BACKGROUND Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand for cesarean section (MDCS) seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics. METHODS A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs), Adeoyo Maternity Hospital (SHC), and UCH Ibadan (THC), representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary. RESULTS The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001). Doctors were major sources of information on MDCS (30.8%) as well as friends (24.3%). Common reasons reported for MDCS were fear of labor pains (68.9%), and fear of poor labor outcome (60.1%), and fear of fecal (20.2%) and urinary incontinence (16.8%). More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001). However, willingness to request MDCS was low (6.6%). More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more likely than those at the SHC or the PHCs to request cesarean section and to favor a woman's right of autonomy to choose her mode of delivery. CONCLUSION The decision for MDCS is a difficult one, because willingness is low and criticism by partners of those who choose MDCS is high. Provision of epidural anesthesia and improved safety of vaginal delivery is recommended. This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries.

Background and Objective: To document bilateral tubal ligation (BTL) rates and highlight the need to improve on the rates. Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group. Results: There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9±1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL. Conclusions: Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section.

OBJECTIVES To assess the prevalence of satisfaction, and associated factors, among parturients who had recently delivered by cesarean. METHODS In a descriptive cross-sectional study, women who delivered by cesarean at the University of Benin Teaching Hospital, Nigeria, were enrolled between April and July 2010. A simple, qualitative, semi-structured researcher-administered questionnaire was used for data collection. Data analysis was done via SPSS version 16. RESULTS Among 220 women who delivered by cesarean, 211 women were enrolled in the study and were interviewed 2-5 days after delivery. The mean age was 30.8 ± 5.1 years, and the median parity was 1. An initial negative reaction to the decision for cesarean delivery was reported by 76% of respondents, 19% were indifferent, and 5% reported an initial positive reaction. Satisfaction with delivery by cesarean was reported by 80% of the respondents. Satisfaction with cesarean delivery was significantly associated with age, level of education, initial reaction to the decision for cesarean delivery, and elective cesarean. CONCLUSION Most parturients expressed overall satisfaction after delivery by cesarean. There is a need for in-depth studies in low-income countries to further evaluate satisfaction with regard to various aspects of the cesarean delivery experience.

Objective. To explore the perception and attitude of women with previous caesarean section towards repeat caesarean section. Method. Observational study of women with prior caesarean delivery using an anonymous semi-structured questionnaire. Information elicited include the socio-demographic characteristics, outcome of the last caesarean delivery, experience of complications or domestic violence, acceptance of repeat caesarean section if advised by the doctor and the reason for any refusal. Results. One hundred thirty-nine parturients participated in the study. Seventy-seven percent had 1 previous caesarean delivery while 24.46% will decline a repeat caesarean section. Major reasons for refusal were postoperative pain, cultural aversion, fear of death, and cost of caesarean delivery. The rate of acceptance was significantly higher amongst those with more than one prior caesarean section while the rate of refusal was significantly higher amongst those who experienced perinatal death in the last caesarean delivery. Twelve percent experienced domestic violence (almost entirely psychological) mainly from the spouse or his relatives. Conclusion. A significant proportion of women with previous caesarean delivery will decline a repeat caesarean section if medically indicated. There is need for bahavior change communication involving the community, improved postoperative pain management, and better counseling especially on safety of the procedure.

Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2-0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1-7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.

The objective of this study was to determine why parturients in a low resource setting fail to keep an appointment for induction of labour and evaluate the subsequent pregnancy outcome. The method used was a prospective matched case control study. Results showed that women with only primary school education were significantly more common in the study group (8% vs 1%; p < 0.05). The main reason for failing to keep the appointment was because they preferred spontaneous onset of labour (56.6%) and the 'spousal factor'(23.9%). Patients who were counselled by the consultant obstetrician were less likely to decline compared with those counselled by the resident doctors. Although the pregnancy outcome was comparable, failed induction of labour leading to caesarean section was significantly commoner among the study group (p < 0.05). It was concluded that social and cultural factors affecting the utilisation of health services should be considered by obstetric care providers in developing countries, to promote safe motherhood.

SummaryScaling-up of skilled attendants and facility-based services is necessary for improving maternal and child care in developing countries but their effectiveness is crucially influenced by the uptake of such services. This study set out to establish the pattern and uptake of maternity services and associated factors against the backdrop of rapid urbanization in Nigeria. A cross-sectional study of socio-demographic and obstetric characteristics of mothers attending the Bacille Calmette-Guérin (BCG) immunization clinics in inner-city Lagos was conducted from July 2005 to December 2007, and their association with non-hospital delivery and use of unskilled attendants was determined by multiple logistic regression analyses. Of the 6465 participants, over half (51.4%) delivered outside hospital facilities and 81.8% of this group had no skilled attendants at delivery. Non-hospital delivery or the presence of unskilled attendants at delivery was associated with teenage mothers, Muslim religion, low or middle social class and use of herbal drugs in pregnancy. Additionally, non-hospital delivery was associated with ethnicity (Yoruba tribe), lack of tertiary education or full-time employment, accommodation with shared sanitation facilities and multiparity. The results suggest that availability of and access/proximity to hospital facilities or skilled attendants is no guarantee of uptake of maternity services. Efforts aimed at improving maternal and child health in developing countries should take cognisance of the socio-demographic and cultural underpinnings of maternal health-seeking behaviour of urban mothers beyond the provision of facility-based services or strengthening of the existing health care systems.

BACKGROUND Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme. METHODS A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses. RESULTS Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery. CONCLUSIONS The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.

OBJECTIVE To determine Ghanaian women's preferred mode of delivery and opinion of caesarean section after caesarean delivery. DESIGN A cross sectional study of women who recently delivered by caesarean section prior to hospital discharge. SETTING Two teaching hospitals in Ghana: Komfo Anokye Teaching Hospital, Kumasi, and Korle-Bu Teaching Hospital, Accra. RESPONDENTS 154 patients who delivered by caesarean section between the 1(st) and 31(st) August, 2003 were interviewed. Of the 154 initiating the interview, 151 completed, and 145 had complete data. MAIN OUTCOME MEASURES Delivery preference and general opinion of caesarean delivery. RESULTS The majority of women interviewed indicated that they preferred vaginal delivery (55%). Despite preference for vaginal delivery among these women who had delivered by caesarean section, the majority had a generally positive opinion of caesarean section (53%). CONCLUSION Ghanaian women with experience of caesarean delivery prefer vaginal delivery.

AIM This study was an analysis of women diagnosed with acute appendicitis in pregnancy, to appraise the maternal and fetal outcomes and explore the correlations with negative appendectomy. MATERIAL AND METHODS A retrospective study was undertaken at the University of Benin Teaching Hospital, Nigeria. The service delivery records of all pregnant women who underwent appendectomy for acute appendicitis from January 2000 to December 2009 were analyzed. RESULTS Among 16,173 deliveries, 23 pregnant women were diagnosed with acute appendicitis. The age of the women ranged between 15 and 34 years (median = 26 years), while the majority (65.2%) were nulliparous. The mean gestational age at presentation was 21.1 ± 6.9 weeks with up to 15 (65.2%) patients presenting in the second trimester. Eighteen (78.3%) patients had histopathologically proven appendicitis giving a negative appendectomy rate of 21.7%. Postoperative complications were noted in eight (34.8%) patients. Half of these occurred within the negative appendectomy group. The negative appendectomy group also contributed significantly to the adverse obstetric outcome: preterm labor, 8.7% of 21.7%, preterm delivery, 4.5% of 13.6% and a fetal loss rate of 4.3% of 13%. One maternal death occurred in the group with diseased appendix giving a maternal mortality rate of 4.3%. CONCLUSIONS While a higher index of suspicion among clinicians will ensure earlier diagnosis and improve the associated maternal and fetal prognosis, the need to reduce the negative laparotomy rate is highlighted by the high rate of adverse obstetric outcomes amongst the negative appendectomy group.

Improving the quality of care is essential for achieving reductions in maternal mortality. Audit is one of the methods which can be used to simultaneously assess as well as improve quality. This commentary discusses one type of audit--confidential enquiries into maternal death. We believe that the enthusiasm for establishing a confidential enquiry system in Nigeria is growing. The challenges faced in setting up an audit system are discussed and 6 steps are proposed to locate the conduct of a confidential enquiry as part of a set of activities which will take cognizance of existing know-how, create shared ownership and provide a coherent picture of needs and information gaps in the provision of quality maternity services. Having such a system in place can be a route towards achieving a progressive vision of accountability for the reduction of maternal mortality in Nigeria.

Objective: To determine the outcome of induction of labor, specifically incidence of uterine rupture and reliable predictors of repeat caesarean delivery, in women undergoing induction of labor after previous caesarean section. Methods: A review of obstetric and perinatal records of 167 women who had their labor induced after one transverse lower uterine incision performed at previous caesarean delivery in a referral tertiary hospital in Nigeria between January 2006 and December 2009. Results: The incidence of uterine rupture was 2.4%. Independent risk factors for repeat caesarean delivery were absence of prior vaginal delivery (OR 3.7; 95% CI 1.9-7.1), duration of latent phase >2 h (OR 4.3; 95% CI 1.7-11.2), postdated pregnancy (OR 2.2; 95% CI 1.1-4.0) and previous caesarean for non-recurrent indication (OR 2.1; 95% CI 1.1-4.0). Conclusion: Choice of appropriate delivery option for this cohort of women based on the identified risk factors is essential to minimize the incidence of failed vaginal birth and its associated adverse maternal and neonatal outcome.

The study was designed to determine the outcome of an advocacy program aimed at implementing a policy of free maternal and child health (MCH) services in Nigeria. The team conducted a situational analysis on costing of MCH services, and used the results to conduct public health education and advocacy. Advocacy consisted of public presentation on MCH to high-level policymakers, dissemination of situational analysis report, and media publicity. The implementation of free MCH services at national and sub-national levels was assessed 3 years after. The results showed that the number of States offering comprehensive free MCH services increased from four to nine; the States offering partially free MCH services increased from 11 to 14 (8.1% increase); while those not offering any form of free treatment decreased from 22 to 14 (21.7% decrease). We conclude that advocacy and public health education is effective in increasing the commitment of policymakers to provide resources for implementing evidence-based maternal and child health services in Nigeria.

Pregnancy in the rudimentary horn is rare and carries grave consequences for the mother and fetus. A case report is presented of a 26 year old single gravida 3 para 0(+2) lady with rupture of a rudimentary horn pregnancy at a gestational age of 20 weeks. Laparotomy was done and the rudimentary horn excised. Post-operative recovery was uneventful. The need for a high index of suspicion and the role of ultrasonography in the accurate diagnosis is highlighted.

OBJECTIVE To assess outcome at an infertility management center in Nigeria. METHODS Diagnoses were made for 1948 consecutive couples following the World Health Organization guideline on the investigation of infertile couples, treatment was provided, and the couples were followed up over a 10-year period. RESULTS The infertility was primary in 14.3% and secondary in 85.7% of cases. Treatment failed in 59.9% and succeeded in 40.1% of cases, resulting in pregnancy for 13.5% of the couples with female infertility factors alone, 6.5% of the couples with male infertility factors alone, and 3.6% of those with both male and female factors. The pregnancy rate was 16.6% for couples with idiopathic infertility. CONCLUSION Pregnancy outcome was relatively poor because conventional treatments did not cure the most prevalent causes of infertility, and assisted reproductive technology is therefore advocated.

Sub-Saharan Africa has the highest death rate from induced abortion in the world, and young women in southern Nigeria are particularly likely to terminate their pregnancies. This study assesses the prevalence of and factors associated with induced abortion among 602 young women aged 15-24 who were surveyed in Edo State, Nigeria, in 2002. We find that 41 percent of all pregnancies reported by the young women surveyed were terminated, and we estimate the age-specific abortion rate for 15-19-year-olds in Edo State at 49 abortions per 1,000 women, which is slightly higher than previous local estimates and nearly double the countrywide estimate for women aged 15-49. We construct explanatory multivariate models to predict the likelihood that a young woman has experienced sexual intercourse, has become pregnant, and has undergone an induced abortion, controlling for important demographic and risk-behavior factors. Young women unmarried at the time of the interview are found to be significantly more likely than married women to have had an abortion. Young women who have experienced transactional or forced sex are also significantly more likely to report ever having had an abortion, as are young women who have experienced more than one pregnancy. We conclude with suggestions for modifying the content and target populations of behavioral change messages and programs in the area.

Introduction of structured competency-based training for specialty registrars and implementation of European Working Time Directives (EWTD) have affected the quality of maternity care. In York District Hospital, consultant resident on-call (CRO) without registrar cover was introduced in July 2010 to address the long-standing problem of middle-grade out-of-hours coverage. To examine the impact of introducing out-of-hours consultant resident on-call on maternity care, data from 486 deliveries including 59 CRO and 59 registrar shifts were collected retrospectively, from July 2010 to April 2011. Main outcome measures include mode of delivery, second-stage management, maternal and neonatal outcomes. Feedback from consultants, junior trainees and midwives on the impact of CRO were collated through semi-structured interviews. More normal vaginal deliveries (71.8% vs 63.0%) and fewer emergency caesarean sections (12.5% vs 20.6%) were performed in the CRO shifts compared with registrar on-call. Instrumental delivery rates in labour rooms vs theatre were higher when compared with the registrar group. Overall, good patient and staff experience was reflected during interviews. Our work shows that introduction of CRO in out-of-hours settings is acceptable among staff and is associated with fewer obstetric interventions. However, improved job descriptions may be needed in order to make the CRO post more attractive.

To describe the self-reported oral health knowledge, attitudes and oral hygiene habits, among pregnant women receiving antenatal care at the Lagos State University teaching Hospital (LASUTH). A cross-sectional questionnaire-based survey was conducted at the LASUTH antenatal clinic during the period January - June 2008. Most of the respondents demonstrated a reasonable level of oral health knowledge and positive attitudes towards oral health. However, there were gaps in the oral health knowledge of the women surveyed. The relationship between the level of oral health knowledge and ethnicity (p=0.856), level of education (p=0.079), age category (p=0.166), and trimester of pregnancy (p=0.219) were not statistically significant. In addition, the women's knowledge and attitude towards oral health was not reflected in their oral hygiene practices. There is a need to provide oral health education for pregnant women during antenatal care in order to highlight the importance of good oral health in achieving good health for both the mother and her baby.

BACKGROUND: homebirth for low risk women attended by competent midwives who are networked within a responsive maternity care service is supported by research as safe. Concerns exist over the safety of homebirths which are unattended by trained health professionals, or for women with medically defined risk factors. Both these birth choices are unsupported by mainstream maternity care options in Australia and therefore represent birth choices considered to be 'outside the system'. AIM: to explore the perceptions of risk held by women who choose to have a freebirth (birth at home intentionally unattended by a trained birth attendant) or a 'high-risk' homebirth (professionally attended home birth where a mother or baby has medically defined risk factors). Both of these choices are considered to be 'outside the system'. METHODS: twenty women were interviewed about their choice to 'birth outside the system', nine choosing freebirth and 11 choosing to have an attended homebirth despite the presence of medically defined risk factors; three were primiparous and seventeen were multiparous. Women intending to have, or having had a freebirth or high risk homebirth, were interviewed using semi-structured interviews. Interviews were transcribed and analysed using thematic analysis. FINDINGS: the three main themes about perceptions of risk that were evident in this study were:'Birth always has an element of risk','The hospital is not the safest place to have a baby'; and 'interference is a risk'. DISCUSSION: the participants acknowledge that birth is a time in life that carries an element of risk. They perceive that hospital represents a more risky place to give birth than at home and that interventions and interruptions during labour and birth increase risk. Women who birth outside the system perceive the risks of birth in hospital differently to most women. These women feel that by birthing outside the system they are making a choice that protects them and their babies from the risks associated with birthing in hospital and thus provides them with the best and safest birthing option. CONCLUSION: in pursuing the best for themselves and their babies, women who birth outside the system spent a lot of time and energy considering the risks and weighing these up. For them birth in hospital is considered less safe than birth at home.

BACKGROUND Women who experience unexpected labour and birth interventions describe feeling distressed and have an increased risk of postnatal depression. Primigravidae who have an unrealistic expectation of labour and birth may be at higher risk of these outcomes. AIMS To determine whether primigravidae and their carers have a realistic expectation of uncomplicated labour and birth. METHODS One hundered and ninety-five primigravidae, 32 obstetricians, 76 midwives, 198 medical students prior to their obstetric term and 131 medical students after their obstetric term completed a short questionnaire about the likelihood of primigravid women undergoing spontaneous onset of labour, no augmentation of labour and a cephalic vaginal birth without instrumental assistance, defined as birth without intervention. This number was compared to the local published data. RESULTS Overall, the study subjects believed that women had a 48% chance of birth without intervention, and a 26% chance of birth without intervention or perineal sutures. The statewide published figures for these two outcomes are 21 and 8%, respectively. Staff, both obstetric and midwifery, were more accurate than medical students who were in turn more accurate than pregnant women. Attendance at antenatal education classes by pregnant women did not improve accuracy. Level of experience did not improve accuracy by medical staff. Medical students were more accurate after teaching than before teaching. CONCLUSION Primigravidae in late pregnancy and maternity staff do not have a realistic expectation of a labour and birth that is free from medical intervention. This may impact on choices women make about care in pregnancy and labour.

Objective  Pre-eclampsia contributes significantly to maternal, foetal and neonatal morbidity and mortality. The risk factors for pre-eclampsia have not been well documented in Uganda. In this paper, we describe the risk factors for pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala. Methods  This casecontrol study was conducted from 1st May 2008 to 1st May 2009. 207 women with pre-eclampsia were the cases, and 352 women with normal pregnancy were the controls. The women were 15-39 years old, and their gestational ages were 20 weeks or more. They were interviewed about their socio-demographic characteristics, past medical history and, their past and present obstetric performances. Results  The risk factors were low plasma vitamin C (OR 3.19, 95% CI: 1.54-6.61), low education level (OR 1.67, 95% CI: 1.12-2.48), chronic hypertension (OR 2.29, 95% CI 1.12-4.66), family history of hypertension (OR 2.25, 95% CI: 1.53-3.31) and primiparity (OR 2.76, 95% CI: 1.84-4.15) and para≥5 (3.71, 95% CI:1.84-7.45). Conclusion  The risk factors identified are similar to what has been found elsewhere. Health workers need to identify women at risk of pre-eclampsia and manage them appropriately so as to prevent the maternal and neonatal morbidity and mortality associated with this condition.

The introduction of new models of care in the Irish maternity services has been recommended by both advocacy groups and strategic reports. Yet there is a dearth of information about what models of care pregnant women want. We surveyed women in early pregnancy who were attending a large Dublin maternity hospital. Demographic and clinical details were recorded from the hospital chart. Of the 501 women, 351 (70%)(352 (70.3%) of women wanted shared antenatal care between their family doctor and either a hospital doctor or midwife. 228 (45.5%) preferred to have their baby delivered in a doctor-led unit, while 215 (42.9%) preferred a midwifery-led unit. Of those 215 (42.9%), 118 (55%) met criteria for suitability. There was minimal demand (1.6%) for home births. Choice was influenced by whether the woman was attending for private care or not. Safety is the most important factor for women when choosing the type of maternity care they want. Pregnant women want a wide range of choices when it comes to models of maternity care. Their choice is strongly influenced by safety considerations, and will be determined in part by risk assessment.

BACKGROUND The role of obstetric sonography in the development of diagnostic ultrasound technology has remained invaluable in obstetric and gynaecological investigation. OBJECTIVES This work investigated the awareness of information, expectations and experiences of pregnant women coming for obstetric sonography. METHODS One hundred and ten (110) pregnant women in Anambra State of Nigeria were prospectively studied during prenatal ultrasound scan. RESULTS The mean age of the studied population was 30.5 +/- 14.5 years. Majority (85%) of the subjects were already aware of obstetric ultrasound scan. Most of the subjects were between the ages of 26-35. 73% got their information from antenatal centre. Over 20% were interested in the lies and presentation of their foetus. During the scan, about 69% subjects interested with the sonographers, and more than half of the population (51%) saw their babies. CONCLUSION The role of prenatal a-sonography in obstetric care should be promoted by creating awareness campaign in antenatal centres, and initiating mother/sonographers interaction are necessary.

Objective: Cesarean section (C/S) is still being perceived as an abnormal means of delivery by many antenatal women in Nigeria. This study aims to determine the perceptions of antenatal clients in the southeastern Nigeria on C/S. Materials and Methods: The study was conducted using a structured questionnaire administered to 300 consenting pregnant clients attending the antenatal clinic. The data were analyzed and presented in a simple frequency table. Results: The average C/S rate in the hospital was 16.6%. Only 4 (1.4%) viewed C/S as very good and elected to undergo C/S. Thirty-four (12.3%) considered C/S as bad and would reluctantly undergo the procedure. Two hundred and twenty-five (81.2%) would accept C/S if their life or that of their fetus is in great danger. Conclusion: This study affirms previous suspicion that a significant proportion of antenatal clients are averse to C/S and the negative cultural perception of the people to C/S reinforced this aversion.

BACKGROUND Most pregnant women in Denmark say they have not talked to their midwives about alcohol in pregnancy, and they have mostly been advised that some alcohol intake is all right. From 1999 to 2007, the Danish National Board of Health advised pregnant women that some alcohol intake was acceptable. Since 2007, the recommendation has been alcohol abstinence. The aim of this study was to describe the attitudes toward, knowledge about, and information practice concerning alcohol drinking in pregnancy among midwives in Denmark in 2000 and 2009 and how their answers related to the 2 different official recommendations at the time. METHODS In 2000, we invited all midwives in the antenatal care center at Aarhus University Hospital. Ninety-four percent were interviewed about their attitudes toward and beliefs and knowledge about alcohol during pregnancy. Questions were also asked about information on alcohol provided to pregnant women. Identical questions were asked to all midwives (100%) in the antenatal care center in 2009. RESULTS In 2000, most midwives (69%) considered some alcohol intake in pregnancy acceptable, mostly on a weekly level, and only 28% advised abstinence. Binge drinking, on the other hand, was considered harmful by most. There was considerable inter-person variation in the participants' attitudes and what they recommended to pregnant women. In 2009, substantially more midwives (48%) considered abstinence to be best, and significantly, more midwives (61%) gave this advice to pregnant women. Participants had received information on alcohol mostly in a professional context. Their knowledge about the official recommendations about alcohol was good, but many did not inform about the official recommendation. CONCLUSIONS The attitudes toward and beliefs and knowledge about drinking in pregnancy among midwives have changed along with a change in official policy. The change was mostly independent of personal characteristics of the midwives, including age, gender, and place of work.

OBJECTIVE to explore women's experience of singing lullabies in pregnancy and their understanding of possible benefits for themselves and their infants. DESIGN AND PARTICIPANTS over four group sessions with musicians, six pregnant women, all expecting their first baby, learnt to sing three lullabies. Qualitative semi-structured interviews were conducted approximately three months after the birth to capture the women's experiences. Participants were recruited at antenatal classes at a metropolitan maternity hospital in Ireland. FINDINGS The women enjoyed participation in the lullaby project and all felt it benefited them and their babies. Themes uncovered included:(1) beyond words: music and the articulation of deep emotion;(2) a balm for the soul: the power and pleasure of beautiful music; and (3) music and the facilitation of infant development. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: Singing lullabies in pregnancy had a soothing and calming effect and was a pleasant experience for participants. It was also an emotional experience and appeared to facilitate the expression of difficult emotion such as fear and anxiety. This effect is likely to have a significant and positive impact on well-being for pregnant women and as such warrants further exploration.