making and the American pursuit of health. 3) What is the relationship between the medical treatment of menopause and cultural conceptions of aging? This project locates the use of HRT in the context of changing expectations and changing roles for older women in American society. Using historical methodologies to investigate the variety of actors engaged in disseminating information about menopause, aging, and medical treatment, this study will enrich our understanding of the practices, contexts, and meanings of aging and related health-care issues among American women. The primary product will be a book written for a broad audience, including historians, health policy makers, physicians, nurses, other health care providers, and the general public. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPACT HEALTH/QOL

TOTAL

WORKLOAD--MATERNAL

POSTPARTUM

Principal Investigator & Institution: Mcgovern, Patricia; Environ & Occupational Health; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2004 Summary: The trajectory of health and quality of life for employed women upon return to work after childbirth is unknown. The effects of stress and role conflict from total workload on women's postpartum health are not well established. Yet, mothers of infants represent one of the fastest growing segments in the US labor market. The purpose of this project is to estimate a function relating total workload (i.e., hours of paid and unpaid work), use of family medical leave, job stress, and work-family conflict to maternal health at critical points in time after childbirth. The research model is adapted from economic models of health and household production function theory, and integrates elements of the biopsychosocial approach to stress and health. The study employs a prospective design with panel data collection at 6 weeks, 3 months, 6 months, 12 months and 18 months after childbirth. Selected intervals reflect critical times in women's postpartum recovery and employment patterns that have implications for maternal workload and well-being. Potential subjects will be recruited from selected hospitals and screened for eligibility. Upon hospital discharge following childbirth, 782 women will be surveyed at intervals described above using both telephone and mailed administration of survey instruments depending on the timing of data collection. A system of equations will be estimated for women's total workload, use of family medical leave, job stress, work-family conflict, health status and quality of life at each time period. Consistent with this theoretical approach an analytic procedure called two-stage least squares will be employed. This approach permits cross-sectional analyses that estimate the impact of explanatory variables (e.g., job stress) on the dependent variables of interest (e.g., maternal health) at one specific point in time (e.g., six months after childbirth). In addition, the use of panel data permits longitudinal analyses that will allow us to estimate alternative models such as distributed lag models. This latter approach will enable us to estimate current values of the dependent variable (e.g.,

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maternal health at 18 months after childbirth) as a function of both current and past values of the explanatory variables (e.g., total workload at 12 months and 18 months after childbirth). Results from the study will provide important information on maternal health and quality of life at a vulnerable time in the life cycle of women and their families. The study findings will identify workplace and job characteristics and family and personal choices that support women's health and quality of life. Knowledge of these factors will facilitate the design and testing of policy and programmatic interventions relevant to employers, policy makers and occupational health providers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOCAL ANESTHETIC CARDIOTOXICITY: NANOTECHNOLOGY THERAPY Principal Investigator & Institution: Dennis, Donn M.; Anesthesiology; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2007 Summary: (provided by applicant): Local anesthetics (LAs) reversibly prevent impulse transmission in nerves by voltage-, time- and frequency-dependent blockade of sodium channel conductance (I-Na). These pharmacological actions underlie the therapeutic use of LAs in clinical care to provide regional anesthesia (e.g., epidural blockade) for patients undergoing surgical procedures or childbirth. However, inadvertent intravascular injection or overdose may lead to undesired INa blockade in other tissues (e.g., heart, central nervous system) and thereby cause potentially life threatening adverse events (e.g., cardiac arrest, seizures). Although seizure activity and respiratory depression caused by LA overdose are potentially life threatening, these events can be readily treated with antiepileptic medications and controlled artificial ventilation, respectively. Of equal or greater importance, few options (e.g., ACLS) currently exist for treatment of cardiac toxicity caused by intravascular injection. For these reasons, an agent or technique allowing rapid, efficacious treatment of the cardiac effects of LA toxicity would be useful. The objectives of this grant are to generate the knowledge necessary to create agents specifically designed to treat patients suffering from the toxic effects of LAs. Recent advances in particle science engineering now afford new and exciting opportunities to develop highly effective therapeutic strategies aimed at successfully treating drug poisonings. Specifically, the recent advent of nanotechnology with its tremendous potential to solve major biomedical problems now offers unparalleled opportunities to solve the problem of LA toxicity. Four types of biocompatible and biodegradable nanoparticles (NPs) with 10-100 nm diameter will be synthesized by colleagues in the NSF Engineering Research Center for Particle Science and Technology for detoxification of LAs. These NPs will rely on absorption (microemulsions), adsorption (electron acceptor), or both mechanisms (2 types of "smart" microemulsions) to reduce the free concentration of LA in various media and decrease the biological effects of LA in tissues and intact organisms. The NPs will be studied to 1) detail the physicochemical characterization of the NP-LA interaction (Objective A), and 2) determine whether the cardiotoxic effects of LAs can be attenuated by NPs in biological systems (Objective B). This highly multidisciplinary project spanning organic chemistry, engineering, and medicine contains two objectives and three specific aims: Specific Aim #1: Determine the extraction efficiency of NPs to remove LAs from simple (normal saline) and complex (human plasma and blood) media. Optimize LA extraction efficiency of the various NPs. Specific Aim #2: Determine the molecular mechanisms whereby the different types of NPs can efficiently extract LAs. Specific Aim #3: Determine the effectiveness of nanoparticles to attenuate

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or reverse the cardiotoxic effects of LAs at three functional levels: 1) single cell (ventricular myocytes), 2) tissue (isolated hearts), and 3) intact rat (closed chest). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROCHEMISTRY OF GESTATION-PRODUCED ANALGESIA Principal Investigator & Institution: Gintzler, Alan R.; Professor; Biochemistry; Suny Downstate Medical Center 450 Clarkson Ave New York, Ny 11203 Timing: Fiscal Year 2000; Project Start 01-DEC-1983; Project End 29-FEB-2004 Summary: (adapted from the Abstract): The underlying objective of the proposed research is to test the hypothesis that the antinociception of pregnancy and hormonallysimulated pregnancy (HSP) is mediated by a multiplicative interaction between spinal kappa and delta opioid systems and between these systems and descending noradrenergic pathways. The specific objectives are to (1) determine if the analgesia of pregnancy and HSP consists of the sum of separate, independent spinal cord analgesic systems or if it requires their concomitant activation; (2) determine if the antinociception of pregnancy and HSP is mediated in part by increased spinal kappa and delta receptor density and/or distribution; (3) determine if enhanced spinal noradrenergic tone is necessary for a substantial component of pregnancy analgesia and if this influence is mediated by the hypogastric nerve; and (4) determine if the newly-discovered spinal ORL1/nociceptin hypoanalgesic system modulates analgesia of pregnancy and HSP. All-in-all, this research should elucidate the component of the intrinsic pain-attenuating system that is activated during gestation and could provide a basis developing interventions for the management of pain in pregnancy and childbirth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROTROPHINS, INCONTINENCE

HORMONES

AND

POSTPAROUS

Principal Investigator & Institution: Smith, Peter G.; Professor; Molecular & Integrative Phys; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from Applicant's Description): Traumatic labor and vaginal delivery during childbirth can produce permanent dysfunction of the pelvic musculature, in many cases leading to urinary and fecal incontinence. Damage to the pelvic nerves and failure to achieve complete reinnervation account for much of the deficit. Factors that modulate regrowth of damaged axons therefore may influence functional recovery. The investigators have shown recently that smooth muscle of the reproductive tract, which shares many similarities with urethral and anal sphincter smooth muscle, undergoes dramatic changes in innervation as a consequence of hormonal fluctuations. Elevated plasma estrogen results in marked reductions in numbers of sympathetic nerves, while other neuronal populations are unaffected. Preliminary data suggest that these changes are related to decreased nerve growth factor (NGF) synthesis. The investigators hypothesize that the high levels of estrogen in periparous females result in depressed neurotrophin synthesis in pelvic smooth muscle. Accordingly, sympathetic nerves, whose presence is essential for normal sphincter contractile tone, fail to regenerate to their full potential after nerve injury. In Specific Aim 1, the investigators will determine the effects of estrogen and pregnancy on protein and mRNA levels of NGF and the related neurotrophin, NT3, in urethral and anal sphincter smooth muscle using in situ hybridization, quantitative competitive polymerase chain reaction, immunohistochemistry and enzyme-linked immunoassays.

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In the second aim, they will use quantitative in situ hybridization and immunohistochemistry to determine the extent to which estrogen and pregnancy influence expression of the neurotrophin receptors trkA and p75NTR, which mediate the sympathetic nerve response to NGF and NT3. In aim 3, they will use immunohistochemistry to examine the effects of estrogen and pregnancy on the normal innervation of the urethral and anal sphincter smooth muscles. Aim 4 will employ immunohistochemistry and physiological and pharmacological measurements of urethral and anal smooth muscle contractile function to assess the effects of estrogen on sphincter reinnervation following a noradrenergic neurotoxin lesion with 6hydroxydopamine, or pelvic distension to simulate childbirth trauma, and these will be compared with injury of normal delivery. The fifth aim uses collagen gel co-cultures of sphincter smooth muscle and sympathetic ganglia in the presence of selective neutralizing antibodies to ascertain the roles of neurotrophins in modulating sympathetic neurite sprouting toward smooth muscle of estrogen-treated or pregnant rats. These studies should provide important new information on how hormones may affect neurotrophin synthesis by smooth muscle of the organs of continence, and how this in turn may alter sympathetic reinnervation of sphincters after axonal damage due to traumatic vaginal delivery, thus leading to urinary and fecal incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NMR OF FBP PROTECTION IN HYPOXIC RAT BRAIN SLICES Principal Investigator & Institution: Litt, Lawrence; Professor; Anesthesia and Perioperative Care; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-JUL-1985; Project End 31-DEC-2003 Summary: It has been known for years that pre- and post-treatment with fructose-1,6bisphosphate (FBP) can dramatically improve hypoxic/ ischemic tolerance in vivo in brain, muscle, and intestinal tissues, suggesting huge potential benefits in high risk childbirth, surgeries where there is major blood flow interruption or total circulatory arrest, and organ transplantation. Primary mechanisms of FBP protection affect intracellular metabolism, which is now easier to explore because of advances in high resolution nuclear magnetic resonance (NMR) spectroscopy. The Specific Aims of 14.1 Tesla ex vivo and in vitro multinuclear NMR spectroscopy studies of neonatal rat brain slices are to determine: 1) if [1-13C]fructose-1,6-bisphosphate enters oxygenated and/or hypoxic cells, and if so, its metabolic fate and influence. 2) if FBP-induces metabolic changes in the intracellular metabolism of glucose, particularly during oxygen deprivation. [U-13C]glucose will be used to distinguish glial from neuronal TCA cycle activity. [2-13C]glucose will probe the activity of the pentose phosphate pathway (PPP). [1-13C]glucose will be used to determine total glucose utilization. 3) if FBP preservation of ATP is secondary to its prevention of glutamate toxicity and/or its prevention of damage from PARS (polyadenosine 5'-diphosphoribose synthetase, also know as PARP.) During hypoxia FBP increases glucose metabolism by the PPP, a source of ribose. Hypoxia studies will be performed with nontoxic glutamate receptor blockade and nontoxic inhibition of glutamata release, and with inhibitors of PARS. 4) if hypoxiainduced changes in ATP are associated with concomitant changes in the apparent diffusion coefficient of brain slice water, ADCw, which is commonly used clinically; increases in brain slice water; histological measures of cell swelling; and immunohistological measures of cell and mitochondrial injury. The hypotheses tested are that: 1) FBP enters cells more readily during hypoxia and serves as a metabolic modulator and substrate; 2) Because of PARS, ATP maintenance by FBP during hypoxia

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requires increased glucose metabolism by the PPP; 3) apparent intracellular diffusion coefficients can be used to accurately estimate cell swelling and the integrity of intracellular metabolism; and 4) when FBP sustains ATP levels during hypoxia, mitochondrial viability is also sustained. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OVERWEIGHT STATUS AFTER CHILDBIRTH Principal Investigator & Institution: Walker, Lorraine O.; Luci B. Johnson Centennial Professor; None; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, Tx 78712 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-DEC-2003 Summary: Obesity has reached epidemic proportions in the US. One approach to stemming this epidemic is expanding the science about critical periods of obesity development such as the period surrounding childbearing. Not only is childbearing a critical period for weight gain and obesity development for US women, it is also a key turning point that may have negative effects on health behaviors, such as exercise; mood; and body image. These multiple dimensions of well-being are integrated in a preliminary model of "thriving" in postpartum. Thriving as a framework for studying weight management in postpartum integrates weight with (1) promoting healthy lifestyles; (2) managing psychosocial distress; and (3) enhancing body image satisfaction. The thriving model also includes both static (such as ethnicity) and dynamic factors (such as lactation). This study will validate with low income African American, Hispanic, and White women during the first year after childbirth a thriving-based model of postpartal weight management. Study aims include (1) comparing dimensions of thriving in African American, Hispanic, and White women; (2) examining relationships between weight status and factors influencing thriving, especially those mediated by ethnicity; (3) validating relationships between measured weight status and psychosocial variables; (4) exploring relationships between measured weight status and macro- and micronutrients in the diet; and (5) formulating a model for weight management intervention during postpartum for women at risk of continued overweight. A sample of 556 low income women (33.3 percent white, 33.3 percent black, and 33.3 percent Hispanic) will be recruited into a prospective, longitudinal design with assessments at shortly after birth in the hospital; 6 weeks, and 3,6, and 12 months postpartum. At these time points, observations will be made on body mass index based on measured weights, dietary intake of macro- and micro-nutrients, physical activity, food habits, self-care practices, body image, weight-related distress, and depressive symptoms. Study outcomes include formulation of a model for weight management intervention after childbirth for overweight women which takes into account influencing factors, and patterns of postpartal weight loss for African American, Hispanic and White women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION

PILOT--PREVENTIVE

INTERVENTION

FOR

MATERNAL

Principal Investigator & Institution: Lagomasino, Isabel; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, Ca 90059 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: Elevated rates of depressive symptoms have been well-documented among low-income mothers, including Latinas who are at high risk for living in poverty. However, Latinos have consistently been found to underutilize mental health services

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when these services are needed for such disorders as depression. Despite maternal depression in this group representing a disparity in health and functioning for both Latino mothers and their children, there is a lack of effective intervention strategies to decrease this health disparity. One way to address this disparity is by delivering services through Promotoras, lay health workers who are familiar with the neighborhood, culture, language and social status of immigrant Latinas. This proposal will examine the effectiveness of a preventive intervention for postpartum Latina women in decreasing symptoms of minor depression and will explore how treatment of these mothers may affect their parenting of and attachment to their infants. Teh Promotoras who regularly conduct home visits for postpartum Latinas will be trained in administering a screening instrument for detection of minor depression, the PrimeMD. Four Promotoras will then be trained and supervised in delivering a standardized 12session cognitive behavioral therapy intervention developed to prevent depression in pregnant women and new mothers. 100 postpartum Mexican American immigrant women recently discharged from the hospital following childbirth, will be identified as having minor depression and will be consented to participate in the study. The participants will be randomized to either the intervention group or a control condition. The main outcome variable will be maternal depression symptoms as measured by a structured interview for the Hamilton Rating Scale. Data will also be collected on appropriateness of parenting, attachment, and developmental outcome measures to estimate effect sizes and sample size needed (through power calculations) for a full-scale trial of the preventive intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTING SMOKING RELAPSE DURING PREGNANCY AND BEYOND Principal Investigator & Institution: Brandon, Thomas H.; Director, Tobacco Research; Psychology; University of South Florida 4202 E Fowler Ave Tampa, Fl 33620 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): The prenatal risks of tobacco smoking motivate many women to quit smoking during pregnancy and to maintain abstinence for several months. Unfortunately, the majority of these women relapse to smoking either during their pregnancy or within the first six months postpartum. Resumption of smoking is associated with cancer and other health risks to the smokers themselves and to those exposed to their environmental tobacco smoke, including the infant and other members of the family. Because so many women are able to achieve at least short-term abstinence during their pregnancy, the pregnancy and postpartum periods are collectively viewed as a "window of opportunity for interventions designed to prevent smoking relapse. Although modest success has been achieved at aiding women in smoking cessation during pregnancy, attempts to prevent subsequent smoking relapse have been unsuccessful to date. The goal of Study I is to develop the key materials for a costeffective minimal intervention preventing smoking relapse among pregnant/postpartum women. The intervention will be modeled after one developed by the research team that has been found to reduce smoking relapse by approximately twothirds among a general population of recent quitters. This intervention comprises a series of eight Stay Quit booklets mailed to former smokers over a year. The booklets were developed based on theory and research on smoking relapse, and were found to be extremely cost-effective. However, because pregnant and postpartum women differ in many ways from the general population of ex-smokers, it cannot be assumed that the existing intervention would adequately meet their unique needs. The end product of

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Study I will be a series often Forever Free for Baby and Me booklets designed to be provided to women between their sixth month of pregnancy and eight months postpartum. The content of the booklets will be based on three sources of information: (1) the existing, validated Stay Quit booklets, (2) theory and research on smoking relapse during and after pregnancy, and (3) systematic formative research comprising focus groups, in-depth interviews, and learner verification interviews. Subjects will include pregnant and postparatum women who have maintained tobacco abstinence, as well as those who have relapsed; their partners; and relevant health professionals in the community. Study II will be a randomized, controlled trial of the intervention developed in Study I. Women who have quit smoking during pregnancy will be recruited via childbirth education classes and randomly assigned to receive the series of Forever Free booklets versus a usual care control condition. Follow up will be conducted through 12 months postpartum, and a format cost-effectiveness analysis wilt be conducted. If shown to be effective, this minimal intervention would be easy and inexpensive to disseminate to women via a variety of channels and settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROMOTING HEALTHY LIFESTYLES AMONG WOMEN Principal Investigator & Institution: Kieffer, Edith C.; Health Behavior and Hlth Educ; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The prevalence of type 2 diabetes is rising among African American and Latino women of childbearing age, with severe consequences for individuals, families and communities. Diet and exercise behaviors, excessive pregnancy weight gain and postpartum weight retention may lead to the development of longerterm obesity that contributes to this trend. The prenatal-postpartum period offers a unique opportunity for interventions that may reduce these risks. The overall aim of this community-based randomized controlled clinical trial is to demonstrate the effectiveness of a healthy lifestyle intervention tailored to the needs of pregnant and postpartum African American and Latino women in Detroit, Michigan and designed to reduce behavioral and clinical risk factors for type 2 diabetes. Two hypotheses (specific aims 1 and 2) will be tested: Compared to the control intervention, healthy lifestyle intervention participants will have 1) improved levels of protective behaviors (increased daily level of physical activity and improved daily dietary composition) that reduce the risk of type 2 diabetes; and 2) improved their status on clinical measures of risk for type 2 diabetes (anthropometric and metabolic status). Specific aim 3 addresses whether theory-based variables, including changes in attitudes, behavioral and control beliefs, perceived social support and behavioral intention change from baseline, and whether these changes influence behavioral outcomes. Specific aim 4 will identify aspects of project planning and implementation that contribute. to achievement of behavioral and clinical outcomes. The study will be conducted by an existing partnership between university and community organizations that has a successful record of communitybased participatory epidemiological and intervention research. The healthy lifestyle intervention draws from the theories of planned behavior and social support and takes into account specific social, cultural, economic and physical environmental challenges faced by low-income women in Detroit. It addresses the rapidly changing context of pregnancy and the postpartum period, which bring additional challenges but also opportunities for adoption and maintenance of healthy behaviors. The target population will be 400 Latino and African American women who will be recruited in prenatal care

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settings during their first trimester of pregnancy. After a qualifying period designed to reduce later attrition, 320 will be randomized into either a healthy lifestyle intervention or a control intervention group. The healthy lifestyle intervention will include a 17session curriculum that integrates pregnancy, childbirth and postpartum preparation, social support from a Women's Health Advocate (WHA) and group social support activities. The control intervention group will receive a 4-session curriculum that integrates pregnancy, childbirth and postpartum preparation. Measures will be collected at 10-14 weeks, -26 weeks and -36 weeks of gestation and -6 weeks postpartum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROMOTION OF COPARENTING DURING FAMILY FORMATION PERIOD Principal Investigator & Institution: Feinberg, Mark E.; Prevention Research Center; Pennsylvania State University-Univ Park 201 Old Main University Park, Pa 16802 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2005 Summary: (provided by applicant): The central aim of this proposal is to develop and pilot test a preventive intervention aimed at enhancing couples' coparenting skills in order to promote positive adjustment to parenthood, family formation, and early parenting. The intervention will prepare first-time parents (either married or cohabitating) for the individual and couple-level stresses that a new child often brings, which coincides with elevated rates of depression for both parents and high rates of marital conflict and dissatisfaction. The sessions will combine brief didactic presentations with structured exercises, role-playing, discussion, and couple problemsolving practice. The intervention's short-term goals include enhanced coparenting cooperation and diminished hostile/competitive behaviors. Long-term goals include improved parental adjustment, increased marital quality, and increased parental sensitivity. The first specific aim is to develop and manualize the proposed intervention in the first year. To ensure widespread adoption through existing institutional healthcare structures, the program will be designed to be delivered through childbirth education departments. The strategic siting of coparenting programs in such departments will provide a universal, non-stigmatizing service-delivery framework. For this initial phase of pilot development, a team of researchers and childbirth educators will collaborate on developing the program to ensure both ecological validity and match with childbirth education departments' missions. The second specific aim is to administer a pilot trial of the intervention for six groups of couples--three groups at each of two sites. This proposal includes a pilot study of the effects of the program across randomized intervention and control conditions (75 couples in each condition), with pretest, posttest, and 6-month follow-up data collection waves. Methods will include self-report questionnaires and videotaped observational family interactions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REPRODUCTIVE RISK FACTORS FOR PELVIC ORGAN PROLAPSE Principal Investigator & Institution: Brown, Jeanette S.; Professor and Director; Ob, Gyn and Reproductive Scis; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 25-SEP-2001; Project End 31-AUG-2005 Summary: (provided by applicant): Pelvic organ prolapse is a common problem among middle-aged and older women and risk factors for the development of pelvic organ prolapse are not well defined. While childbirth has been identified as a risk factor for

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pelvic organ prolapse, there has been limited research on the relationship between specific parturition events and the occurrence of pelvic organ prolapse in later life. Currently, we are conducting the Reproductive Risk factors for urinary Incontinence Study at Kaiser (RRISK), a 4-year funded study to determine the association between specific childbirth events, hysterectomy, hormone use and subsequent urinary incontinence. This retrospective cohort study will enroll 2100 community-dwelling, ethnically diverse women ages 40 to 69 on which there are continuous medical records since the age of 18. All participants had extensive assessment of urinary incontinence and potential risk factors using self-report, in-person interview, and chart abstraction of labor and delivery and surgical records. We propose randomiy selecting a 1100 participant subsample of the RRISK cohort to objectively assess pelvic organ prolapse using the Pelvic Organ Prolapse Quantitation staging system. Our specific aims over the next 4 years are to detennine the prevalence of prolapse by vaginal segment and severity (Stage I- IV), and age group. The ethmc diversity of study subjects will allow comparison of prevalence estimates between major ethnic groups; to determine the association between specific aspects of parturition and development of prolapse in later life; to ascertain the association between hysterectomy (type and indication) and subsequent prolapse; To identify other potential risk factors (heavy lifting, obesity, medical illness, etc.) for prolapse, especially those that are preventable or modifiable; and to describe the associations of pelvic organ prolapse with urinary and fecal incontinence and to compare risk factors for each of these conditions. Our proposed study of reproductive risk factors for prolapse in a well- characterized representative cohort of community-dwelling women will provide an adequate sample size, excellent outcome measures, and extensive reliable data on a range of risk factors for pelvic organ prolapse, including chart abstracted information on important aspects of reproductive history. Identification of risk factors for prolapse will help guide the development of preventive intervention trials to test the efficacy of modifying risk factors for pelvic organ prolapse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF EXPECTATIONS IN PREVENTING POSTPARTUM DEPRESSION Principal Investigator & Institution: Khazan, Inna Z.; Psychology; Clark University (Worcester, Ma) 950 Main Street Worcester, Ma 01610 Timing: Fiscal Year 2002; Project Start 13-MAR-2004; Project End 31-AUG-2004 Summary: (provided by applicant): The goal of the proposed study is to design, implement, and evaluate the effectiveness of an intervention program aimed at preventing or reducing the likelihood of postpartum depression. This intervention will focus on providing new mothers with more realistic expectations regarding infant and childcare-related stressors. This focus is justified by the findings of previous studies which have shown that: a. infant and childcare related stressors are among the few factors consistently found to account for a significant amount of variance in the postpartum depression scores; b. parents-to-be are likely to hold unrealistic expectations regarding many areas of their lives and violations of these expectations are linked to more difficulty during the transition to parenthood; c. both direct and indirect evidence links violated expectations regarding infant and childcare-related stressors to increased levels of postpartum depressive symptomatology. The proposed intervention will take place during childbirth classes (a control group will consist of families participating in standard childbirth education classes). Mothers will be asked to report on their expectations regarding infant and childcare related stressors both before and after the

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intervention. When the babies reach 3 months of age, mothers' levels of postpartum depressive symptomatology will be assessed and they will be asked to report on the reality of their infants' behavior and difficulty of childcare. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SMOKING RELAPSE AMONG MOTHERS OF INFANTS Principal Investigator & Institution: Gaffney, Kathleen F.; Associate Professor; None; George Mason University 400 University Dr Fairfax, Va 22030 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2005 Summary: (provided by applicant): The overall purposes of the proposed feasibility study are to: (1) build on the findings of recent postpartum smoking cessation research by exploring previously untested factors that may place mothers of infants at risk for relapse, and (2) provide direction for a future clinical intervention trial to reduce their risk. Specific aims are to: (1) explore the capacity of perceived infant irritability, perceived parenting stress, and evaluation of self as mother to predict smoking behavior and smoking abstinence self-efficacy, (2) establish criteria for at risk candidates for a clinical intervention designed to reduce the risk of smoking cessation relapse, and (3) based on study findings, provide an empirical basis for the refinement and development of a conceptual model for helping mothers of infants who face the challenge of being smoke-free. The significance of a project designed to promote the understanding and support of maternal smoking cessation during the first year after childbirth is underscored by recent findings that 50 percent of women who quit smoking during pregnancy, resume smoking by the time their infants are 3 months old, with the concomitant untoward sequelae for maternal and infant health. Mothers (N = 208) who identify themselves as having been smokers in the month prior to pregnancy and who quit smoking during pregnancy will be recruited into the study from a communitybased clinical setting for low-income women. The study's conceptual model is an innovative blending of principles derived from two well-established models: the Relapse Prevention Model (Marlatt, 1985) and the Child Health Model (Barnard & Eyres, 1979). Data will be collected using a combination of face-to-face interviews, written self-reports, and carbon monoxide readings when the mothers' babies are 6 to 8 weeks of age (the peak age for in that crying). Data analysis will include multiple and logistic regression, discriminant analysis, and canonical correlation models. Implications for practice, research, and policy will be disseminated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE EPIDEMIOLOGY OF FECAL INCONTINENCE AFTER CHILDBIRTH Principal Investigator & Institution: Guise, Jeanne-Marie M.; Assistant Professor; Obstetrics and Gynecology; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001; Project Start 07-AUG-2001; Project End 31-JUL-2005 Summary: Fecal incontinence is thought to be a common condition with profound social impact. Obstetric delivery is thought to be the leading contributor to development of fecal incontinence in women. There are no population-based studies of fecal incontinence following childbirth; the highest-risk period. Previous studies examining postpartum fecal incontinence are from single institutions, populations that are subject to referral bias, and small numbers; making generalizability of the results impossible. The primary goal of this proposal is to provide population-based information on incidence, and risk factors with essential correlation with anatomic/physiologic findings

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and longitudinal follow-up. The specific aims of this proposal are to: - Provide population-based estimates of incidence of fecal incontinence in all postpartum women delivering in Oregon state. - Identify contributing modifiable and non-modifiable risk factors for the development of postpartum fecal incontinence. - Explore in depth a possible causal relationship between obstetric delivery methods and postpartum fecal incontinence. - Develop a cohort of women with postpartum fecal incontinence to follow longitudinally to identify factors that predict the likelihood of resolution, recurrence or worsening of symptoms. - Correlate anatomic and physiologic findings to symptoms of fecal incontinence. - Understand the physical, psychological, social ramifications of fecal incontinence. These data will provide a better understanding of the extent of the problem and will provide data essential for future trials of prevention and treatment of fecal incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TISSUE OXYGEN AND FUNCTION IN ACUTE ANEMIA & TRANSFUSION Principal Investigator & Institution: Toy, Pearl T.; Professor; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001 Summary: About 12 million units of red blood cells are transfused annually in the United States. Patients who are acutely anemic may have bled from trauma, extensive laboratory testing, childbirth, gastrointestinal disease, or complex orthopedic, cardiac or transplant surgery. The indications for red cell transfusion are unclear because of lack of measurable endpoints that indicate inadequate tissue oxygen and/or function. Hemoglobin (Hb) concentration alone is insufficient as an indication. The goal of this project is to find endpoints that will measure tissue oxygenation and/or function in acute anemia. In the previous grant period, we used the acute isovolemic hemodilution model and found no changes in subcutaneous tissue oxygen and infrequent ECG ST changes at Hb concentration of 5 g/dL. Importantly, we found cognitive function impairment at Hb concentrations of 5-6g/dL that was reversible with transfusion of fresh red blood cells. We now propose to continue to use the acute isovolemic hemodilution model to study the efficacy of therapy for this anemia- associated cognitive impairment, to further study the effect of anemia on the nervous system and the heart, and to study subcutaneous tissue oxygen in surgery patients. The specific aims are to determine whether: (1) transfusion of stored rather than fresh red cells, or (2) 100% inspired oxygen will reverse the anemia-associated cognitive impairment; in the nervous system during acute anemia, whether (3) cerebral blood flow distribution is changed, (4) evoked potentials are impaired and (5) cerebral information processing slowing occurs. In addition, we will determine whether (6) heart rate is associated with myocardial ST changes in acute anemia, and whether (7) subcutaneous tissue oxygen is reduced in acutely anemic surgical patients. Data from this research will provide new information as to how acute anemia impairs neurological, cardiac and subcutaneous oxygenation and/or function and which treatment modalities are effective. This research is directly responsive to one of the RFA's area of emphasis: "Indications for Red Blood Cell or Platelet Transfusion." Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRAINING SIMULATOR FOR EPIDURAL NEEDLE INSERTION Principal Investigator & Institution: Anderson, Bruce D.; Physical Sciences, Inc. 20 New England Business Center Andover, Ma 01810

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Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 30-APR-2003 Summary: (provided by applicant): In the Phase I program, Physical Sciences Inc. (PSI) proposes to develop a training simulator for epidural catheter insertion that combines features of physical and virtual reality simulation. The simulator will consist of a commercially available model of human vertebrae covered with polyurethane that mimics the feel of skin. The physical model will allow palpation to determine the location of needle insertion, as is done to patients. Between each vertebra will be a novel actuator and position sensor. When a Touhy needle punctures the artificial skin, it enters a computer controlled haptic feedback, virtual environment. The actuator and sensor will apply the resistive force to the needle corresponding to the location of the needle tip and the tissues that are applying pressure to the side of the needle. The haptic tissue model will be constructed using tissue dimensions and the material properties of biological tissues. Phase I will build a single vertebral joint simulator. The Phase II simulator will be a complete vertebral column and include visual learning aids. The simulator will train medical personnel to deliver epidural anesthesia at several intervertebral joints for relief of surgical pain, chronic pain, and childbirth pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: URINARY INCONTINENCE--REPRODUCTIVE/HORMONAL RISK FACTORS Principal Investigator & Institution: Thom, David H.; Assistant Professor; Family and Community Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 29-SEP-1998; Project End 31-JUL-2004 Summary: (Adapted from Investigator's Abstract) The proposed epidemiologic study will assemble a retrospective cohort of long-term female members of a large health maintenance organization to determine the association between specific childbirth (parturition) events, hysterectomy, hormone use and urinary incontinence (UI) in later life. The study will also provide important descriptive information on UI by type, age group, ethnicity, severity and age of onset. Childbirth, hysterectomy and hormone use have all been implicated as risk factors for UI based on previous epidemiologic studies. Physiologic studies suggest that pelvic nerve and muscle damage during parturition may be associated with an increased risk for UI in the post-partum period. While UI is relatively uncommon after the immediate post-partum period, its prevalence increases with age. Apparently, however, no study has examined the relationship between specific reproductive events and UI in later life. The proposed study will enroll 2,100 ethnically diverse women ages 40 to 69 who have been members of a large health maintenance organization, Kaiser Permanente Medical Care Program (KPMCP) of Northern California, continuously since age 18. KPMCP has archived medical records for all members since 1946. Onset of UI, as well as lifetime reproductive history and hormone use, will be assessed using life event calendar methods. Type of UI (stress, urge and mixed) will be determined by in-person interviews. The primary outcome variable will be time to onset, by type, of "regular" UI, defined as UI occurring at least once per month for at least 3 consecutive months, exclusive of pregnancy and the first 3 post-partum months. Severity of UI will also be assessed and examined as an outcome. Specific potential risk factors associated with parturition, including use of forceps, episiotomy, oxytocin, perineal tears, anesthesia, length of labor and infant birth weight will be abstracted from the labor and delivery records. Detailed descriptions of hysterectomy/oophorectomy will be abstracted from surgical records. Multivariate analysis will be used to estimate the risk of UI associated with each of the exposure

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variables of interest independent of other exposure variables and covariables. The investigators note that because UI is a common condition with substantial economic and quality of life impact, identifying modifiable risk factors for UI would have a potentially large impact on public health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “childbirth” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for childbirth in the PubMed Central database: •

Anal incontinence after childbirth. by Eason E, Labrecque M, Marcoux S, Mondor M.; 2002 Feb 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=99311

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Cohort study of depressed mood during pregnancy and after childbirth. by Evans J, Heron J, Francomb H, Oke S, Golding J.; 2001 Aug 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=35345

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Control of Pain in Childbirth. by Whitacre RJ.; 1945 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194489

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Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial. by Peter EA, Janssen PA, Grange CS, Douglas MJ.; 2001 Oct 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81582

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Materials on Leboyer Method of Childbirth. by Prestwich L.; 1978 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=199458

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Psychiatric admissions of low-income women following abortion and childbirth. by Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG.; 2003 May 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=154179

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Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth. by Small R, Lumley J, Donohue L, Potter A, Waldenstrom U.; 2000 Oct 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27510

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with childbirth, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “childbirth” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for childbirth (hyperlinks lead to article summaries): •

“Altered consciousness” during childbirth: potential clues to post traumatic stress disorder? Author(s): Kennedy HP, MacDonald EL. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 380-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361350&dopt=Abstract

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“I felt violated”: women's experience of childbirth-associated anger. Author(s): Mozingo JN, Davis MW, Thomas SP, Droppleman PG. Source: Mcn. the American Journal of Maternal Child Nursing. 2002 NovemberDecember; 27(6): 342-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439136&dopt=Abstract

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A company of women and men: men's recollections of childbirth in medieval England. Author(s): Lee BR. Source: Journal of Family History. 2002 April; 27(2): 92-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12004900&dopt=Abstract

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A comparison of young women's psychosocial status based on age of their first childbirth. Author(s): Vicary JR, Corneal DA. Source: Family & Community Health. 2001 July; 24(2): 73-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11373167&dopt=Abstract

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A place for the partner? Expectations and experiences of support during childbirth. Author(s): Somers-Smith MJ. Source: Midwifery. 1999 June; 15(2): 101-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10703413&dopt=Abstract

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A qualitative study of childbirth as spoken about in midwives' ante- and postnatal consultations. Author(s): Olsson P, Jansson L, Norberg A. Source: Midwifery. 2000 June; 16(2): 123-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11151548&dopt=Abstract

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A randomized controlled trial of intervention in fear of childbirth. Author(s): Saisto T, Salmela-Aro K, Nurmi JE, Kononen T, Halmesmaki E. Source: Obstetrics and Gynecology. 2001 November; 98(5 Pt 1): 820-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704175&dopt=Abstract

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A survey of trainee obstetricians preferences for childbirth. Author(s): Wright JB, Wright AL, Simpson NA, Bryce FC. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 July; 97(1): 23-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435003&dopt=Abstract

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A survey of women's experiences of vaginal loss from 24 hours to three months after childbirth (the BLiPP study). Author(s): Marchant S, Alexander J, Garcia J, Ashurst H, Alderdice F, Keene J. Source: Midwifery. 1999 June; 15(2): 72-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10703409&dopt=Abstract

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Acute onset of obsessive-compulsive disorder in males following childbirth. Author(s): Abramowitz J, Moore K, Carmin C, Wiegartz PS, Purdon C. Source: Psychosomatics. 2001 September-October; 42(5): 429-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739911&dopt=Abstract

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Adding up 30 years of childbirth advocacy: how far have we come? Author(s): Young D. Source: Birth (Berkeley, Calif.). 2000 March; 27(1): 1-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10865553&dopt=Abstract

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Adherence to cultural practices following childbirth in migrant Chinese women and relation to postpartum mood. Author(s): Matthey S, Panasetis P, Barnett B. Source: Health Care for Women International. 2002 September-November; 23(6-7): 56775. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418979&dopt=Abstract

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Adolescents' experiences of childbirth: contrasts with adults. Author(s): Low LK, Martin K, Sampselle C, Guthrie B, Oakley D. Source: Journal of Midwifery & Women's Health. 2003 May-June; 48(3): 192-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764304&dopt=Abstract

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Advising prospective mothers about the maternal morbidity of vaginal childbirth. Author(s): Bump RC. Source: American Journal of Obstetrics and Gynecology. 2002 October; 187(4): 823. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12388956&dopt=Abstract

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Agreement between older subjects and proxy informants on history of surgery and childbirth. Author(s): Robbins JM, Wolfson CM, Bergman H, Clarfield AM, Kleiman S, Bilker W, Baumgarten M. Source: Journal of the American Geriatrics Society. 2000 August; 48(8): 975-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10968305&dopt=Abstract

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An evaluation of midwives' counseling of pregnant women in fear of childbirth. Author(s): Ryding EL, Persson A, Onell C, Kvist L. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 January; 82(1): 10-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580833&dopt=Abstract

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Anal incontinence after childbirth. Author(s): Eason E, Labrecque M, Marcoux S, Mondor M. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 February 5; 166(3): 326-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868640&dopt=Abstract

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Anesthesia for childbirth: controversy and change. Author(s): Caton D, Frolich MA, Euliano TY. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5 Suppl Nature): S25-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12011871&dopt=Abstract

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Antenatal, delivery and postnatal comparisons of maternal satisfaction with two pilot Changing Childbirth schemes compared with a traditional model of care. Author(s): Spurgeon P, Hicks C, Barwell F. Source: Midwifery. 2001 June; 17(2): 123-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11399133&dopt=Abstract

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Anti-D administration after childbirth for preventing Rhesus alloimmunisation. Author(s): Cochrane Database Syst Rev. 2003;(2):CD000025 Source: Cochrane Database Syst Rev. 2000; (2): Cd000021. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804383

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Anti-D administration after childbirth for preventing Rhesus isoimmunisation. Author(s): Anderson T. Source: Pract Midwife. 1999 May; 2(5): 10-1. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024602&dopt=Abstract

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Anxiety and functional status after childbirth. Author(s): McVeigh CA. Source: Aust Coll Midwives Inc J. 2000 March; 13(1): 14-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11107372&dopt=Abstract

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Are pain tolerance of female runners and use of pain coping strategies related to the experience of childbirth? Author(s): Crawford H, Gijsbers K. Source: Percept Mot Skills. 2000 June; 90(3 Pt 1): 1045-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10883795&dopt=Abstract

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Ascertaining women's choice of title during pregnancy and childbirth. Author(s): Denning AS, Tuttle LK, Bryant VJ, Walker SP, Higgins JR. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 May; 42(2): 125-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069137&dopt=Abstract

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Assessment tool promotes continence after childbirth. Author(s): Dandy D. Source: Nurs Times. 1999 July 14-20; 95(28): 42-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10524154&dopt=Abstract

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Attitudes and beliefs about childbirth among college students: results of an educational intervention. Author(s): Cleeton ER. Source: Birth (Berkeley, Calif.). 2001 September; 28(3): 192-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11552968&dopt=Abstract

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Attitudes of Canadian women toward birthing centres and midwife care for childbirth. Author(s): Wen SW, Mery LS, Kramer MS, Jimenez V, Trouton K, Herbert P, Chalmers B. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1999 September 21; 161(6): 708-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10513277&dopt=Abstract

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Australian adolescents' attitudes and beliefs concerning pregnancy, childbirth and parenthood: the development, psychometric testing and results of a new scale. Author(s): Condon JT, Donovan J, Corkindale CJ. Source: Journal of Adolescence. 2001 December; 24(6): 729-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11790053&dopt=Abstract

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Benefits of massage therapy and use of a doula during labor and childbirth. Author(s): Keenan P. Source: Alternative Therapies in Health and Medicine. 2000 January; 6(1): 66-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10631824&dopt=Abstract

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Breast cancer risk after childbirth in young women with family history (Denmark). Author(s): Wohlfahrt J, Olsen JH, Melby M. Source: Cancer Causes & Control : Ccc. 2002 March; 13(2): 169-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11936823&dopt=Abstract

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Bubba, childbirth, and the power of prayer: a clinical pastoral education memory. Author(s): Baroody J. Source: J Pastoral Care. 2000 Winter; 54(4): 461-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191000&dopt=Abstract

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Can women's cognitive appraisals be registered throughout childbirth? Author(s): Alehagen S, Wijma K, Wijma B. Source: Gynecologic and Obstetric Investigation. 2000; 49(1): 31-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10629370&dopt=Abstract

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Care for adolescent pregnancy and childbirth. Author(s): Treffers PE, Olukoya AA, Ferguson BJ, Liljestrand J. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 November; 75(2): 111-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11684107&dopt=Abstract

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Caregiver support for women during childbirth. Author(s): Hodnett ED. Source: Cochrane Database Syst Rev. 2002; (1): Cd000199. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869571&dopt=Abstract

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Caregiver support for women during childbirth. Author(s): Hodnett ED. Source: Cochrane Database Syst Rev. 2000; (2): Cd000199. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796179&dopt=Abstract

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Caregiver support for women during childbirth. Author(s): Anderson T. Source: Pract Midwife. 1999 September; 2(8): 10-1. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10723394&dopt=Abstract

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Caregiver support for women during childbirth: does the presence of a labor-support person affect maternal-child outcomes? Author(s): Taylor JS. Source: American Family Physician. 2002 October 1; 66(7): 1205-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387431&dopt=Abstract

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Caring behaviors by nurses: women's perceptions during childbirth. Author(s): Manogin TW, Bechtel GA, Rami JS. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2000 March-April; 29(2): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10750681&dopt=Abstract

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Changing childbirth proves a late starter. Author(s): Burke K. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1999 September 1-7; 13(50): 12-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10661198&dopt=Abstract

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Changing Childbirth: a pilot project. Author(s): Hicks C, Spurgeon P, Barwell F. Source: Journal of Advanced Nursing. 2003 June; 42(6): 617-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12787235&dopt=Abstract

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Childbirth advice literature as it relates to two childbearing ideologies. Author(s): Pincus J. Source: Birth (Berkeley, Calif.). 2000 September; 27(3): 209-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251505&dopt=Abstract

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Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery. Author(s): Willis S, Faridi A, Schelzig S, Hoelzl F, Kasperk R, Rath W, Schumpelick V. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2002 June; 387(2): 101-7. Epub 2002 May 18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12111263&dopt=Abstract

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Childbirth and infant development knowledge gaps in interpersonal settings. Author(s): Gaziano C, O'Leary J. Source: Journal of Health Communication. 1998 January-March; 3(1): 29-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10947373&dopt=Abstract

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Childbirth and pragmatic midwifery in rural Ghana. Author(s): Geurts K. Source: Medical Anthropology. 2001; 20(4): 379-408. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11817851&dopt=Abstract

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Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Author(s): Creedy DK, Shochet IM, Horsfall J. Source: Birth (Berkeley, Calif.). 2000 June; 27(2): 104-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251488&dopt=Abstract

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Childbirth and the responsibility of choice. Author(s): Long K. Source: Midwifery Today Int Midwife. 2002 Winter; (64): 16-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12526588&dopt=Abstract

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Childbirth anger. Author(s): Hall S. Source: Mcn. the American Journal of Maternal Child Nursing. 2003 March-April; 28(2): 125. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12675038&dopt=Abstract

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Childbirth anger. Author(s): Weinstein LB. Source: Mcn. the American Journal of Maternal Child Nursing. 2003 March-April; 28(2): 125. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12629320&dopt=Abstract

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Childbirth as healing: three women's experience of independent midwife care. Author(s): Milan M. Source: Complementary Therapies in Nursing & Midwifery. 2003 August; 9(3): 140-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12852930&dopt=Abstract

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Childbirth care-seeking behavior in Chiapas. Author(s): Hunt LM, Glantz NM, Halperin DC. Source: Health Care for Women International. 2002 January; 23(1): 98-118. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11822563&dopt=Abstract

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Childbirth choices in Florida: alive and well. Author(s): Suarez SH. Source: The Florida Nurse. 1999 June; 47(2): 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11995136&dopt=Abstract

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Childbirth education classes: sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation. Author(s): Lu MC, Prentice J, Yu SM, Inkelas M, Lange LO, Halfon N. Source: Maternal and Child Health Journal. 2003 June; 7(2): 87-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870624&dopt=Abstract

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Childbirth expectations of Chinese first-time pregnant women. Author(s): Ip WY, Chien WT, Chan CL. Source: Journal of Advanced Nursing. 2003 April; 42(2): 151-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12670384&dopt=Abstract

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Childbirth in bed. The historical perspective. Author(s): Boyle M. Source: Pract Midwife. 2000 December; 3(11): 21-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026562&dopt=Abstract

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Childbirth in Switzerland. Author(s): Schmider D. Source: Midwifery Today Int Midwife. 2000 Spring; (53): 54-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189629&dopt=Abstract

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Childbirth in the forthcoming millennium. Author(s): Finnegan M. Source: Nouv Com Int Cathol Infirm Assist Med Soc. 1998; (1-2): 2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11081041&dopt=Abstract

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Childbirth is what we believe it is. Author(s): Downe S. Source: Pract Midwife. 2002 October; 5(9): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400403&dopt=Abstract

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Childbirth: expectations, choices, and trends. Author(s): Sjogren B. Source: Lancet. 2000 December; 356 Suppl: S12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191467&dopt=Abstract

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Childbirth-induced trauma to the urethral continence mechanism: review and recommendations. Author(s): Baessler K, Schuessler B. Source: Urology. 2003 October; 62(4 Suppl 1): 39-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14550836&dopt=Abstract

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Childbirth-related perineal trauma: clinical significance and prevention. Author(s): Connolly AM, Thorp JM Jr. Source: Clinical Obstetrics and Gynecology. 1999 December; 42(4): 820-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10572696&dopt=Abstract

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Chinese medicine for pregnancy and childbirth. Author(s): Wilkowski R. Source: Midwifery Today Int Midwife. 2001 Summer; (58): 39-41. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12154718&dopt=Abstract

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Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease. Author(s): Lak M, Peyvandi F, Mannucci PM. Source: British Journal of Haematology. 2000 December; 111(4): 1236-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11167767&dopt=Abstract

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Closing the gap. Diastasis symphysis pubis in childbirth. Author(s): Podmore S. Source: Pract Midwife. 1999 November; 2(10): 20-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024553&dopt=Abstract

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Cochrane pregnancy and childbirth database: resource for evidence-based practice. Author(s): Callister LC, Hobbins-Garbett D. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2000 March-April; 29(2): 123-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10750677&dopt=Abstract

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Cohort study of depressed mood during pregnancy and after childbirth. Author(s): Evans J, Heron J, Francomb H, Oke S, Golding J. Source: Bmj (Clinical Research Ed.). 2001 August 4; 323(7307): 257-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11485953&dopt=Abstract

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Collaboration to implement smoking cessation guidelines during the childbirth continuum. Author(s): Saks NP, Hartigan P, Howard N, Schneider JM, Nathan G, Fidler C, Beck CH Jr. Source: Jt Comm J Qual Improv. 2001 December; 27(12): 664-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11765383&dopt=Abstract

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Commentary: studying maternal experiences of childbirth. Author(s): Dahlberg K, Berg M, Lundgren I. Source: Birth (Berkeley, Calif.). 1999 December; 26(4): 215-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10655825&dopt=Abstract

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Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth--a prospective population-based study of mothers and fathers. Author(s): Skari H, Skreden M, Malt UF, Dalholt M, Ostensen AB, Egeland T, Emblem R. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 October; 109(10): 1154-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387470&dopt=Abstract

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Consumer-professional partnership to improve research: the experience of the Cochrane Collaboration's Pregnancy and Childbirth Group. Author(s): Sakala C, Gyte G, Henderson S, Neilson JP, Horey D. Source: Birth (Berkeley, Calif.). 2001 June; 28(2): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380386&dopt=Abstract

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Contemporary methods in hypnotic preparation for childbirth. Author(s): Oster MI. Source: Crna. 2000 November; 11(4): 160-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866022&dopt=Abstract

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Continuity of caregivers for care during pregnancy and childbirth. Author(s): Cochrane Database Syst Rev. 2001;(2):CD000063 Source: Cochrane Database Syst Rev. 2000; (2): Cd000062. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11405949

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Continuous support for women during childbirth. Author(s): Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Source: Cochrane Database Syst Rev. 2003; (3): Cd003766. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917986&dopt=Abstract

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Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data. Author(s): Tracy SK, Tracy MB. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 August; 110(8): 717-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892682&dopt=Abstract

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Cross-cultural issues concerning sexuality, fertility, and childbirth. Author(s): South-Paul JE. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2003 March-April; 16(2): 180-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665187&dopt=Abstract

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Cultural and spiritual meanings of childbirth. Orthodox Jewish and Mormon women. Author(s): Callister LC, Semenic S, Foster JC. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1999 September; 17(3): 280-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10690070&dopt=Abstract

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Cultural childbirth practices and beliefs in Zambia. Author(s): Maimbolwa MC, Yamba B, Diwan V, Ransjo-Arvidson AB. Source: Journal of Advanced Nursing. 2003 August; 43(3): 263-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859785&dopt=Abstract

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Culturally sensitive care during childbirth. Author(s): Raines DA, Morgan Z. Source: Applied Nursing Research : Anr. 2000 November; 13(4): 167-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11078781&dopt=Abstract

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Depressed mood during pregnancy and after childbirth. Data do not support idea that depression is more common antenatally than postnatally. Author(s): Oates MR, Lee A. Source: Bmj (Clinical Research Ed.). 2001 December 8; 323(7325): 1367-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11791253&dopt=Abstract

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Depressed mood during pregnancy and after childbirth. Time points for assessing perinatal mood must be optimised. Author(s): Lappin J. Source: Bmj (Clinical Research Ed.). 2001 December 8; 323(7325): 1367; Author Reply 1368. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11791254&dopt=Abstract

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Depressed mood during pregnancy and after childbirth. Treatment for depression is important confounding variable. Author(s): Sheehan J, Crotty FM. Source: Bmj (Clinical Research Ed.). 2001 December 8; 323(7325): 1367; Author Reply 1368. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11791255&dopt=Abstract

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Depression associated with abortion and childbirth: a long-term analysis of the NLSY cohort. Author(s): Cougle JR, Reardon DC, Coleman PK. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2003 April; 9(4): Cr105-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709667&dopt=Abstract

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Did mothers begin with an advantage? A study of childbirth and maternal health in England and Wales, 1778-1929. Author(s): Riley J. Source: Population Studies. 2003; 57(1): 5-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745806&dopt=Abstract

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Dissections after childbirth. Author(s): Gasecki AP, Kwiecinski H, Lyrer PA, Lynch TG, Baxter T. Source: Journal of Neurology. 1999 August; 246(8): 712-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10460450&dopt=Abstract

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Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Author(s): Ayers S, Pickering AD. Source: Birth (Berkeley, Calif.). 2001 June; 28(2): 111-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380382&dopt=Abstract

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Does fear of childbirth during pregnancy predict emergency caesarean section? Author(s): Johnson R, Slade P. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 November; 109(11): 1213-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452457&dopt=Abstract

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Doulas: an alternative yet complementary addition to care during childbirth. Author(s): Kayne MA, Greulich MB, Albers LL. Source: Clinical Obstetrics and Gynecology. 2001 December; 44(4): 692-703. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11600852&dopt=Abstract

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Early discharge after childbirth: too late for a randomized trial? Author(s): Thompson JF, Roberts CL, Ellwood DA. Source: Birth (Berkeley, Calif.). 1999 September; 26(3): 192-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10655820&dopt=Abstract

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Early modern childbirth. Author(s): Fee E, Brown TM, Beatty RL. Source: American Journal of Public Health. 2003 March; 93(3): 432. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12604487&dopt=Abstract

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Education for contraceptive use by women after childbirth. Author(s): Hiller JE, Griffith E, Jenner F. Source: Cochrane Database Syst Rev. 2002; (3): Cd001863. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12137636&dopt=Abstract

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Education for contraceptive use by women after childbirth. Author(s): Hiller JE, Griffith E. Source: Cochrane Database Syst Rev. 2000; (2): Cd001863. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796830&dopt=Abstract

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Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth. Author(s): Garcia FA, Miller HB, Huggins GR, Gordon TA. Source: Obstetrics and Gynecology. 2001 April; 97(4): 567-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11275029&dopt=Abstract

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Effective care in pregnancy and childbirth: a synopsis. Author(s): Enkin M, Keirse MJ, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr GJ. Source: Birth (Berkeley, Calif.). 2001 March; 28(1): 41-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264628&dopt=Abstract

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Efficacy of Hypericum and Calendula oils in the epithelial reconstruction of surgical wounds in childbirth with caesarean section. Author(s): Lavagna SM, Secci D, Chimenti P, Bonsignore L, Ottaviani A, Bizzarri B. Source: Farmaco (Societa Chimica Italiana : 1989). 2001 May-July; 56(5-7): 451-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11482776&dopt=Abstract

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Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. Author(s): Mayberry LJ, Clemmens D, De A. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5 Suppl Nature): S81-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12011875&dopt=Abstract

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Equipment for surgical interventions and childbirth in weightlessness. Author(s): Mutke HG. Source: Acta Astronautica. 1981 April; 8(4): 399-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11542960&dopt=Abstract

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Estrogen administration does not reduce the rate of recurrence of affective psychosis after childbirth. Author(s): Kumar C, McIvor RJ, Davies T, Brown N, Papadopoulos A, Wieck A, Checkley SA, Campbell IC, Marks MN. Source: The Journal of Clinical Psychiatry. 2003 February; 64(2): 112-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633118&dopt=Abstract

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Evaluating policy and practice: what are the effects of early hospital discharge after childbirth? Author(s): Lumley JM. Source: The Medical Journal of Australia. 2000 June 5; 172(11): 524-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10920746&dopt=Abstract

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Evaluation of an early discharge program for infants after childbirth in a military population. Author(s): Gries DM, Phyall G, Barfield WD. Source: Military Medicine. 2000 August; 165(8): 616-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10957856&dopt=Abstract

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Evidence-based childbirth only for breech babies? Author(s): Keirse MJ. Source: Birth (Berkeley, Calif.). 2002 March; 29(1): 55-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11843791&dopt=Abstract

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Evidence-based practice and its application to childbirth care for low-risk women. Author(s): Rooks JP. Source: Journal of Nurse-Midwifery. 1999 July-August; 44(4): 355-69. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10466282&dopt=Abstract

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Excess breast cancer risk and the role of parity, age at first childbirth and exposure to radiation in infancy. Author(s): Holmberg E, Holm LE, Lundell M, Mattsson A, Wallgren A, Karlsson P. Source: British Journal of Cancer. 2001 August 3; 85(3): 362-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11487266&dopt=Abstract

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Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women. Author(s): Melender HL. Source: Birth (Berkeley, Calif.). 2002 June; 29(2): 101-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051188&dopt=Abstract

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Experiences of Lesbian couples during childbirth. Author(s): Buchholz SE. Source: Nursing Outlook. 2000 November-December; 48(6): 307-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11135145&dopt=Abstract

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Experiences of security associated with pregnancy and childbirth: a study of pregnant women. Author(s): Melender HL, Lauri S. Source: International Journal of Nursing Practice. 2002 December; 8(6): 289-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12390581&dopt=Abstract

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Fathers should provide support during childbirth. Author(s): Richards JW Jr. Source: American Family Physician. 2003 May 15; 67(10): 2071. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776957&dopt=Abstract

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Fear of childbirth during pregnancy: a study of more than 8000 pregnant women. Author(s): Geissbuehler V, Eberhard J. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2002 December; 23(4): 229-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12520860&dopt=Abstract

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Fear of childbirth: a neglected dilemma. Author(s): Saisto T, Halmesmaki E. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 March; 82(3): 201-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694113&dopt=Abstract

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Fears and coping strategies associated with pregnancy and childbirth in Finland. Author(s): Melender HL. Source: Journal of Midwifery & Women's Health. 2002 July-August; 47(4): 256-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138933&dopt=Abstract

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Fears associated with pregnancy and childbirth--experiences of women who have recently given birth. Author(s): Melender HL, Lauri S. Source: Midwifery. 1999 September; 15(3): 177-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10776242&dopt=Abstract

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Female genital mutilation (FGM) management during pregnancy, childbirth and the postpartum period. Author(s): Rushwan H. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 July; 70(1): 99-104. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10884538&dopt=Abstract

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First-time mothers' satisfaction with labor and childbirth information received: a Malawian perspective. Author(s): Malata M. Source: Clin Excell Nurse Pract. 2000 March; 4(2): 83-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11075049&dopt=Abstract

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From 'culture of dehumanization of childbirth' to 'childbirth as a transformative experience': changes in five municipalities in north-east Brazil. Author(s): Misago C, Kendall C, Freitas P, Haneda K, Silveira D, Onuki D, Mori T, Sadamori T, Umenai T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 November; 75 Suppl 1: S67-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11742645&dopt=Abstract

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Has medicalisation of childbirth gone too far? Childbirth in Taiwan is certainly overmedicalised. Author(s): Yeh PS. Source: Bmj (Clinical Research Ed.). 2002 July 13; 325(7355): 103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12125687&dopt=Abstract

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Has medicalisation of childbirth gone too far? Regional analgesia in labour permits childbirth without fear. Author(s): Camann W. Source: Bmj (Clinical Research Ed.). 2002 July 13; 325(7355): 103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12114249&dopt=Abstract

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Has medicalisation of childbirth gone too far? Timely intervention is the key. Author(s): Lim MN. Source: Bmj (Clinical Research Ed.). 2002 July 13; 325(7355): 103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12125686&dopt=Abstract

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Has the medicalisation of childbirth gone too far? Author(s): Johanson R, Newburn M, Macfarlane A. Source: Bmj (Clinical Research Ed.). 2002 April 13; 324(7342): 892-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11950741&dopt=Abstract

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Health problems after childbirth. Author(s): Albers LL. Source: Journal of Midwifery & Women's Health. 2000 January-February; 45(1): 55-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10772735&dopt=Abstract

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Herbal medicine in pregnancy and childbirth. Author(s): Westfall RE. Source: Adv Ther. 2001 January-February; 18(1): 47-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11512532&dopt=Abstract

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High-risk childbirth practices in remote Nepal and their determinants. Author(s): Thapa N, Chongsuvivatwong V, Geater AF, Ulstein M. Source: Women & Health. 2000; 31(4): 83-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11310813&dopt=Abstract

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HIV, childbirth and suicidal behaviour: a review. Author(s): Green L, Ardron C, Catalan J. Source: Hosp Med. 2000 May; 61(5): 311-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10953735&dopt=Abstract

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Holistic obstetrics: the origins of “natural childbirth” in Britain. Author(s): Moscucci O. Source: Postgraduate Medical Journal. 2003 March; 79(929): 168-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697920&dopt=Abstract

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Home too soon? A comment on the early discharge of women from hospital after childbirth. Author(s): Scrivens L, Summers AD. Source: Aust J Midwifery. 2001 September; 14(3): 28-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760009&dopt=Abstract

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Homeopathy for the childbirth attendant. Author(s): Ferreira K. Source: Midwifery Today Int Midwife. 2003 Spring; (65): 38-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710150&dopt=Abstract

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Honoring childbirth. Birth as a healing experience. Author(s): Freedman LH. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2000 June-July; 4(3): 72, 70-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249392&dopt=Abstract

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Hospital infection. The scourge of childbirth. Author(s): Briance P. Source: Pract Midwife. 2001 April; 4(4): 46. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026619&dopt=Abstract

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Hospital variation in episiotomy use and the risk of perineal trauma during childbirth. Author(s): Webb DA, Culhane J. Source: Birth (Berkeley, Calif.). 2002 June; 29(2): 132-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12000414&dopt=Abstract

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Humanization of childbirth in Bolivia. Author(s): Onuki D. Source: Midwifery Today Int Midwife. 2002 Winter; (64): 54-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12526599&dopt=Abstract

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Humanizing childbirth. Author(s): Lyttle B. Source: The American Journal of Nursing. 2000 October; 100(10): 52-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11059320&dopt=Abstract

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HypnoBirthing. A radical change on our perspective of pain in childbirth. Author(s): Wainer N. Source: Midwifery Today Int Midwife. 2000 Autumn; (55): 36-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189565&dopt=Abstract

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Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial. Author(s): Peter EA, Janssen PA, Grange CS, Douglas MJ. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2001 October 30; 165(9): 1203-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11706909&dopt=Abstract

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Importance of the midwife in the first-time mother's experience of childbirth. Author(s): Tarkka MT, Paunonen M, Laippala P. Source: Scandinavian Journal of Caring Sciences. 2000; 14(3): 184-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035270&dopt=Abstract

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Individual or group antenatal education for childbirth/parenthood. Author(s): Gagnon AJ. Source: Cochrane Database Syst Rev. 2000; (4): Cd002869. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034780&dopt=Abstract

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Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth. Author(s): Frudinger A, Halligan S, Spencer JA, Bartram CI, Kamm MA, Winter R. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 November; 109(11): 1207-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452456&dopt=Abstract

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Investigating the relationship between satisfaction with social support and functional status after childbirth. Author(s): McVeigh CA. Source: Mcn. the American Journal of Maternal Child Nursing. 2000 January-February; 25(1): 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10676082&dopt=Abstract

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Investigating the risk of pressure damage during childbirth. Author(s): Newton H, Butcher M. Source: British Journal of Nursing (Mark Allen Publishing). 2000 March 23-April 12; 9(6 Suppl): S20-2, S24, S26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11051872&dopt=Abstract

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Is childbirth safe in the UK and are there enough obstetricians? Letter to a chief executive. Author(s): Eddy JW. Source: Hosp Med. 2000 March; 61(3): 204-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10789393&dopt=Abstract

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Is the childbirth experience improved by a birth plan? Author(s): Lundgren I, Berg M, Lindmark G. Source: Journal of Midwifery & Women's Health. 2003 September-October; 48(5): 322-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526345&dopt=Abstract

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Issues for South Asian Indian patients surrounding sexuality, fertility, and childbirth in the US health care system. Author(s): Fisher JA, Bowman M, Thomas T. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2003 March-April; 16(2): 151-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665181&dopt=Abstract

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Italian-American women and changing childbirth practices. Author(s): Carangelo A. Source: Midwifery Today Int Midwife. 2001 Winter; (60): 48-51. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584821&dopt=Abstract

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Jailed mothers. A chaplain delivers restorative justice childbirth. Author(s): Rateliff K. Source: Midwifery Today Int Midwife. 2000 Spring; (53): 30-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189616&dopt=Abstract

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Japanese couples' childbirth experiences in Michigan: implications for care. Author(s): Yeo S, Fetters M, Maeda Y. Source: Birth (Berkeley, Calif.). 2000 September; 27(3): 191-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251502&dopt=Abstract

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Japanese women's experience of childbirth in the United States. Author(s): Ito M, Sharts-Hopko NC. Source: Health Care for Women International. 2002 September-November; 23(6-7): 66677. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418987&dopt=Abstract

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Length of hospital stay, obstetric conditions at childbirth, and maternal readmission: a population-based cohort study. Author(s): Liu S, Heaman M, Kramer MS, Demissie K, Wen SW, Marcoux S; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Source: American Journal of Obstetrics and Gynecology. 2002 September; 187(3): 681-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12237648&dopt=Abstract

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Long-term health consequences of delayed childbirth: NHANES III. Author(s): Alonzo AA. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 2002 January-February; 12(1): 37-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11786291&dopt=Abstract

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Losing the plot: narrative construction and longitudinal childbirth research. Author(s): Miller T. Source: Qualitative Health Research. 2000 May; 10(3): 309-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10947478&dopt=Abstract

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Major threats to childbirth in developing countries. Author(s): Paruk F, Moodley J. Source: Hosp Med. 1999 September; 60(9): 633-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10621788&dopt=Abstract

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Making childbirth a normal process. Author(s): Righard L. Source: Birth (Berkeley, Calif.). 2001 March; 28(1): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264621&dopt=Abstract

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Malaria prophylaxis and the reduction of anemia at childbirth. Author(s): Geelhoed DW, Visser LE, Addae V, Asare K, Schagen van Leeuwen JH, van Roosmalen J. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 August; 74(2): 133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11502291&dopt=Abstract

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Male appropriation and medicalization of childbirth: an historical analysis. Author(s): Cahill HA. Source: Journal of Advanced Nursing. 2001 February; 33(3): 334-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251720&dopt=Abstract

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Marion's message. Childbirth and healing. Author(s): McLean MT. Source: Midwifery Today Int Midwife. 2003 Spring; (65): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710134&dopt=Abstract

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Massage for childbirth and pregnancy--8 years on. Author(s): Kimber L. Source: Pract Midwife. 2002 March; 5(3): 20-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11915418&dopt=Abstract

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Maternal satisfaction and pain control in women electing natural childbirth. Author(s): Kannan S, Jamison RN, Datta S. Source: Regional Anesthesia and Pain Medicine. 2001 September-October; 26(5): 468-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561269&dopt=Abstract

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Measuring nursing support during childbirth. Author(s): Gale J, Fothergill-Bourbonnais F, Chamberlain M. Source: Mcn. the American Journal of Maternal Child Nursing. 2001 September-October; 26(5): 264-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11552577&dopt=Abstract

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Midwife-led units. A natural home for childbirth? Author(s): Nolan M. Source: Pract Midwife. 2001 October; 4(9): 22-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026673&dopt=Abstract

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Midwives' experience of the encounter with women and their pain during childbirth. Author(s): Lundgren I, Dahlberg K. Source: Midwifery. 2002 June; 18(2): 155-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12139913&dopt=Abstract

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Midwives' perceptions of the use of technology in assisting childbirth in Northern Ireland. Author(s): Sinclair M, Gardner J. Source: Journal of Advanced Nursing. 2001 October; 36(2): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11580797&dopt=Abstract

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Midwives' support needs as childbirth changes. Author(s): Kirkham M, Stapleton H. Source: Journal of Advanced Nursing. 2000 August; 32(2): 465-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10964196&dopt=Abstract

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Obstetric anesthesia and analgesia: options for pain relief during childbirth. Author(s): Lee SH, Barcohana Y. Source: Medicine and Health, Rhode Island. 2001 October; 84(10): 329-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11693051&dopt=Abstract

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Only a minor part of cerebral palsy cases begin in labour. But still room for controversial childbirth issues in court. Author(s): Bakketeig LS. Source: Bmj (Clinical Research Ed.). 1999 October 16; 319(7216): 1016-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10521172&dopt=Abstract

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Osteopathy in pregnancy and childbirth. Interview by Jenny Green. Author(s): Sandler S, Korth S. Source: Pract Midwife. 2000 July-August; 3(7): 38-43. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026438&dopt=Abstract

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Out of the womb, into the fire. The myth of the safety of hospital childbirth. Author(s): Doubleday J. Source: Midwifery Today Int Midwife. 1999 Summer; (50): 24-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10478046&dopt=Abstract

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Pain and suffering in childbirth. A look at attitudes, research and history. Author(s): Van Hoover C. Source: Midwifery Today Int Midwife. 2000 Autumn; (55): 39-42, 69. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189566&dopt=Abstract

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Pain and women's satisfaction with the experience of childbirth: a systematic review. Author(s): Hodnett ED. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5 Suppl Nature): S160-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12011880&dopt=Abstract

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Parents' needs to talk about their experiences of childbirth. Author(s): Olin RM, Faxelid E. Source: Scandinavian Journal of Caring Sciences. 2003 June; 17(2): 153-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753516&dopt=Abstract

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Paying for choice in childbirth. Author(s): Sommerville F. Source: Nurs Times. 1999 June 2-8; 95(22): 20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10455703&dopt=Abstract

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Pelvic floor disturbance after childbirth: vaginal delivery damages the upper levels of sphincter innervation. Author(s): Sato T, Konishi F, Minakami H, Nakatsubo N, Kanazawa K, Sato I, Itoh K, Nagai H. Source: Diseases of the Colon and Rectum. 2001 August; 44(8): 1155-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535856&dopt=Abstract

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Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh. Author(s): Kusiako T, Ronsmans C, Van der Paal L. Source: Bulletin of the World Health Organization. 2000; 78(5): 621-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10859856&dopt=Abstract

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Perineal massage for prevention of perineal trauma in childbirth. Author(s): Johanson R. Source: Lancet. 2000 January 22; 355(9200): 250-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10675069&dopt=Abstract

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Personal preferences of obstetricians towards childbirth. Author(s): Land R, Parry E, Rane A, Wilson D. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2001 August; 41(3): 249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11592537&dopt=Abstract

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Physical health problems after childbirth and maternal depression at six to seven months postpartum. Author(s): Brown S, Lumley J. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 October; 107(10): 1194-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11028568&dopt=Abstract

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Poorest women 20 times more likely to die in childbirth. Author(s): Mayor S. Source: Bmj (Clinical Research Ed.). 2001 December 8; 323(7325): 1324. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739211&dopt=Abstract

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Postnatal morbidity after childbirth and severe obstetric morbidity. Author(s): Waterstone M, Wolfe C, Hooper R, Bewley S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 February; 110(2): 128-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12618155&dopt=Abstract

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Post-traumatic stress disorder after childbirth. Do midwives have a preventative role? Author(s): Church S, Scanlan M. Source: Pract Midwife. 2002 June; 5(6): 10-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099126&dopt=Abstract

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Preparing for motherhood: authoritative knowledge and the undercurrents of shared experience in two childbirth education courses in Cagliari, Italy. Author(s): Ketler SK. Source: Medical Anthropology Quarterly. 2000 June; 14(2): 138-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10879367&dopt=Abstract

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Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Author(s): Thompson JF, Roberts CL, Currie M, Ellwood DA. Source: Birth (Berkeley, Calif.). 2002 June; 29(2): 83-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051189&dopt=Abstract

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Prevalence and predictors of post-traumatic stress symptoms following childbirth. Author(s): Czarnocka J, Slade P. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2000 March; 39 ( Pt 1): 35-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10789027&dopt=Abstract

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Prevalence and predictors of women's experience of psychological trauma during childbirth. Author(s): Soet JE, Brack GA, DiIorio C. Source: Birth (Berkeley, Calif.). 2003 March; 30(1): 36-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12581038&dopt=Abstract

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Preventing perineal trauma during childbirth: a systematic review. Author(s): Walker JL. Source: Obstetrics and Gynecology. 2000 July; 96(1): 154. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10928906&dopt=Abstract

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Preventing perineal trauma during childbirth: a systematic review. Author(s): Eason E, Labrecque M, Wells G, Feldman P. Source: Obstetrics and Gynecology. 2000 March; 95(3): 464-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10711565&dopt=Abstract

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Prevention of childbirth injuries to the pelvic floor. Author(s): Heit M, Mudd K, Culligan P. Source: Curr Womens Health Rep. 2001 August; 1(1): 72-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112955&dopt=Abstract

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Problems after vacuum-assisted childbirth. Author(s): Dwyer D. Source: Nursing. 2002 January; 32(1): 74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12929681&dopt=Abstract

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Professional attitudes to Changing Childbirth in Nottingham, UK. Author(s): Holroyd S, Bailey V, James V, Pitman A, Whynes DK. Source: International Journal of Nursing Studies. 2002 February; 39(2): 177-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11755448&dopt=Abstract

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Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression. Author(s): Cochrane Database Syst Rev. 2001;(2):CD001338 Source: The British Journal of Clinical Psychology / the British Psychological Society. 2000 September; 39 ( Pt 3): 223-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11405987

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Promoting normality in childbirth. Author(s): Johanson R, Newburn M. Source: Bmj (Clinical Research Ed.). 2001 November 17; 323(7322): 1142-3. Erratum In: Bmj 2002 January 12; 324(7329): 98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11711387&dopt=Abstract

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Psychiatric admissions of low-income women following abortion and childbirth. Author(s): Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 May 13; 168(10): 1253-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12743066&dopt=Abstract

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Psychosocial characteristics of women and their partners fearing vaginal childbirth. Author(s): Saisto T, Salmela-Aro K, Nurmi JE, Halmesmaki E. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 May; 108(5): 492-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368135&dopt=Abstract

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Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden. Author(s): Essen B, Johnsdotter S, Hovelius B, Gudmundsson S, Sjoberg NO, Friedman J, Ostergren PO. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 December; 107(12): 1507-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11192108&dopt=Abstract

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Race, culture, and the colonization of childbirth in northern Canada. Author(s): Jasen P. Source: Social History of Medicine : the Journal of the Society for the Social History of Medicine / Sshm. 1997 December; 10(3): 383-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11619824&dopt=Abstract

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Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth. Author(s): Small R, Lumley J, Donohue L, Potter A, Waldenstrom U. Source: Bmj (Clinical Research Ed.). 2000 October 28; 321(7268): 1043-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11053173&dopt=Abstract

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Rectal analgesia for pain from perineal trauma following childbirth. Author(s): Hedayati H, Parsons J, Crowther CA. Source: Cochrane Database Syst Rev. 2003; (3): Cd003931. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917995&dopt=Abstract

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Rediscovering the “M” in “MCH”: maternal health promotion after childbirth. Author(s): Walker LO, Wilging S. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2000 May-June; 29(3): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10839571&dopt=Abstract

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Reinnervation after childbirth--a new paradigm for sensory bowel symptoms? Author(s): Quinn M. Source: Gut. 2001 October; 49(4): 597-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11589194&dopt=Abstract

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Reliability and validity of the Inventory of Functional Status after Childbirth when used in an Australian population. Author(s): McVeigh C, Chaboyer W. Source: Nursing & Health Sciences. 2002 September; 4(3): 107-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12153408&dopt=Abstract

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Reproductive history and involvement in pregnancy and childbirth of fathers of babies born to teenage mothers in Stockholm, Sweden. Author(s): Ekeus C, Christensson K. Source: Midwifery. 2003 June; 19(2): 87-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809628&dopt=Abstract

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Responding to fear of childbirth. Author(s): Bewley S, Cockburn J. Source: Lancet. 2002 June 22; 359(9324): 2128-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090975&dopt=Abstract

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Response to 'Midwives' support needs as childbirth changes' by M. Kirkham & H. Stapleton (2000) Journal of Advanced Nursing 32, 465-472. Author(s): Roche Reid B. Source: Journal of Advanced Nursing. 2001 August; 35(3): 388-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11489021&dopt=Abstract

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Response to: Male appropriation and medicalization of childbirth; an historical analysis by H.A. Churchill (2001) Journal of Advanced Nursing 33, 334-342. Author(s): Mander R. Source: Journal of Advanced Nursing. 2001 August; 35(3): 390-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11489022&dopt=Abstract

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Risk of late-stage breast cancer after a childbirth. Author(s): Wohlfahrt J, Andersen PK, Mouridsen HT, Melbye M. Source: American Journal of Epidemiology. 2001 June 1; 153(11): 1079-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11390326&dopt=Abstract

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Scintigraphic assessment of colonic transit in women with slow-transit constipation arising de novo and following pelvic surgery or childbirth. Author(s): Scott SM, Knowles CH, Newell M, Garvie N, Williams NS, Lunniss PJ. Source: The British Journal of Surgery. 2001 March; 88(3): 405-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11260108&dopt=Abstract

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Security associated with pregnancy and childbirth--experiences of pregnant women. Author(s): Melender HL, Lauri S. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2001 December; 22(4): 229-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840577&dopt=Abstract

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Self-efficacy for labor and childbirth fears in nulliparous pregnant women. Author(s): Lowe NK. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2000 December; 21(4): 219-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191169&dopt=Abstract

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Self-hypnosis: alternative anesthesia for childbirth. Author(s): Ketterhagen D, VandeVusse L, Berner MA. Source: Mcn. the American Journal of Maternal Child Nursing. 2002 NovemberDecember; 27(6): 335-40; Quiz 341. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439135&dopt=Abstract

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Serious maternal morbidity after childbirth: prolonged hospital stays and readmissions. Author(s): Hebert PR, Reed G, Entman SS, Mitchel EF Jr, Berg C, Griffin MR. Source: Obstetrics and Gynecology. 1999 December; 94(6): 942-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10576180&dopt=Abstract

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Sex and relationships following childbirth: a first report from general practice of 131 couples. Author(s): Dixon M, Booth N, Powell R. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2000 March; 50(452): 223-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10750236&dopt=Abstract

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Sexual activity during pregnancy and after childbirth: results from the Sexual Preferences Questionnaire. Author(s): von Sydow K, Ullmeyer M, Happ N. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2001 March; 22(1): 29-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11317607&dopt=Abstract

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Sexual function after childbirth in Nigerian women. Author(s): Oboro VO, Tabowei TO. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 September; 78(3): 249-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384272&dopt=Abstract

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Sexuality during pregnancy and after childbirth: a metacontent analysis of 59 studies. Author(s): von Sydow K. Source: Journal of Psychosomatic Research. 1999 July; 47(1): 27-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10511419&dopt=Abstract

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Sheila Kitzinger's and Jenny Kitzinger's letter from Europe: childbirth and breastfeeding in the British media. Author(s): Kitzinger S, Kitzinger J. Source: Birth (Berkeley, Calif.). 2001 March; 28(1): 60-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264631&dopt=Abstract

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Smooth, speedy, painless, and still midwife delivered? The Dutch midwife and childbirth technology in the early twentieth century. Author(s): Marland H. Source: Clio Medica (Amsterdam, Netherlands). 2001; 61: 173-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11603152&dopt=Abstract

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Some thoughts on unassisted childbirth. Author(s): Gaskin IM. Source: Midwifery Today Int Midwife. 2003 Summer; (66): 38-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848041&dopt=Abstract

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Spontaneous cervical and mediastinal emphysema following childbirth. Author(s): Dhrampal A, Jenkins J. Source: Anaesthesia. 2001 January; 56(1): 93-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11167460&dopt=Abstract

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Stress debriefing after childbirth: a randomised controlled trial. Author(s): Priest SR, Henderson J, Evans SF, Hagan R. Source: The Medical Journal of Australia. 2003 June 2; 178(11): 542-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765500&dopt=Abstract

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Suicide. The unspoken consequence of mental illness during pregnancy and childbirth. Author(s): Church S, Scanlan M. Source: Pract Midwife. 2002 September; 5(8): 22-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12298330&dopt=Abstract

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Suture of second-degree perineal tears after childbirth. Author(s): Wild SM. Source: Lancet. 2002 April 6; 359(9313): 1253. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11955576&dopt=Abstract

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The anatomy of the perineal membrane: its relationship to injury in childbirth and episiotomy. Author(s): Hudson CN, Sohaib SA, Shulver HM, Reznek RH. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 May; 42(2): 193-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069149&dopt=Abstract

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The challenge of preparing and enabling 'skilled attendants' to promote safer childbirth. Author(s): Maclean GD. Source: Midwifery. 2003 September; 19(3): 163-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946332&dopt=Abstract

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The Childbirth Self-Efficacy Inventory: a replication study. Author(s): Sinclair M, O'Boyle C. Source: Journal of Advanced Nursing. 1999 December; 30(6): 1416-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10583653&dopt=Abstract

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The determinants of time off work after childbirth. Author(s): McGovern P, Dowd B, Gjerdingen D, Moscovice I, Kochevar L, Murphy S. Source: Journal of Health Politics, Policy and Law. 2000 June; 25(3): 527-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10946388&dopt=Abstract

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The effect of childbirth on pelvic organ mobility. Author(s): Dietz HP, Bennett MJ. Source: Obstetrics and Gynecology. 2003 August; 102(2): 223-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907092&dopt=Abstract

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The effects of childbirth on the pelvic-floor. Author(s): Dannecker C, Anthuber C. Source: Journal of Perinatal Medicine. 2000; 28(3): 175-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10923301&dopt=Abstract

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The ethics of childbirth: are all roads leading to cesarean? Author(s): Guise JM. Source: Obstetrical & Gynecological Survey. 2001 October; 56(10): 593-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11590312&dopt=Abstract

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The experience of stress incontinence after childbirth. Author(s): Mason L, Glenn S, Walton I, Appleton C. Source: Birth (Berkeley, Calif.). 1999 September; 26(3): 164-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10655816&dopt=Abstract

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The impact of childbirth experiences on women's sense of self: a review of the literature. Author(s): Parratt J. Source: Aust J Midwifery. 2002; 15(4): 10-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593243&dopt=Abstract

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The Ipswich Childbirth Study: 1. A randomised evaluation of two stage postpartum perineal repair leaving the skin unsutured. Author(s): D'Souza D. Source: British Journal of Obstetrics and Gynaecology. 1999 January; 106(1): 89-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10426270&dopt=Abstract

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The Ipswich childbirth study: one year follow up of alternative methods used in perineal repair. Author(s): Grant A, Gordon B, Mackrodat C, Fern E, Truesdale A, Ayers S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 January; 108(1): 34-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11213002&dopt=Abstract

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The missing squatting bar. Childbirth education in the 90s. Author(s): Lee N. Source: Midwifery Today Int Midwife. 1999 Summer; (50): 40-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10478052&dopt=Abstract

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The National Childbirth Trust breastfeeding counsellor training. Author(s): Wise P. Source: Pract Midwife. 2003 February; 6(2): 36-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621874&dopt=Abstract

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The obstetrical and postpartum benefits of continuous support during childbirth. Author(s): Scott KD, Klaus PH, Klaus MH. Source: Journal of Women's Health & Gender-Based Medicine. 1999 December; 8(10): 1257-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10643833&dopt=Abstract

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The role of the father in childbirth. Author(s): Larimore WL. Source: Midwifery Today Int Midwife. 1999 Autumn; (51): 15-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10808861&dopt=Abstract

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The shoulders follow the head: postcranial constraints on human childbirth. Author(s): Trevathan W, Rosenberg K. Source: Journal of Human Evolution. 2000 December; 39(6): 583-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11102269&dopt=Abstract

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The technocratic, humanistic, and holistic paradigms of childbirth. Author(s): Davis-Floyd R. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 November; 75 Suppl 1: S5S23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11742639&dopt=Abstract

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The theory and practice of natural childbirth. 1953. Author(s): Goodrich FW Jr. Source: Yale J Biol Med. 2000 January-December; 73(1-6): 91-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11765969&dopt=Abstract

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Tokophobia: an unreasoning dread of childbirth. A series of 26 cases. Author(s): Hofberg K, Brockington I. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2000 January; 176: 83-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10789333&dopt=Abstract

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Touch during childbirth: yesterday and today. Author(s): Klein M. Source: Isr Med Assoc J. 2003 February; 5(2): 145-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674672&dopt=Abstract

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Traumatic stress after childbirth: the role of obstetric variables. Author(s): Soderquist J, Wijma K, Wijma B. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2002 March; 23(1): 31-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12061035&dopt=Abstract

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Trusting enough to be out of control: a pilot study of women's sense of self during childbirth. Author(s): Parratt J, Fahy K. Source: Aust J Midwifery. 2003 March; 16(1): 15-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858479&dopt=Abstract

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Tuberculosis mortality and recent childbirth: a retrospective case-control study of Gibraltarian women, 1874-1884. Author(s): Burke SD, Sawchuk LA. Source: Social Science & Medicine (1982). 2003 February; 56(3): 477-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12570968&dopt=Abstract

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Unemployment and psychological distress one year after childbirth in France. Author(s): Saurel-Cubizolles MJ, Romito P, Ancel PY, Lelong N. Source: Journal of Epidemiology and Community Health. 2000 March; 54(3): 185-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10746112&dopt=Abstract

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Using music during childbirth. Author(s): Browning CA. Source: Birth (Berkeley, Calif.). 2000 December; 27(4): 272-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251514&dopt=Abstract

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Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study. Author(s): Paul BK, Rumsey DJ. Source: Social Science & Medicine (1982). 2002 June; 54(12): 1755-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113433&dopt=Abstract

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Vaginal childbirth and bladder neck mobility. Author(s): Dietz HP, Clarke B, Vancaillie TG. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 522-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495100&dopt=Abstract

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Vaginal disinfection with chlorhexidine during childbirth. Author(s): Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M. Source: International Journal of Antimicrobial Agents. 1999 August; 12(3): 245-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10461843&dopt=Abstract

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What do men have to do with it? Fathers and mid-twentieth-century childbirth. Author(s): Leavitt JW. Source: Bulletin of the History of Medicine. 2003 Summer; 77(2): 235-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955960&dopt=Abstract

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What is normal childbirth? A consumer perspective. Author(s): Nolan ML. Source: Pract Midwife. 2001 June; 4(6): 15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026839&dopt=Abstract

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What is normal childbirth? The educational perspective. Author(s): Kirkman S. Source: Pract Midwife. 2001 June; 4(6): 14. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026838&dopt=Abstract

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What is normal childbirth? The midwife practitioner's view. Author(s): Weston R. Source: Pract Midwife. 2001 June; 4(6): 13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026837&dopt=Abstract

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What new or old techniques have proven useful to you in preventing tears during childbirth? Author(s): Galant S, Sterrenberg M, Kay P, Farris-Folkerts D, Sollman R, Lennox S. Source: Midwifery Today Int Midwife. 2003 Spring; (65): 8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710135&dopt=Abstract

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Women planning and experiencing pregnancy and childbirth: information needs and sources. Author(s): Benn C, Budge RC, White GE. Source: Nurs Prax N Z. 1999 November; 14(3): 4-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11221319&dopt=Abstract

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Women's expectations and experiences of childbirth. Author(s): Gibbins J, Thomson AM. Source: Midwifery. 2001 December; 17(4): 302-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11749063&dopt=Abstract

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Women's health after childbirth: a longitudinal study in France and Italy. Author(s): Saurel-Cubizolles MJ, Romito P, Lelong N, Ancel PY. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 October; 107(10): 1202-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11028569&dopt=Abstract

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Women's perceptions and experiences of childbirth in United Arab Emirates. Author(s): Rizk DE, Nasser M, Thomas L, Ezimokhai M. Source: Journal of Perinatal Medicine. 2001; 29(4): 298-307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11565198&dopt=Abstract

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Women's reluctance to seek help for stress incontinence during pregnancy and following childbirth. Author(s): Mason L, Glenn S, Walton I, Hughes C. Source: Midwifery. 2001 September; 17(3): 212-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11502141&dopt=Abstract

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Women's sexual health after childbirth. Author(s): Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 February; 107(2): 186-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10688502&dopt=Abstract

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Women's sexuality after childbirth: a pilot study. Author(s): Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I. Source: Archives of Sexual Behavior. 1999 April; 28(2): 179-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10483509&dopt=Abstract

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CHAPTER 2. NUTRITION AND CHILDBIRTH Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and childbirth.

Finding Nutrition Studies on Childbirth The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “childbirth” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “childbirth” (or a synonym): •

A prospective study in a southern Indian hospital on the prescription of medication during the lying in period following childbirth. Author(s): Dept. of Pharmacology & Clinical Pharmacology, Christian Medical College & Hospital Vellore, India. Source: Thomas, M Jairaj, P Mathew, L G Soz-Praventivmed. 1994; 39(5): 273-9 0303-8408

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Adherence to cultural practices following childbirth in migrant Chinese women and relation to postpartum mood. Author(s): South West Sydney Area Health Service, Liverpool, NSW, Australia. [email protected] Source: Matthey, S Panasetis, P Barnett, B Health-Care-Women-Int. 2002 Sep-November; 23(6-7): 567-75 0739-9332

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Analgesic efficacy of paracetamol/codeine and paracetamol/dextropropoxyphene in pain after episiotomy and ruptures in connection with childbirth. Source: Jacobson, J Bertilson, S O J-Int-Med-Res. 1987 Mar-April; 15(2): 89-95 0300-0605

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Carbohydrate loading in preparation for childbirth. Author(s): St Louis University School of Medicine, MO 63110. Source: Heston, T F Simkin, P P Med-Hypotheses. 1991 February; 34(2): 97-8 0306-9877

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Childbirth after surgical repair of truncus arteriosus. A case report. Author(s): AMI Brookwood Medical Center, Birmingham. Source: Perry, C P J-Reprod-Med. 1990 January; 35(1): 65-7 0024-7758

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Chinese medicine for pregnancy and childbirth. Source: Wilkowski, R Midwifery-Today-Int-Midwife. 2001 Summer; (58): 39-41

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Complementary medicine. Using aromatherapy in childbirth. Source: Burns, E Blamey, C Nurs-Times. 1994 March 2-8; 90(9): 54-60 0954-7762

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Destructive heat and cooling prayer: Malay humoralism in pregnancy, childbirth and the postpartum period. Author(s): Department of Sociology and Anthropology, Fordham University, Bronx, NY 10458. Source: Laderman, C Soc-Sci-Med. 1987; 25(4): 357-65 0277-9536

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Doulas: an alternative yet complementary addition to care during childbirth. Author(s): Nurse-Midwifery Division, University of New Mexico, School of Medicine, Albuquerque, New Mexico 87131-5286, USA. Source: Kayne, M A Greulich, M B Albers, L L Clin-Obstet-Gynecol. 2001 December; 44(4): 692-703 0009-9201

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Economic considerations for epidural anesthesia in childbirth. Source: Eakes, M Nurs-Econ. 1990 Sep-October; 8(5): 329-32 0746-1739

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Efficacy of Hypericum and Calendula oils in the epithelial reconstruction of surgical wounds in childbirth with caesarean section. Author(s): Dipartimento di Studi di Chimica e Tecnologia delle Sostanze Biologicamente Attire, Universita di Roma, La Sapienza, Rome, Italy. [email protected] Source: Lavagna, S M Secci, D Chimenti, P Bonsignore, L Ottaviani, A Bizzarri, B Farmaco. 2001 May-July; 56(5-7): 451-3 0014-827X

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Ejaculation obtained by intracavernous papaverine in a cervical spinal cord injury patient resulting in pregnancy and childbirth. Case report. Author(s): Department of Urology, Chubu-Rosai Hospital, Nagoya, Japan.

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Source: Otani, T Kai, S Narushima, M Paraplegia. 1994 March; 32(3): 180-1 0031-1758 •

Epifoam after childbirth for perineal pain. Source: Anonymous Drug-Ther-Bull. 1987 May 18; 25(10): 39-40 0012-6543

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Herbal medicine in pregnancy and childbirth. Author(s): Centre for Environmental Health, Department of Biology, University of Victoria, BC, Canada. Source: Westfall, R E Adv-Ther. 2001 Jan-February; 18(1): 47-55 0741-238X

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High-risk childbirth practices in remote Nepal and their determinants. Author(s): Birendra Hospital, Kathmandu, Nepal. [email protected] Source: Thapa, N Chongsuvivatwong, V Geater, A F Ulstein, M Women-Health. 2000; 31(4): 83-97 0363-0242

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Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial. Author(s): Department of Anaesthesia, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver. Source: Peter, E A Janssen, P A Grange, C S Douglas, M J CMAJ. 2001 October 30; 165(9): 1203-9 0820-3946

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Increased sensitivity of dopamine receptors and recurrence of affective psychosis after childbirth. Author(s): Department of Psychiatry, Institute of Psychiatry, London. Source: Wieck, A KuMarch, R Hirst, A D Marks, M N Campbell, I C Checkley, S A BMJ. 1991 September 14; 303(6803): 613-6 0959-8138

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Japanese couples' childbirth experiences in Michigan: implications for care. Author(s): University of Michigan, School of Nursing, Ann Arbor 48109-0482, USA. Source: Yeo, S Fetters, M Maeda, Y Birth. 2000 September; 27(3): 191-8 0730-7659

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Navajo childbirth in transition. Author(s): Gallup Indian Medical Center, NM 87301. Source: Waxman, A G Med-Anthropol. 1990 March; 12(2): 187-206 0145-9740

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New study could help women at risk after childbirth. Source: Anonymous Essent-Drugs-Monit. 1993; (15): 8 1015-0919

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Personal beliefs and alternative childbirth choices: a survey of 552 women who planned to give birth at home. Source: Bastian, H Birth. 1993 December; 20(4): 186-92 0730-7659

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Social work practice with childbirth-injured women in Nigeria. Author(s): School of Social Work, University of Alabama, Tuscaloosa 35487. Source: Ojanuga, D Health-Soc-Work. 1994 May; 19(2): 120-4 0360-7283

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South African traditional herbal medicines used during pregnancy and childbirth. Author(s): Department of Experimental and Clinical Pharmacology, University of the Witwatersrand, Johannesburg, South Africa. Source: Veale, D J Furman, K I Oliver, D W J-Ethnopharmacol. 1992 June; 36(3): 185-91 0378-8741

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The ideas and experiences of pregnancy and childbirth of Asian and non-Asian women in east London. Author(s): Department of Psychology, University of East London, UK. Source: Woollett, A Dosanjh, N Nicolson, P Marshall, H Djhanbakhch, O Hadlow, J Br-JMed-Psychol. 1995 Mar; 68 ( Pt 1)65-84 0007-1129

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The role of lavender oil in relieving perineal discomfort following childbirth: a blind randomized clinical trial. Author(s): Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, England. Source: Dale, A Cornwell, S J-Adv-Nurs. 1994 January; 19(1): 89-96 0309-2402

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Traditional practices of women from India: pregnancy, childbirth, and newborn care. Author(s): Nursing Program, Seneca College of Applied Arts & Technology, North York, Ontario, Canada. Source: Choudhry, U K J-Obstet-Gynecol-Neonatal-Nurs. 1997 Sep-October; 26(5): 533-9 0884-2175

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Women's perceptions of the complications of pregnancy and childbirth in two Esan communities, Edo state, Nigeria. Author(s): Department of Sociology and Anthropology, University of Benin, Nigeria. Source: Asowa Omorodion, F I Soc-Sci-Med. 1997 June; 44(12): 1817-24 0277-9536

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

Nutrition

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND CHILDBIRTH Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to childbirth. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “childbirth” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Element Family Encyclopedia of Health: The Complete Family Reference Guide to Alternative and Orthodox Medical Diagnosis, Treatment and Preventive Healthcare Source: Shaftesbury, England: Element Books Ltd. 1998. 720 p. Contact: Available from Element Books Ltd. Longmead, Shaftesbury, Dorset SP7 8LP, England. Phone: 1747 851 339; FAX: 01747 851 394. PRICE: $35.60. ISBN: 1862043019. Summary: This book for consumers and health care providers is a reference guide to the holistic management of common health problems. It takes an integrated approach to health care, describing both alternative and conventional medical approaches to diagnosis, treatment, and prevention. An introduction provides background information about holistic medicine, health and healing, and recommended contents of the medicine cabinet. Chapters 1-6, the main body of the text, are organized around the different stages of life: (1) sex, fertility, and conception, (2) pregnancy and childbirth, (3) infancy and childhood, (4) young adult, (5) adult, and (6) middle age and onwards. Each

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chapter describes common health problems and the recommended treatments. Chapter 7 addresses nutrition, special diets, and the effects of specific foods and nutrients. Chapter 8 describes alternative and conventional diagnostic techniques. Chapter 9 describes a wide variety of alternative therapies. Chapter 10 discusses the uses, effects, and safety of different drugs. The book includes more than 200 illustrations and charts, a glossary, suggested readings, a directory of international resources, and an index.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to childbirth and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “childbirth” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to childbirth: •

Acupuncture for pain relief during childbirth. Author(s): Ternov K, Nilsson M, Lofberg L, Algotsson L, Akeson J. Source: Acupuncture & Electro-Therapeutics Research. 1998; 23(1): 19-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9607101&dopt=Abstract

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Anal incontinence after childbirth. Author(s): Eason E, Labrecque M, Marcoux S, Mondor M. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 February 5; 166(3): 326-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868640&dopt=Abstract

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Bedside musical care: applications in pregnancy, childbirth, and neonatal care. Author(s): Olson SL. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1998 September-October; 27(5): 569-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9773369&dopt=Abstract

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Benefits of massage therapy and use of a doula during labor and childbirth. Author(s): Keenan P. Source: Alternative Therapies in Health and Medicine. 2000 January; 6(1): 66-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10631824&dopt=Abstract

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Bubba, childbirth, and the power of prayer: a clinical pastoral education memory. Author(s): Baroody J. Source: J Pastoral Care. 2000 Winter; 54(4): 461-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191000&dopt=Abstract

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Changing American birth through childbirth education. Author(s): Bradley LP. Source: Patient Education and Counseling. 1995 February; 25(1): 75-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7603936&dopt=Abstract

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Childbirth and the responsibility of choice. Author(s): Long K. Source: Midwifery Today Int Midwife. 2002 Winter; (64): 16-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12526588&dopt=Abstract

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Childbirth as healing: three women's experience of independent midwife care. Author(s): Milan M. Source: Complementary Therapies in Nursing & Midwifery. 2003 August; 9(3): 140-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12852930&dopt=Abstract

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Childbirth education in the 1990s and beyond. Author(s): Zwelling E. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1996 June; 25(5): 425-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8791230&dopt=Abstract

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Childbirth preparation through hypnosis: the hypnoreflexogenous protocol. Author(s): Schauble PG, Werner WE, Rai SH, Martin A. Source: Am J Clin Hypn. 1998 April; 40(4): 273-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9868807&dopt=Abstract

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Childbirth, disease and death among the Mennonites in nineteenth-century Russia. Author(s): Toews JB. Source: Mennon Q Rev. 1985; 57(4): 450-68. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11617674&dopt=Abstract

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Chinese medicine for pregnancy and childbirth. Author(s): Wilkowski R. Source: Midwifery Today Int Midwife. 2001 Summer; (58): 39-41. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12154718&dopt=Abstract

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Choice in childbirth. Author(s): Smith K.

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Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1995 April 12-18; 9(29): 22-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7766506&dopt=Abstract •

Concerns about the institutionalization of childbirth education. Author(s): Lothian J. Source: Birth (Berkeley, Calif.). 1997 June; 24(2): 133-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9271983&dopt=Abstract

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Contemporary methods in hypnotic preparation for childbirth. Author(s): Oster MI. Source: Crna. 2000 November; 11(4): 160-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866022&dopt=Abstract

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Cultural and spiritual meanings of childbirth. Orthodox Jewish and Mormon women. Author(s): Callister LC, Semenic S, Foster JC. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1999 September; 17(3): 280-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10690070&dopt=Abstract

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Cultural childbirth practices and beliefs in Zambia. Author(s): Maimbolwa MC, Yamba B, Diwan V, Ransjo-Arvidson AB. Source: Journal of Advanced Nursing. 2003 August; 43(3): 263-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859785&dopt=Abstract

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Cultural meanings of childbirth. Author(s): Callister LC. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1995 May; 24(4): 327-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7643264&dopt=Abstract

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Cultural perceptions of childbirth: a cross-cultural comparison of childbearing women. Author(s): Callister LC, Vehvilainen-Julkunen K, Lauri S. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1996 March; 14(1): 66-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8698983&dopt=Abstract

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Culturally sensitive care during childbirth. Author(s): Raines DA, Morgan Z.

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Source: Applied Nursing Research : Anr. 2000 November; 13(4): 167-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11078781&dopt=Abstract •

Doulas: an alternative yet complementary addition to care during childbirth. Author(s): Kayne MA, Greulich MB, Albers LL. Source: Clinical Obstetrics and Gynecology. 2001 December; 44(4): 692-703. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11600852&dopt=Abstract

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Dr Grantly Dick-Read (1890-1959) of Norfolk and natural childbirth. Author(s): Dunn PM. Source: Archives of Disease in Childhood. 1994 September; 71(2): F145-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7979472&dopt=Abstract

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Efficacy of Hypericum and Calendula oils in the epithelial reconstruction of surgical wounds in childbirth with caesarean section. Author(s): Lavagna SM, Secci D, Chimenti P, Bonsignore L, Ottaviani A, Bizzarri B. Source: Farmaco (Societa Chimica Italiana : 1989). 2001 May-July; 56(5-7): 451-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11482776&dopt=Abstract

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Experience of childbirth in birth center care. A randomized controlled study. Author(s): Waldenstrom U, Nilsson CA. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1994 August; 73(7): 547-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8079605&dopt=Abstract

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Fear of childbirth and psychosomatic support. A follow up of 72 women. Author(s): Sjogren B. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 September; 77(8): 819-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9776595&dopt=Abstract

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From purification to celebration: the history of the service for women after childbirth. Author(s): Kristolaitis C. Source: J Can Church Hist Soc. 1986; 28(2): 53-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11617277&dopt=Abstract

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Has the medicalisation of childbirth gone too far? Author(s): Johanson R, Newburn M, Macfarlane A. Source: Bmj (Clinical Research Ed.). 2002 April 13; 324(7342): 892-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11950741&dopt=Abstract

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Herbal medicine in pregnancy and childbirth. Author(s): Westfall RE.

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Source: Adv Ther. 2001 January-February; 18(1): 47-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11512532&dopt=Abstract •

High-risk childbirth practices in remote Nepal and their determinants. Author(s): Thapa N, Chongsuvivatwong V, Geater AF, Ulstein M. Source: Women & Health. 2000; 31(4): 83-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11310813&dopt=Abstract

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Hmong women in Wisconsin: what are their concerns in pregnancy and childbirth? Author(s): Jambunathan J, Stewart S. Source: Birth (Berkeley, Calif.). 1995 December; 22(4): 204-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8573235&dopt=Abstract

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Holistic obstetrics: the origins of “natural childbirth” in Britain. Author(s): Moscucci O. Source: Postgraduate Medical Journal. 2003 March; 79(929): 168-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697920&dopt=Abstract

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Homeopathy for the childbirth attendant. Author(s): Ferreira K. Source: Midwifery Today Int Midwife. 2003 Spring; (65): 38-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710150&dopt=Abstract

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Hyperventilation technetium-99m-HMPAO brain SPECT in moyamoya disease to assess risk of natural childbirth. Author(s): Kume N, Hayashida K, Shimotsu Y, Matsunaga N. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 1997 December; 38(12): 1894-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9430464&dopt=Abstract

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HypnoBirthing. A radical change on our perspective of pain in childbirth. Author(s): Wainer N. Source: Midwifery Today Int Midwife. 2000 Autumn; (55): 36-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189565&dopt=Abstract

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Italian-American women and changing childbirth practices. Author(s): Carangelo A. Source: Midwifery Today Int Midwife. 2001 Winter; (60): 48-51. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584821&dopt=Abstract

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Jailed mothers. A chaplain delivers restorative justice childbirth. Author(s): Rateliff K. Source: Midwifery Today Int Midwife. 2000 Spring; (53): 30-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189616&dopt=Abstract

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Japanese couples' childbirth experiences in Michigan: implications for care. Author(s): Yeo S, Fetters M, Maeda Y. Source: Birth (Berkeley, Calif.). 2000 September; 27(3): 191-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251502&dopt=Abstract

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Lamaze and Bradley childbirth classes. Author(s): Blumfield W. Source: Birth (Berkeley, Calif.). 1997 June; 24(2): 132-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9271982&dopt=Abstract

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Lamaze and Bradley childbirth classes: contrasting perspectives toward the medical model of birth. Author(s): Monto MA. Source: Birth (Berkeley, Calif.). 1996 December; 23(4): 193-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9086956&dopt=Abstract

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Managing pain during childbirth. Author(s): Britt R, Pasero CL. Source: The American Journal of Nursing. 1998 August; 98(8): 10-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9711141&dopt=Abstract

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Marion's message. Childbirth and healing. Author(s): McLean MT. Source: Midwifery Today Int Midwife. 2003 Spring; (65): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710134&dopt=Abstract

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Massage for childbirth and pregnancy--8 years on. Author(s): Kimber L. Source: Pract Midwife. 2002 March; 5(3): 20-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11915418&dopt=Abstract

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No more hard labor. High-tech and high-touch remedies for easing the pain of childbirth. Author(s): Shute N. Source: U.S. News & World Report. 1997 November 10; 123(18): 92-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10174507&dopt=Abstract

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Old wives' tales about pregnancy and childbirth. Author(s): Brink PJ. Source: Western Journal of Nursing Research. 1997 June; 19(3): 280-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9170987&dopt=Abstract

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Osteopathy in pregnancy and childbirth. Interview by Jenny Green. Author(s): Sandler S, Korth S. Source: Pract Midwife. 2000 July-August; 3(7): 38-43. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026438&dopt=Abstract

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Out of the darkness and into the light: women's experiences with depression after childbirth. Author(s): Berggren-Clive K. Source: Can J Commun Ment Health. 1998 Spring; 17(1): 103-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10351169&dopt=Abstract

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Out of the womb, into the fire. The myth of the safety of hospital childbirth. Author(s): Doubleday J. Source: Midwifery Today Int Midwife. 1999 Summer; (50): 24-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10478046&dopt=Abstract

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Perineal massage for prevention of perineal trauma in childbirth. Author(s): Johanson R. Source: Lancet. 2000 January 22; 355(9200): 250-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10675069&dopt=Abstract

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Plasma concentrations of beta-endorphin and adrenocorticotropic hormone in women with and without childbirth preparation. Author(s): Florido J, Oltras CM, Fajardo MC, Gonzalez-Escanuela E, Villaverde C, Gonzalez-Gomez F. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1997 June; 73(2): 121-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9228490&dopt=Abstract

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Practices that minimize trauma to the genital tract in childbirth: a systematic review of the literature. Author(s): Renfrew MJ, Hannah W, Albers L, Floyd E. Source: Birth (Berkeley, Calif.). 1998 September; 25(3): 143-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9767217&dopt=Abstract

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Predictors of childbirth pain and maternal satisfaction. Author(s): Dannenbring D, Stevens MJ, House AE.

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Source: Journal of Behavioral Medicine. 1997 April; 20(2): 127-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9144036&dopt=Abstract •

Preventing perineal trauma during childbirth: a systematic review. Author(s): Eason E, Labrecque M, Wells G, Feldman P. Source: Obstetrics and Gynecology. 2000 March; 95(3): 464-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10711565&dopt=Abstract

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Prevention of childbirth injuries to the pelvic floor. Author(s): Heit M, Mudd K, Culligan P. Source: Curr Womens Health Rep. 2001 August; 1(1): 72-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112955&dopt=Abstract

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Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression. Author(s): Elliott SA, Leverton TJ, Sanjack M, Turner H, Cowmeadow P, Hopkins J, Bushnell D. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2000 September; 39 ( Pt 3): 223-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11033746&dopt=Abstract

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Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden. Author(s): Essen B, Johnsdotter S, Hovelius B, Gudmundsson S, Sjoberg NO, Friedman J, Ostergren PO. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 December; 107(12): 1507-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11192108&dopt=Abstract

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Race, culture, and the colonization of childbirth in northern Canada. Author(s): Jasen P. Source: Social History of Medicine : the Journal of the Society for the Social History of Medicine / Sshm. 1997 December; 10(3): 383-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11619824&dopt=Abstract

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Rituals of childbirth in the Tigrigna of Ethiopia (Axum area). Author(s): Selassie AG. Source: Newsl Inter Afr Comm Tradit Pract Affect Health Women Child. 1986 July; (2): 9-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12157987&dopt=Abstract

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Self-hypnosis: alternative anesthesia for childbirth. Author(s): Ketterhagen D, VandeVusse L, Berner MA.

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Source: Mcn. the American Journal of Maternal Child Nursing. 2002 NovemberDecember; 27(6): 335-40; Quiz 341. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439135&dopt=Abstract •

The ideas and experiences of pregnancy and childbirth of Asian and non-Asian women in east London. Author(s): Woollett A, Dosanjh N, Nicolson P, Marshall H, Djhanbakhch O, Hadlow J. Source: The British Journal of Medical Psychology. 1995 March; 68 ( Pt 1): 65-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7779769&dopt=Abstract

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The impact of childbirth experiences on women's sense of self: a review of the literature. Author(s): Parratt J. Source: Aust J Midwifery. 2002; 15(4): 10-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593243&dopt=Abstract

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The technocratic, humanistic, and holistic paradigms of childbirth. Author(s): Davis-Floyd R. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 November; 75 Suppl 1: S5S23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11742639&dopt=Abstract

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The theory and practice of natural childbirth. 1953. Author(s): Goodrich FW Jr. Source: Yale J Biol Med. 2000 January-December; 73(1-6): 91-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11765969&dopt=Abstract

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Traditional beliefs and practices of pregnancy and childbirth. Author(s): Logan C. Source: Botsw Natl Health Bull. 1985; 1(1): 64-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12282437&dopt=Abstract

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Traditional practices of women from India: pregnancy, childbirth, and newborn care. Author(s): Choudhry UK. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1997 September-October; 26(5): 533-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9313183&dopt=Abstract

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Trusting enough to be out of control: a pilot study of women's sense of self during childbirth. Author(s): Parratt J, Fahy K.

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Source: Aust J Midwifery. 2003 March; 16(1): 15-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858479&dopt=Abstract •

Using music during childbirth. Author(s): Browning CA. Source: Birth (Berkeley, Calif.). 2000 December; 27(4): 272-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251514&dopt=Abstract

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What is normal childbirth? A consumer perspective. Author(s): Nolan ML. Source: Pract Midwife. 2001 June; 4(6): 15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026839&dopt=Abstract

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What is normal childbirth? The educational perspective. Author(s): Kirkman S. Source: Pract Midwife. 2001 June; 4(6): 14. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026838&dopt=Abstract

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What is normal childbirth? The midwife practitioner's view. Author(s): Weston R. Source: Pract Midwife. 2001 June; 4(6): 13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026837&dopt=Abstract

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What new or old techniques have proven useful to you in preventing tears during childbirth? Author(s): Galant S, Sterrenberg M, Kay P, Farris-Folkerts D, Sollman R, Lennox S. Source: Midwifery Today Int Midwife. 2003 Spring; (65): 8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710135&dopt=Abstract

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When the unborn give birth: special childbirth issues for adult adoptees and brave new babies. Author(s): Kriegman-Chin M. Source: The Birth Gazette. 1996 Fall; 12(4): 37-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9015978&dopt=Abstract

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Who said childbirth is natural? The medical mission of Grantly Dick Read. Author(s): Caton D. Source: Anesthesiology. 1996 April; 84(4): 955-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8638851&dopt=Abstract

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Women's evaluation of their childbirth performance. Author(s): Mackey MC.

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Source: Matern Child Nurs J. 1995 April-June; 23(2): 57-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7650974&dopt=Abstract •

Women's perceptions of the complications of pregnancy and childbirth in two Esan communities, Edo state, Nigeria. Author(s): Asowa-Omorodion FI. Source: Social Science & Medicine (1982). 1997 June; 44(12): 1817-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9194243&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to childbirth; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Alopecia Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Source: Healthnotes, Inc.; www.healthnotes.com

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Hair Loss Source: Integrative Medicine Communications; www.drkoop.com Kidney Stones Source: Integrative Medicine Communications; www.drkoop.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Hypnotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,706,00.html Music Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,719,00.html Naturopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,722,00.html Shamanic Midwifery Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Therapeutic Touch Source: Integrative Medicine Communications; www.drkoop.com

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Chinese Medicine Dingkun Dan Alternative names: Dingkun Pills; Dingkun Dan (Ding Kun Dan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Honghua Alternative names: Safflower; Flos Carthami Source: Chinese Materia Medica Lingxiaohua Alternative names: Trumpetcreeper Flower; Flos Campsis Source: Chinese Materia Medica

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Shanzha Alternative names: Hawthorn Fruit; Fructus Crataegi Source: Chinese Materia Medica Xihonghua Alternative names: Saffron; Stigma Croci Source: Chinese Materia Medica •

Herbs and Supplements Arctostaphylos Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Cat's Claw Source: Prima Communications, Inc.www.personalhealthzone.com Corydalis Alternative names: Corydalis turtschaninovii, Corydalis yanhusuo Source: Healthnotes, Inc.; www.healthnotes.com Dioscorea Villosa Source: Integrative Medicine Communications; www.drkoop.com Feverfew Source: Prima Communications, Inc.www.personalhealthzone.com Juniper Berry Source: Prima Communications, Inc.www.personalhealthzone.com Lavandula Alternative names: Lavender; Lavandula sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Lavender Alternative names: Lavandula officinalis Source: Healthnotes, Inc.; www.healthnotes.com Nettle Source: Prima Communications, Inc.www.personalhealthzone.com Vitex Alternative names: Vitex agnus-castus Source: Healthnotes, Inc.; www.healthnotes.com Wild Yam Alternative names: Dioscorea villosa Source: Integrative Medicine Communications; www.drkoop.com Witch Hazel Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON CHILDBIRTH Overview In this chapter, we will give you a bibliography on recent dissertations relating to childbirth. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “childbirth” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on childbirth, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Childbirth ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to childbirth. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Bio-psycho-social Model of Music Therapy-assisted Childbirth: an Integrative Approach to Working with Families by Dicamillo, Mary Patricia; Edd from Pepperdine University, 1999, 179 pages http://wwwlib.umi.com/dissertations/fullcit/9955926

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A Comparative Study of Pre-natal Childbirth Education with Selected Obstetrical Variables (lamaze, Pregnancy, Labor, Gravida) by Avery, Susie Goode, Edd from The University of Tulsa, 1985, 94 pages http://wwwlib.umi.com/dissertations/fullcit/8510383

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A Comparison of Childbirth Preparation and Non-preparation on Selected Physiological Variables and Attitudes to Pregnancy and Delivery in Private Patients by Furney, Steven Reed, Edd from The University of Tennessee, 1980, 108 pages http://wwwlib.umi.com/dissertations/fullcit/8108138

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A Comparison of the Effectiveness of Childbirth Preparatory Techniques (lamaze, Imagery Assisted Relaxation) by Lindberg, Cheryl Senf, Phd from University of North Texas, 1985, 61 pages http://wwwlib.umi.com/dissertations/fullcit/8515730

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A Longitudinal Analysis of Welfare Use and Educational Attainment among Teenage Parents: Comparing the Effects of Socioeconomic Background with Age and Marital Status at Childbirth by Ghosh, Mistu; Phd from Tulane University, 2002, 226 pages http://wwwlib.umi.com/dissertations/fullcit/3046643

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A Longitudinal Study of Preparation for Childbirth, Pain in Labour and Postnatal Depression by Leachman, Jennifer, Phd from University of Bath (united Kingdom), 1988, 327 pages http://wwwlib.umi.com/dissertations/fullcit/DX84607

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A Meta-analytic Study of the Effects of Childbirth Education Research from 1960 to 1981 by Jones, Linda Corson, Phd from Texas A&m University, 1983, 122 pages http://wwwlib.umi.com/dissertations/fullcit/8323680

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A National Model for Nurse Childbirth Educators Utilizing Existing Teacher Preparation Programs by Phillips, Celeste Rose Nagel, Edd from University of Southern California, 1981 http://wwwlib.umi.com/dissertations/fullcit/f484790

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A Study of the Transition from a Social Model to a Medical Model of Childbirth on the Greek Island of Rhodes by Lefkarites, Mary P., Phd from New York University, 1984, 538 pages http://wwwlib.umi.com/dissertations/fullcit/8421453

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A Time of Celebration? an Investigation of the Psychological Distress Associated with the Events of Childbirth by Stafford, Jane Ann; Phd from State University of New York at Binghamton, 2002, 116 pages http://wwwlib.umi.com/dissertations/fullcit/3047715

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Alternative Settings for Childbirth: a Comparative Analysis by Wheeler, Eunice Louise, Phd from The University of North Carolina at Chapel Hill, 1979, 186 pages http://wwwlib.umi.com/dissertations/fullcit/8014008

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An Educational Needs Assessment of Pregnancy Delayers: a Comparative Survey of Primiparas 30 Years of Age and over and Childbirth Educators by Britt, Robin Burke, Edd from University of Houston, 1988, 209 pages http://wwwlib.umi.com/dissertations/fullcit/8828078

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An Examination of Anxiety, Sexuality and Child-rearing Response Tendencies of Couples in Childbirth Education. by Stewart, Patricia Metheuse, Phd from The University of Akron, 1979, 394 pages http://wwwlib.umi.com/dissertations/fullcit/7908884

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Attitudes and Traits Related to Perceptions of Self-efficacy by Expectant Fathers (childbirth Education) by Smith, Judy Elan, Phd from The Claremont Graduate University, 1992, 184 pages http://wwwlib.umi.com/dissertations/fullcit/9220609

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Birth Alternatives: Definitions of Childbirth and Professional Jurisdiction (midwifery) by Howell-white, Sandra J., Phd from Rutgers the State University of New Jersey - New Brunswick, 1994, 247 pages http://wwwlib.umi.com/dissertations/fullcit/9511484

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Birth Control: Lay Challenge to Medical Authority over Childbirth by Steckevicz, Mary Jo, Phd from Northeastern University, 1981, 328 pages http://wwwlib.umi.com/dissertations/fullcit/8205053

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Birthing on the Threshold: Childbirth and Modernity among Lower Class Women in Tamil Nadu, South India by Van Hollen, Cecilia Coale, Phd from University of California, Berkeley, 1998, 302 pages http://wwwlib.umi.com/dissertations/fullcit/9902290

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Birthing the Text: Authorship and Childbirth in Early Modern England by Dupuis, Margaret Helen, Phd from University of Oregon, 1998, 202 pages http://wwwlib.umi.com/dissertations/fullcit/9826698

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Catching Babies: the Change from Midwife to Physician-attended Childbirth in Wisconsin, 1870-1930 by Borst, Charlotte G., Phd from The University of Wisconsin Madison, 1989, 531 pages http://wwwlib.umi.com/dissertations/fullcit/8915524

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Cesarean Childbirth: Bio-psycho-social Effects by Lyter, Sharon Colleen, Phd from Rutgers the State University of New Jersey - New Brunswick, 1986, 199 pages http://wwwlib.umi.com/dissertations/fullcit/8620053

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Childbirth among Rural Greek Women in Crete: Use of Popular, Folk, and Cosmopolitan Medical Systems by Arnold, Marlene Sue, Phd from University of Pennsylvania, 1985, 297 pages http://wwwlib.umi.com/dissertations/fullcit/8515341

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Childbirth As a Developmental Milestone by Johnson, Lucy Holmes, Phd from The Union Institute, 1997, 269 pages http://wwwlib.umi.com/dissertations/fullcit/9810053

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Childbirth Customs As Women's Culture: a Jurisprudential Argument for Protection under International and American Legal Norms by Anglin, Gayl Marie; Phd from University of Southern California, 2002, 162 pages http://wwwlib.umi.com/dissertations/fullcit/3073740

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Childbirth Education Programs: a Study of Women Participants and Non-participants by Vinal, Donna Jean Frede, Phd from The University of Nebraska - Lincoln, 1981, 128 pages http://wwwlib.umi.com/dissertations/fullcit/8118068

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Childbirth Education: an Exploration of Men's Behavior during Pregnancy by Diemer, Geraldine Ann Junghans, Phd from The University of Wisconsin - Madison, 1988, 160 pages http://wwwlib.umi.com/dissertations/fullcit/8824088

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Childbirth in Rural Korea: Delivery Patterns and Processes by Crabtree, Benjamin Franklin, Phd from The University of Connecticut, 1986, 349 pages http://wwwlib.umi.com/dissertations/fullcit/8629917

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Childbirth, Marital Resources, and the Division of Domestic Labor by Yu, Yan, Phd from The Florida State University, 1996, 185 pages http://wwwlib.umi.com/dissertations/fullcit/9712180

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Childbirth, Midwifery, and Science: the Life and Work of the French Royal Midwife Louise Bourgeois (1563--1636) by Sheridan, Bridgette Ann Majella; Phd from Boston College, 2002, 216 pages http://wwwlib.umi.com/dissertations/fullcit/3066234

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Comparison of the Responses to Preterm Labor, Discomforts and Pains of Pregnancy and Preterm Birth between Formal Childbirth Education Attendees and Nonattendees by El-sabagh, Nahed El-nabawy; Phd from Case Western Reserve University (health Sciences), 2002, 196 pages http://wwwlib.umi.com/dissertations/fullcit/3061309

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Conceptions and Preconceptions: Childbirth and Nutrition in Rural Malaysia by Laderman, Carol Ciavati, Phd from Columbia University, 1979, 454 pages http://wwwlib.umi.com/dissertations/fullcit/8204505

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Contested Conceptions: Experiences and Discourses of Pregnancy and Childbirth in Germany, 1914--1933 by Stokes, Patricia R.; Phd from Cornell University, 2003, 950 pages http://wwwlib.umi.com/dissertations/fullcit/3087060

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Control in Childbirth: a Study of Postpartum Moods by Garner, Lynne Carr, Phd from University of Massachusetts, 1986, 186 pages http://wwwlib.umi.com/dissertations/fullcit/8622671

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Diffusion of Innovations in Childbirth: an Analysis of Sociocultural Factors Associated with Traditional, Natural and Home Birth. by Pollinger, Annette Clare, Phd from Fordham University, 1977, 338 pages http://wwwlib.umi.com/dissertations/fullcit/7714905

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Doula Care: the (re)-emergence of Woman-supported Childbirth in the United States by Morton, Christine H.; Phd from University of California, Los Angeles, 2002, 357 pages http://wwwlib.umi.com/dissertations/fullcit/3059588

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Dysmenorrhea, Menstrual Cycle Phase, and Previous Childbirth Pain Experience Responsiveness to Laboratory Pain by Hapidou, Eleni; Phd from Mcmaster University (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL50233

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'each One As She May': Intelligence, Childbirth, and Narrative Interiority in Early Twentieth-century American Fiction (twentieth Century, Norris, Frank, Stein, Gertrude, Dreiser, Theodore, Larsen, Nella) by Perkins, Priscilla Ashley, Phd from Rutgers the State University of New Jersey - New Brunswick, 1996, 347 pages http://wwwlib.umi.com/dissertations/fullcit/9618544

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Ethnicity and Childbirth: the Birthing Process of American Jews by Silber, Mark, Phd from Boston University Graduate School, 1983, 485 pages http://wwwlib.umi.com/dissertations/fullcit/8320014

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Expectancy and the Experience of Childbirth the Effect of the Relationship on Postpartum Affect by Phillipson-price, Adrienne; Ded from Mcgill University (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK58166

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Expectancy and the Experience of Childbirth: the Effect of the Relationship on Postpartum Affect by Phillipson-price, Adrienne, Ded from Mcgill University (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/f100038

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Expectant Mothers and Childbirth Films: the Effects of Childbirth Films on Anxiety, Confidence and Expectations (patient Education) by Dube-fortin, Catherine Elizebeth, Edd from Boston University, 1987, 252 pages http://wwwlib.umi.com/dissertations/fullcit/8704800

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Family, Childbirth, Marriage, and Schooling among Nair Women in Kerala, India: Portraits in Cultural Change by Pai, Seeta A.; Edd from Harvard University, 2002, 187 pages http://wwwlib.umi.com/dissertations/fullcit/3055876

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Focusing on Birth: a Philosophy of Technology and Childbirth by Kornelsen, Judith Ann; Phd from Simon Fraser University (canada), 1998, 343 pages http://wwwlib.umi.com/dissertations/fullcit/NQ37721

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From Home to Hospital: Jewish and Italian American Women and Childbirth, 19201940 (home Births, Hospital Births) by Danzi, Angela Darienzo, Phd from New York University, 1993, 253 pages http://wwwlib.umi.com/dissertations/fullcit/9411090

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Full Figures: How Metaphor, Example, and Childbirth Make Culture by Byrne, Mairead Clare; Phd from Purdue University, 2001, 300 pages http://wwwlib.umi.com/dissertations/fullcit/3037545

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Gradual Return to Work: the Antecedents and Consequences of Switching to Parttime Work after First Childbirth by Kim, Stacy S.; Phd from University of Pennsylvania, 2000, 119 pages http://wwwlib.umi.com/dissertations/fullcit/9965505

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Grandmothers Laughing: Intergenerational Transmission of Cultural Beliefs about Pregnancy and Childbirth among Native American Women by Long, Claudia Robin, Phd from Portland State University, 1997, 173 pages http://wwwlib.umi.com/dissertations/fullcit/9805289

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Identifying the Expressed Learning Needs of Primiparous Women Enrolled in Childbirth Preparation Class by Page, Julie Dawn; Msc from Queen's University at Kingston (canada), 2002, 100 pages http://wwwlib.umi.com/dissertations/fullcit/MQ69323

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Informal Supports in Rural Black Families around the Event of Childbirth by Beckley, Gemma Douglas, Dsw from Columbia University, 1986, 200 pages http://wwwlib.umi.com/dissertations/fullcit/8623482

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Irish and Jewish Women's Experience of Childbirth and Infant Care in East London, 1870-1939: the Responses of Host Society and Immigrant Communities to Medical Welfare Needs by Marks, Lara Vivienne, Phd from University of Oxford (united Kingdom), 1990, 439 pages http://wwwlib.umi.com/dissertations/fullcit/D-93965

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Labor Force Withdrawal and Entry Surrounding First Childbirth of Married Women by Chang, Jiyeun, Phd from The University of Wisconsin - Madison, 1997, 358 pages http://wwwlib.umi.com/dissertations/fullcit/9807827

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Labor Is Hard Work: the Social Organization of Childbirth. by Kovit, Leonard, Phd from Duke University, 1974, 246 pages http://wwwlib.umi.com/dissertations/fullcit/7502395

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Labor Negotiations: a Study of Interactions during Hospital Childbirth by Cotter, Mary Elizabeth, Edd from Columbia University Teachers College, 1996, 224 pages http://wwwlib.umi.com/dissertations/fullcit/9620147

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Life Matters: Childbirth, Embodiment and Selfhood of Chinese Women in San Francisco by Du, Wei, Phd from Indiana University, 1998, 179 pages http://wwwlib.umi.com/dissertations/fullcit/9825510

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Lifting the Curse of Eve: Textual Constructions of Gender and Identity in Women's Writings on Childbirth by Jacobsen, Cheryl Rose, Phd from The University of Iowa, 1991, 275 pages http://wwwlib.umi.com/dissertations/fullcit/9217159

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Living Arrangements of Mothers Following Childbirth: Do They Affect Subsequent Fertility? (birth Intervals, Coresidence) by Deang, Lionel Pineda, Phd from The University of North Carolina at Chapel Hill, 1992, 215 pages http://wwwlib.umi.com/dissertations/fullcit/9234953

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Management of a Social Experiment across Multiple Settings and Institutions Regarding Childbirth Education Programs and Type of Birth (cesarean, Lamaze, Documentation, Experimental) by Aleksa, Linda Charlotte, Edd from Virginia Polytechnic Institute and State University, 1986, 188 pages http://wwwlib.umi.com/dissertations/fullcit/8620582

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Mother-child Free Play Interactions: Relationships of Free Play Styles to Maternal Sex, Education, Religion, Number of Children, Liberation, Use of Natural Childbirth and Breast Feeding; and Age, Sex, Trust and Persistence of the Child. by Freiberg, Karen Louise Hansen, Phd from Syracuse University, 1974, 244 pages http://wwwlib.umi.com/dissertations/fullcit/7513985

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Mothers Helping Daughters to Become Mothers: the Sociocultural Context of 'satogaeri' Childbirth in Contemporary Japan by Fiedler, Deborah Cordero, Phd from University of Pittsburgh, 1996, 363 pages http://wwwlib.umi.com/dissertations/fullcit/9727835

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Narrating, Attitudes, and Health: the Effects of Recounting Pregnancy and Childbirth Experiences on the Well-being of the Participants (storytelling) by Keeler, Teresa Frances, Phd from University of California, Los Angeles, 1984, 210 pages http://wwwlib.umi.com/dissertations/fullcit/8428529

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Natural Childbirth: an Audiovisual Presentation by Hughes, Penny Ann, Edd from University of Northern Colorado, 1979, 56 pages http://wwwlib.umi.com/dissertations/fullcit/8004449

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'never Forget Her Sex': Medicalizing Childbirth in Manitoba, 1880s to 1920s by Miller, Tamara Lee-ann; Phd from The University of Manitoba (canada), 2002, 354 pages http://wwwlib.umi.com/dissertations/fullcit/NQ76740

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Nursing the Muse: the Childbirth Metaphor in H. D.'s Poetry (doolittle) by Hollenberg, Donna Krolik, Phd from Tufts University, 1986, 327 pages http://wwwlib.umi.com/dissertations/fullcit/8609007

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Pain, Cognitive Activity and Childbirth by Wuitchik, Michael I; Phd from University of Calgary (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL38105

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Parents' Attitudes, Expectations, and Satisfactions Related to Maternity Care, and the Implications for Childbirth Education (introjects, Responsibility, Hospital) by Hall, Ellen Fietz, Phd from University of California, Santa Barbara, 1983, 324 pages http://wwwlib.umi.com/dissertations/fullcit/8411233

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Patterns of Medical Care Utilization: Childbirth in Three Texas Towns by Kean, William Lybrand, Phd from The University of Texas at Austin, 1980, 180 pages http://wwwlib.umi.com/dissertations/fullcit/8021457

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Poor Mothers and Babies: a Social History of Childbirth and Child Care Institutions in Nineteenth Century New York City by Quiroga, Virginia Anne Metaxas, Phd from State University of New York at Stony Brook, 1984, 251 pages http://wwwlib.umi.com/dissertations/fullcit/8416627

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Relationship between Satisfaction Rating of Childbirth Education Participants and the Congruence of Their Psychological Type with the Psychological Type of the Childbirth Education Instructors (adult Education, Myers Briggs Indicator, Teaching, Learning S by Reon, Catherine L., Phd from University of Pittsburgh, 1984, 176 pages http://wwwlib.umi.com/dissertations/fullcit/8511082

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Relationship of Personality Traits and Pregnancy Attitudes to Choice of Childbirth Method in First Pregnancy Couples by Weiss, Nitza, Phd from Fordham University, 1983, 123 pages http://wwwlib.umi.com/dissertations/fullcit/8326192

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Releasing and Relieving Encounters: Experiences of Pregnancy and Childbirth by Lundgren, Ingela; Phd from Uppsala Universitet (sweden), 2002, 75 pages http://wwwlib.umi.com/dissertations/fullcit/f711969

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Reproducing Selves: Contradiction, Control, and Identity in Natural Childbirth by Richardson-gates, Lisa Rose, Phd from University of Southern California, 1995, 267 pages http://wwwlib.umi.com/dissertations/fullcit/9630754

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Silver Sutures: the Medical Career of J. Marion Sims (childbirth, Sexual Surgery, Women, Slavery, Southern Medicine) by Mcgregor, Deborah Kuhn, Phd from State University of New York at Binghamton, 1986, 199 pages http://wwwlib.umi.com/dissertations/fullcit/8608714

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Social Networks and Natural Childbirth by Mcswain, Dianne Bradd, Phd from University of California, Davis, 1980, 186 pages http://wwwlib.umi.com/dissertations/fullcit/8027069

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Sociocultural Aspects of Natural Childbirth. by Cave, Carolyn Bartels, Phd from State University of New York at Buffalo, 1976, 322 pages http://wwwlib.umi.com/dissertations/fullcit/7616997

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Studying the Psychological and Physiological Correlates of Perinatal Performance and Postpartal Adaptation: a Proposed Model (childbirth, Transition to Parenthood, Pregnancy, Motherhood) by Benn, Joanne Louise, Phd from The Pennsylvania State University, 1985, 353 pages http://wwwlib.umi.com/dissertations/fullcit/8525994

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Technology, Authority, and Childbirth: a Case Study of the Control of Birthing in Delaware by Turkel, Kathleen Doherty, Phd from University of Delaware, 1988, 200 pages http://wwwlib.umi.com/dissertations/fullcit/8904591

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Technology, the Natural and the Other: the Case of Childbirth Representations in Contemporary Popular Culture by Shorr, Lori Ann, Phd from University of Pittsburgh, 1997, 254 pages http://wwwlib.umi.com/dissertations/fullcit/9909557

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The Arguments of Labor: Twentieth-century American Women's Autobiographical Childbirth Narratives by Hooker, Deborah Anne, Phd from University of Florida, 1997, 405 pages http://wwwlib.umi.com/dissertations/fullcit/9824087

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The Art and Ritual of Childbirth in Renaissance Italy by Musacchio, Jacqueline Marie, Phd from Princeton University, 1995, 436 pages http://wwwlib.umi.com/dissertations/fullcit/9605074

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The Childbirth Odyssey: the Last Rural Midwives in German-speaking Europe Tell Their Stories. a Translation and Analysis of Marianne Grabrucker's ``vom Abenteuer Der Geburt: Die Letzten Landhebammen Erzaehlen'' by Cummings, Tiffany, Da from State University of New York at Albany, 1998, 386 pages http://wwwlib.umi.com/dissertations/fullcit/9831206

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The Cultural Character of Childbirth Education by Danford, Cloe Ann, Phd from Michigan State University, 1998, 225 pages http://wwwlib.umi.com/dissertations/fullcit/9922305

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The Effect of a Cognitive-behavioral Curriculum on Obstetric Outcome: the S.p.o.r.t. Framework for Childbirth by Smith, Mara D. H., Edd from Boston University, 1997, 83 pages http://wwwlib.umi.com/dissertations/fullcit/9705315

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The Effect of Childbirth Education Classes on Parental Values and Health Locus of Control by Laing, Glynis Johns, Phd from Texas Woman's University, 1983, 88 pages http://wwwlib.umi.com/dissertations/fullcit/8401205

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The Effect of Childbirth Education on Anxiety during Pregnancy by Hutchesonwilliams, Wilma, Edd from Temple University, 1985, 94 pages http://wwwlib.umi.com/dissertations/fullcit/8521091

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The Effects of Childbirth Films on Knowledge and Anxiety of Childbirth Class Attenders As a Function of Locus of Control, Film Content and General Anxiety by Anderson, Susan Elina, Edd from Boston University School of Education, 1981, 108 pages http://wwwlib.umi.com/dissertations/fullcit/8203882

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The Effects of Maternity Leave Legislation on Mothers' Labor Supply after Childbirth by Baum, Charles L., Ii; Phd from The University of North Carolina at Chapel Hill, 1999, 79 pages http://wwwlib.umi.com/dissertations/fullcit/9938114

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The Effects of Person-environment Interactions on Selected Childbirth Outcomes of Women Having Home and Hospital Births by Hodnett, Ellen Donnelly; Phd from University of Toronto (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK62266

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The Impact of Childbirth Preparation and Support on Labor and Birth Outcomes by Johnston-robledo, Ingrid, Phd from University of Rhode Island, 1997, 84 pages http://wwwlib.umi.com/dissertations/fullcit/9805235

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The Lamaze Method of Childbirth and Pastoral Care Opportunities by Kocotos, Harry, Jr., Dmin from Drew University, 1981, 106 pages http://wwwlib.umi.com/dissertations/fullcit/8119835

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The Meaning of Birth and the Birth of Meaning: Childbirth Classes, Socialization, and Women's Understandings of Birth by Monto, Martin A., Phd from University of California, Los Angeles, 1992, 258 pages http://wwwlib.umi.com/dissertations/fullcit/9303490

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The Phenomenology of Woman to Mother the Transformative Experience of Childbirth by Bergum, Vangie; Phd from University of Alberta (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL32609

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The Relationship between Married Women's Labor Supply and Fertility Decisions (childbirth) by Even, William Edward, Phd from The University of Iowa, 1984, 212 pages http://wwwlib.umi.com/dissertations/fullcit/8428241

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The Relationship of Life Change History and Control over Birth to Postpartum Blues (childbirth, Postnatal Care, Depression, Maternity) by Worby, Marsha F., Phd from Michigan State University, 1985, 130 pages http://wwwlib.umi.com/dissertations/fullcit/8603499

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The Relationship of Personality Type and Learning Style to Learner Satisfaction with Various Types of Learning Activities Associated with Prenatal Childbirth Education Courses by Brewer, Jan Michelle Hunter, Phd from Texas A&m University, 1987, 109 pages http://wwwlib.umi.com/dissertations/fullcit/8720868

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The Relative Efficacies of One-day and Six-week Childbirth Education Classes: Demographic Characteristics of First-time Mothers and Their Perception of the Labor and Birth Process and of Pain Management Strategies by Renauer, Eileen Marita; Phd from University of Kansas, 2001, 124 pages http://wwwlib.umi.com/dissertations/fullcit/3067093

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The Social Legitimization of Children in Suriname Society: an Ethnographic Account of Pregnancy and Childbirth among the Creole in Greater Paramaribo by Staker, Mark Lyman, Phd from University of Florida, 1992, 271 pages http://wwwlib.umi.com/dissertations/fullcit/9331237

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The Transformation of Childbirth in America, 1650-1900 by Bogdan, Janet Carlisle, Phd from Syracuse University, 1987, 550 pages http://wwwlib.umi.com/dissertations/fullcit/8805163

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There Is More to Childbirth Than Having a Baby. by Levesque, Louise Tencza, Phd from Brandeis University, 1977, 319 pages http://wwwlib.umi.com/dissertations/fullcit/7722817

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Times Past--times Present: the Midwife (childbirth) by Lentz, Judith R., Phd from Rice University, 1996, 336 pages http://wwwlib.umi.com/dissertations/fullcit/9631055

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Under the Influence: a Study of the Problem of Pain Relief in Childbirth in the United States with Emphasis upon the Natural Childbirth Movement, 1914-1960 by Sandelowski, Margarete Jenny, Phd from Case Western Reserve University, 1982, 318 pages http://wwwlib.umi.com/dissertations/fullcit/8304328

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Unnatural Childbirth: a Feminist Sociology of Birth in America by Mallon, Christine Laura, Phd from University of California, Irvine, 1997, 356 pages http://wwwlib.umi.com/dissertations/fullcit/9816395

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Unnatural Developments: Gendered Spaces and Childbirth Places in the Dominican Republic by Jones, Jennifer, Phd from University of California, Berkeley, 1999, 368 pages http://wwwlib.umi.com/dissertations/fullcit/9922893

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Walking the Tightrope: Women's Work Choices and Time Allocation Strategies Surrounding Childbirth in Cebu, Philippines by Viswanathan, Meera; Phd from The University of North Carolina at Chapel Hill, 2001, 266 pages http://wwwlib.umi.com/dissertations/fullcit/3007906

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'We Ought Not to Be Inactive Spectators': Physicians and Childbirth in America, 17801840 by Patterson, Amy Suzanne; Phd from University of California, Davis, 1999, 441 pages http://wwwlib.umi.com/dissertations/fullcit/9940123

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'Women Ben Purifyid of Her Childeryn': the Purification of Women after Childbirth in Medieval England by Lee, Becky Rose; Phd from University of Toronto (canada), 1998, 235 pages http://wwwlib.umi.com/dissertations/fullcit/NQ53915

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Women, Medicine, and Power: the Social Transformation of Childbirth in Taiwan by Wu, Chia-ling, Phd from University of Illinois at Urbana-champaign, 1997, 209 pages http://wwwlib.umi.com/dissertations/fullcit/9812810

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Women's Labor Supply Reactions to Divorce and Childbirth in Germany by Yang, Qing , Phd from Syracuse University, 1998, 123 pages http://wwwlib.umi.com/dissertations/fullcit/9842224

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Women's Sacred Occupation: Pregnancy, Childbirth, and Early Infant Rearing in the Antebellum South by Mcmillen, Sally Gregory, Phd from Duke University, 1985, 267 pages http://wwwlib.umi.com/dissertations/fullcit/8605520

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND CHILDBIRTH Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning childbirth.

Recent Trials on Childbirth The following is a list of recent trials dedicated to childbirth.8 Further information on a trial is available at the Web site indicated. •

A Study of HIV Levels During Pregnancy and After Childbirth Condition(s): HIV Infections; Pregnancy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: The purpose of this study is to find out if HIV-infected pregnant women taking anti-HIV drugs have an increased amount of HIV in their blood (viral load) after having the baby. The purpose of A5153s, a substudy of A5150, is to characterize two anti-HIV drugs (nelfinavir [NFV] and lopinavir/ritonavir [LPV/r]) in HIV-infected women during pregnancy and after childbirth. Sometimes pregnant women have an increase in their HIV viral load after their baby is born. This study will try to find out how often this happens. It will also examine possible reasons why the increase in viral load occurs. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00041964

8

These are listed at www.ClinicalTrials.gov.

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “childbirth” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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•

For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON CHILDBIRTH Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “childbirth” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on childbirth, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Childbirth By performing a patent search focusing on childbirth, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on childbirth: •

7-[carboxyalkyl or alkenyl]-6-[alkyl or alkenyl]3-oxo-2,4-dioxobicyclo-[3.2.1] octane and derivatives thereof Inventor(s): Burk; Robert M. (Laguna Beach, CA), Krauss; Achim H. (Irvine, CA), Woodward; David F. (El Toro, CA) Assignee(s): Allergan, Inc. (Irvine, CA) Patent Number: 5,416,106 Date filed: December 28, 1993 Abstract: The present invention relates to 7-[carboxyalkyl or alkenyl]-6-[alkyl or alkenyl]-3-oxo-2,4-dioxobicyclo[3.2.1 ] octanes and derivatives thereof. In particular, hydroxyl, nitro, amino, amido, azido, oxime, thiol, ether and thiol ether derivatives of said carboxy group are contemplated. In particular, 7-[6-carboxy-2-hexenyl]-6-[3hydroxy-1-octenyl] of 3-oxo-2,4-dioxobicyclo-[3.2.1] octane and derivatives thereof are disclosed. These compounds are useful as ocular hypotensives and as (a) thromboxane mimetics for the prevention of hemorrhaging as follows:, during surgery; tooth extraction; hemorrhaging associated with gastro-intestinal diseases and conditions such as hemorrhoids, inflammatory bowel diseases and gastric and peptic ulcers; as a result of stroke; as a complication in retinal diseases resulting in impaired vision and associated with menstruation, childbirth and uterine dysfunction and (b) selective vasoconstrictors for treating systemic hypotension, e.g. in restoring normal blood pressure in hemorrhagic, anaphylactic, or septic shock victims; to provide local antiinflammatory effects in the eye, skin and nose; to limit plasma exudation in burns, etc. and optimizing blood born delivery of drugs and diagnostics in encapsulating vehicles. Excerpt(s): Ocular hypotensive agents are useful in the treatment of a number of various ocular hypertensive conditions, such as post-surgical and post-laser trabeculectomy ocular hypertensive episodes, glaucoma, and as presurgical adjuncts. Glaucoma is a disease of the eye characterized by increased intraocular pressure. On the basis of its etiology, glaucoma has been classified as primary or secondary. For example, primary glaucoma in adults (congenital glaucoma) may be either open-angle or acute or chronic angle-closure. Secondary glaucoma results from pre-existing ocular diseases such as uveitis, intraocular tumor or an enlarged cataract. Web site: http://www.delphion.com/details?pn=US05416106__

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Apparatus for assisting childbirth Inventor(s): Lawson; Seth W. (Huntsville, AL), Smeltzer, III; Stanley S. (Huntsville, AL) Assignee(s): The United States of America as represented by the Administrator of the (Washington, DC) Patent Number: 5,649,934 Date filed: December 6, 1994 Abstract: The invention consists of novel, scissors-like forceps in combination with optical monitoring hardware for measuring the extraction forces on a fetal head. The novel features of the forceps together with knowledge of real time forces on the fetal head enable a user to make a much safer delivery for mother and baby.

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Excerpt(s): This invention pertains to devices for assisting in childbirth. Specifically, the present invention pertains to an improved version of obstetrical forceps. Many devices have been developed over the years to assist in the delivery of babies. These devices have included forceps, cylindrical net-like devices, suction devices, and miscellaneous other devices. The forceps typically grasp the fetal head in a scissors-like manner. Examples of such forceps include U.S. Pat. Nos. 3,665,925, 3,785,381, 3,789,849. The cylindrical net-like devices typically grasp the fetal head automatically when tension is applied to the net. Examples of net-like devices include U.S. Pat. Nos. 4,597,391, 4,875,482, 5,122,148, and 5,217,467. The suction devices simply grasp the fetal head with suction. An example of a suction device can be found in U.S. Pat. No. 3,794,044. Other devices include U.S. Pat. No. 3,848,606 (which consists of a concave surface that is attached to the fetal head with an adhesive) and U.S. Pat. No. 5,139,503 (which consists of a pair of spatulas that are attached to and pivot from the ends of a semicircular segment). The goal of all these devices has been to minimize, if not completely eliminate, the risk of injury to both the mother and the fetus. However, as a practical matter, such devices have been ineffective or just too difficult to use. This invention has the ability to assist in the safe delivery of a fetus. The invention consists of novel, scissors-like forceps in combination with optical monitoring hardware for measuring the extraction forces on a fetal head. The novel features of the forceps together with knowledge of real time forces on the fetal head enable a user to make a much safer delivery for mother and baby. Web site: http://www.delphion.com/details?pn=US05649934__ •

Apparatus for measuring intrauterine pressure and fetal heart rate and method for using same Inventor(s): Neal; Randall H. (2414 Forbes Dr., Bellevue, NE 68123), Neal; Richard C. (19108 Trailview, San Antonio, TX 78258) Assignee(s): none reported Patent Number: 6,434,418 Date filed: April 12, 2000 Abstract: A modified Foley catheter transmits desired data to transducers that allow the measuring of intrauterine pressure and fetal heart rate by healthcare providers on appropriate output devices. A method employs the catheter to indirectly measure intrauterine pressure and fetal heart rate from within the maternal bladder or rectum, thereby allowing the healthcare professional to choose to monitor these fetal characteristics without committing the mother and fetus to childbirth and without the risks associated with intrauterine measuring methods. Excerpt(s): Applicants' invention relates to a device for measuring intrauterine pressure and fetal heart rate and method for same. More particularly, it relates to a device that employs a Foley-type urinary drainage catheter with a sensing member to measure pressure within the bladder or rectum and correlate the measured pressure to the pressure exerted within the patient's uterus. Additionally, a fetal heart rate sensing member at or near the tip of the catheter is used to measure fetal heart rate from within the maternal bladder or rectum. Electronic fetal monitoring is a mainstay of fetal surveillance before and during labor. Much of the analysis focuses on the fetal cardiac responses to various intrinsic and extrinsic provocations, including contractions. Electronic fetal monitoring can predict the absence of asphyxia with greater accuracy than other conventional techniques. Electronic fetal monitoring can improve prenatal

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outcome by reducing the risk of intrapartum stillbirth and low Apgar scores. It also facilities the physician's ability to diagnose potential abnormalities during labor and allows for early intervention, such as emergency cesarian sections. Electronic fetal monitoring can employ several modalities. Two of the most common and helpful are measurements of the intrauterine pressure and fetal heart rate. By monitoring the patterns of the fetus' heart rate in time with the intrauterine contractions, the physician can assess possible fetal distress. Web site: http://www.delphion.com/details?pn=US06434418__ •

Apparatus for measuring the oxygen saturation of fetuses during childbirth Inventor(s): Rosenheimer; Michael N. (Guenzlhofen, DE) Assignee(s): MIPM Mammendorfer Institut fuer Physik und Medizin GmbH (Hattenhofen, DE) Patent Number: 5,497,771 Date filed: March 30, 1994 Abstract: An apparatus for measuring the oxygen saturation of fetuses during childbirth, using a probe, assigned to the fetal scalp, with two or four photodiodes operating at different wave lengths and a photodetector disposed in the plane of the photodiodes as parts of an optical reflection measurement portion for determining the oxygen saturation in the arterial or pulsating bloodstream, which is proportional to the ratio of oxyhemoglobin to the sum of oxyhemoglobin and desoxyhemoglobin by reflection measurement in an area, which is not subjected to a partial vacuum. Output signals of the apparatus are supplied to an evaluating pulsoxymeter over a cable connection having a plug-and-socket connector. Excerpt(s): The invention relates to an apparatus for measuring the oxygen saturation of fetuses during childbirth, using a probe, which is assigned to the fetal scalp and held in position by means of a partial vacuum and has two photodiodes operating at different wavelengths and a photodetector as parts of an optical reflection measurement portion for determining the oxygen saturation in the arterial or pulsating bloodstream of fetuses, which is proportional to the ratio of oxyhemoglobin to the sum of oxyhemoglobin and desoxyhemoglobin, the output signals of the probe being supplied to an evaluating pulsoxymeter over a lead connection having a plug-and-socket connector. In a known apparatus of this type, as disclosed in EP-O-135 840 A2, a probe, which comprises two photodiodes operating at different wavelengths and one photodetector, is held fast by a partial vacuum at a fetal scalp in order to measure the oxygen saturation that is proportional to the ratio of oxyhemoglobin to the sum of oxyhemoglobin and desoxyhemoglobin in the arterial or pulsating bloodstream continuously over the optical reflection measurement portion. For this embodiment of the probe, the photodiodes are disposed in the upper part of the housing and emit light with a frequency of 660 nm (red) and 940 ng (infrared) onto the fetal scalp. The light reflected from the fetal scalp reaches the photodetector, which is disposed in the lower part of the housing and the signals of which are passed on to the pulsoxymeter. This pulsoxymeter evaluates the data so obtained, so that changes in the oxygen saturation in the fetal scalp can be recognized and appropriate medical diagnoses made with the help of the data obtained by the pulsoxymeter and appropriate interventions carried out. Moreover, parts of the housing of the probe are constructed as EKG contact electrodes, one of which, when positioned appropriately, is in contact with the fetal scalp in order to be able to measure, in addition, the fetal heart rate continuously. Since the partial vacuum

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region of the known probe extends over the whole of the cross sectional area of the probe, the measurement is also carried out in this partial vacuum region. Web site: http://www.delphion.com/details?pn=US05497771__ •

Appliance for supporting women during childbirth Inventor(s): Degen; Paul (Liestal, CH) Assignee(s): Bischof; Michael (Liestal, CH) Patent Number: 5,280,794 Date filed: October 23, 1992 Abstract: An appliance for supporting a woman during childbirth includes a flexible supporting part of flat design for supporting the woman's back, buttocks and thighs. Attached to the supporting part are suspension elements by means of which the supporting part can be suspended. The supporting part preferably has a basic shape in the form of an elongate quadrilateral, with two longitudinal sides, a head side and a leg side. The leg side is bent in or recessed thereby forming two tabs which are intended for supporting the thighs and between which the child-bearing region in the vicinity of the woman's vagina remains freely accessible. By adjusting the suspension height of the head side or leg side, the position of the supporting part and therefore the woman's position can be selected, any position from an upright posture to a supine position being possible. Excerpt(s): The invention relates to an appliance for supporting a woman during childbirth. As is known, women in childbirth are nowadays supported almost exclusively in the lying position. However, experts have repeatedly pointed out, more recently with greater force, that the supine position is for the child-bearing woman a questionable and disadvantageous position which entails a number of considerable disadvantages in the course of the birth process and which, moreover, in no way corresponds to the natural position. The preference for the lying child-bearing position is without doubt due, on the one hand, to the development of clinical obstetrics in the past few decades. But on the other hand, there is also a lack of appliances, by means of which a child-bearing woman can be supported suitably and comfortably in an upright child-bearing posture in accordance with current medical requirements. Furthermore, an appliance allowing an upright child-bearing posture must at the same time also permit a lying position, if necessary, for example for a surgical operation when complications occur. Web site: http://www.delphion.com/details?pn=US05280794__

•

Beltless fiber optic labor contraction sensing device Inventor(s): Watson; Richard L. (1985 Cougar Tail, McPherson, KS 57465) Assignee(s): none reported Patent Number: 6,607,486 Date filed: January 10, 2001 Abstract: A beltless fiber optic labor contraction sensing device including a fiber optic strain sensor for detecting labor contractions during childbirth. The fiber optic strain sensor includes an optic cable, a light source for transmitting a light beam through the

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optic cable and a light detector for identifying changes in the optical signal. The fiber optic strain sensor is operable to generate an appropriate response to any changes in the optical signal that are caused by the application of force against the fiber optic cable. An adhesive pad or sensor jacket is provided to secure the fiber optic strain sensor to the mother's abdomen without the use of a belt or strap. The contraction device includes wireless communication for transmitting an output signal to a standard contraction recording device. Further, one or more of the components of the labor contraction sensing device are fabricated so as to be disposable. Excerpt(s): The present invention relates to a device for monitoring labor contractions during childbirth. Particularly, the present invention relates to a fiber optic labor contraction sensor adapted to adhere to a females abdomen without the use of a belt or strap. More particularly, the beltless fiber optic labor contraction sensor includes a fiber optic strain sensor that generates an output signal in response to labor contractions and communicates the output signal to a signal transceiver. The signal transceiver is operable to communicate the incidence of labor contractions through radiotelemetry or other wire less communication. During childbirth, both the strength and frequency of the mother's labor contractions are monitored. To monitor labor contractions, medical personnel typically utilize force-type strain gauges held against the mother's abdomen by an elastic belt placed around the mother's waist. In use, such monitors are, however, bulky and extremely uncomfortable. Further, conventional monitors are generally highly cumbersome and fail to provide the mother with mobility outside the bed during the birthing process. More specifically, a mother is normally restricted to the bed during childbirth and if the mother needs to exit the bed and move about, she must first remove the attached monitor. Another limitation of presently employed monitoring devices is the limited range of mobility afforded the mother due to the signal cables connecting the monitoring device to a contraction recording system. The problems described above are not intended to be exhaustive but are merely a few of those tending to reduce the effectiveness of the monitors presently used to detect labor contractions. These problems demonstrate that presently used monitors are not satisfactory and illustrate further the need for an improved device for detecting labor contractions. Web site: http://www.delphion.com/details?pn=US06607486__ •

Child-birth assisting system Inventor(s): Gai; Mingying (Los Angeles, CA), Hahn; Soonkap (Poway, CA), Lloyd; Peter M. (Oceanside, CA), Pan; Wei (La Jolla, CA), Yamamoto; Ron (San Francisco, CA) Assignee(s): JCS Biomedical, Inc. (Poway, CA) Patent Number: 5,405,356 Date filed: June 30, 1993 Abstract: The childbirth-assisting device uses an automatically synchronized expandable pneumatic girdle-to externally augment the secondary force of labor. The pneumatic girdle is fitted around the abdomen of the woman and the girdle is inflated to create a downward pressure on the abdomen when a contraction occurs. The synchronization of the girdle's inflation and the contractions is provided by an electronic controller which receives a signal from an intra-uterine monitor indicating a contraction and causes the girdle to inflate at a certain rate until a preset intra-uterine pressure is attained. Once the intra-uterine pressure reaches the pre-set pressure, the girdle pressure is maintained until the offset of the contraction is detected, at which time the girdle is deflated.

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Excerpt(s): The invention generally relates to the field of labor assisting devices, and specifically to a device which simulates the secondary force of labor. A normal labor process is divided into three stages. Among these stages, the first and second stages are the crucial ones which are directly involved in the delivery of fetus. The first stage of labor begins with the onset of rhythmic uterine contraction and ends at the complete dilation of the cervix which is about 10 cm in diameter. The complete dilation of the cervix marks the beginning of the second stage of labor which ends immediately after the birth of the fetus. The third stage of labor extends from the birth of the baby to the complete expulsion of the placenta. The labor progress is driven by two types of labor forces. The primary force is produced by the involuntary contractions of uterine muscle. The secondary force is produced by the increase of intra-abdominal pressure through voluntary contractions of the abdominal muscles and diaphragm. These forces cause an increase of intrauterine pressure to provide a critical expulsion force on fetus. As often seen in clinical practice, systemic analgesic drugs, epidural anesthesia and long duration of exhaustive labor all can lead to the weakening of secondary force, and sequentially to delayed labor duration or even dystocia (arrest of labor). Numerous clinical studies have correlated a prolonged labor duration and dystocia with many undesirable outcomes, such as higher rate of infant mortality, neonatal seizures and postpartum hemorrhage. To solve these serious problems, clinical instruments (forceps or vacuum suction) or cesarean section are often required to terminate labors. However, both instrumental delivery and cesarean section are far from trouble-free. While a cesarean section is basically safe, it remains a major surgical procedure. Patients who lo give birth by cesarean section are at much greater risk of childbirth-related illness or death than women who deliver vaginally. Also, the average cesarean birth has a length of hospital stay double that of a normal delivery and costs up to three times as much. Instrumental delivery also has limitations and may result in numerous complications including head and facial injuries to fetus. Therefore, it is in the best interest of both mother and fetus to prevent the incidence of prolonged duration of labor or dystocia. Web site: http://www.delphion.com/details?pn=US05405356__ •

Delivery assistance device Inventor(s): Alexander; Gary (Baton Rouge, LA) Assignee(s): Medisys Technologies, Inc. (Baton Rouge, LA) Patent Number: 6,398,790 Date filed: May 4, 2001 Abstract: A device for assisting childbirth, preferably made of separate sheets of loosely knitted polypropylene loops. Each sheet has a control end, an opposite mouth end, and a pair of insertion arms attached to the edges of the sheets. The insertion arms of each sheet slidingly engage one another. Thus, one sheet may be inserted between the fetal head and the birth canal wall until it is properly placed about the fetal head. The second sheet can then engage the first sheet, sliding into position around the fetal head as well, thereby forming an elongated gripping member completely encircling the fetal head. A drawstring may be provided to assist in initiating traction. Thereafter, pulling on the gripping member will cause the loops to lengthen longitudinally and compress in their transverse dimension, causing the circumference of the gripping member to decrease and thereby grip the fetal head. Excerpt(s): The invention relates to obstetrical devices in general and to devices for assisting delivery of a human fetus in particular. The principle delivery assistance

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device in the prior art are forceps. Forceps generally comprise a pair of opposed metal arms that are separately placed on either side of the fetus's head. Once the arms are in place, they are typically joined together at a centrally located hinge so that inward pressure on the control end of the two arms will result in the inward movement of the gripping ends of the arms against the fetus's head. Through this gripping, traction is obtained with the fetus's head, and by exerting lateral force against the forceps, the fetus may be extracted from the birth canal. Several problems can arise in the use of the forceps. When properly applied, the gripping end of the forceps are positioned over the upper jaw bone of the fetus in line with the ear. However, properly placing the forceps can be difficult. Frequently, only the top of the fetus's head is visible in the birth canal when the forceps are applied. Particularly when the fetus is not properly positioned in a face down position in the birth canal, it can be difficult for the physician or other medical professional to locate the appropriate place on the fetus to position the forceps. Thus, instead of the bones of the upper jaw, the forceps may be placed against the nose, eye, temple, or other inappropriate portion of the fetus's head. When the forceps are tightened, pressure is exerted against this fetus's head with the gripping points of the forceps. If these points are positioned improperly, pressure may be exerted on an eye, an ear, a temple, or other portions of the fetus's head which may be injured or deformed under such pressure, and in fact such injuries are all too common in forceps assisted deliveries. Web site: http://www.delphion.com/details?pn=US06398790__ •

Device and method for reducing wound trauma Inventor(s): Steen; Mary (27 Bryony Street, Leeds, LS10 4SS, GB) Assignee(s): none reported Patent Number: 5,935,595 Date filed: May 8, 1997 Abstract: The device according to this invention is provided to reduce the trauma which can be caused by an open wound such as that caused after childbirth and in particular to reduce the trauma of an open wound in the perineal and/or rectal area which can be painful and uncomfortable to a person having experienced childbirth. The device comprises a housing having a gel-like material therein which can be cooled prior to application to the area and said material has a high thermal capacity so that when the device is applied a cooling effect is created, an occluding effect of the open wound is provided and furthermore a cushioning effect on the area surrounding the wound is also provided thereby allowing the device to be used comfortably and also to improve the comfort of the person to whom the same is applied. Excerpt(s): The invention which is the subject of this application is a device to alleviate the condition of pain and trauma caused by open wounds in persons and particularly for use in relation to perineal and rectal trauma and to which reference is made herein in but which should not be read as a restriction on the possible scope of the use of the device. Perineal and rectal trauma can cause a great deal of distress and discomfort in many women before and following childbirth which may last for a considerable period of time thereafter. It is found that perineal trauma is especially prevalent amongst women who have experienced childbirth with the use of forceps and other instruments. It is now known and accepted that this can cause considerable distress and suffering to these women. It is also known that many women experience problems with haemorrhoids before and after delivery. The short term effects of perineal and rectal

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trauma can inhibit a woman from mobilising fully, prevent her from sitting down comfortably and impair her ability or willingness to care for her newborn baby. It is also known that perineal trauma can increase the problems of insomnia, reduce appetite, interfere with lactation and, in conjunction with depression, which is sometimes encountered, can lead to maternal exhaustion. A long term effect can be the occurrence of dyspareunia. Web site: http://www.delphion.com/details?pn=US05935595__ •

Device for assisting childbirth Inventor(s): Alexander; Gary E. (10212 N. Magna Carta, Baton Rouge, LA 70815) Assignee(s): none reported Patent Number: 5,122,148 Date filed: May 14, 1990 Abstract: A device to assist in removing a fetus from a woman's vagina during childbirth is provided comprising a pliable, elongated, hollow member sized to fit over the head of the fetus and a size adjustable collar attached at one end of the member to restrict the opening of the hollow member at that end to the desired size. Excerpt(s): This invention relates in general to obstetric devices, and more particular to devices useful in removing the baby during vaginal delivery. Today's state of the art obstetrics utilizes various procedures to assist in instances of difficult vaginal deliveries. These procedures basically fall into three categories: version, Caesarian and forceps assisted delivery. In the case of severe cephalo-pelvic disproportion, placenta previa, vaso previa, and other contraindications to vaginal delivery, the "C-Section", whether classic or low transverse, remains the mainstay procedure. However, it has long been recognized that to the extent that C-Section deliveries can be successfully avoided, statistical maternal and fetal benefits will be realized. Even the non-difficult vaginal delivery can benefit from non-traumatic assists. Many problems may develop during delivery which require assist from the attending obstetrician to successfully remove the baby from the birth canal. One such problem results from the presenting part of the baby, usually its head, descending too slowly. This is particularly true in the case of the primigravida mother. Even with a completely dilated and effaced cervix, and an adequate pelvis, a fetus might refuse to descend beyond station "+1", especially when the mother is suffering from contraction exhaustion. This can remain a problem even with an assist from administration of oxytocin (Pitocin). This problem is frequently exacerbated by anesthesia, particularly in the instance of epidural anesthesia which frequently produces induced non-beneficial partial atony of the engaged and dedicated muscles. Such partial atony frequently results in non-beneficial, and sometimes hazardous, prolongation of labor. Station "+1" is considered midpelvis and in the usual case is considered too high for a forceps assisted delivery. The risks to the fetus with forceps application at this level are extreme. Forceps cannot be safely used until the presenting part is at least at station "+2", and preferably between stations "+2" and "+3", which is the floor of the perineum. Web site: http://www.delphion.com/details?pn=US05122148__

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Device for holding medical instrumentation sensors at and upon the cervix os of a human female, particularly for holding the ultrasonic transducers of an ultrasonic transit time, real-time, cervical effacement and dilatation monitor Inventor(s): Bullard; Kelli M. (c/o UCSF Fetal Treatment Center 1661 Health Sciences West 3rd & Parnassus, San Francisco, CA 94143), Guberek; Michael P. (426 Jolina Way, Encinitas, CA 92024), Harrison; Michael (c/o UCSF Fetal Treatment Center 1661 Health Sciences West 3rd & Parnassus, San Francisco, CA 94143), Kemper; W. Scott (3334 Buena Vista St., San Diego, CA 92109) Assignee(s): none reported Patent Number: 5,851,188 Date filed: August 8, 1995 Abstract: A flexible elastomeric annulus-shaped membrane having a shape-retentive memory and exerting a force so as to assume and to maintain a predetermined closedloop geometric shape, normally a circle, fits circumferentially about the cervix os of a human female so as to hold and retain medical instrumentation probes, preferably two opposed wire-connected ultrasonic transducers of a real-time transit-time ultrasonic monitor of cervical dilatation and effacement. The annular membrane may optionally extend as a tube downwards in the vaginal canal, in the manner of a female diaphragm, as to shield the wires from the walls of the vagina. The membrane expands and contracts with such cyclical variation in the dilatation and effacement of the cervix os as occurs from the earliest onset of labor until imminent childbirth. The membrane holding the transducer probes of an ultrasonic cervimeter may be situated in place about the cervix os for prolonged periods ranging to several months, or may be placed only at the onset of full labor, for monitoring purposes. Excerpt(s): The present application is a companion to U.S. patent application Ser. No. 08/514,234 for a SYSTEM AND METHOD FOR THE INFUSING OF TOCOLYTIC DRUGS IN RESPONSE TO THE ONSET OF PREMATURE LABOR DETECTED BY ULTRASONIC MONITORING OF THE DILATATION AND/OR EFFACEMENT OF THE CERVIX OS filed on an even date herewith. The related application is to inventors including the selfsame Michael Harrison, W. Scott Kemper and Michael P. Guberek who are among the co-inventors of the present application. The contents of the predecessor and of the companion patent applications are incorporated herein by reference. The present invention generally concerns devices for holding medical instrumentation probes at an in contact with the cervix os of a human female. Web site: http://www.delphion.com/details?pn=US05851188__

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Disposable apparatus for monitoring intrauterine pressure and fetal heart rate Inventor(s): Wallace; William D. (Salt Lake City, UT) Assignee(s): Utah Medical Products (Salt Lake City, UT) Patent Number: 4,873,986 Date filed: April 27, 1988 Abstract: A disposable apparatus for monitoring intrauterine pressure and fetal heart rate during labor and childbirth. The apparatus includes a semiconductor pressure transducer mounted on a substrate. In one embodiment, the substrate is secured within a flexible boot adapted to allow the pressure pulses present in a uterus to be

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communicated to the pressure transducer by way of a gel placed in aligned holes provided in both the substrate and the flexible boot. The pressure transducer is located at the leading end of a cable which includes electrical conductors. A plurality of electrodes are also disposed along the outer surface of the cable so as to be able to receive the electrical signals generated by the heart of the fetus. Each of the electrodes and the pressure transducer are connected to a monitor/display device by way of the conductors within the cable. The cable may be provided with an internal stiffening stylet to facilitate insertion of the apparatus into the uterus or other body compartment. The internal structure of the cable is provided with a vent channel which communicates with the semiconductor transducer and extends along the cable to a hole in the plug on the distal end of the cable, to permit calibration and/or referencing of the transducer to atmospheric pressure. In one embodiment a lumen is provided in the cable to allow sampling of body fluids or infusion of fluids into the body. Excerpt(s): This invention relates to apparatus used to monitor fetal condition during labor and childbirth. More particularly, the present invention is directed to a novel, disposable apparatus for use in direct measurement and monitoring of intrauterine pressure and fetal heart rate during labor and childbirth. Each year, approximately 3.5 million children are born within the United States. In order to assist physicians in treating a mother and child approaching childbirth, monitoring devices are quite commonly used during the final states of labor to monitor both the mother's uterine contractions and the fetal heart rate. Such monitoring devices can quickly provide the physician with information about the rate, duration, and intensity of the mother's uterine contractions and the effect of the contractions on the fetal heart rate. This information can help the physician ensure that oxygen and nutrients are being properly transferred from the mother to the fetus during labor and childbirth and can help the physician identify potential problems before they become life-threatening. It is often the case that uterine contractions and the fetal heart rate are monitored using devices which can be secured externally to the surface of the mother's abdomen. For example, a pressure sensitive button called a tocotransducer is often secured to the mother's abdomen to provide information about the frequency and duration of the uterine contractions. The fetal heart rate may be externally monitored by an ultrasound transducer, a phonotransducer, or some other suitable device. Web site: http://www.delphion.com/details?pn=US04873986__ •

Doll capable of bodily functions Inventor(s): Pracas; Victor M. (32 Challenger Ave., Parmelia, Western Australia, 6167, AU) Assignee(s): none reported Patent Number: 5,083,962 Date filed: February 20, 1990 Abstract: The present invention provides a doll (10) which is arranged to be fed both liquids and non-liquids or solids. These are received in respective first and second chambers (20, 22). The present invention also provides a chamber pot (54) for a doll (10). Further, the present invention provides a casing (98) for enclosing or enveloping a doll (10) to simulate the womb. The present invention allows for a visual explanation of childbirth and childcare to be given to young children. This may be supplemented by instructions from another source, e.g. an adult or text.

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Excerpt(s): The present invention relates to a doll, a chamber pot for a doll and to a casing for enclosing or enveloping a doll. The present invention also provides a chamber pot for a doll. Further, the present invention provides a casing for enclosing or enveloping a doll to simulate the womb. The present invention allows for a visual explanation of childbirth and childcare to be given to young children. This may be supplemented by instructions from another source, e.g. an adult or a text. Web site: http://www.delphion.com/details?pn=US05083962__ •

Double handled vacuum extractor Inventor(s): Neward; Theodore C. (Claremont, CA) Assignee(s): Pristech, Inc. (San Antonio, TX) Patent Number: 5,803,926 Date filed: June 7, 1995 Abstract: A vacuum extractor for use in childbirth which enables the baby's head to be easily maneuvered during delivery. The extractor comprises an open cup with an elongated stem having an opening through which a vacuum may be provided within the cup, and a pair of elongated arms coupled to the cup along substantially opposite sides of the cup. The arms are coupled to the cup by living hinges which allow at least one of the arms to be positioned against the rear, closed portion of the cup such that the extractor presents a relatively low profile for facilitating insertion of the extractor during childbirth. Once in position on the baby's head within the womb, the handles provided at the opposite ends of the arms may be used to maneuver the baby's head during delivery. Excerpt(s): The present invention relates to apparatus for facilitating the extraction of a baby during childbirth. In some instances during childbirth, a completely natural birth is not possible and assistance must be rendered by the attending physician in order for the child to be delivered. Such assistance may be rendered with forceps and other similar devices, but these devices tend to be bulky and difficult to operate and their use introduces some chances of injury or discomfort to the mother and child. An alternative to forceps is a vacuum extractor device which uses a vacuum cup for attachment onto the head of the child. Joined to the cup is an elongated stem which is used to manipulate the cup. The physician may then apply a pulling force, accompanied by the proper positioning, to be transmitted to the child's head by manipulation of the stem of the device. An existing obstetrical vacuum extractor is disclosed in U.S. Pat. No. 3,202,152. That patent describes a vacuum operated device, more specifically a vacuum cup, for attaching to the head of a child, and an elongated stem joined to the cup which is used to manipulate the cup, thereby enabling a pulling force to be applied to the child's head. Although that patent describes an effective vacuum extractor, the device can be difficult to manipulate into position onto the child's head. Web site: http://www.delphion.com/details?pn=US05803926__

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External uterine contraction monitoring device Inventor(s): Hon; Edward D. (Both of Bradbury, CA), Hon; Edward H. (Both of Bradbury, CA), Hon; Robert W. (Los Altos, CA) Assignee(s): The Hon Group (Encino, CA) Patent Number: 5,070,888 Date filed: October 2, 1986 Abstract: An improved monitoring device for externally monitoring labor contractions preceding childbirth which does not require the use of a belt is disclosed consisting of a transducer assembly removably fixed to a base adhesively attached to the abdomen of the woman. Excerpt(s): The present invention relates to apparatus for monitoring uterine contractions during pregnancy and throughout labor and delivery. Information relating to the frequency, magnitude and pattern of such contractions is valuable to the physician, as a measure of the normal progression of labor. Additionally, it provides a guide for nurses and physicians in the use of medication or the need for other remedial actions. The two types of apparatus most widely used at the present time for monitoring labor contractions are: (1) internal catheters inserted into the uterus to measure changes in the amniotic fluid pressure in the amniotic sac such as generally shown in the Pack U.S. Pat. No. 4,543,965; and (2) external devices which consists of a pressure transducer held in place on the abdomen of the patient by a belt fitted around the waist of the patient such as generally shown in the Fuzzell U.S. Pat. No. 3,520,294. 1. The uterine cervix must be partially dilated and the amniotic sac ruptured. Web site: http://www.delphion.com/details?pn=US05070888__

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Extractor for childbirth and aspirator/injector device Inventor(s): Deutchman; Arnold H. (2200 Lane Rd., Columbus, OH 43220), Deutchman; Mark E. (1609 Oak Hill Rd., Memphis, TN 38138) Assignee(s): none reported Patent Number: 5,395,379 Date filed: July 22, 1993 Abstract: A medical device which is manually operable to draw a vacuum using a piston and cylinder combination may be used for creating a vacuum in the cup of a birth extraction device or to withdraw fluids from a body cavity or perform biopsies. The structure includes a closed loop at the remote end of the cylinder which allows the device to be manipulated by one hand and it may include check valves to prevent any fluid withdrawn from the body from being reinjected into the body cavity or vessel by location of check valves in a withdrawal duct and a drainage port. The same device may be used for injecting fluids into a body cavity and may include structure between the loop and cylinder to apply force to the piston to discharge fluids through a needle attached to the remote end of the cylinder. Excerpt(s): This invention relates to a piston and cylinder combination used to create a vacuum on a birth cup to assist in the delivery of an infant. A similar piston and cylinder structure may be used to withdraw fluids from body cavities, perform needle biopsies of soft tissues and solid organs, inject substances into the body, or transfer fluids from one vessel to another or otherwise create low volume, high pressure vacuum

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for medical or industrial uses. The original concept of this invention arose from difficulties encountered by one of the inventors in hospital delivery rooms where the structure and associated apparatus of existing obstetric vacuum extractors for assisting childbirth proved to be cumbersome. Modern technology has advanced considerably in providing apparatus to monitor the progress of mothers in labor and the condition of the fetus during labor. The process of vaginal birth may be assisted by hard steel forceps or a variety of available vacuum extraction devices. Although forceps are highly effective when used in the proper circumstances, vacuum extraction devices are less likely to cause maternal or infant injury and can replace forceps in many cases. Web site: http://www.delphion.com/details?pn=US05395379__ •

Method and apparatus for monitoring fetal cerebral oxygenation during childbirth Inventor(s): Sefranek; Thomas C. (112 Great Rd., Shirley, MA 01464), Stoddart; Hugh Adam (8 Mill Rd., Harvard, MA 01451), Stoddart; Hugh Franklin (P.O. Box 200, Groton, MA 01450) Assignee(s): none reported Patent Number: 6,381,480 Date filed: May 26, 2000 Abstract: An apparatus is disclosed for monitoring fetal cerebral oxygenation during childbirth. The apparatus includes a tunable source of infrared photons, a probe to access a single location on the scalp of the fetus for injecting the infrared photons generated by the photon source, and for receiving scattered photons reflected from within the skull of the fetus. The apparatus at least has first and second detectors for detecting the presence of photons received through the probe at selected different delay intervals so as to be capable of distinguishing photons reflected from different depths or at different instances from within the head of the fetus. Excerpt(s): The present invention generally pertains to a method and apparatus for monitoring fetal cerebral oxygenation during childbirth. More particularly, the present invention relates to a method and apparatus for monitoring fetal cerebral oxygenation using near-infrared spectroscopy. As is well known, oxygen is transferred from the maternal blood to the fetal circulation through the placenta. During uterine contractions, increased pressure on the placenta impedes blood flow and interrupts the supply of oxygen to the fetus to a degree proportional to the duration, intensity, and frequency of the contractions. The fetus has a number of protective mechanisms including a special form of hemoglobin, with its dissociation curve shifted to the left, which binds more oxygen at lower partial pressures. Also, when the oxygen supply is cut off, the fetal metabolism continues to produce chemical energy (ATP) by anaerobically converting glucose to lactate--"glycolysis." (Red cells themselves do not use oxygen but get all their energy this way.) Reestablishment of blood flow provides the oxygen to metabolize the excess lactate and return cells to normal metabolism. Despite these protective measures, if the fetus is compromised by a sustained interruption of the blood supply or when the normal placental vasculature is impaired, profound fetal hypoxia can result in permanent brain damage or death. If fetal hypoxia is detected early enough, an operative delivery can be initiated to prevent or reduce brain damage. There are presently no good ways to monitor fetal oxygenation distress. Web site: http://www.delphion.com/details?pn=US06381480__

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Method and apparatus monitoring the progress of labor Inventor(s): Paltieli; Yoav (Haifa, IL) Assignee(s): Ultra-Guide Ltd. (Haifa, IL) Patent Number: 6,200,279 Date filed: May 5, 1998 Abstract: A method of monitoring the progress of labor in a mother during childbirth, by attaching a position sensor to a predetermined point on the mother's pelvic bones; monitoring the location of the position sensor in three- dimensional space relative to a reference; and monitoring the location of the fetal presenting part with respect to the predetermined point on the mother's pelvic bones. The location of the fetal presenting part may be indicated by a similar position sensor, or by imaging. Other conditions, such as effacement, cervical dilatation, and cervical position may also be monitored in a similar manner. Excerpt(s): The present invention relates to a method and apparatus for monitoring the progress of labor during childbirth. Normal labor is generally divided into three stages: The first stage begins with the onset of labor and ends when dilatation of the cervix is complete; the second stage begins at that point and ends with the complete birth of the baby; and this is followed by the third stage which ends with the delivery of the placenta. During labor it is common to use either an external ultrasonic system for recording the baby's heart rate, and an external system for detecting the mother's uterine contractions, or an electronic system to sense the baby's heart pulses by an electrode attached to the baby's head and the mother's contractions by a pressure catheter applied to the mother inside the uterus. However, a number of other physiological conditions of the mother and baby during labor must also be monitored in order to determine the progress of labor. These additional conditions include: (1) effacement (the thinning out of the cervix that occurs before and during the first stage of labor); (2) cervical dilatation (the increase in size of the cervical opening); (3) position of the cervix (the relation of the cervix to the vaginal axis, normally the fetal head); and (4) station (the level of a predetermined point of the fetal presenting part with reference to the mother's pelvis). The more common determination of station is the distance between the tip of the fetal head and the ischial spines which can be palpable by the physician; but a more accurate determination of station is the distance between the bi-parietal diameter (BPD) of the fetal head and the mother's pelvic inlet. Web site: http://www.delphion.com/details?pn=US06200279__

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Method and system for the pregnancy condition protocol of an emergency medical dispatch system Inventor(s): Clawson; Jeffrey J. (4649 Farm Meadow La., Salt Lake City, UT) Assignee(s): none reported Patent Number: 6,076,065 Date filed: March 28, 1997 Abstract: A method and system for receiving, processing and responding to emergency medical calls for patients with pregnancy related medical problems is described. A consistent, standard and systematic process is provided which in combination with adequate training, supervision and quality assurance serves to provide a method for

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gathering emergency medical information regarding a patients pregnancy problems, categorizing such information into various determinant levels for appropriate response, and for giving qualified emergency medical information to callers thereby permitting "zero time" response by those at the scene. By using this invention properly a dispatcher is guided through the interrogation of callers concerned with pregnancy, childbirth or miscarriage medical problems, gathering critical information and giving the appropriate guidance to the caller. This invention specifically guides the dispatcher through the steps of the pregnancy/childbirth/miscarriage protocol, thereby identifying the degree of urgency of such complaints and appropriately dispatching emergency medical responders. Excerpt(s): This invention relates to methods and systems for processing and responding to emergency medical inquiries. Specifically, this invention relates to the process or method of managing the dispatch of emergency medical care to callers or patients with pregnancy, childbirth or miscarriage problem complaints. Providing adequate emergency medical care presents several critical challenges to medical care providers. These challenges include: the proximity to the care provider, the time required for help to arrive, the identification of the criticality of the emergency, the appropriate level of care provided, the variances in training of emergency medical dispatcher personnel, and limited nature of emergency care resources. This invention addresses these challenges by providing a consistent and proven system for: First, gathering necessary medical complaint information from emergency medical inquiry callers and providing emergency verbal instructions to individuals at the scene. Second, prioritizing the complaint to determine the criticality of the emergency. Third, assisting dispatched responders to be prepared for each emergency situation. Fourth, advising those on the way to provide care at the scene of specific problems or potential hazards. When used correctly this invention decreases the effective response time, while increasing the professionalism and control of emergency medical dispatchers, increases the accuracy and appropriateness of patient interrogation and well as the quality of gathered information, reduces the number of multiple unit responses thereby reducing the risk of emergency medical vehicular collisions, improves patient care, reduces burnout and stress of dispatchers by improving their quality of training, decreases the risk of responder injury or mistake by providing responders with improved knowledge of the situation, and provides an means for continuously improving the quality of emergency patient care. While being included within a greater invention that addresses all of the above issues, this invention specifically addresses the pregnancy/childbirth/miscarriage problem protocol or procedure. Pregnancy problems constitute some of the most common, urgent and critical of emergency medical calls. Accurate, efficient and systematic responses to these calls can and does make the difference in the successful resolution of pregnancy problems. This invention specifically addresses these types of problems. It is desirable to provide a systematic and standardized method for responding to emergency medical requests. Although in the related art some attempt has been made to address the problem of medical care assessment, the related art does not address the specific problems of emergency dispatcher response to pregnancy, childbirth or miscarriage problem calls. Rather related art approaches describe the following. A process of helping patients assess their health, select appropriate health care, and guide such patients to an appropriate level and type of care. An automated medical history taking system and a technique wherein selected branch paths through a question repertory are provided. A method and apparatus for coordinating the actions of two or more medical teams, especially for instructional purposes. An expert system for providing suggested treatments for a patient with physical trauma. A medical payment system that incorporates computer

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technology in the storage, retrieval and processing of patient data and insurance claims. A knowledge base containing medical/pathological information on various diseases. A hospital computerized system for entering information pertinent to a patient's stay in the hospital. An expert computer system for processing medical claims. An interactive computerized apparatus and method for presenting medical information for diagnosis and study of disease. An automated and interactive positive motivation system to send a series of motivational messages and/or questions to a client to change or reinforce a specific behavioral problem. An artificial intelligent expert system. A rapid response health care communications system for providing rapid and reliable health services to patients located within or outside a health care facility. Web site: http://www.delphion.com/details?pn=US06076065__ •

Obstetric bonnet for assisting childbirth and method of manufacturing the same Inventor(s): Elliott; Byron D. (San Antonio, TX) Assignee(s): Board of Regents, The University of Texas System (Austin, TX) Patent Number: 5,507,752 Date filed: August 10, 1992 Abstract: Flexible, collapsible, dome or cylinder-shaped bonnet that provides a substantially airtight fit to a fetal head and utilizes frictional and internally-created vacuum forces for assisting childbirth. The bonnet is manually inserted and rolled over the cranium of the fetus, stopping short of the eyes and the ears. Friction and internally created vacuum forces are created when the bonnet is pulled, thus securing the bonnet to the fetus's head and allowing orientation and delivery. The device is comprised of a dome or cylinder-shaped body made of a collapsible elastic material, an optional raised "lip" located on the exterior of the open end, and may have a mechanical extension attached to the closed end. System embodiments allow for the attachment to the exterior of the closed end grommets and/or mechanical extensions that will irreversibly stretch, lengthen, and expose warning alerts in the event that excessive longitudinal force is applied. The bonnet is a significant improvement because it allows a firmer grip on the fetus' head with less danger of damage to either the mother or the fetus. Thus traction and rotational forces may be safely applied to a fetus without the need to use forceps or hard suction cups. Excerpt(s): The invention relates generally to obstetric traction delivery devices, such as forceps and vacuum cups, and more particularly to a flexible, collapsible bonnet which is manually placed over the top of the fetus' head and unrolled, stopping short of the eyes and ears. When pulled, the bonnet utilizes graded and limited friction and internally-created vacuum forces to secure itself to the fetus' head, thus allowing orientation and application of traction forces to the fetus. Presently, forceps and vacuum cup devices are used for assisting child delivery in difficult cases. Typical instances occur when the parturient force of the mother is not sufficiently strong, or when there is a need to maneuver the fetus for delivery. Forceps may be padded and are typically made from unyielding materials, such as stainless steel. When such rigid material is engaged against the soft, moldable fetal head, undesirable and potentially damaging compression may occur. A faulty application or incorrect use of forceps may not only injure the fetus, but may cause maternal injuries as well. Since present day obstetrical training programs tend to vary in their emphasis on forceps use, those who use forceps likewise vary in forceps use proficiency. The less the proficiency, the greater the risk that either fetal or maternal injuries may follow. While there have been numerous forceps

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modifications to suit specific indications, the basic forces acting on the fetal head are the same regardless of the particular type of forceps used. Compression of the fetal head between the two blades of the forceps provides the necessary force as traction is being applied by the obstetrician to effect delivery. Excessive compressive and/or traction forces may cause trauma to the fetus and possibly the mother. Web site: http://www.delphion.com/details?pn=US05507752__ •

Obstetric device Inventor(s): Mancarella; Donatello (Auf dem Kampchen 33, 42699 Solingen, DE) Assignee(s): none reported Patent Number: 5,601,528 Date filed: April 3, 1995 Abstract: The obstetric device according to the invention has two balloon or ring-shaped bodies (1, 2) of essentially identical design, which are positioned on an axis which runs in the horizontal direction when positioned for use, where the upper sections of the bodies (1, 2) are separated from one another by a gap (8) which narrows in the downward direction and their top sides form a seat (7) for a parturient sitting on the two bodies (1, 2), and a pedestal-like base (9) which can be positioned in an essentially stable, fixed spatial relationship to the bodies (1, 2), and has footrests (10) on which the feet of the parturient can be supported. In a preferred practical example, the pedestallike base (9) has a fluid-tight catch basin (11) and a projection (16) which reaches over and behind the bar (3) connecting the bodies (1, 2) to one another. The obstetric device enables the parturient to assume a relaxed position during childbirth and a secure and gentle birth for the child to be born. (FIG. 1) Excerpt(s): The invention relates to an obstetric device for facilitating childbirth and relieving the parturient while giving birth. It is known practice to use relaxation devices, such as that described in DE-PS 42 07 540 C2, as early as the preparatory phase of childbirth. A relaxation device of this kind particularly serves to massage and relax the muscles of the pelvic floor during the phases before birth, and thus to improve the management of the pain caused by dilation in the pelvic floor region. In this context, the relaxation device consists of two essentially identical balloon or ring-shaped elastic bodies, which are arranged in an essentially rotationally symmetrical manner around an axis which forms the connecting line between the bodies and runs in the horizontal direction when positioned for use. In this context, the bodies are arranged and connected to one another in such a way that, when set down on a floor surface, their upper sections are separated from one another by a gap which narrows in the downward direction and their top sides form a seat on which the parturient can sit. The relaxation of the muscles of the pelvic floor desirable for the mechanical aspects of labour, and gentle horizontal traction on the gluteal muscles, are achieved by moving the pelvis of the parturient, sitting on both bodies. It is thus possible to autogenically train the exerted pelvic floor muscles and, through the rhythmic movements of the parturient on the two balloon-shaped bodies, to improve management of the dilation pain in the pelvic floor region during the bearing-down phase. The relaxation device only serves to relax the parturient during the preparatory phase of childbirth. However, it is not possible to facilitate childbirth with this device. Web site: http://www.delphion.com/details?pn=US05601528__

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Obstetric forceps Inventor(s): Biehl; Margit (St. Wendel, DE) Assignee(s): Fraunhofer-Gesellschaft zur Forderung der angewandten Forschung e.V. (Munich, DE) Patent Number: 6,425,899 Date filed: October 24, 2001 Abstract: Disclosed is an obstetric forceps for grasping a baby during childbirth, the forceps having blades which are approximately adapted to the shape of a baby's head, are made of a rigid material and have contact surfaces for grasping the baby's head, the contact surfaces being provided with at least one device for detecting the pressure prevailing between the contact surfaces and the baby's head. The invention is distinguished by the contact surfaces of the forceps blades each is provided with an elongated, elastically ductile contact body, and the pressure detection device is designed in such a manner that the contact body has, at least at the side facing the contact surface, an electrically conductive surface and that electrodes, which are insulated from each other, are provided at the contact surfaces of the forceps blades, upon deformation of the contact body, the electrodes being contactable with the same in such a manner that with increasing deformation of the contact body, an increasing number of electrodes are electrically interconnected by the electrically conductive surface of the contact body. Excerpt(s): The present invention relates to an obstetric forceps for grasping a baby during childbirth, which forceps have blades which are approximately adapted to the shape of a baby's head, are made of a rigid material and have contact surfaces for grasping the baby's head, which contact surfaces are provided with at least one device for detecting the pressure prevailing between the contact surface and the baby's head. Obstetric forceps for grasping a baby during childbirth are common knowledge. Obstetric forceps are partly made of metal and comprise two forceps elements moveably connected by means of a joint, also referred to as a catch. State of the art forceps have a handle section and a grasping section which are separated by the joint. Forceps blades adapted to the shape of a baby's head are provided at the grasping section with which the baby's head can be grasped by exactly fitting around the head respectively at least partially surrounding the head. The handle section is provided with handles for operating the forceps. At the section leading to the joint of each handle, there is a laterally projecting extraction hook which is employed to extract the child grasped by the forceps out of the mother's body. However, occasionally in so-called forceps births there is injury to the baby's head ranging from nerve damage to impression fractures of the skull caused by too much pressure applied by the forceps on the baby's head during delivery. The pressure acting on the baby's head cannot be controlled by means of known methods and devices. Thus, the pressure is solely controlled by the sensitivity of the fingers of the obstetrician operating the forceps. This can lead to problems particularly if the obstetrician is strong or inexperienced, because too much pressing force may be applied to the baby's head with such forceps. Web site: http://www.delphion.com/details?pn=US06425899__

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Obstetrical instrument system and method Inventor(s): Acker; David E. (Setauket, NY), Weinfeld; Ze'Ev (Jerusalem, IL) Assignee(s): Biosense, Inc. (Setauket, NY) Patent Number: 5,935,061 Date filed: December 31, 1997 Abstract: The childbirth process is monitored by applying one or more probes to the mother and monitoring the locations of the probes by transmitting non-ionizing fields such as magnetic fields between the probes and reference elements in proximity to the mother. The magnitude and direction of movement of the probes indicates the magnitude and direction of uterine contractions. Fetal position and cervical dilation may be monitored by providing additional probes attached to the fetus and to the cervix. Excerpt(s): The present invention relates to instruments and methods for monitoring the mammalian birth process. During childbirth, medical personnel commonly monitor the degree of dilation of the mother's cervix, the location of the fetus within the cervix and uterus and the strength and frequency of the mother's labor contractions. Much of this monitoring is conducted by direct visual observation and manual palpation. Various instruments have been proposed to aid the monitoring process. As disclosed in the U.S. Pat. No. 5,438,996, a cervimeter for monitoring the degree of cervical dilation may be based on direct mechanical measurements; or on ultrasonic measurement. In the ultrasonic cervimeter, a small ultrasonic transmitting device is attached to the mother's cervix adjacent its opening, and a small receiving device is also attached to the cervix, but on the opposite of the opening. The time of flight of ultrasonic signals between the transmitter and receiver provides an indication of the distance between them and hence an indication of the degree of cervical dilation. As disclosed in the '996 patent, and as further described in U.S. Pat. No. 3,768,459, an electromagnetic cervimeter uses an electromagnetic transmitting coil attached to one side of the cervix and an electromagnetic receiving coil attached to the opposite side. The strength of electromagnetic coupling between these coils provides an indication of the distance between the transmitter and receiver and hence an indication of cervical dilation. As described in U.S. Pat. No. 3,913,563, the magnitude of uterine contractions can be monitored by use of a strain gauge. A flexible reed is mounted on a frame carried by the belt. The belt holds the frame against the abdominal wall. The reed extends through the frame and also contacts the abdominal wall. Contractions cause movement of the reed. The degree of movement provides an indication of the magnitude of the muscle contraction. As described in U.S. Pat. Nos. 5,634,476 and 5,218,972, pressure measuring devices bearing on the abdomen can also be used to measure changes in pressure caused by the contractions. Web site: http://www.delphion.com/details?pn=US05935061__

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Obstetrical pneumogirdle Inventor(s): Flores-Valderrama de Gonzalez; Maria de la Luz (Andes #2722, Col. Jardin Obispado, 64010 Monterrey, Nuevo Leon, MX) Assignee(s): none reported Patent Number: 5,782,856 Date filed: May 29, 1996

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Abstract: This invention relates to an obsterical pneumogirdle having a body formed by a front section and a back section between which an inflatable chamber is placed. When inflated, the chamber remains located exactly over the front wall of a pregnant woman's abdomen, in such a way that appropriate intermittent pressure may be exerted over the patient's womb. This obstertrical pneumogirdle also comprises a monitor, a manometer a pneumatic electronic control system, an inlet for oxygen or air, a pressure adjustment knob, cables for electric feeding, a hose for pressure monitoring, a plurality of girdle braces, a switch to start or stop the system's operation, an air hose and switch to start or stop air flow is interconnected to an air pump, and devices to fasten the girdle to the patient's body. All these components are disposed in such a way to make the air injection possible as well as the regulation of pressure, and further, to procure a safe, calm and efficient childbirth. Excerpt(s): By the use of this invention a delivery work has been achieved in multiple childbirth, more natural and with much less danger for the fetus, because this invention works in concert with the spasms produced by the contractions, helping the muscular activity while exerting additional pressure during expulsion period. This invention works at the same time as each contraction takes place and relaxes after each contraction, so it does not interfere with the appropriate circulation of the uterusplacenta and the convenient oxygenation of the fetus. The system also contains with a pressure adjustment knob (4) to adjust the necessary air pressure in the air chamber (11) in order to provide to the patient the constant or intermittent pressure needed in her case. With the purpose of energizing the system, the pneumatic electronic control system (1) is provided with an appropriate air pump (of common knowledge), by means of which it is possible to pump air into the chamber (11), through the secondary hose (8B). The pneumatic electronic control system (1) has with an electric feeding cable (5) which provides the electric current necessary for the pneumatic electronic control system (1), said cable being connected to a power source of alternating current, or a power source of direct current (a battery). The obstetric pneumogirdle (9) also contains an emergency inlet (6A) to which at a desired time a secondary hose (6) may be connected, to monitor the pressure through a manual manometer (6B), This would permit the doctor delivering the baby to constantly visualize the pressure exerted over the patient's (13) womb (12). Web site: http://www.delphion.com/details?pn=US05782856__ •

Obstetrical spatulas Inventor(s): Salas-Ceniceros; Salvador (Apartado Postal 11F, Durango, MX) Assignee(s): none reported Patent Number: 5,139,503 Date filed: November 28, 1990 Abstract: A pair of obstetrical spatulas especially useful during the second stage or expulsion stage of labor during childbirth to assist in helping the fetal head to exit from the pelvic outlet by closely simulating the normal movements of the fetal head in the birth canal. Each spatula includes a blade provided with cephalic curve configuration to conform with and engage the fetal head with the blades including a shank or pedicule which form an angle of approximately 35.degree. with the longitudinal axis of the blades to provide a perineal curve. The pedicules are connected to a semicircular segment by a hinge at each end of the semicircular segment to enable articulate movement of the pedicules and blades in directions toward and away from each other

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and in longitudinal or axial directions. One of the hinge connections between the pedicule and semicircular segment is separable to enable more effective and accurate positioning of the blades in relation to the fetal head and pelvic outlet by individually positioning the blades after which the hinge is connected. A traction bar and handle with a force indicator is connected to the semicircular segment to control and indicate the traction force exerted on the spatulas. Excerpt(s): The present invention generally relates to a pair of obstetrical spatulas especially useful during the second stage or expulsion stage of labor during childbirth. The spatulas assist in helping the fetal head to exit from the pelvic outlet by closely simulating the normal movements of the fetal head in the birth canal. The spatulas include blades provided with cephalic curve configuration to conform with and engage the fetal head with the blades including a shank or pedicule which form an angle of approximately 35.degree. with the longitudinal axis of the blades to provide a perineal curve. The pedicules are connected to a semicircular segment by a hinge at each end of the semicircular segment to enable articulate movement of the pedicules and blades in directions toward and away from each other and in longitudinal or axial directions. One of the hinge connections between the pedicule and semicircular segment is a separable connection to enable more effective and accurate positioning of the blades in relation to the fetal head and pelvic outlet while the blades and pedicules can be individually positioned after which the hinge is connected. A traction bar and handle with a force indicator is connected to the semicircular segment to control and indicate the traction force exerted on the spatulas. The spatulas are constructed of stainless steel and are compressed rather than being forged to enable the blades to be quite thin for easy insertion and application to the fetal head while maintaining appropriate strength for this purpose. Obstetrical forceps have been developed and are in use to assist movement of a fetus through the birth canal. Such devices have the disadvantage of introduction of cephalic compression which may become excessive and thus injurious to the fetus and also can introduce excessive traction forces to the fetus. The following U.S. patents are relevant to obstetrical forceps. The above listed patents do not disclose the specific structure of the pair of spatulas of this invention and do not disclose an articulable pair of spatulas with an axial traction system for assistance in the birth of a fetus during the second stage or expulsion period of labor. Web site: http://www.delphion.com/details?pn=US05139503__ •

Parturition bed Inventor(s): Podgorschek; Iris (Vienna, AT) Assignee(s): Berghammer; Karin (AT) Patent Number: 5,522,098 Date filed: May 12, 1994 Abstract: A parturition bed having a lying surface (1) transversely divided into two mutually adjustable parts has a main supporting part (2) and a leg supporting part (3) that may be adjusted from a common lying plane into planes approximately parallel to the lying plane located at different heights with respect to each other. The leg supporting part (3) can be moved when in a lowered position in relation to the main supporting part (2)in the longitudinal direction of the parturition bed into a free space located below the main supporting part (2), at least in the pelvis supporting area of the latter.In order to allow the parturient to take any desired position, including a vertical position, during childbirth, while ensuring easy access to the doctor and midwife, the

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main supporting part (2) is supported on an overhanging beam (6) with relation to a main stay (5) arranged at the head end of the main supporting part (2) and supported on the floor (4), and can be lifted into a higher position and lowered back again by an adjusting mechanism (8, 9, 11, 12, 13). Excerpt(s): The invention concerns a parturition bed with a lying surface transversely divided into two mutually adjustable parts, i.e. a main supporting part providing support for the pelvis and upper part of the body of the parturient, and a leg supporting part providing support for her legs. Both the main supporting part and the leg supporting part may be adjusted from the specified height of their common lying plane to positions roughly parallel to this lying plane and at varying heights with respect to one another, i.e. a mechanism allows the leg supporting part to be lowered and raised. When the leg supporting part is in a lowered position in relation to the main supporting part, it can be slid into the free space below the main supporting part, at least as far in as the pelvis supporting portion of the latter, and in the longitudinal direction of the parturition bed. Simple parturition beds exist, e.g. in form of the U.S. Pat. No. 4,615,058, the EP-A- 0 136 419, the U.S. Pat. No. 4,682,376 and the DE-GM- 88 06419. The U.S. Pat. No. 2,832,655 deals with a parturition bed of the kind described above; the leg supporting part can be lowered to a level immediately below that of the main supporting part and in this lowered position can be slid underneath the main supporting part, making it possible to use the parturition bed as a gynaecological chair. The AU-A - 8 326 375 discloses a very similar kind of bed. Web site: http://www.delphion.com/details?pn=US05522098__ •

Perineometer for domestic use in prevention of urinary incontinence and method of using the same Inventor(s): Pinder; Kenneth L. (4195 Doncaster Way, Vancouver, British Columbia, CA), Sawchuck; Diane J. (3917 West 29th Avenue, Vancouver, British Columbia, CA) Assignee(s): none reported Patent Number: 5,733,230 Date filed: February 21, 1996 Abstract: This invention relates to a novel perineometer for domestic use and a method of using the same. More particularly, this invention pertains to a novel perineometer which can be used by a woman at home or in a non-medically controlled environment. Its use is specific to the rehabilitation of pelvic floor muscles by pelvic muscle exercises (PME) particularly following childbirth, to strengthen pelvic floor muscles to prechildbirth condition, thereby reducing risk of future urinary incontinence. A perineometer for enabling a woman to conduct pelvic muscle exercises under domestic conditions comprising: (a) a generator for generating pneumatic pressure in the perineometer; (b) a flexible pneumatically inflatable hollow bulb connected pneumatically to the manual pneumatic pressure generator (a); and (c) and a support connected to the pneumatic pressure generator (a) or bulb (b), said support supporting a microprocessor, a source of direct electrical current, an electronic pneumatic pressure sensor, a manually manipulatable memory switch electronically connected to the microprocessor, an on-off switch for controlling the transmission of electrical current from an electricity storage means and the microprocessor, and an electronic digital readout display enabling a woman using the perineometer to monitor the effectiveness of her pelvic floor muscle strengthening exercises by reference to the electronic digital readout display.

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Excerpt(s): This invention relates to a novel perineometer for domestic use. More particularly, this invention pertains to a novel perineometer which can be used by a woman at home or in a non-medical environment for treatment and rehabilitation of pelvic floor muscles by pelvic muscle exercises (PME). The benefits include improved vaginal tone after childbirth, maintenance of sexual health, and prevention of some forms of urinary incontinence, specifically stress incontinence. Urinary incontinence is a major health problem that affects 50 to 70 percent of the institutionalized female elderly and up to 30 percent of all older female adults. The most common form is stress urinary incontinence. Stress urinary incontinence results from a sudden rise in bladder pressure that exceeds urethral resistance. This rise occurs under conditions such as coughing, sneezing or lifting. Appropriate pelvic muscle exercises have been found to strengthen the skeletal muscles, which increases the capacity of these muscles to exert pressure against the urethra, and thus reduce or eliminate urinary incontinence. It has been estimated that one million Canadians, from all age groups, suffer from urinary incontinence and only one in five seek medical help. Because of this, the sale of adult diapers has ballooned into a multibillion-dollar industry in North America, with advertisements running on prime time television. Yet in most cases, urinary incontinence can be either cured or significantly improved. (Dr. Gary Naglie, a specialist in geriatric medicine at the Toronto Hospital, Toronto, Ontario, claims there are a variety of different treatments, including pelvic exercises, medication and surgery.) It is widely recognized among obstetricians and gynecologists that three treatments exist for urinary incontinence, including pelvic exercises, medication and surgery. Web site: http://www.delphion.com/details?pn=US05733230__ •

Pregnancy and childbirth educational board game Inventor(s): McQuitty; LaNette J. (2821 S. Franklin Ct., New Berlin, WI 53151), Siller; Aimee C. (7006 N. 44th St., Milwaukee, WI 53223) Assignee(s): none reported Patent Number: 6,428,004 Date filed: July 11, 2000 Abstract: A pregnancy and childbirth education board game includes a game board, a plurality game pieces, and at least one set of playing cards. The game board includes a plurality of playing spaces. Preferably, there are two groups of playing spaces. The first group of playing spaces are formed around a periphery of the game board. The second group of playing spaces are disposed inside the first group. The at least one set of playing cards instruct players to move their game piece a set number of space(s) and player also reads information out loud on the playing card concerning pregnancy and childbirth. The first player to reach the last playing space wins the game. Excerpt(s): The present invention relates generally to board games and more specifically to a pregnancy and childbirth board game which educates and entertains players about pregnancy, labor, and childbirth. Currently it appears there is no board game which educates and entertains expectant parents, family members, friends, health care providers, and players about pregnancy, labor, and childbirth. It also appears that there is no board game which provides learning experiences and facilitates communication between expectant parents, family members, friends, health care provides and players about pregnancy, labor, and childbirth. It further appears that there exists no board game which helps improve the physical and emotional outcome of pregnancy, labor and childbirth. Accordingly, there is a clearly felt need in the art for a pregnancy and

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childbirth educational board game which educates and entertains players about pregnancy, labor, and childbirth. Web site: http://www.delphion.com/details?pn=US06428004__ •

Rectovaginal surgical repair instrument Inventor(s): Willard; Cindylee (615 Justis St., Mountain Home, AR 72653) Assignee(s): none reported Patent Number: 5,746,749 Date filed: April 26, 1995 Abstract: A rectovaginal surgical instrument for the repair of rectovaginal tears, incisions and fistulas, especially those associated with childbirth. The instrument includes an elongated generally cylindrically shaped member, one end being continuously curved toward a tip and the other end having a flange and optionally wing guides, curved, or post guides, for retaining and/or guiding forceps or other surgical instruments. Excerpt(s): The present invention relates to a surgical device to aid in the repair of rectovaginal tears, incisions and fistulas, especially those which occur in connection with childbirth and require suturing at the conclusion of the childbirth process. Despite the many advances in modern medical and surgical procedures, there are some procedures which remain relatively unchanged. In childbirth, tissue in and around the vagina and the vaginal opening quite often is torn or is surgically incised in an episiotomy during or in anticipation of parturition. Such tears or incisions must be surgically repaired by suturing after delivery. During the period before the repair has been accomplished, the mother may be in considerable discomfort and may be bleeding heavily. There is a need to accomplish the suturing as quickly as possible to relieve or minimize the discomfort and decrease the amount of blood loss. Web site: http://www.delphion.com/details?pn=US05746749__

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Soft, readily expandable vacuum bell assembly Inventor(s): Cooper; Richard N. (One Jefferson Pkwy., Apt. 25, Lake Oswego, OR 97035), Smith; Emily M. (18989 Couch Market Rd., Bend, OR 97708), Smith; Lawrence M. (18989 Couch Market Rd., Bend, OR 97708) Assignee(s): none reported Patent Number: 5,224,947 Date filed: October 21, 1991 Abstract: The subject invention is directed to a vacuum bell assembly for assisting an obstetrician in controlling and accurately attaching the cranial traction cup to a predetermined attachment point on the infant's head during childbirth. The handle is typically designed to offer a measure of flexibility when pulling traction is applied during use so that even if the obstetrician is not pulling exactly on a straight axis, the cup will not be disengaged from it's attachment to the fetal scalp thereby interrupting the delivery process. The vacuum bell assembly has a cranial extraction cup fabricated from a soft, readily expandable material. This reduces the chances of injury to the fetal scalp and to the tender tissue of the vaginal walls in the birth canal. The cranial traction

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cup defines an internal attachment chamber having an outer opening for attaching the cup to a portion of an infant's head located within the internal attachment chamber. The nature of the material from which the cup is fabricated allows the cup rim to expand and fit the head of each individual infant. In this way, when suction forces from within the internal attachment chamber during use are applied to the infant's head, the cranial traction cup assists in withdrawing the infant from its mother's birth canal during childbirth. Because a proper fit on each infant's head is ensured by the cup design, no vacuum leaks will occur when subatmospheric pressure is applied. This enables an obstetrician to pull in an effective and efficient manner to advance the infant's head through the birth canal. Excerpt(s): The present invention generally relates to a soft, readily expandable vacuum bell assembly and, specifically, to a soft, readily expandable vacuum bell assembly for obstetrical use in the delivery room in an effective and efficient manner. In some instances during the birth of a child a completely natural birthing process is not possible. Therefore, assistance must be rendered by the attending physician in order for the child to be delivered from the birth canal. In the past, forceps and other like devices which tend to be bulky and hard to handle were employed to provide assistant during the course of delivery. These devices often caused injury to the mother and child. Vacuum extractors have also been employed in vacuum extraction assemblies. In 1953 the Malmstrom metal cup was introduced. In 1965, a vacuum extraction cup made of polyethylene was first marketed. These vacuum bells or cups are of the type hereafter described in U.S. Pat. No. 3,202,152 which are used during infant delivery to provide assistance in maneuvering the baby's head in the birth canal. In this way, a proper presentation of the baby is made to the obstetrician thereby facilitating the birthing process. The vacuum bell, which is operated by applying subatmospheric pressure, is secured to the head of a child and then manipulated properly to augment the parturient forces exerted by the mother during the delivery process and withdraw the child from the birth canal. By using the vacuum forces exerted by the bell assembly, the amount of effort needed to be expended by the mother is reduced, the expulsion of the baby from the birth canal can be more easily facilitated, and the time the baby needs to spend in the delivery process is greatly reduced. Web site: http://www.delphion.com/details?pn=US05224947__ •

System and method for evaluating labor progress during childbirth Inventor(s): Bendavid; Bruno (Montreal, CA), Boisclair; Mario (Montreal, CA), Hamilton; Emily (Verdun, CA), Kimanani; Ebi (Beaconsfield, CA) Assignee(s): LMS Medical Systems Ltd. (Montreal, CA) Patent Number: 6,423,016 Date filed: June 8, 2000 Abstract: An apparatus for tracking the labor progress of a patient during childbirth. Clinical measurements associated with a patient are received including a measurement of a previous dilatation of the cervix, a contraction count, a previous level of descent of the child, a previous effacement measurement of the cervix, an epidural status, and a parity status. The clinical measurements are processed to generate an expected future dilatation of the cervix by taking a linear combination of the clinical measurements. The expected dilatation of the cervix can then be used to assist a physician in determining whether a cesarean delivery is appropriate. A system for tracking labor progress is provided including a broker unit, a labor progress unit, and an information-gathering

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unit. The broker unit coordinates the communications in the system by receiving messages and forwarding messages to the components of the system as well as by providing publish/subscribe capabilities. Excerpt(s): This invention relates to the field of medical diagnostic devices and systems in the area of clinical obstetrics and more particularly to a system and method for the assessment of labour progress during childbirth. This invention is applicable in assisting decision making in clinical medicine and can be used to reduce the number of unnecessary caesarean deliveries. The labor of childbirth is the process by which uterine contractions cause the fetus and placenta to be expelled from the uterus and birth canal. Rhythmic contractions of the uterine muscle create a force that pushes the fetus against the opening of the uterus, commonly referred to as the cervix. The cervix is a tubular structure that is firm and closed during pregnancy, keeping the baby and membranes protected inside the uterus. At term, the cervix softens and in labor the continuing pressure of the fetus on the cervix causes it to shorten (efface) and to open (dilate) up to 10 centimeters. As the cervix completely effaces and dilates, the contractions and the mother push the baby through the birth canal. The level of descent of the baby through this passage is referred to as station. Contractions are the forces that promote cervical dilatation. Resistance of the cervix and the birth canal are the opposing forces to the contractions. In addition, the resistance of the cervix changes as it becomes more effaced and more dilated. Commonly, the effacement, the dilatation, the frequency of the contractions and the station are measured clinically during labor and are used by the doctors to determine if the labor is progressing normally. Generally, if the doctor determines that the labor is progressing normally, the delivery is permitted to continue through the birth canal. However, if the doctor determines that the labor is not progressing normally, a cesarean section is effected to complete the delivery. Web site: http://www.delphion.com/details?pn=US06423016__ •

Ultrasound labor monitoring method and apparatus Inventor(s): Jerath; Ravinder (2100 Central Ave., Augusta, GA 30903) Assignee(s): none reported Patent Number: 5,222,485 Date filed: September 17, 1990 Abstract: An obstetrical device is provided for use during labor and childbirth to determine and monitor accurately the position of a fetal head and the configuration of the cervix using ultrasonographic techniques. The device comprises an elongated inflatable latex rubber sac closed at one end by a latex rubber diaphragm that is supported by a resilient peripheral ring. In use, the device is inserted into the birth canal with a portion of the sac positioned in the vaginal cavity, a portion extending through the cervical canal and with the diaphragm positioned in the uterus adjacent the fetal head. The diaphragm is maintained in the uterus by the flexible peripheral ring, which has a diameter greater than that of the cervical canal. With the device thus positioned, it is inflated with a saline solution causing it to expand, bear against, and take the shape of the vaginal cavity, uterus, and fetal head. A longitudinal ultrasonographic image taken from just outside the vagina, then, clearly reveals the interface between the saline solution and surrounding tissue and thus the configuration of the cervix and station of the fetal head for accurate measurement directly from the ultrasound image.

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Excerpt(s): This invention relates to medical obstetrics and particularly to the application of ultrasonographic techniques for monitoring the progress of labor during childbirth. During labor and childbirth, a number of physiological conditions of mother and infant typically are monitored by the attending obstetrician to determine precisely when and how the infant is to be delivered. Among the most important of these conditions are the magnitude and rate of cervical dilatation, the extent to which the cervical walls have thinned or effaced and the rate of such effacement, and the longitudinal position or station of the baby's head within the birth canal. Obviously, the reliability and accuracy of the determination of these factors can be very important since the critical decisions of when to deliver the infant and whether or not to deliver the infant by cesarian section are commonly made based on such determinations. While medical science has made great strides in recent decades, very little progress has been made in methods of determining and monitoring the conditions of the cervix and the station of an infant's head during labor. Generally, these factors are still determined as they have been for decades through manual insertion of the doctor's or nurse's fingers through the vagina for physical examination and estimation of the condition of the cervix and infant. This method, however, has long been plagued with persistent inherent problems that can and sometimes do result in untimely delivery of the infant and can even result in the performance of unnecessary cesarian sections. These problems persist largely because the accuracy and reliability of estimates based on physical examinations are highly dependent upon the experience or even the finger size of the attending doctor or nurse. Widely varying estimates of dilatation, effacement, and station can thus be obtained depending upon who conducts the examination. This problem is often exacerbated where two or even more attendants conduct cervical examinations in the course of labor to establish dilatation and effacement rates since the resulting Friedman curves, upon which many decisions and prognoses of labor related problems are based, become virtually meaningless. It can thus be seen that an almost total lack of objectivity and standardization exists among obstetricians and obstetric attendants in the determination and monitoring of the conditions of the cervix and station of the baby during labor. Web site: http://www.delphion.com/details?pn=US05222485__

Patent Applications on Childbirth As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to childbirth: •

Fetal-pulse-wave-velocity-related-information obtaining apparatus and childbirth monitoring apparatus Inventor(s): Ikenoue, Tsuyomu; (Miyazaki-gun, JP), Ito, Hisashi; (Komaki-shi, JP), Samejima, Hiroshi; (Miyazaki-gun, JP) Correspondence: Oliff & Berridge, Plc; P.O. Box 19928; Alexandria; VA; 22320; US Patent Application Number: 20030216658 Date filed: March 14, 2003

10

This has been a common practice outside the United States prior to December 2000.

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Abstract: A fetal-pulse-wave-velocity-related-information obtaining apparatus, including a heartbeat-synchronous-signal detecting device at least a portion of which is adapted to be worn on at least one of a fetus and a mother so as to detect a heartbeatsynchronous signal produced from a proximal portion of the fetus; a pulse-wave detecting device which detects a pulse wave from a distal portion of the fetus that is located on a distal side of the proximal portion of the fetus; and a pulse-wave-velocityrelated-information obtaining device for iteratively obtaining, based on the heartbeatsynchronous signal detected by the heartbeat-synchronous-signal detecting device and the pulse wave detected by the pulse-wave detecting device, respective sets of pulsewave-velocity-related information each of which is related to a velocity at which the pulse wave propagates in the fetus. Excerpt(s): The present invention relates to a fetal-pulse-wave-velocity-relate- dinformation obtaining apparatus which obtains pulse-wave-velocity-relate- d information from a fetus, and a childbirth monitoring apparatus having the function of obtaining pulse-wave-velocity-related information from a fetus. Here, pulse-wavevelocity-related information is defined as information that is related to a velocity at which a pulse wave propagates in a living subject; such as a pulse-wave velocity itself or a pulse-wave propagation time. When a mother delivers an infant, there is a risk of fetal distress if blood pressure of the fetus is excessively low after uterine contraction (i.e., labor pain). Thus, a childbirth monitoring apparatus commonly has the function of monitoring degree of labor pain (i.e., degree of uterine contraction) of the mother and heart rate of the fetus. A fetus is supplied through umbilical cord with blood and oxygen. However, during uterine contraction, blood cannot flow from the umbilical cord to the fetus. Thus, the fetus is periodically subjected to state of low oxygen. If the state of low oxygen lasts for a long time, the fetus is subjected to a risk of cerebral hypoxia. In addition, past studies have elucidated that before a fetus gets the risk of cerebral hypoxia, blood pressure of the fetus significantly decreases. However, the conventional childbirth monitoring apparatus cannot monitor the blood pressure of the fetus, and accordingly a medical person recognizes the risk of cerebral hypoxia of the fetus based on only change of labor-pain waveform and change of heart rate of the fetus. Thus, it has been difficult to quickly recognize the risk that a fetus gets cerebral hypoxia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Medical timing system for use before and during childbirth labor Inventor(s): Forbath, Frank P.; (Costa Mesa, CA) Correspondence: Gene Scott; Patent Law & Venture Group; Suite K-105; 3151 Airway AVE.; Costa Mesa; CA; 92626; US Patent Application Number: 20020015361 Date filed: June 20, 2001 Abstract: A handheld childbirth labor timing apparatus includes a timing device with a visible display, a calculating device, a memory device and a selection device. In various embodiments the apparatus is programmed to execute methods for the simple timing of the durations of and intervals between actual childbirth contractions, for practicing selected sequences of such contractions in preparing for childbirth, and also for storing a set of expected sequences that, when matched, with an actual childbirth labor sequence will present an alerting signal to the user so as to timely summon medical help.

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Excerpt(s): The present invention claims the priority date of a prior filed provisional patent application having Ser. No. 60/212,872 and an official filing date of Jun. 20, 2000 and which discloses substantially the same invention as described herein. This invention relates generally to hand-held timers and calculators and more particularly to such a timer and calculator enabled for providing benefit during human pregnancy. Blaylock et al., U.S. Pat. No. 5,377,170 describes a timer which measures the duration of a first of two consecutive contractions and also measures the elapsed time period between the beginning of said first contraction and the beginning of a second of two consecutive contractions and which displays successive pairs of first and second contractions and which also compares the most recent time measurement values to a user programmed target time and further alerts the user when a measured time is less than said programmed target time. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for monitoring the progress of labor Inventor(s): Paltieli, Yoav; (Haifa, IL) Correspondence: Eitan, Pearl, Latzer & Cohen Zedek, Llp; Suite 1001; 10 Rockefeller Plaza; New York; NY; 10020; US Patent Application Number: 20030114779 Date filed: November 7, 2002 Abstract: A method of monitoring the progress of labor in a mother during childbirth, by using a position sensor to measure a predetermined point on the mother monitoring the location of the position sensor in three-dimensional space; and monitoring the location of the fetal presenting part with respect to the predetermined point on the mother. The location of the fetal presenting part may be indicated by a similar position sensor, or by imaging. Other conditions, such as effacement, cervical dilatation, and cervical position may also be monitored in a similar manner. A reference or affixation point may be provided to the position sensor by, for example, attaching a key or shaped object to one or more points on the fetus or mother. Excerpt(s): The present application is a continuation-in-part of prior U.S. patent application Ser. No. 09/698,568, filed on Oct. 27, 2000, entitled "METHOD AND APPARATUS FOR MONITORING THE PROGRESS OF LABOR," incorporated herein by reference in its entirety, which is a continuation of U.S. patent application Ser. No. 09/072,850, filed on May 5, 1998, entitled "METHOD AND APPARATUS FOR MONITORING THE PROGRESS OF LABOR," incorporated herein by reference in its entirety, now U.S. Pat. No. 6,200,279, and which claims priority from U.S. Provisional Patent Application Serial No. 60/045,556 filed on May 5, 1997, incorporated herein by reference in its entirety. The present invention relates to a method and apparatus for monitoring the progress of labor during childbirth. Normal labor is generally divided into three stages: the first stage begins with the onset of labor and ends when dilatation of the cervix is complete; the second stage begins at that point and ends with the complete birth of the baby; and this is followed by the third stage which ends with the delivery of the placenta. During labor it is common to use either an external ultrasonic system for recording the baby's heart rate, and an external system for detecting the mother's uterine contractions, or an electronic system to sense the baby's heart pulses by an electrode attached to the baby's head and the mother's contractions by a pressure catheter applied to the mother inside the uterus.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Neonatal safety net system Inventor(s): Eckart, Marcella M.; (Harvey, ND) Correspondence: Michael S. Neustel; 2534 South University Drive, Suite NO. 4; Fargo; ND; 58103; US Patent Application Number: 20030023211 Date filed: July 24, 2001 Abstract: A neonatal safety net system for preventing injury to a baby during childbirth. The neonatal safety net system includes a support member, an extended member extending from the support member, a plurality of end straps attached to the support member, and a plurality of middle straps attached to the support member. The extended member is frictionally positioned between the mother and the delivery table. The support member acts as a safety net when the end straps are connected to an obstetrician. The middle straps are secured around the woman's thighs to further prevent movement of the support member during childbirth. Excerpt(s): The present invention relates generally to neonatal safety devices and more specifically it relates to a neonatal safety net system for preventing injury to a baby during childbirth. It is estimated that there are over 10,000 childbirths per day in the United States alone. Unfortunately, a number of babies are injured as a result of being accidentally dropped by medical personnel during the childbirth procedure. Hence, there is a need for a system that will reduce the chance of injury to a baby during childbirth. Examples of patented neonatal safety devices which are illustrative of the prior art include U.S. Pat. No. 5,287,860 to Owens; U.S. Pat. No. 4,963,138 to Braun; U.S. Pat. No. 4,823,418 to Downs; U.S. Pat. No. 4,880,418 to Tramont; U.S. Pat. No. 4,007,741 to Waldrop. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Postpartum supporting apparatus Inventor(s): Honda, Yuka; (Tokyo, JP), Kimura, Kentaro; (Niiza-Si, JP), Ono, Hirokazu; (Kawasaki-shi, JP) Correspondence: Mcdermott, Will & Emery; 600 13th Street, N.W.; Washington; DC; 20005-3096; US Patent Application Number: 20020087102 Date filed: December 12, 2001 Abstract: Disclosed is a postpartum supporting apparatus, comprising a storage unit and an output unit. The storage unit stores reference data that is used to compare with postpartum measurement data representing an index of body condition after childbirth for determining whether the progress of restoration of the body condition after childbirth is good or not. The output unit outputs said reference data in order to compare with the postpartum measurement data representing the index of body condition after childbirth. Excerpt(s): The present invention relates to a postpartum supporting apparatus for supporting a woman for successful restoration of body condition after childbirth. The

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words "body condition", as used herein, means body weight condition, body fat condition, and the like. In general, the body condition for a woman significantly changes throughout the period of pregnancy from its initial stage to the final stage or childbirth, and thereafter, the woman gradually restores to the original body condition as was before the pregnancy. If restoration of the body condition after childbirth is not good it means that the health of the woman is adversely affected. For example, it may happen that the woman develops gestosis or have difficult delivery at the time of next pregnancy. Otherwise, the woman may suffer from any abnormal of fecundity, any malfunction of ovulation and any adult disease. Therefore, there is a need for precisely determining whether the progress of restoration of the body condition after childbirth is good or not and, if not, rapidly providing certain treatments accordingly. A patent application has been filed, entitled "Method and Apparatus for Judging Recovery of Physical Condition in Puerperium" (see TOKUGANHEI No. 11-250650). According to this patent application the physical condition is taken as the body condition and bioelectrical impedance characteristic is used as an index of the physical condition. Then, an evaluation about the restoration of physical condition after childbirth is performed depending upon change in bioelectrical impedance characteristics as measured after childbirth, or upon the result of comparison of bioelectrical impedance characteristics as measured before pregnancy or at the initial stage of pregnancy and after childbirth. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Uterine balloon apparatus and method Inventor(s): Piraka, Hadi; (Northville, MI) Correspondence: Alex Rhodes; 30100 Telegraph Road, Suite 460; Bingham Farms; MI; 48025; US Patent Application Number: 20010007945 Date filed: February 12, 2001 Abstract: A uterine balloon apparatus and method for countering hemorrhaging in a patient after childbirth. The balloon apparatus is comprised of a balloon, a physiologic fluid, such as a normal saline solution and a control. A characteristic feature of the invention is that a fluid pressure inside of the balloon is maintained at a safe level by the control as a uterus contracts to resume its physiologic function. The control is comprised of a pressure relief valve, a pressure regulator valve, a fill valve and flexible tubing. Another characteristic feature of the invention is that the fluid pressure inside of the balloon is prevented from exceeding a level which would cause a premature ejection of the balloon or damage to the uterus. The balloon in an inflated state, is inserted into the uterus with the assistance of a catheter which extends part way into the interior of the balloon. After the balloon has been inserted, a sufficient quantity of a warm physiologic fluid, such as a normal saline solution is infused into the balloon to distend the balloon against the uterine wall and terminate bleeding. When bleeding has been terminated, the pressure regulator valve is adjusted to prevent the pressure in the balloon from rising during contractions of the uterus. When the pressure begins to rise, the pressure regulator valve opens and some of the physiologic fluid is released to maintain the pressure at a safe level. An optional pressure gauge and high/low pressure warning systems are provided to monitor the operation of the balloon apparatus. Excerpt(s): Continuation-in-part of application Ser. No. 09/455,254, filed on Dec. 6, 1999. This invention relates to the surgical art of controlling bleeding and more specifically to

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an uterine balloon apparatus and method for countering maternal hemorrhaging. Maternal hemorrhage following childbirth is a major life-threatening condition. Various remedies are in use to stop hemorrhaging, including packing the uterus and blocking the uterine arteries. However, these remedies may not work or may be associated with high blood loss. A hemorrhaging patient after childbirth may be subject to major procedures, such as mass blood transfusions, hysterectomy, or in some instances may result in a loss of her life. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with childbirth, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “childbirth” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on childbirth. You can also use this procedure to view pending patent applications concerning childbirth. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON CHILDBIRTH Overview This chapter provides bibliographic book references relating to childbirth. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on childbirth include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “childbirth” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on childbirth: •

The A-to-Z of pregnancy and childbirth: A concise encyclopedia Source: Alameda, CA: Hunter House. 1994. 336 pp. Contact: Available from Hunter House, P.O. Box 2914, Alameda, CA 94501. Telephone: (510) 865-5282. $16.95; $2.50 shipping for 1st book, $0.75 each additional book. Summary: This book for the consumer is presented in a dictionary format providing information on a variety of topics in pregnancy and childbirth. Entries are listed in alphabetical order, and have concise explanations. A short bibliography lists other general publications on women's health, pregnancy, and childbirth. Organizations and hotlines are listed for a few areas of women's health including childbirth education, DES, endometriosis, and breast cancer. A fold out, month-by-month chart of fetal and maternal development is also included.

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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “childbirth” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “childbirth” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “childbirth” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England, Rob Horowitz (1998); ISBN: 0965987302; http://www.amazon.com/exec/obidos/ASIN/0965987302/icongroupinterna

•

Complete Book of Pregnancy and Childbirth, The : New Edition by Sheila Kitzinger (Author) (1996); ISBN: 0679450289; http://www.amazon.com/exec/obidos/ASIN/0679450289/icongroupinterna

•

Husband-Coached Childbirth : The Bradley Method of Natural Childbirth by Robert A. Bradley, Ashley Montagu (Foreword) (1996); ISBN: 0553375563; http://www.amazon.com/exec/obidos/ASIN/0553375563/icongroupinterna

•

Ina May's Guide to Childbirth by Ina May Gaskin (2003); ISBN: 0553381156; http://www.amazon.com/exec/obidos/ASIN/0553381156/icongroupinterna

•

Mothering Magazine's Having a Baby, Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth by Peggy O'Mara (Author), Jackie Facciolo (Illustrator) (2003); ISBN: 0743439635; http://www.amazon.com/exec/obidos/ASIN/0743439635/icongroupinterna

•

Mothering the New Mother: Women's Feelings and Needs After Childbirth a Support and Resource Guide by Sally Placksin (2000); ISBN: 1557043175; http://www.amazon.com/exec/obidos/ASIN/1557043175/icongroupinterna

•

Natural Childbirth the Bradley Way by Susan McCutcheon, et al (1996); ISBN: 0452276594; http://www.amazon.com/exec/obidos/ASIN/0452276594/icongroupinterna

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Pregnancy, Childbirth, and the Newborn, Revised and Updated : The Complete Guide by Penny Simkin (Author), et al (2001); ISBN: 074321241X; http://www.amazon.com/exec/obidos/ASIN/074321241X/icongroupinterna

•

The Hip Mama Survival Guide : Advice from the Trenches on Pregnancy, Childbirth, Cool Names, Clueless Doctors, Potty Training and Toddler Avengers by Ariel Gore (Author) (1998); ISBN: 0786882328; http://www.amazon.com/exec/obidos/ASIN/0786882328/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “childbirth” (or synonyms) into the search box, and select “books only.”

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From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

A way to natural childbirth; a manual for physiotherapists and parents-to-be. Author: Heardman, Helen.; Year: 1952; Edinburgh, Churchill Livingstone, 1973; ISBN: 0443010617 http://www.amazon.com/exec/obidos/ASIN/0443010617/icongroupinterna

•

Awake and aware: participating in childbirth through psychoprophylaxis. Author: Chabon, Irwin,; Year: 1965; New York, Delacorte Press [c1966, reprinted 1968]

•

Childbirth without fear; the original approach to natural childbirth. Revised and edited by Helen Wessel and Harlan F. Ellis. Author: Dick-Read, Grantly,; Year: 1966; New York, Harper; Row [c1972]; ISBN: 0060110341 http://www.amazon.com/exec/obidos/ASIN/0060110341/icongroupinterna

•

Childbirth without fear; the principles and practice of natural childbirth. Author: Dick-Read, Grantly,; Year: 1952; [London] Heinemann [1968]; ISBN: 433074019

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Commonsense childbirth. Author: Hazell, Lester Dessez.; Year: 1960; New York, Putnam [c1969]

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Controlled childbirth; based on the psychoprophylactic method, by Adele Birkbeck [and] Margaret Keen. Author: Birkbeck, Adele.; Year: 1963; [Vancouver, B. C., c1969]

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Giving birth; the parents' emotions in childbirth. Author: Kitzinger, Sheila.; Year: 1966; New York, Taplinger [c1971]; ISBN: 0800832728 http://www.amazon.com/exec/obidos/ASIN/0800832728/icongroupinterna

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Husband-coached childbirth. Author: Bradley, Robert Austin,; Year: 1965; New York, Harper; Row [c1965]

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Motherhood and personality; psychosomatic aspects of childbirth [by] Léon Chertok with M. Bonnaud [et al. Author: Chertok, Léon.; Year: 1963; London] Tavistock Publications; [Philadelphia], Lippincott [1969]; ISBN: 422718807

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Natural childbirth and the family. Author: Wessel, Helen,; Year: 1967; New York, Harper; Row [c1973]; ISBN: 0060145420 http://www.amazon.com/exec/obidos/ASIN/0060145420/icongroupinterna

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Preparing for childbirth; a manual for expectant parents. Author: Goodrich, Frederick Warren,; Year: 1963; Englewood Cliffs, N. J., Prentice-Hall [c1966]

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Relaxation and exercises for natural childbirth. Author: Heardman, Helen.; Year: 1962; Edinburgh, Livingstone, 1966

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Sex development and maternity; childbirth without pain by the psycho-prophylactic method. Author: Vellay, Pierre.; Year: 1963; London, Hutchinson of London with George Allen; Unwin [1968]; ISBN: 090875001

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Six practical lessons for an easier childbirth., by Elisabeth Bing. Author: Bing, Elisabeth.; Year: 1966; New York, Grosset; Dunlap [1967]

11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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•

The adventure of birth; experiences in the Lamaze method of prepared childbirth. Author: Bing, Elisabeth.; Year: 1955; New York, Simon and Schuster [c1970]; ISBN: 671204866

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The experience of childbirth. Author: Kitzinger, Sheila.; Year: 1963; Harmondsworth] Penguin Books [1967]

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The natural childbirth of Tara, by Philip and Ellen Thomas. Author: Thomas, Philip.; Year: 1967; New York, Fell [c1973]; ISBN: 0811902110 http://www.amazon.com/exec/obidos/ASIN/0811902110/icongroupinterna

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The new childbirth. Author: Wright, Erna.; Year: 1959; New York, Hart [1967, c1966]

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The new childbirth; the new approved method for easier childbearing through control of fear and pain. Author: Wright, Erna.; Year: 1965; London, Library 33 [1966]

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Training for childbirth. Author: Dallas Association for Parent Education.; Year: 1966; Milwaukee [1962?]

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Training for childbirth; an exercise manual for expectant parents, by Geraldine DeRose & Merle M. White. Author: DeRose, Geraldine.; Year: 1962; [San Jose, Calif., c1973]

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Why natural childbirth? A psychologist's report on the benefits to mothers, fathers, and babies, by Deborah Tanzer with Jean Libman Block. Author: Tanzer, Deborah.; Year: 1964; Garden City, N. Y., Doubleday, 1972

Chapters on Childbirth In order to find chapters that specifically relate to childbirth, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and childbirth using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “childbirth” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on childbirth: •

Childbirth and Incontinence Source: in Parker, W.H., et al. Incontinence Solution: Answers for Women of All Ages. New York, NY: Simon and Schuster. 2002. p.67-88. Contact: Available from Fireside, Rockefeller Center. 1230 Avenue of the Americans, New York, NY 10020. (800) 456-6798. PRICE: $13.00; plus shipping and handling. ISBN: 0743215877. Summary: Urinary incontinence is the uncontrollable loss of enough urine to cause social or sanitary difficulties. This chapter discusses childbirth and urinary incontinence. The chapters is from a book that offers women up to date medical explanations for incontinence and its treatment. The authors first review how childbirth can cause incontinence, noting that there are many factors that can lead to incontinence: the strength of the pelvic supporting structures the woman is born with, the forces these structures have resisted over the years (including childbirth, heavy lifting and straining during bowel movements), the ability to heal if these tissues are injured, and the effect of the aging process on the collagen that gives strength to these structures. Other topics include the impact of long labor on incontinence, vaginal delivery and its consequences,

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forceps delivery and incontinence, nonmedical reasons to avoid cesarean section deliveries, how childbirth can weaken the bladder, the use of Kegel exercises during and after pregnancy, childbirth as a cause of anal incontinence, complications of episiotomy, and strategies to prevent the incontinence associated with childbirth. The chapter includes the stories of two women who had complications of incontinence after pregnancy. Chapter references are located at the end of the book. 1 figure. 9 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to childbirth have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 •

Women's health on the Internet Source: New York, NY: Haworth Press. 2000. 153 pp. Contact: Available from Haworth Press, 10 Alice Street, Binghamton, NY 13904-1580. Telephone: (800) 342-9678 / fax: (607) 722-1424. $34.95 cloth, $24.95 paper, plus shipping and handling. Summary: This book shows searchers how the Internet can be used to locate information about the diagnosis, treatment, and prognosis of women's health problems. Topics included are Web resources and how to evaluate and search Web sites, a case study of NOAH (New York Online Access to Health), a women's health site, and women as health care consumers. Additionally provided are sections on specific women's health issues such as physical fitness, pregnancy, childbirth and early pregnancy resources, caregiving, menopause, and diabetes. Each section begins with an abstract and keywords, and an index concludes the book.

12

You will need to limit your search to “Directory” and “childbirth” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “childbirth” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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CHAPTER 8. MULTIMEDIA ON CHILDBIRTH Overview In this chapter, we show you how to keep current on multimedia sources of information on childbirth. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on childbirth is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “childbirth” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “childbirth” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on childbirth: •

Bottom Line on Hemorrhoids Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 051997A. Summary: Straining when going to the bathroom, constipation, prolonged sitting, and infection can all contribute to hemorrhoids, defined as enlarged veins around the anus. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of hemorrhoids are covered. Dr. Wyman explains the difference between internal and external hemorrhoids (merely an anatomical distinction), and prolapsed

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hemorrhoids, which are enlarged internal hemorrhoids that drop (prolapse) outside the anus. Symptoms include pain and bleeding; pain because of blood clots and bleeding due to trauma to the thin walled veins in that area. The causes of hemorrhoids include straining during defecation, pregnancy, prolonged sitting, constipation, childbirth, and obesity. Dr. Wyman recommends that anyone over the age of 40 who experiences rectal bleeding should consult a physician; younger people who experience recurrent bleeding should also see their physician (to rule out inflammatory bowel disease). Treatment options for hemorrhoids include changes in habits, such as not straining, not wiping vigorously, softening the stool with dietary changes (usually the addition of dietary fiber), and not prolonging sitting on the toilet. Surgery is used for external hemorrhoids, to remove the veins and tributaries; for internal hemorrhoids, rubber band ligation is very effective. The program also explores the problem of perianal dermatitis, including its risk factors and treatment options (which focus on keeping the area clean and dry, and not using over the counter creams that are petroleum based). The program reiterates the importance of having any rectal bleeding investigated by one's health care provider. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). •

Chasing Rainbows Contact: Bizzare Productions, 2015 41st St NW #L30, Rochester, MN, 55901, (507) 2520461. Summary: This brief video shows a cartoon pencil sketching abstract figures related to AIDS, such as male-to-male sex, the ying and yang symbols, women, childbirth, death, dying, and tears. It tells the viewer to "erase" AIDS, and encourages the use of condoms.

•

Someone You Know Source: Jenkintown, PA: Hepatitis B Foundation. 1997. (videocassette). Contact: Available from Hepatitis B Foundation. 101 Greenwood Avenue, Suite 570, Jenkintown, PA 19046. (215) 884-8786. Fax (215) 887-1931. E-mail: [email protected]. Website: http://www.hepb.org. PRICE: $6.00 for shipping. Summary: This general health education videotape program educates viewers about the hepatitis B virus (HBV) and its present status as an 'epidemic' in the U.S. The program begins with a brief overview of liver functions (energy generation, detoxification of drugs and poisons, and making blood proteins and clotting factors) and the pathology caused by HBV infections. The program stresses that there is no cure for hepatitis B, although a preventive vaccine is available. Dr. Thomas London reviews the symptoms of acute illness, including nausea, vomiting, fever, jaundice, and extreme fatigue; and explains how the virus is transmitted through blood contact (including that from sharing toothbrushes or razors), through sexual contact, and from infected mother to her child during childbirth. Other topics covered include child care issues, the use of universal precautions, classroom supplies to prevent transmission, the percentages of infected persons who go on to chronic carrier status, the role of the World Health Organization, the long term complications of carrying HBV, and the costs of health care associated with HBV. The program includes an interview with Dr. Baruch Blumberg, the scientist who won the Nobel prize for developing the HBV vaccine. Another physician interviewed, Dr. Timothy Block, emphasizes the importance of universal immunization, the problems with assuming safety if one is not a member of a supposed 'high risk' group, and the need for chronic carriers to take very good care of their health and be screened twice per year to prevent morbidity and mortality. The program features

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numerous interviews with patients who are chronic carriers of HBV; they focus on the psychosocial aspects, including the stigma of having the disease, the long-term effects of constant fatigue, and worries about infecting their children and loved ones. The program concludes with a brief summary of the Hepatitis B Foundation. •

A Will to Live (Female Version) Contact: SBG Productions, 2724 Dorr Ave, Fairfax, VA, 22031, (703) 698-7750. Summary: This videorecording depicts a group of inmates in the Prince William/Manassas Detention Center discussing HIV and its effects on their lives. A facilitator, "Billy Jones", a former inmate and a recovering addict, leads the group as they discuss what HIV is, how it can be prevented, and how it can be transmitted. They explore their emotions about the fears of rejection, and who they should tell about their HIV status. The video emphasizes issues that are relevant to women, including pregnancy and childbirth, cofactors, and discusses the use of alcohol. Myths about HIV are dispelled. The video concludes with a summary. A version for a male audience is also available as AD0013588.

•

The Life You Save Contact: World Health Organization, Health Laboratory Technology and Blood Safety Unit, 20 Avenue Appia, 1211 Geneva 27. Summary: This videorecording seeks to encourage blood donation from volunteers in Zimbabwe. Blood donation is urged as a humanitarian measure to provide an adequate supply for accidents, childbirth, and surgery. The blood donation process is explained, including what measures are utilized to ensure its safety. Fears about the possibility of contracting AIDS from donating blood, as well as receiving blood, are dispeled. The videorecording concludes with a listing of sites within Zimbabwe where individuals can volunteer to give blood.

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Bladder Leakage (Urinary Incontinence): Don't Suffer in Silence! Source: Royal Palm Beach, FL: Hepworth International, Inc. 1996. (videocassette). Contact: Available from SRS Medical Systems, Inc. 14950 NE 95th Street, Redmond, WA 98052. (800) 345-5642 or (425) 882-1101. PRICE: $19.95 each. Item number 4632B. Summary: This videotape program educates the public about treatments for bladder leakage. The program features experts in the field of urinary incontinence (UI) explaining the various treatment options. Topics covered include the types and causes of bladder leakage, prevention strategies (particularly before and after surgery, including childbirth), a structured program of pelvic muscle exercises (Kegels), foods and beverages that cause frequent urination, how to control the urge to urinate, treatment options including surgery and drug therapy, and where to find additional help and information. The program emphasizes that education and knowledge are the first steps toward successful treatment. The video comes with a self-test that helps viewers determine if they are a candidate for medical treatment for bladder leakage (UI). This viewer insert also lists beverages and foods to avoid if UI is a problem. (AAM).

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Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “childbirth” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on childbirth: •

Stop Shooting Up AIDS: Drugs and AIDS Prevention Campaign; Part 1 Contact: Professional Management Associates, Incorporated, 7315 Wisconsin Ave, Ste 1100W, Bethesda, MD, 20814, (301) 961-8580. Entertainment Industries Council, Los Angeles, CA, 90025. Summary: This sound recording contains 13 radio public service announcements (PSAs) from the "Stop Shooting Up AIDS" campaign directed at 20- to 40-year old intravenous drug users, their sexual partners, and others close to them. The PSAs contain messages related to the three ways of transmitting AIDS: sharing needles, sexual relations, and pregnancy and childbirth. The series feature four HIV positive people who share their stories with the listener. Most of the spots urge the listeners to get into drug treatment and avoid sharing needles, while two warn women using drugs to get tested before they get pregnant. Twelve of the PSAs are 30-second first-person narratives; the last item is a one-minute rap song. This recording contains part one in a two-part series of radio PSAs, with part two scheduled for release at a later date.

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Women and HIV Infection: U.S. Public Health Service National Conference, Washington, D.C., December 13 - 14, 1990 Contact: Gardiner - Caldwell SynerMed, PO Box 458, Califon, NJ, 07830. Summary: This sound recording presents highlights of proceedings from the National Conference on Women and AIDS/HIV Infection, held December 13-14, 1990, in Washington, D.C. Brief excerpts are presented from a number of speeches, addressing such topics as risk factors, diagnosis of Human immunodeficiency virus (HIV) infection in women, treatment options, and HIV-antibody testing and counseling procedures. Speakers analyze the role that women play in caring for the family, pointing out that a diagnosis of HIV infection in a woman often means the same diagnosis for another family member. Their families tend to rely on these women as caregivers; overburdened, they often get little or no care for themselves. Opportunistic infections common to women are discussed during the sound recording. Speakers also examine how HIV infection passes to infants during pregnancy or childbirth, and the difficulties inherent in diagnosing HIV infection in very young children who still carry their mothers' antibodies. The proceedings include discussion on the pros and cons of treatment with azidothymidine (AZT).

Bibliography: Multimedia on Childbirth The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in childbirth (or synonyms). Then, in

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the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on childbirth: •

Alternative methods of childbirth [videorecording]: physician Source: family interaction / a Hahnemann University and Videotech Associates Inc. production; Year: 1983; Format: Videorecording; [S.l.]: The Associates, c1983

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Anesthetics and analgesics for childbirth [filmstrip] Source: Medical Electronic Educational Services; produced by School of Nursing, University of Missouri-Columbia; Year: 1973; Format: Filmstrip; Tucson: The Services, c1973

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BMC pregnancy and childbirth [electronic resource]. Year: 9999; Format: Electronic resource; London: BioMed Central, [2001-

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Childbirth [slide] Source: Emergency Training, inc; Year: 1978; Format: Slide; Westport, Conn.: E.D.I.: [for sale by Emergency Training], c1978

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Childbirth [videorecording] Source: produced by American Safety Video Publishers, Inc; Year: 1991; Format: Videorecording; Naples, Fla.: ASVP, c1991

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Emergency childbirth [motion picture] Source: produced by U.S. Naval Photographic Center; Year: 1961; Format: Motion picture; [S.l]: Dept. of the Navy, 1961

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Emergency childbirth [videorecording] Source: a Paul Burnford film; Year: 1992; Format: Videorecording; [S.l.]: Paul Burnford Educational Films, c1992

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Emergency childbirth II [videorecording] Source: a Paul Burnford film; Year: 1983; Format: Videorecording; [S.l.]: Paul Burnford Educational Films, c1983

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Emergency childbirth procedures [videorecording] Source: [presented by] Jones & Bartlett Publishers; Year: 1991; Format: Videorecording; Boston, Mass.: Jones & Bartlett, c1991

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Labor and childbirth [motion picture] Source: [presented by] Medical Films, Inc.; produced for Medical Films, Inc. by Photo & Sound Productions; Year: 1950; Format: Motion picture; United States: Medical Films, [1950]

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Painless childbirth [videorecording] Source: [Omni Hypnosis Training Center]; produced by Videonics DirectED PLUS; Year: 1991; Format: Videorecording; Deland, FL: Omni Hypnosis Center, c1991

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Perineal repair after childbirth [videorecording] Source: a presentation of Films for the Humanities & Sciences; Leeds University Television; Year: 1999; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1999

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The Cochrane pregnancy & childbirth database [electronic resource] Source: BMJ Publishing Group [and] Update Software; Year: 1996; Format: Electronic resource; Oxford, England: Cochrane Collaboration and Update Software, 1995-[1996]

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The Psychoprophylactic method of childbirth [filmstrip] Source: Medical Electronic Educational Services; Year: 1978; Format: Filmstrip; Tucson: The Services, c1978

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CHAPTER 9. PERIODICALS AND NEWS ON CHILDBIRTH Overview In this chapter, we suggest a number of news sources and present various periodicals that cover childbirth.

News Services and Press Releases One of the simplest ways of tracking press releases on childbirth is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “childbirth” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to childbirth. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “childbirth” (or synonyms). The following was recently listed in this archive for childbirth: •

African women at high risk of childbirth death - UN Source: Reuters Health eLine Date: October 20, 2003

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African women at high risk of childbirth death Source: Reuters Medical News Date: October 20, 2003

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Childbirth doesn't lower breast cancer survival Source: Reuters Health eLine Date: August 11, 2003

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Childbirth cuts risk of hip fracture in old age Source: Reuters Medical News Date: April 25, 2003

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Childbirth cuts chance of breaking hip in old age Source: Reuters Health eLine Date: April 25, 2003

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Childbirth tied to black women's breast cancer risk Source: Reuters Health eLine Date: March 18, 2003

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Surgical cut in childbirth still too common-report Source: Reuters Health eLine Date: December 27, 2002

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Fear of childbirth not linked to likelihood of Caesarean delivery Source: Reuters Medical News Date: October 31, 2002

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Women advised to stay mobile during childbirth Source: Reuters Health eLine Date: September 24, 2002

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Risk of childbirth-related death high for Afghan women Source: Reuters Medical News Date: September 11, 2002

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Risk of dying in childbirth high for Afghani women Source: Reuters Health eLine Date: September 10, 2002

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Backache after childbirth not linked to epidural Source: Reuters Health eLine Date: August 16, 2002

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Nun study: Childbirth may not cause incontinence Source: Reuters Health eLine Date: August 01, 2002

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Childbirth may not cause incontinence Source: Reuters Medical News Date: August 01, 2002

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Avoiding manual pressure on perineum reduces risk of episiotomy after childbirth Source: Reuters Medical News Date: July 26, 2002

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Childbirth tear more likely at certain hours: study Source: Reuters Health eLine Date: July 19, 2002

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Childbirth, education ups longevity in black women Source: Reuters Health eLine Date: April 02, 2002

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Study looks at health risks of delayed childbirth Source: Reuters Health eLine Date: April 01, 2002

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Childbirth death risk high in Jehovah's Witnesses Source: Reuters Health eLine Date: November 08, 2001

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Conservative management often effective for incontinence after childbirth Source: Reuters Medical News Date: September 14, 2001

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Many not counseled about childbirth choices Source: Reuters Health eLine Date: September 10, 2001

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Men's hormones fluctuate around childbirth: study Source: Reuters Health eLine Date: June 15, 2001

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Unemployment, anxiety linked to fear of childbirth Source: Reuters Health eLine Date: June 13, 2001

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Self-confidence can make childbirth less painful Source: Reuters Health eLine Date: May 03, 2001

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Teaching hospitals offer good childbirth outcomes Source: Reuters Health eLine Date: April 03, 2001

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to

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Market Wire’s home page at http://www.marketwire.com/mw/home, type “childbirth” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “childbirth” (or synonyms). If you know the name of a company that is relevant to childbirth, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “childbirth” (or synonyms).

Newsletters on Childbirth Find newsletters on childbirth using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “childbirth.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “childbirth” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

AAKP Patient Plan. Phase 4: Ongoing Treatment Source: AAKP Patient Plan Newsletter. 1(4): 1-12. 2001. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. Summary: This newsletter accompanies and supports the final part of a four phase series of instructional materials for kidney patients. Created by the American Association of Kidney Patients (AAKP), this series is designed to address questions and concerns at various phases of the disease process. The four phases covered are diagnosis and treatment options, access and initiation, stabilization, and ongoing treatment. During each of these phases, the patient can keep control of his or her life by staying active and learning as much as possible about kidney disease and treatment. This newsletter focuses on strategies to maintain good health during ongoing treatment for kidney disease. Articles include one woman's experiences of 10 years with a kidney transplant; the importance of empowerment; strategies for coping with all the pills and medications required for long term immunosuppression; answers to questions about

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phosphorus binders (drugs used to help keep normal phosphorus and calcium levels in the blood); and transplantation, pregnancy, and childbirth. One sidebar lists relevant web sites for more information. The newsletter concludes with a glossary of terms, blank space to record questions to ask one's health care provider, and a form for joining the AAKP. The newsletter encourages readers to educate themselves and become active members of their own health care team. There are quotes and suggestions from other kidney patients sprinkled throughout the articles. The newsletter is illustrated with black and white photographs.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “childbirth” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on childbirth: •

Correcting Myths About Incontinence Source: HIP Report. Help for Incontinent People Report. 11(4): 1. Fall 1993. Contact: Available from National Association for Continence (NAFC) (formerly Help for Incontinent People, or HIP). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Summary: This brief article explores some common myths about urinary incontinence and provides readers with the facts. Topics covered include incontinence as a normal part of aging; incontinence in women as a result of childbirth; incontinence after prostate surgery; diagnostic tests used to determine incontinence; and treatment methods.

•

Urinary Incontinence and Sexuality Source: Quality Care. 16(3): 5. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This brief newsletter article reviews the problem of urinary incontinence and its impact on the patient's sexuality. The impact of incontinence may upset an established love life or create particular difficulties with a new relationship. Intimacy is about being close, and incontinence or the fear of leakage might be an obstacle, both mentally and physically. Problems may be greatest for those who have known continence but have lost it as a result of a difficult childbirth or surgery. This surgery can include hysterectomy or prolapse surgeries for women and prostatectomy for men. Loss of orgasm can also occur after surgery. There is often embarrassment, anger, and frustration with these adverse outcomes. Some causes for leakage include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. The author notes that incontinence episodes with sex can sometimes be cured, often improved, but always managed by optimal care. The author briefly summarizes the

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principles of successful management: make sure the bladder and bowel are empty before sexual activity, use warmed lubricating gel, avoid a position that may provoke leakage, and share concerns with the sexual partner. The author encourages readers to work with their health care providers to manage urinary incontinence problems. •

Nocturia: When Nature Calls at Night Source: Harvard Health Letter. 24(10): 6. August 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Summary: This health newsletter article describes nocturia, the condition of frequent urination at night. Nocturia is often more of a bother than a major burden, but readers are cautioned that it can be a sign of early kidney, bladder, or prostate disease. Nocturia can also be a byproduct of heart failure and other conditions that cause edema (retention of fluid). Physicians usually treat nocturia by addressing the conditions that cause it. More men in their 40s and 50s are bothered by nocturia than women the same age, but the numbers start to even out with age. For men, nocturia is often associated with prostate problems. In this situation, the bladder can't completely empty because benign prostatic hyperplasia (BPH), the noncancerous enlargement of the prostate gland, compresses the urethra and slows or impedes the flow of urine. For women, childbirth and lower estrogen levels cause the muscles of the pelvic floor to weaken. Weaker pelvic floor muscles can mean less control and more interruptions at night to urinate. The article concludes by encouraging readers to seek treatment for nocturia, particularly that which interferes with adequate sleep, as there are a variety of approaches to the problem. 1 figure.

•

Pelvic Muscle Rehabilitation Source: Quality Care. 16(3): 1-2. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article reviews the use of pelvic floor muscle exercises (Kegel exercises) to prevent or treat urinary incontinence. The author notes that exercising the muscles of the pelvic floor on a regular basis should be as much a part of a woman's preventive health care routine as an annual Pap smear and monthly breast self examination. Pelvic muscles are frequently damaged during childbirth and sometimes by surgery in the pelvic area (hysterectomy or prolapse surgeries for women and prostatectomy for men). The author describes the purpose of pelvic muscle rehabilitation and then details how the exercises are done. The author notes that some people may only need written directions to undertake these exercises, but some people may need help from a health care professional to locate and exercise the pelvic muscles. Biofeedback, electrical stimulation, and vaginal weights are the most common methods used to help individuals locate and begin to use their pelvic muscles. The author concludes that, whichever method is prescribed, successful pelvic muscle rehabilitation depends on a consistent effort by the individual. 1 figure.

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Incontinence: Ways to Help You Stay Dry Source: Mayo Clinic Health Letter. 16(1): 1-3. January 1998.

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Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This patient education article from the Mayo Clinic newsletter reviews self care strategies for people with urinary incontinence (UI). The author emphasizes that most UI can be treated, with resulting cure or improvement. The author first outlines the urinary system and how the urinary sphincter and urethra work. The author then defines four types of UI: stress, urge, overflow, and mixed. A number of factors can lead to UI, including excess weight, frequent constipation, a chronic cough, or childbirth (all of which can stress and weaken the pelvic floor muscles). Other causes include urinary related infections, overactive bladder muscles, a malfunction of the urinary sphincter, and high fluid intake. In addition, diseases such as diabetes, stroke, and Parkinson's disease can damage the nerves that control the bladder. In men, UI can also stem from noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), prostate cancer, and prostate surgery. The author describes some of the treatments available, including behavior modification (bladder retraining), avoiding alcohol and caffeine, pelvic floor exercises, medications, bulking agents (injected into the lining of the urethra), urethral plug, urethral patch, pessary, and surgery. The author concludes that most people treated for incontinence can see a significant reduction in urine leakage. One sidebar details how to perform Kegel exercises to strengthen pelvic floor muscles. 1 figure. •

Effects of Genital Prolapse on Micturition Source: Issues in Incontinence. 3(4): 2-3, 7-10. Spring 1998. Contact: Available from Saxe Healthcare Communications. P.O. Box 1282, Burlington, VT 05402. Fax (802) 655-3127. Summary: Women with genital prolapse can present with a variety of lower urinary tract symptoms (LUTS) including urinary frequency, urgency, hesitancy, incomplete emptying, and incontinence. These symptoms might or might not be related to the prolapse, but with careful clinical and urodynamic investigation it is usually possible to determine the underlying pathophysiology with a high degree of accuracy. This article describes an approach to the evaluation and management of women with all forms of genital prolapse. Most commonly, genital prolapse is a result of childbirth, the upright position, and trophic changes of the vaginal supporting structure, or trauma or previous pelvic surgery. Genital prolapse can affect the urethra in three ways. The prolapse itself can mechanically obstruct the urethra, it can pull open the posterior wall of the urethra and thereby cause sphincteric incontinence, or it can dissipate the effects of abdominal pressure on the urethra. The functional consequences of prolapse are that it might impede Valsalva voiding, mask sphincteric incontinence, or mask incontinence due to detrusor overactivity. Prolapse might also be associated, by an unknown mechanism, with detrusor instability. Directed patient history, physical examination, diary, pad test, and cystometric testing are key components of a comprehensive evaluation. The authors conclude that videourodynamics with pessary reduction of the prolapse creates the most reasonable facsimile of a surgical correction and is effective in unmasking occult stress incontinence in women with severe prolapse who are not incontinent in daily life. 3 figures. 18 references.

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Academic Periodicals covering Childbirth Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to childbirth. In addition to these sources, you can search for articles covering childbirth that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute13: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

13

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:15 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

14

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 15 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “childbirth” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “childbirth” (or synonyms) into the “For these words:” box. The following is a sample result: •

The Silent War Contact: American AIDS Alert Association, 2881 SW 69th Court, Miami, FL, 33155, (305) 262-AIDS. Summary: The author of this paper believes that Americans must take the matter of AIDS prevention into their own hands, and take steps beyond the precautions being issued by the U.S. Government. The author condemns the U.S. Government and its institutions for what he terms "secrecy" and "passive government propaganda." He discusses the rising rate of infection and warns readers to arm themselves with as much information as possible to withstand, what he calls, the worst plague in the history of mankind. The author includes data on all the known and accepted risk factors, including sexual transmission, blood transfusion, childbirth, dental instruments, and needle sharing, and highlights other possible modes of transmission, including ear piercing instruments and saliva. He urges readers to be sexually abstinent prior to marriage.

•

Sourcebook of health insurance data Source: Washington, DC: Health Insurance Association of America. 1994-. annual. Contact: Available from Jim Shimkus, Professional Book Distributors, P.O. Box 6996, Alpharetta, GA 30239. Telephone: (800) 848-0773. $15.00 plus $3.60 handling. Summary: This annual compilation of health insurance data focuses on managed care programs, medical care costs, hospital utilization, and morbidity and mortality statistics. The sources for this book are the Health Insurance Association of America's annual survey along with reports from insurance companies, government agencies, hospital and medical associations, and private research companies. Tables depict interrelationships between medical costs and the Consumer Price Index, physician fees, and the Gross National Product. The report includes figures on the Social Security Disability Insurance Program, workplace injuries, childbirth costs, transplant procedures, and AIDS-related expenditures. Hospital utilization statistics such as discharge rates, length of stay, and uncompensated care expenditures include data for community hospitals. A historical overview of the health insurance industry and health

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maintenance organizations is included along with a chronological listing of industryrelated facts. •

Adolescent sex, contraception, and childbearing: A review of recent research Source: Washington, DC: Child Trends. 1995. 215 pp. Contact: Available from Child Trends, 4301 Connecticut Avenue, N.W., Suite 100, Washington, DC 20008. Telephone: (202) 362-5580 / fax: (202) 362-5533 / e-mail: [email protected] / Web site: http://www.childtrends.org. $14.00 includes shipping and handling. Summary: This report contains a review of recent scientific research on the behavior that results in births to adolescents. It includes antecedents to sexual intercourse, the use of contraception at first intercourse, behaviors related to pregnancy and pregnancy resolution, and childbirth. It includes an introduction to the study, trend analysis, the research reviews, and summaries for each topic. The report discusses research priorities, bibliographical references are provided; and statistical tables and figures are also included. A related publication, 'Adolescent Pregnancy Prevention Programs: Interventions and Evaluations,' considers research on intervention and prevention programs. An overview of both research reviews appears in 'Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy, and Parenthood.'.

•

Maternal and newborn length of stay Source: [Chicago, IL: Section for Maternal and Child Health, American Hospital Association]. 1995. 26 pp. Contact: Available from American Hospital Association, Section for Maternal and Child Health, One North Franklin, Chicago, IL 60606. Telephone: (312) 422-2000 / fax: (312) 422-4590 / Web site: http://www.aha.org. Out of print. Summary: This report contains information health professionals need to influence the development of policies affecting the health of mothers and newborn infants as health systems, insurers, and hospitals tend to reduce the length of stay following childbirth. It includes background information, notes current trends and issues; considers research on the practice of early discharge; and reviews proposed legislative and regulatory responses. The report contains a statement of principle from the American Hospital Association and a table summarizing the position statements of various national health organizations. Descriptions of programs developed by five hospitals responding to the early discharge problem are provided.

•

Disconnected dads: Strategies for promoting responsible fatherhood Source: Washington, DC: Family Impact Seminar. 1995. 70 pp. Contact: Available from Family Impact Seminar , 5111 Battery Lane, Bethesda, MD 20814. Telephone: (301) 656-9666 / e-mail: [email protected]. $15.00. Summary: This report examines the problems caused by the increase in the number of men who do not adequately meet the responsibilities inherent in their having children. The report considers the policy implications of this problem, examines efforts to correct the problem as part of the growth of the fatherhood movement, and considers innovative programs to assess state and federal policies that encourage responsible fatherhood. It examines three types of programs: those preventing childbirth during adolescence or outside of wedlock, those encouraging fathers to provide economic

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support for their children, and those promoting stronger family relationships. The report includes lists of resources and references, highlights of the seminar for which the report was prepared, and a summary of the strategies discussed.

The NLM Gateway16 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “childbirth” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 7445 1796 343 129 6 9719

HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.20 Simply search by “childbirth” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

16

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

17

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 18 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 19 20

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists21 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.22 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.23 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

21 Adapted 22

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 23 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on childbirth can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to childbirth. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to childbirth. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “childbirth”:

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•

Other guides High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Labor and Delivery http://www.nlm.nih.gov/medlineplus/laboranddelivery.html

Within the health topic page dedicated to childbirth, the following was listed: •

General/Overviews Birth and the First Moments After Source: American Academy of Pediatrics http://medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ7BBZHQDC&sub _cat=4 Healthy Pregnancy: Childbirth Source: National Women's Health Information Center http://www.4woman.gov/Pregnancy/birth.htm JAMA Patient Page: Birth Labor Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ92BFN66D& sub_cat=2001

•

Diagnosis/Symptoms How to Tell When Labor Begins Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ3K3L417C& sub_cat=4 Signs of Labor: Know What to Expect Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PR00083

•

Treatment Anesthesia Options for Labor and Delivery: What Every Expectant Mother Should Know Source: American Association of Nurse Anesthetists http://www.aana.com/patients/options.asp Epidurals: Reducing Pain during Labor and Delivery Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PR00065 Episiotomy: Is It Always Necessary? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HO00064 Labor Induction Source: American Academy of Family Physicians http://familydoctor.org/handouts/450.html

Patient Resources

•

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Specific Conditions/Aspects Birth Plans Source: Nemours Foundation http://kidshealth.org/parent/pregnancy_newborn/pregnancy/birth_plans.html Birthing Centers and Hospital Maternity Services Source: Nemours Foundation http://kidshealth.org/parent/system/doctor/birth_centers_hospitals.html Birthing Classes Source: Nemours Foundation http://kidshealth.org/parent/pregnancy_newborn/pregnancy/birth_class.html Breech Babies: What Can I Do if My Baby is Breech? Source: American Academy of Family Physicians http://familydoctor.org/handouts/310.html Dealing with Pain during Childbirth Source: Nemours Foundation http://kidshealth.org/parent/pregnancy_newborn/pregnancy/childbirth_pain.ht ml Fetal Heart Rate Monitoring Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ21KVF27C& sub_cat=4 Giving Birth “In Place”: Emergency Preparedness for Childbirth Source: American College of Nurse-Midwives http://www.midwife.org/focus/inplace.cfm Meconium Aspiration Source: Nemours Foundation http://kidshealth.org/parent/medical/lungs/meconium.html Pregnancy: What to Expect When Your Due Date Has Passed Source: American Academy of Family Physicians http://familydoctor.org/handouts/143.html Premature Birth Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00137 Routine Vaginal Delivery Source: American Academy of Pediatrics http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZD2SFHQDC &sub_cat=2001 Vaginal Birth after Cesarean Delivery Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ10PRJ97C&s ub_cat=4 What to Take to the Hospital Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/240_1039.asp

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•

Law and Polic Newborns' and Mothers' Health Protection Act Source: Centers for Medicare & Medicaid Services http://cms.hhs.gov/hipaa/hipaa1/content/nmhpa.asp

•

Organizations American College of Nurse-Midwives http://www.midwife.org/ American College of Obstetricians and Gynecologists http://www.acog.org/ National Women's Health Information Center Source: Dept. of Health and Human Services http://www.4woman.gov/

•

Research Home Uterine Monitors Not Useful for Predicting Premature Birth Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/jan2002/nichda23.htm Increase in Induction: Unnecessary or Saving More Babies? Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZGRKYBBW C&sub_cat=2001 Magnitude of Maternal Morbidity During Labor and Delivery, United States, 1993-1997 Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/fs030327.htm Water Birth May Be Dangerous to Infants Source: Nemours Foundation http://kidshealth.org/research/water_birth.html

•

Statistics FASTATS: Births--Method of Delivery Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/delivery.htm FASTATS: Obstetrical Procedures Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/obgyn.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on childbirth. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

AIDS & Childbirth Contact: AIDS Education and Research Trust, PO Box 91, Horsham. Summary: This brochure discusses issues related to Acquired immunodeficiency syndrome (AIDS), caused by Human immunodeficiency virus (HIV), and pregnancy and childbirth. General AIDS information is presented. The HIV-antibody test is discussed in terms of its advantages and disadvantages, both before and during pregnancy. Pregnancy terminations, childbirth procedures, and breastfeeding are also briefly mentioned.

•

Pregnancy and childbirth Source: Washington, DC: Joint Center for Political and Economic Studies. 2002. 4 pp. Contact: Available from Joint Center for Political and Economic Studies, 1090 Vermont Avenue, N.W., Suite 1100, Washington, DC 20005-4961. Telephone: (202) 789-3500 / fax: (202) 789-6390 / e-mail: [email protected] / Web site: http://www.jointcenter.org. Available at no charge; also available from the Web site at no charge. Summary: This fact sheet discusses research into the attitudes of African American adolescent females about pregnancy and childbirth, including trends and comparisons with other racial groups. Tables provide statistical data on birth rates by age of mother, ethnicity, females reporting having ever been pregnant, and males reporting getting someone pregnant. References are included. This fact sheet is a summary from the full report: The Reproductive Health of African American Adolescents: What We Know and What We Don't Know.

•

Continence Facts: Pregnancy, Childbirth and Bladder Control Source: Westmount, Quebec: Canadian Continence Foundation. 1997. 2 p. Contact: Canadian Continence Foundation. B.P/P.O. 30, Succ. Victoria Branch, Westmount, Quebec, Canada, H3Z 2V4. (514) 488-8379. Email: [email protected]. Website: www.continence-fdn.ca. PRICE: $2.00; bulk copies available. Summary: Urinary incontinence (UI) is the loss of bladder control. This fact sheet outlines the interplay between pregnancy, childbirth, and bladder control. Topics include how pregnancy and childbirth can affect bladder control, how to know when to consult a health care provider, preventing bladder problems by using Kegel (pelvic floor muscle) exercise during and after pregnancy, and the types of physicians who may be part of a patient's health care team before, during, and after pregnancy. Readers are reminded that temporary bladder control problems are common during pregnancy, and exercising pelvic floor muscles can help prevent or treat bladder control problems. Readers are encouraged to work closely with their health care providers to find solutions for their UI problems. The fact sheet includes the contact information for the Canadian Continence Foundation (www.continence-fdn.ca). 4 figures.

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Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Emotional Effects of Induced Abortion Summary: This article discusses emotional and psychological disturbances following induced abortion and compares these feelings with the childbirth experience. Source: Planned Parenthood Federation of America http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6038

•

Locate a Lamaze Certified Childbirth Educator Summary: Search this web site to locate a Lamaze Certified Childbirth Educator in your area. Source: Lamaze International http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4899

•

Pregnancy, Childbirth, and Bladder Control Source: National Kidney and Urologic Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7762 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to childbirth. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

Patient Resources

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to childbirth. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with childbirth. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about childbirth. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “childbirth” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “childbirth”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For

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publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “childbirth” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “childbirth” (or a synonym) into the search box, and click “Submit Query.”

169

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.24

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

24

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)25: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

25

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

175

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on childbirth: •

Basic Guidelines for Childbirth Childbirth - emergency delivery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000009.htm

•

Signs & Symptoms for Childbirth Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm

•

Background Topics for Childbirth Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Hypothermia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000038.htm

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Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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CHILDBIRTH DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]

Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH]

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Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (-

Dictionary 179

COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antiepileptic: An agent that combats epilepsy. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a

180 Childbirth

specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atony: Lack of normal tone or strength. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta-Endorphin: A peptide consisting of amino acid sequence 61-91 of the endogenous pituitary hormone beta-lipotropin. The first four amino acids show a common tetrapeptide sequence with methionine- and leucine enkephalin. The compound shows opiate-like activity. Injection of beta-endorphin induces a profound analgesia of the whole body for several hours. This action is reversed after administration of naloxone. [NIH]

Dictionary 181

Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Birth Rate: The number of births in a given population per year or other unit of time. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood Proteins: Proteins that are present in blood serum, including serum albumin, blood coagulation factors, and many other types of proteins. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH]

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Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bulking Agents: Laxatives that make bowel movements soft and easy to pass. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Canonical: A particular nucleotide sequence in which each position represents the base more often found when many actual sequences of a given class of genetic elements are compared. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH]

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Cardiac arrest: A sudden stop of heart function. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiotoxic: Having a poisonous or deleterious effect upon the heart. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH]

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Child Care: Care of children in the home or institution. [NIH] Child Welfare: Organized efforts by communities or organizations to improve the health and well-being of the child. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Competitive Behavior: The direct struggle between individuals for environmental necessities or for a common goal. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols

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C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH]

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Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cross-Cultural Comparison: Comparison of various psychological, sociological, or cultural factors in order to assess the similarities or diversities occurring in two or more different cultures or societies. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical

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compounds that contain a ring of atoms in the nucleus. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery Rooms: Hospital units equipped for childbirth. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Instruments: Hand-held tools or implements especially used by dental professionals for the performance of clinical tasks. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermatitis: Any inflammation of the skin. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the

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alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discriminant Analysis: A statistical analytic technique used with discrete dependent variables, concerned with separating sets of observed values and allocating new values. It is sometimes used instead of regression analysis. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH]

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Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dystocia: Difficult childbirth or labor. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH]

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Endosonography: Ultrasonography of internal organs using an ultrasound transducer sometimes mounted on a fiberoptic endoscope. In endosonography the transducer converts electronic signals into acoustic pulses or continuous waves and acts also as a receiver to detect reflected pulses from within the organ. An audiovisual-electronic interface converts the detected or processed echo signals, which pass through the electronics of the instrument, into a form that the technologist can evaluate. The procedure should not be confused with endoscopy which employs a special instrument called an endoscope. The "endo-" of endosonography refers to the examination of tissue within hollow organs, with reference to the usual ultrasonography procedure which is performed externally or transcutaneously. [NIH]

Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Environmental tobacco smoke: ETS. Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers (second-hand smoke). Inhaling ETS is called involuntary or passive smoking. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH]

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Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Facial: Of or pertaining to the face. [EU] Facial Injuries: General or unspecified injuries to the soft tissue or bony portions of the face. [NIH]

Family Characteristics: Size and composition of the family. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Relations: Behavioral, psychological, and social relations among various members of the nuclear family and the extended family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU]

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Fetal Distress: Adverse or threatening condition of the fetus identified by fetal bradycardia or tachycardia and passage of meconium in vertex presentation. [NIH] Fetal Heart: The heart of the fetus of any viviparous animal. It refers to the heart in the postembryonic period and is differentiated from the embryonic heart (heart/embryology) only on the basis of time. [NIH] Fetal Monitoring: Physiologic or biochemical monitoring of the fetus. It is usually done during labor and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fistulas: An abnormal passage from one hollow structure of the body to another, or from a hollow structure to the surface, formed by an abscess, disease process, incomplete closure of a wound, or by a congenital anomaly. [NIH] Flatus: Gas passed through the rectum. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Food Habits: Acquired or learned food preferences. [NIH] Food Preferences: The selection of one food over another. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH]

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Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Goniotomy: A surgical procedure for congenital glaucoma in which a sweeping incision is made in the neshwork at the filtration angle by means of a knife-needle inserted through the opposite limbus and carried across the anterior chamber parallel to the iris. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their

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health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhaging: A copious discharge of blood from the blood vessels. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH]

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Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoralism: An ancient Greek medical theory that health and illness result from a balance or imbalance of body fluids or "humors". The humors are blood, phlegm, yellow bile, and black bile. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH]

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Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH]

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Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among

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individuals. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischial: A pointed projection on the posterior margin of the ischium. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lacerations: Torn, ragged, mangled wounds. [NIH] Lactation: The period of the secretion of milk. [EU] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH]

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Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

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Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as health maintenance organizations and preferred provider organizations. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Meconium: The thick green-to-black mucilaginous material found in the intestines of a fullterm fetus. It consists of secretions of the intestinal glands, bile pigments, fatty acids, amniotic fluid, and intrauterine debris. It constitutes the first stools passed by a newborn. [NIH]

Mediastinal Emphysema: Presence of air in the mediastinal tissues due to leakage of air from the tracheobronchial tree, usually as a result of trauma. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH]

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Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Midwifery: The practice of assisting women in childbirth. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucilaginous: Pertaining to or secreting mucus. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Mutilation: Injuries to the body. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU]

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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Natural Childbirth: Psychophysical relaxation techniques that are used to facilitate childbirth. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle Sharing: Usage of a single needle among two or more people for injecting drugs. Needle sharing is a high-risk behavior for contracting infectious disease. [NIH] Nelfinavir: A potent HIV protease inhibitor. It is used in combination with other antiviral drugs in the treatment of HIV in both adults and children. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotrophins: A nerve growth factor. [NIH]

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Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nocturia: Excessive urination at night. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Family: A family composed of spouses and their children. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Nurse Midwives: Professional nurses who have received postgraduate training in midwifery. [NIH] Obstetrical Forceps: Surgical instrument designed to extract the newborn by the head from the maternal passages without injury to it or the mother. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occupational Health: The promotion and maintenance of physical and mental health in the work environment. [NIH] Octanes: Eight-carbon saturated hydrocarbon group of the methane series. Include isomers and derivatives. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Only Child: Child who has no siblings. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species

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or between individuals of different species. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Particle: A tiny mass of material. [EU] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch

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over the eye. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Pessary: 1. An instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. A medicated vaginal suppository. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotypes: An organism as observed, i. e. as judged by its visually perceptible characters

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resulting from the interaction of its genotype with the environment. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish

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policies pertaining to plans, programs or procedures. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postpartum Hemorrhage: The presence of abnormal uterine bleeding immediately after labor or childbirth. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preferred Provider Organizations: Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH]

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Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to

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recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychometric testing: Psychological and mental testing and quantitative analysis of an individual's psychological traits or attitudes or mental processes. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of

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pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

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Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Residential Mobility: Frequent change of residence, either in the same city or town, or between cities, states or communities. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the

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cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ritonavir: An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV. [NIH] Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Role-play: In this method, a conflict is artificially constructed, and the trainee is given a strategic position in it. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH]

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Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for

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oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH]

Dictionary 215

Stromal: Large, veil-like cell in the bone marrow. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and atomic weight 98.91. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]

216 Childbirth

Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trabecular Meshwork: A porelike structure surrounding the entire circumference of the anterior chamber through which aqueous humor circulates to the canal of Schlemm. [NIH] Trabeculectomy: Any surgical procedure for treatment of glaucoma by means of puncture or reshaping of the trabecular meshwork. It includes goniotomy, trabeculotomy, and laser perforation. [NIH] Traction: The act of pulling. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trophic: Of or pertaining to nutrition. [EU] Truncus Arteriosus: The embryonic arterial trunk arising from the heart which then divides into the aorta and the main pulmonary artery. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50

Dictionary 217

to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Arteries: Either of a pair of arteries originating from the internal iliac artery and passing through the umbilical cord to carry blood from the fetus to the placenta. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Universal Precautions: Prudent standard preventive measures to be taken by professional and other health personnel in contact with persons afflicted with a communicable disease, to avoid contracting the disease by contagion or infection. Precautions are especially applicable in the diagnosis and care of AIDS patients. [NIH] Uranium: A radioactive element of the actinide series of metals. It has an atomic symbol U, atomic number 92, and atomic weight 238.03. U-235 is used as the fissionable fuel in nuclear weapons and as fuel in nuclear power reactors. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvea: The middle coat of the eyeball, consisting of the choroid in the back of the eye and the ciliary body and iris in the front of the eye. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH]

218 Childbirth

Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Viremia: The presence of viruses in the blood. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly

Dictionary 219

used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zygote: The fertilized ovum. [NIH]

221

INDEX A Abdomen, 102, 107, 109, 116, 117, 177, 182, 196, 197, 199, 214, 215 Abdominal, 11, 103, 116, 149, 177, 182, 183, 187, 204, 214 Abscess, 177, 192 Acceptor, 13, 177, 204 ACE, 51, 75, 177 Acetaminophen, 24, 43, 63, 177 Acoustic, 177, 190 Acrylonitrile, 177, 212 Actin, 177, 201, 202 Adaptation, 89, 177, 197 Adenosine, 177, 182, 206 Adjustment, 19, 117, 177 Adolescence, 10, 29, 157, 177 Adrenergic, 6, 177, 188, 190, 215 Adsorption, 13, 177 Adsorptive, 177, 178 Adverse Effect, 178, 213 Affinity, 178, 213 Age Groups, 120, 178 Age of Onset, 23, 178, 216 Aged, 80 and Over, 178 Agonist, 178, 188, 202 Alertness, 178, 182 Algorithms, 178, 181 Alimentary, 178, 188, 205 Alkaline, 178, 182 Alkaloid, 178, 201, 204 Alpha Particles, 178, 210 Alternative medicine, 145, 178 Alveoli, 178, 218 Amino Acid Sequence, 178, 179, 180 Amino Acids, 178, 180, 205, 207, 209, 212, 216 Amnion, 179 Amniotic Fluid, 109, 179, 193, 200 Anal, 5, 12, 14, 24, 27, 31, 43, 68, 84, 135, 179, 188, 190, 191, 199 Analgesic, 14, 62, 103, 177, 179, 184, 201, 203 Anaphylactic, 98, 179 Anaphylaxis, 179 Anatomical, 137, 179, 196 Anemia, 22, 46, 179, 181 Anemic, 22, 179

Anesthesia, 13, 15, 23, 27, 46, 47, 53, 62, 75, 103, 105, 162, 179 Anesthetics, 13, 141, 179, 190 Animal model, 7, 179 Annealing, 179, 207 Anorectal, 5, 179 Antagonism, 179, 182 Antibacterial, 179, 188 Antibodies, 15, 140, 179, 196, 206 Antibody, 140, 165, 178, 179, 180, 184, 190, 195, 196, 197 Antiepileptic, 10, 13, 179 Antigen, 178, 179, 185, 195, 196, 197 Anti-infective, 180, 184 Anti-inflammatory, 98, 177, 180 Antipyretic, 177, 180 Antiviral, 180, 202 Anus, 137, 179, 180, 182, 205, 210 Anxiety, 28, 34, 84, 86, 90, 145, 180 Aorta, 180, 183, 216, 218 Aqueous, 180, 198, 216 Arterial, 100, 180, 195, 209, 216 Arteries, 129, 180, 181, 186, 201, 217 Asphyxia, 99, 180 Atmospheric Pressure, 107, 180 Atony, 105, 180 Attenuated, 13, 180 Auditory, 180, 191 Axonal, 15, 180 Axons, 14, 180 B Bacteria, 177, 179, 180, 191, 192, 201, 217 Base, 109, 113, 114, 180, 182, 187, 198 Benign, 148, 149, 180, 193 Benign prostatic hyperplasia, 148, 149, 180 Beta-Endorphin, 74, 180 Bilateral, 4, 181 Bile, 181, 192, 195, 198, 199, 200 Bile Pigments, 181, 198, 200 Biochemical, 181, 192 Biological Transport, 181, 188 Biotechnology, 24, 25, 133, 145, 155, 181 Birth Rate, 165, 181 Bladder, 59, 99, 120, 135, 139, 147, 148, 149, 165, 166, 180, 181, 196, 208, 211, 214, 217 Blastocyst, 181, 185, 206 Blood Coagulation, 181, 182

222 Childbirth

Blood Coagulation Factors, 181 Blood Glucose, 181, 194 Blood pressure, 4, 98, 125, 181, 183, 195, 201, 214 Blood Proteins, 138, 181 Blood transfusion, 129, 156, 181, 194 Blood vessel, 177, 181, 183, 194, 205, 210, 213, 214, 215, 218 Blood Viscosity, 181, 194 Body Fluids, 107, 181, 189, 195, 214 Body Image, 16, 181 Body Mass Index, 6, 16, 181, 204 Bone Marrow, 182, 196, 200, 215 Bowel, 52, 134, 148, 179, 182, 186, 188, 197, 214 Bowel Movement, 134, 182, 186, 188, 214 Bradycardia, 182, 192 Branch, 112, 165, 173, 182, 209, 214, 215 Bulking Agents, 149, 182 Burns, 62, 98, 182 Burns, Electric, 182 C Caesarean section, 37, 38, 62, 71, 182 Caffeine, 149, 182 Calcium, 147, 182, 185, 204 Calcium Channels, 182, 204 Canonical, 21, 182 Carbon Dioxide, 182, 192, 206, 211 Carboxy, 98, 182 Carcinogenic, 182, 197 Cardiac, 13, 22, 99, 182, 183, 189, 190, 192, 202 Cardiac arrest, 13, 183 Cardiopulmonary, 183, 194 Cardiopulmonary Bypass, 183, 194 Cardiotoxic, 13, 183 Cardiovascular, 6, 182, 183 Cardiovascular disease, 6, 183 Carotene, 183, 211 Case report, 62, 183, 184 Cataract, 98, 183 Catecholamine, 183, 188 Catheters, 109, 183 Caudal, 183, 207 Causal, 22, 183, 190 Central Nervous System, 13, 182, 183, 191, 192, 193, 201 Cerebral, 22, 47, 110, 125, 183, 190, 204 Cerebral Palsy, 47, 183 Cerebrovascular, 183 Cerebrum, 183

Cervical, 54, 62, 106, 111, 116, 123, 124, 126, 183 Cervix, 103, 105, 106, 109, 111, 116, 122, 123, 124, 126, 175, 183, 211 Cesarean Section, 103, 123, 135, 183 Child Care, 89, 138, 184 Child Welfare, 7, 184 Chlorhexidine, 59, 184 Chronic, 4, 23, 98, 138, 149, 184, 188, 197, 198, 215 CIS, 184, 211 Clinical Medicine, 123, 184, 207 Clinical study, 184, 186 Clinical trial, 5, 93, 94, 155, 184, 186, 209, 210 Cloning, 181, 184 Codeine, 24, 43, 62, 63, 184, 203 Cofactor, 184, 208 Cohort Studies, 184, 190 Colitis, 184, 197 Collagen, 15, 134, 184, 208 Communicable disease, 184, 217 Competitive Behavior, 19, 184 Complement, 184, 185 Complementary and alternative medicine, 67, 68, 81, 185 Complementary medicine, 62, 68, 185 Compress, 103, 185 Computational Biology, 155, 185 Conception, 67, 185, 186, 192 Concomitant, 14, 15, 21, 185 Condoms, 138, 185 Cones, 185, 211 Confounding, 8, 36, 185 Connective Tissue, 182, 184, 185, 192, 199 Consciousness, 25, 179, 185, 188 Constipation, 53, 137, 149, 186 Consumption, 186, 187, 211 Continence, 15, 28, 33, 147, 148, 165, 186 Continuum, 34, 186 Contraception, 157, 186 Contraceptive, 37, 186, 205 Contractility, 7, 11, 186 Contraindications, ii, 105, 186 Control group, 11, 20, 186 Controlled clinical trial, 18, 186 Controlled study, 71, 186 Cornea, 186, 212, 217 Coronary, 183, 186, 201 Coronary heart disease, 183, 186 Coronary Thrombosis, 186, 201 Cortex, 186, 191

Index 223

Cortical, 186, 212 Cranial, 121, 186, 193 Cross-Cultural Comparison, 70, 186 Cross-Sectional Studies, 186, 190 Curative, 186, 215 Cyclic, 182, 186 Cytotoxic, 9, 187 D Data Collection, 7, 12, 19, 187, 192 Databases, Bibliographic, 155, 187 De novo, 53, 187 Decidua, 187, 206 Decision Making, 123, 187 Defecation, 138, 187 Degenerative, 187, 194 Delivery Rooms, 110, 187 Delusions, 187, 209 Denaturation, 187, 207 Density, 14, 181, 187, 203, 207 Dental Instruments, 156, 187 Deprivation, 15, 187 Dermatitis, 138, 187 Detoxification, 13, 138, 187 Developing Countries, 45, 187 Diabetes Mellitus, 187, 194, 197 Diagnostic Imaging, 187, 210 Diagnostic procedure, 97, 146, 187 Diaphragm, 103, 106, 123, 187 Dietary Fiber, 138, 187 Diffusion, 15, 86, 181, 188 Digestion, 178, 181, 182, 187, 188, 197, 199, 205, 214 Digestive system, 94, 188, 192 Dilatation, 106, 111, 122, 123, 124, 126, 188, 208, 218 Dilate, 123, 188 Dilation, 103, 114, 116, 188, 218 Direct, iii, 5, 20, 107, 116, 117, 119, 184, 188, 204, 207, 210 Discriminant Analysis, 21, 188 Disease Progression, 188, 218 Disinfection, 59, 188 Disparity, 17, 188 Dissociation, 110, 178, 188, 198 Dissociative Disorders, 188 Distal, 107, 125, 180, 188, 189, 209 Diuresis, 182, 188 Dopamine, 63, 188 Dorsal, 189, 207 Drug Interactions, 189 Drug Tolerance, 189, 215 Duct, 109, 115, 189, 212

Dyspareunia, 105, 189 Dystocia, 103, 189 E Edema, 148, 189 Efficacy, 20, 21, 22, 38, 53, 55, 62, 71, 84, 189 Elastin, 184, 189 Electrode, 111, 126, 189 Electrolyte, 189, 214 Electromyography, 5, 189 Electrons, 180, 189, 198, 204, 210 Embryo, 179, 181, 189, 217 Embryology, 189, 192 Empirical, 21, 59, 189 Endometrial, 189 Endometriosis, 131, 189 Endometrium, 187, 189 Endoscope, 189, 190 Endoscopy, 189, 190 Endosonography, 5, 190 Enkephalin, 180, 190 Environmental Health, 63, 154, 156, 190 Environmental tobacco smoke, 17, 190 Enzymatic, 182, 183, 185, 190, 207, 211 Enzyme, 14, 177, 190, 200, 205, 207, 208, 215, 218 Epidemic, 9, 16, 138, 190 Epidemiologic Studies, 23, 190 Epidemiological, 18, 190 Epidural, 8, 13, 23, 38, 62, 103, 105, 122, 144, 190 Epidural block, 13, 190 Epinephrine, 177, 188, 190, 203, 217 Episiotomy, 4, 5, 23, 42, 55, 62, 121, 135, 144, 162, 190 Epithelial, 38, 62, 71, 181, 187, 190, 194 Epitope, 9, 190 ERV, 7, 140, 158, 190, 191 Erythrocytes, 179, 182, 190, 194, 210 Esophagus, 188, 191, 214 Estrogen, 14, 38, 148, 191 Ether, 98, 191 Ethnic Groups, 20, 191 Eukaryotic Cells, 191, 196 Evacuation, 186, 191 Evoked Potentials, 22, 191 Exhaustion, 105, 179, 191 Exogenous, 177, 191, 216 Expiratory, 190, 191 Expiratory Reserve Volume, 190, 191 Extracellular, 185, 191, 214

224 Childbirth

Extraction, 4, 13, 98, 99, 108, 109, 110, 115, 121, 122, 183, 191 Extrapyramidal, 188, 191 F Facial, 103, 191 Facial Injuries, 103, 191 Family Characteristics, 191 Family Planning, 155, 191 Family Relations, 158, 191 Fat, 128, 182, 183, 186, 191, 204, 214 Fathers, 34, 40, 52, 59, 84, 134, 157, 191 Fatigue, 138, 191, 194 Fatty acids, 191, 200 Fecal Incontinence, 5, 14, 20, 21, 191, 196 Feces, 186, 191, 214 Fetal Distress, 100, 125, 192 Fetal Heart, 99, 100, 106, 107, 163, 192 Fetal Monitoring, 99, 192 Fistulas, 121, 192 Flatus, 191, 192 Focus Groups, 18, 192 Fold, 9, 131, 192 Food Habits, 16, 192 Food Preferences, 192 Forearm, 181, 192 Friction, 113, 192 Fructose, 15, 192 G Gallbladder, 177, 188, 192 Ganglia, 15, 192, 202 Gas, 182, 188, 190, 192, 195, 215, 218 Gas exchange, 192, 218 Gastric, 98, 192, 205 Gastric Juices, 192, 205 Gastric Mucosa, 192, 205 Gastrin, 192, 195 Gastroenterologist, 137, 192 Gastrointestinal, 5, 22, 190, 192 Gene, 3, 6, 7, 133, 181, 193 Gene Expression, 7, 193 Generator, 119, 193 Genetic testing, 193, 207 Genital, 8, 40, 74, 149, 193 Genotype, 6, 193, 206 Geriatric, 120, 193 Gestation, 14, 19, 193, 205, 206 Gestational, 10, 193 Gestational Age, 10, 193 Gland, 193, 199, 202, 204, 208, 212, 214 Glucose, 15, 110, 181, 187, 193, 194, 197 Glutamate, 15, 193 Glycolysis, 110, 193

Goniotomy, 193, 216 Governing Board, 193, 207 Government Agencies, 12, 156, 193, 207 Gravidity, 193, 204 Growth, 157, 177, 179, 187, 193, 202, 206, 216 Gynaecological, 119, 193 H Headache, 182, 193 Health Behavior, 16, 18, 193 Health Care Costs, 194, 200 Health Education, 138, 194 Health Policy, 11, 194 Health Promotion, 52, 137, 194 Health Services, 113, 194 Health Status, 12, 194 Heart attack, 183, 194 Heart failure, 148, 194 Heartbeat, 125, 194 Hemodilution, 22, 194 Hemoglobin, 22, 110, 179, 190, 194, 198 Hemoglobin C, 179, 194 Hemorrhage, 129, 193, 194, 214 Hemorrhaging, 98, 128, 129, 194 Hemorrhoids, 98, 137, 194 Hepatitis, 138, 194 Hepatocytes, 194 Heredity, 193, 195 Homogeneous, 186, 195 Homologous, 194, 195 Hormonal, 10, 14, 195 Hormone, 11, 20, 23, 74, 180, 190, 192, 195, 197, 204 Hormone Replacement Therapy, 11, 195 Host, 87, 195, 196, 218 Humoralism, 62, 195 Hybrid, 195 Hybridization, 15, 195 Hydrogen, 177, 180, 187, 195, 201, 203, 204, 205, 209 Hydroxylysine, 184, 195 Hydroxyproline, 184, 195 Hyperbilirubinemia, 195, 198 Hypertension, 183, 193, 195 Hypertrophy, 180, 195 Hypnotic, 35, 70, 195 Hypotension, 98, 195 Hypotensive, 98, 195 Hypothermia, 175, 194, 195 Hypoxia, 15, 110, 125, 179, 195 Hysterectomy, 20, 23, 129, 147, 148, 195 Hysterotomy, 183, 196

Index 225

I Id, 36, 64, 78, 162, 163, 166, 172, 174, 196 Immune response, 180, 196, 218 Immune Sera, 196 Immune system, 196, 217, 218 Immunity, 9, 196, 216 Immunization, 138, 196, 208 Immunodeficiency, 140, 165, 196 Immunodeficiency syndrome, 165, 196 Immunohistochemistry, 14, 196 Immunologic, 193, 196 Immunosuppressant, 5, 196 Impairment, 5, 22, 196, 200, 209 Implantation, 185, 196 Impotence, 196, 204 In situ, 14, 196 In Situ Hybridization, 14, 196 In vitro, 15, 181, 196, 207 In vivo, 15, 196 Incision, 182, 190, 193, 196, 198, 208, 210 Indicative, 132, 196, 218 Infancy, 39, 67, 196 Infant Mortality, 103, 197 Infant, Newborn, 178, 197 Infarction, 186, 197, 201 Infection, 4, 9, 42, 137, 140, 156, 177, 196, 197, 199, 200, 215, 217, 218 Inflammation, 180, 184, 187, 194, 197, 217 Inflammatory bowel disease, 98, 138, 197 Infusion, 107, 197, 216 Initiation, 32, 146, 197 Inlay, 197, 211 Innervation, 14, 48, 197 Inotropic, 188, 197 Insomnia, 105, 197 Institutionalization, 70, 197 Insulin, 197, 216 Intermittent, 117, 197 Intervertebral, 23, 197 Intestinal, 15, 98, 183, 197, 200 Intestine, 182, 197, 198 Intoxication, 197, 219 Intracellular, 15, 182, 197 Intraocular, 98, 197 Intraocular pressure, 98, 197 Intravascular, 13, 198 Intravenous, 140, 197, 198 Intrinsic, 14, 99, 178, 198 Invasive, 196, 198 Involuntary, 11, 103, 190, 191, 198, 202, 213, 214 Ionization, 198

Ionizing, 116, 178, 198 Ions, 180, 182, 188, 189, 195, 198 Ischial, 111, 198 J Jaundice, 138, 195, 198 Joint, 10, 23, 115, 165, 198, 215 K Kb, 154, 198 Kidney Disease, 94, 138, 146, 154, 166, 198 Kinetic, 198 L Lacerations, 8, 190, 198 Lactation, 10, 16, 105, 198, 204 Lag, 12, 198 Large Intestine, 188, 197, 198, 210, 213 Least-Squares Analysis, 198, 210 Length of Stay, 156, 157, 198 Lens, 183, 198 Lesion, 15, 198, 199 Leucine, 180, 198, 205 Library Services, 172, 199 Life cycle, 13, 199 Ligament, 199, 208 Ligation, 138, 199 Likelihood Functions, 199, 210 Linear Models, 199, 210 Linkages, 194, 199, 205 Lip, 113, 199 Liver, 138, 177, 181, 188, 191, 192, 194, 199 Localization, 196, 199 Localized, 197, 199, 206 Logistic Models, 199, 210 Longitudinal study, 60, 199 Loop, 106, 109, 199 Lubricants, 8, 199, 205 Lumen, 107, 199 Lymph, 183, 199, 200, 202 Lymph node, 183, 199, 200, 202 Lymphatic, 197, 199, 200, 215 Lymphoid, 179, 200 M Managed Care Programs, 156, 200 Manic, 200, 209 Manic-depressive psychosis, 200, 209 Manifest, 180, 200 Manometry, 5, 200 Meconium, 163, 192, 200 Mediastinal Emphysema, 54, 200 Mediate, 10, 15, 188, 200 Medical Records, 20, 23, 200 MEDLINE, 155, 200

226 Childbirth

Membrane, 55, 106, 179, 182, 185, 189, 191, 200, 206, 211 Memory, 29, 68, 106, 119, 125, 200 Meninges, 183, 200 Menopause, 11, 135, 200 Menstruation, 98, 187, 200 Mental Disorders, 95, 200, 208, 209 Mental Health, iv, 5, 7, 16, 50, 75, 95, 154, 158, 200, 203, 208, 209 Mental Health Services, iv, 5, 16, 158, 200 Mental Processes, 188, 200, 209 Metabolic disorder, 6, 200 Methionine, 180, 201 MI, 35, 70, 128, 176, 201 Microbe, 201, 216 Microcirculation, 194, 201 Micronutrients, 16, 201 Miscarriage, 112, 201 Mobility, 10, 56, 59, 102, 201 Modeling, 7, 10, 201 Modification, 149, 201, 210 Modulator, 15, 201 Molecular, 13, 14, 155, 159, 181, 185, 201, 212 Molecule, 180, 185, 188, 190, 201, 203, 204, 210 Monitor, 36, 99, 102, 106, 107, 110, 116, 117, 119, 123, 125, 128, 201, 203 Morphine, 184, 201, 203 Morphology, 11, 31, 183, 201 Motion Sickness, 201, 202 Mucilaginous, 200, 201 Mucins, 201, 212 Muscle Contraction, 116, 201 Musculature, 11, 14, 201 Mutilation, 40, 201 Mydriatic, 188, 201 Myocardium, 201, 202 Myosin, 201, 202 N Naloxone, 180, 202 Natural Childbirth, 42, 46, 57, 71, 72, 76, 88, 89, 91, 132, 133, 134, 202 Nausea, 138, 202 NCI, 1, 94, 153, 184, 202 Necrosis, 197, 201, 202 Needle Sharing, 156, 202 Nelfinavir, 93, 202 Neonatal, 4, 9, 15, 30, 34, 42, 52, 64, 68, 69, 70, 76, 103, 127, 197, 202 Nephrectomy, 4, 202 Nephropathy, 198, 202

Nerve, 5, 14, 23, 115, 177, 179, 180, 197, 202, 211, 212, 214, 216 Nerve Growth Factor, 14, 202 Nervous System, 22, 183, 202, 215 Neuronal, 14, 15, 182, 202 Neurons, 192, 202 Neurotoxin, 15, 202 Neurotrophins, 15, 202 Neutrons, 178, 203, 210 Nocturia, 148, 203 Norepinephrine, 177, 188, 203 Nuclear, 15, 72, 189, 191, 202, 203, 217 Nuclear Family, 191, 203 Nucleic acid, 195, 196, 203 Nucleic Acid Hybridization, 195, 203 Nulliparous, 4, 11, 53, 203 Nurse Midwives, 8, 203 O Obstetrical Forceps, 99, 118, 203 Occult, 149, 203 Occupational Health, 12, 13, 203 Octanes, 98, 203 Ocular, 98, 203 Only Child, 7, 203 Oophorectomy, 23, 203 Opacity, 183, 187, 203 Opium, 201, 203, 204 Opsin, 203, 211 Organ Transplantation, 15, 203 Orgasm, 147, 204 Outpatient, 200, 204 Ovaries, 203, 204, 211, 213 Overactive bladder, 147, 149, 204 Overdose, 13, 204 Overweight, 16, 64, 204 Ovulation, 128, 204 Ovum, 187, 193, 199, 204, 219 Oxidation, 177, 204 Oxygenation, 22, 110, 117, 204 Oxytocin, 23, 105, 204 P Palliative, 204, 215 Palpation, 23, 116, 204 Pancreas, 177, 188, 197, 204 Papaverine, 62, 203, 204 Parietal, 111, 204 Parietal Lobe, 204 Parity, 8, 39, 49, 122, 204 Particle, 13, 204 Parturition, 20, 23, 118, 119, 121, 203, 204 Patch, 149, 204 Pathophysiology, 149, 205

Index 227

Patient Education, 69, 149, 165, 170, 172, 176, 205 Penis, 185, 205, 211 Pepsin, 205 Pepsin A, 205 Peptic, 98, 205 Peptic Ulcer, 98, 205 Peptide, 9, 180, 205, 207, 208, 209 Perforation, 205, 216 Perfusion, 195, 205 Perianal, 138, 205 Perinatal, 8, 36, 45, 48, 56, 60, 89, 197, 205 Perineal, 4, 8, 23, 24, 33, 42, 43, 48, 50, 51, 55, 56, 63, 64, 74, 75, 104, 117, 118, 141, 205 Perineum, 8, 105, 144, 205 Pessary, 149, 205 Petroleum, 138, 205 PH, 57, 110, 148, 205 Pharmacodynamic, 9, 205 Pharmacokinetic, 9, 205 Pharmacologic, 179, 205, 216 Phenotypes, 4, 205 Phospholipids, 191, 206 Phosphorus, 147, 182, 206 Physical Examination, 124, 149, 193, 206 Physical Fitness, 135, 206 Physiologic, 21, 23, 128, 178, 187, 192, 200, 201, 206, 210 Physiology, 8, 177, 206 Pigments, 181, 183, 206, 211 Pilot study, 19, 58, 60, 76, 206 Placenta, 103, 105, 110, 111, 123, 126, 206, 209, 217 Plague, 156, 206 Plants, 178, 182, 193, 201, 203, 206, 216 Plaque, 184, 206 Plasma, 13, 14, 74, 98, 179, 194, 206, 213, 218 Plasma cells, 179, 206 Platinum, 199, 206 Poisoning, 197, 202, 206 Policy Making, 12, 193, 206 Polyethylene, 122, 207 Polymerase, 14, 207 Polymerase Chain Reaction, 14, 207 Polypeptide, 178, 184, 195, 205, 207 Port, 109, 207 Port-a-cath, 207 Posterior, 149, 179, 189, 190, 198, 204, 207, 212 Postnatal, 26, 28, 49, 50, 75, 84, 91, 207

Postoperative, 4, 207 Postoperative Complications, 4, 207 Postpartum Hemorrhage, 103, 207 Post-traumatic, 49, 207 Practice Guidelines, 158, 207 Precursor, 188, 190, 203, 207, 216, 217 Preferred Provider Organizations, 200, 207 Pregnancy Tests, 193, 207 Prenatal, 17, 18, 91, 99, 189, 208 Prenatal Care, 18, 208 Prevalence, 4, 6, 18, 20, 23, 49, 50, 208 Primary Prevention, 50, 75, 208 Probe, 15, 100, 110, 208 Progression, 109, 179, 208 Progressive, 189, 193, 202, 208 Projection, 114, 198, 203, 208 Prolapse, 19, 138, 147, 148, 149, 208 Proline, 184, 195, 208 Prophylaxis, 46, 208 Proportional, 100, 110, 208 Prospective study, 31, 37, 62, 199, 208 Prostate, 147, 148, 149, 180, 208, 211, 216 Prostate gland, 148, 149, 208 Prostatectomy, 147, 148, 208 Prostatic Hyperplasia, 208 Protease, 202, 208, 212 Protein S, 133, 181, 208, 212 Proteins, 3, 178, 179, 180, 181, 184, 195, 201, 205, 206, 209, 213, 216 Protocol, 69, 111, 112, 209 Protons, 178, 195, 198, 209, 210 Proximal, 125, 188, 209 Proxy, 27, 209 Psychiatry, 38, 58, 63, 209, 218 Psychic, 209, 212 Psychology, 17, 20, 49, 50, 63, 75, 76, 188, 209 Psychometric testing, 29, 209 Psychosis, 38, 63, 193, 209 Psychosomatic, 40, 53, 54, 58, 71, 133, 209 Public Health, 4, 24, 37, 140, 158, 209 Public Policy, 155, 209 Publishing, 5, 24, 44, 141, 209 Puerperium, 128, 203, 209 Pulmonary, 181, 186, 209, 216, 218 Pulmonary Artery, 181, 209, 216, 218 Pulse, 124, 125, 201, 209 Punctures, 23, 210 Pupil, 186, 188, 201, 210 Q Quality of Life, 12, 24, 210

228 Childbirth

R Radiation, 39, 198, 210, 219 Radioactive, 195, 196, 198, 203, 210, 215, 217 Radiography, 193, 210 Radiopharmaceutical, 193, 210 Randomized, 7, 8, 17, 18, 19, 24, 26, 37, 43, 63, 64, 71, 189, 210 Randomized clinical trial, 8, 64, 210 Reality Testing, 209, 210 Receptor, 6, 14, 15, 177, 180, 188, 191, 210 Rectal, 51, 104, 138, 210 Rectum, 48, 99, 179, 180, 182, 187, 188, 192, 196, 197, 198, 205, 208, 210 Recurrence, 22, 38, 63, 200, 210 Red blood cells, 22, 190, 210 Refer, 1, 184, 199, 203, 209, 210 Regimen, 189, 210 Regression Analysis, 6, 188, 210 Rehabilitative, 11, 211 Relapse, 17, 21, 211 Relaxant, 204, 211 Relaxation Techniques, 202, 211 Reliability, 52, 124, 211 Remission, 200, 210, 211 Reproductive system, 208, 211 Residential Mobility, 10, 211 Respiration, 182, 201, 211 Respiratory Physiology, 211, 218 Restoration, 127, 211, 212 Retina, 185, 198, 211, 212, 217 Retinal, 98, 188, 211 Retinol, 211 Retropubic, 208, 211 Retrospective, 20, 23, 58, 211 Ribose, 15, 177, 211 Ribosome, 211, 216 Risk factor, 5, 10, 18, 19, 21, 23, 138, 140, 156, 190, 199, 208, 212 Ritonavir, 93, 212 Rods, 211, 212 Role-play, 19, 212 Rubber, 123, 138, 177, 212 S Saline, 13, 123, 128, 212 Saliva, 156, 212 Salivary, 188, 212 Salivary glands, 188, 212 Sanitary, 134, 212 Schizoid, 212, 218 Schizophrenia, 212, 218 Schizotypal Personality Disorder, 212, 218

Sclera, 212, 217 Screening, 17, 184, 212 Secretion, 198, 201, 212, 213 Sedative, 184, 212 Seizures, 9, 13, 103, 212 Self Care, 149, 212 Semen, 208, 213 Sensor, 23, 101, 102, 111, 119, 126, 213 Septic, 98, 213 Sequencing, 207, 213 Serum, 9, 181, 184, 196, 213 Serum Albumin, 181, 213 Sex Characteristics, 177, 213 Sexual Partners, 140, 213 Shock, 98, 179, 213, 216 Side effect, 38, 178, 213, 216 Signs and Symptoms, 211, 213 Skeletal, 120, 213 Skeleton, 177, 198, 213 Skull, 110, 115, 213 Small intestine, 195, 197, 213 Smooth muscle, 7, 14, 182, 201, 204, 213 Sneezing, 11, 120, 213, 214 Social Environment, 210, 213 Social Support, 18, 44, 213 Sodium, 13, 213 Soft tissue, 109, 182, 191, 213, 214 Somatic, 177, 214 Specialist, 120, 167, 188, 214 Species, 190, 195, 203, 214, 216, 218, 219 Sphincter, 5, 14, 31, 43, 48, 149, 214 Spinal cord, 14, 62, 183, 190, 200, 202, 214 Stabilization, 146, 214 Staging, 20, 214 Steel, 110, 113, 118, 214 Stillbirth, 100, 214 Stimulant, 182, 214 Stimulus, 186, 189, 191, 197, 198, 214 Stomach, 177, 188, 191, 192, 195, 202, 205, 213, 214 Stool, 138, 196, 198, 214 Strand, 207, 214 Stress, 4, 10, 11, 12, 21, 23, 25, 34, 37, 49, 55, 56, 58, 60, 112, 120, 149, 183, 202, 212, 214 Stress incontinence, 56, 60, 120, 149, 214 Stress urinary, 4, 11, 120, 214 Stroke, 95, 98, 149, 154, 183, 214 Stromal, 189, 215 Styrene, 212, 215 Subacute, 197, 215 Subclinical, 197, 212, 215

Index 229

Subcutaneous, 22, 189, 215 Substrate, 15, 106, 215 Suction, 99, 103, 113, 122, 215 Supine, 101, 215 Supine Position, 101, 215 Surgical Instruments, 121, 215 Sympathomimetic, 188, 190, 203, 215 Symphysis, 34, 208, 215 Symptomatology, 20, 215 Synergistic, 6, 215 Systemic, 98, 103, 179, 180, 181, 190, 197, 215, 216 T Tachycardia, 192, 215 Technetium, 72, 215 Therapeutics, 68, 215 Thermal, 104, 188, 203, 207, 215 Thoracic, 187, 215 Thorax, 177, 215 Thrombosis, 209, 214, 215 Thymus, 196, 200, 215 Tolerance, 15, 28, 215 Topical, 184, 216 Toxic, iv, 13, 196, 215, 216 Toxicity, 13, 15, 189, 216 Toxicology, 156, 216 Toxins, 180, 182, 197, 216 Trabecular Meshwork, 216 Trabeculectomy, 98, 216 Traction, 103, 104, 113, 114, 118, 121, 216 Transfection, 181, 216 Transfer Factor, 196, 216 Transfusion, 22, 216 Translation, 12, 90, 216 Transmitter, 116, 188, 203, 216 Transplantation, 147, 196, 216 Transurethral, 208, 216 Transurethral Resection of Prostate, 208, 216 Trees, 212, 216 Trophic, 149, 216 Truncus Arteriosus, 62, 216 Tryptophan, 184, 216 Type 2 diabetes, 18, 216 Tyrosine, 188, 217 U Ultrasonography, 190, 193, 217 Umbilical Arteries, 217 Umbilical Cord, 125, 217 Uncompensated Care, 156, 217

Unconscious, 179, 196, 217 Universal Precautions, 138, 217 Uranium, 215, 217 Ureters, 217 Urethra, 120, 148, 149, 180, 205, 208, 216, 217 Urinary tract, 7, 149, 217 Urinate, 139, 148, 217 Urine, 4, 11, 134, 148, 149, 180, 181, 186, 188, 196, 214, 217 Urodynamic, 149, 217 Uterine Contraction, 103, 107, 109, 110, 111, 116, 123, 125, 126, 204, 217 Uvea, 217 Uveitis, 98, 217 V Vaccine, 9, 138, 209, 217 Vagina, 101, 105, 106, 121, 123, 124, 176, 183, 196, 200, 205, 211, 217 Valves, 109, 218 Vascular, 179, 197, 201, 206, 217, 218 Vasodilation, 204, 218 Vasodilator, 188, 204, 218 Vein, 198, 203, 217, 218 Venous, 194, 209, 218 Ventilation, 13, 218 Ventricle, 209, 210, 218 Ventricular, 14, 218 Vertebrae, 23, 197, 214, 218 Vertebral, 23, 218 Veterinary Medicine, 155, 218 Viral, 93, 218 Viral Load, 93, 218 Viremia, 9, 218 Virulence, 180, 216, 218 Virus, 138, 140, 165, 206, 218 Vitro, 218 Vivo, 15, 218 Volition, 198, 218 W Weight Gain, 3, 16, 18, 218 White blood cell, 179, 200, 206, 218 Withdrawal, 87, 109, 218 Womb, 47, 74, 107, 108, 117, 211, 217, 219 X Xenograft, 179, 219 X-ray, 203, 219 Z Zygote, 185, 219

230 Childbirth

Index 231

232 Childbirth