The second part of the study revealed that male offspring
of multiparous mice weighed as much as 40 percent more than the male offspring of primiparous mice, despite eating no more food.
The study also found significantly more inflammation in the livers
of multiparous animals.
In the second part, they examined male offspring
of the multiparous females.
Among women who had a primary cesarean delivery for failure to progress, 42.6 % of primiparous women and 33.5 %
of multiparous women never progressed beyond 5 cm of dilation before delivery (Table 3).
Not exact matches
: «1.1.1 Explain to both
multiparous and nulliparous women who are at low risk
of complications that giving birth is generally very safe for both the woman and her baby.
1.1.2 Explain to both
multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice
of setting wherever they choose to give birth: Advise low ‑ risk
multiparous women that planning to give birth at home or in a midwifery ‑ led unit (freestanding or alongside) is particularly suitable for them because the rate
of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.
Our results support a policy
of offering healthy nulliparous and
multiparous women with low risk pregnancies a choice
of birth setting.
For
multiparous women there was no evidence
of a difference in the primary outcome by planned place
of birth.
However, higher rates
of a composite outcome
of perinatal morbidity and mortality were seen for nulliparous women having homebirths (adjusted odds ratio 1.75; 95 % CI, 1.07 — 2.86), with no differences for
multiparous women.
An additional analysis separating
multiparous and primiparous women was undertaken as well as an analysis
of stillbirth and early neonatal death.
The odds
of cesarean section among women planning out -
of - hospital birth were lower among
multiparous women than among nulliparous women and among women with 12 years
of education or less than among women with more than 12 years
of education (Figure 1).
We used multivariable logistic - regression models to adjust for potential confounders, including maternal race or ethnic group (non-Hispanic white vs. other), parity (nulliparous vs.
multiparous), insurance status (public or none vs. other), extent
of prenatal care (≥ 5 visits vs. < 5 visits), advanced maternal age (≥ 35 years vs. < 35 years), maternal education (> 12 years vs. ≤ 12 years), history or no history
of cesarean delivery, and a composite marker
of conditions that confer increased medical risk.
Overall, and for
multiparous women, planned birth at home generated the greatest mean net benefit with a 100 % probability
of being the optimal setting across all thresholds
of cost effectiveness when perinatal outcomes were considered.
This decision uncertainty surrounding the most cost effective option was not found for place
of birth in
multiparous low risk women without complicating conditions, in whom planned home birth had a 100 % probability
of being the most cost effective option across all thresholds
of cost effectiveness (table 4).
With regards to maternal outcomes in nulliparous and
multiparous women, planned birth at home generated the greatest mean net benefit with a 100 % probability
of being the optimal setting across all thresholds
of cost effectiveness.
This decision uncertainty surrounding the most cost effective option was not found for place
of birth in
multiparous low risk women, on whom planned home birth had a 100 % probability
of being the most cost effective option across all cost effectiveness thresholds between # 0 and # 100000 (table 3).
Given the available literature, before diagnosing arrest
of labor in the second stage and if the maternal and fetal conditions permit, at least 2 hours
of pushing in
multiparous women and at least 3 hours
of pushing in nulliparous women should be allowed (Table 3).
For example, the recent Eunice Kennedy Shriver National Institute
of Child Health and Human Development document suggested allowing one additional hour in the setting
of an epidural, thus, at least 3 hours in
multiparous women and 4 hours in nulliparous women be used to diagnose second - stage arrest, although that document did not clarify between pushing time or total second stage (33).
The duration
of the second stage
of labor and its relationship to neonatal outcomes has been less extensively studied in
multiparous women.
In this study, the 95th percentile rate
of active phase dilation was substantially slower than the standard rate derived from Friedman's work, varying from 0.5 cm / h to 0.7 cm / h for nulliparous women and from 0.5 cm / h to 1.3 cm / h for
multiparous women (the ranges reflect that at more advanced dilation, labor proceeded more quickly)(Table 2).
A prospective study
of the progress
of labor in 220 nulliparous women and 99
multiparous women who spontaneously entered labor evaluated the benefit
of prolonging oxytocin augmentation for an additional 4 hours (for a total
of 8 hours) in patients who were dilated at least 3 cm and had unsatisfactory progress (either protraction or arrest) after an initial 4 - hour augmentation period (21).
The vaginal delivery rate for women who had not progressed despite 2 hours
of oxytocin augmentation was 91 % for
multiparous women and 74 % for nulliparous women.
Researchers have found that after a 3 - hour or more second stage
of labor, only one in four nulliparous women (27) and one in three
multiparous women give birth spontaneously, whereas up to 30 — 50 % may require operative delivery to give birth vaginally in the current second stage
of labor threshold environment (30).
On the basis
of the 95th percentile threshold, historically, the latent phase has been defined as prolonged when it exceeds 20 hours in nulliparous women and 14 hours in
multiparous women (18).
A population - based study
of 58,113
multiparous women yielded similar results when the duration
of the second stage was greater than 2 hours (31).
Rates
of cesarean section for
multiparous women, when women with previous cesarean sections were excluded, were not different (p value cut - off for statistical significance after the Bonferroni correction 0.002).
Using this tool we compared the outcomes
of planned home births with those
of planned hospital births for primiparous and
multiparous women after controlling for the confounding effects
of social, medical, and obstetric background.
Power analysis, based on detecting a significant difference in the combined frequency
of non-optimal factors during and after childbirth, led us to aim for a sample size
of 1600 women, with approximately half being
multiparous and preferably half choosing hospital birth.
Primiparous women and
multiparous women were considered separately because
of well known differences in outcome.
Multiparous women were more likely to choose a hospital birth if they belonged to an ethnic minority; had a non-optimal body mass (Quetelet index outside the range 18.8 - 24.2; P < 0.05); had a history
of obstetric complications, preterm birth, or instrumental delivery; or had received medication (including vitamins and iron) in pregnancy (table 2).
57 % Hispanic, 36 % African - American, 62 %
multiparous (70 %
of these had previous breastfeeding experience), mean age 25 years (SD 6.23), 51.5 % married or living with a partner, 57 % receiving Medicaid
Of women in our study with prolonged second stage diagnosed, 20.5 % were delivered in less than 3 hours (for primiparous women) and in less than 2 hours (for multiparous women) from the time of complete dilatio
Of women in our study with prolonged second stage diagnosed, 20.5 % were delivered in less than 3 hours (for primiparous women) and in less than 2 hours (for
multiparous women) from the time
of complete dilatio
of complete dilation.
Mice have a high incidence
of Hodgkin's - like reticulum cell neoplasm at 18 months
of age and pituitary tumors in old
multiparous females.
A high percentage
of mammary adenocarcinomas (a large proportion
of acinar - type) develop in
multiparous females.
Nevertheless, the MECSH trial showed some significant results and some trends that require replication in larger samples
of mothers drawn from a similarly widely defined at - risk group, including older,
multiparous mothers, and mothers with higher levels
of education than have been reported in other trials.1 14 Mothers
of infants and toddlers in the intervention group provided a home environment that was statistically significantly more supportive
of their child's development through more verbal and emotional responsivity; however, the effect size was small.
The effectiveness
of this model
of sustained nurse home visiting for families from immigrant communities, the impact
of nurse home visiting when delivered as a component within a comprehensive child and family health and development service system, 10 11 and the efficacy for older,
multiparous compared with teenage first - time mothers, remains largely unexplored.
Four a priori analyses were undertaken comparing outcomes for the hypothesised subgroups using 2 × 2 factorial ANOVA to assess main (intervention vs comparison group) effects and interaction (intervention by subgroup effects for mothers who were Australian - born vs overseas - born, first - time vs
multiparous, had one vs multiple risk factors, and scored EDS ≥ 10 (antenatal psychosocial distress) vs EDS < 10), while maintaining the power
of the whole sample.
Comparison
of Primiparous and
Multiparous Mothers: Healthy Families Program Participation, Outcomes, Challenges, and Adaptations, FY 1999 - FY 2010 (PDF - 316 KB) Galano & Huntington (2012) Pew Center for the States Presents an analysis and comparison
of the participation and outcomes
of mothers
of multiple children and first - time mothers in Healthy Families home - visiting programs in Virginia to examine the idea that first - time mothers would benefit more from these services than mothers with previous children.