Domestic Violence in Pregnancy and Low Birth-Weight Infants

Implications for the Nurse in Care Delivery

Domestic Violence and Low Birth Weight Babies

The specific responsibility and one of the most vital factors is the critical assessment of the nurse, nurse practitioner and the treating physician of the pregnant women who is a victim of abuse. The pursuit of conducting a study or monitoring abuse of women cannot be a conclusive study if the nurse specifically does not critically monitor patients that the data applies to in terms of abuse such as socio-economic factors, educational attainment level, age, and other indicators not as readily evident. It is the nurse who assess the patient / expectant mother, and the nurse who will ultimately impact the lives of the mother and the infant either positively or negligently depending on the focus and perceptional ability of the nurse, nursing practitioner, or personal physician. The difficulty appears to lie within the structure of the medical system, which the most needy of patients as to age, risks factors and nutritional imbalances are perpetuated among due to low socioeconomic status on a societal level. Becker, Patricia & Grunwald, Patricia (2000) the Journal of Perinatal & Neonatal Nursing article entitled “Contextual Dynamics of Ethical Decision Making in the NICU” states that: The manner in which the contextual dynamics of the neonatal intensive care unit (NICU) culture influence decisions around withholding and withdrawing treatment for very low birth weight infants is examined based on sociological studies of the NICU culture. The influence of these dynamics on nurse and parent participation in treatment decisions is discussed. Steps toward increasing nurses’ role in decision making and ability to empower the participation of parents include (a) using an understanding of the dynamics of the individual NICU to establish a collaborative team culture, and (b) demonstrating that data obtained through relationship with the infant make an important and valid contribution to ethical decision making. Further research in relation to domestic abuse, specifically as to the detection of, the treatment and prevention of abuse to women and infants during pregnancy is a vital matter particularly in light of the implications that low birthweight may contribute to a lifetime of health problems in individuals and that the problems may be of various types of medical complications and the development of disease in the LBW individual.

Purpose

The purpose of this study and review of literature is to examine the role of the nurse in delivery of healthcare services to mother’s and their infants from the onset of need of care across to end of services needed by the mother and infant that should be the provision of the nurse in this specific role.

Statement of Objective

The objective of this work in writing is to establish in evidentiary research findings recorded in literature the impact that domestic violence during the course of a pregnancy has upon the infant in relation to contributing to low birth weight among newborn infants.

Methodology

The method of research will be through literature review of peer-reviewed journals and will be qualitative as well as quantitative in nature as the findings in research evidence will carry great weight on their own merit and consensus will also be considered a validation of findings in the study. Delineation of the role of delivery nurses will be conducted as well as the nurse in the role of the newborn caretaker.

Introduction

Birth weight is a major determinant of infant and child health and mortality. Birth weight of less than 2.5 kilograms is considered low. (Maternal and Child Health, 2003) Studies reveal that care for infants begin while the infant is yet unborn and is affected greatly by the mothers. Infant mortality is a critical indicator of today’s health population particularly in relation overall state of health concerns. SIDS is, or, Sudden Infant Death Syndrome is one of the leading killers of infant children

Delineation of the Role of Delivery Nurses and Newborn Caretaker

The Maternal and Child Health and Children with Special Health Care Needs MCH/CSHCN Program Manual states that outreach is the “early identification through the High Priority Infant Identification and Tracking System for high-risk infants and pregnant women. Within the scope of this program the Nurse’s duties are as follows:

Provides direct nursing care to individuals with attention to physical, developmental, psychosocial, and emotional habilitation/rehabilitation needs; Provides health education including, but not limited to, current health status and diet. Health education concerning immunizations and developmental status to be provided to families with children; Promotes and teaches health maintenance and a high level of wellness throughout the lifespan; Assist families and individuals with the coping process; Works collaboratively with other disciplines in identifying and meeting the physical, psychological, social and emotional and habilitations needs of individuals; Promotes and participates in early identification and outreach activities; Assesses the development status of infants, children, and adolescents; Assess the current strengths and concerns of family members and incorporates these into the plan of care; Accepts primary responsibility for coordinating the management of care an ensuring follow-up services; Completes a nursing history on all individuals seen in the clinic; Initiates and participates in case conferences in concert with other health care and community service; providers; Makes home visits as appropriate for coordination and continuity of patient care; Provides nursing consultation to individuals, their families, other team members and the community regarding; management of health needs and the need for referral and continuity of service; Supervises and identifies clinic activities performed by non-professional personnel; Identifies and utilizes appropriate Department of Health and other resources to meet the needs of individuals; and their families; Advocates for the needs of individuals and their families; Performs clinic functions in relation to medical records, lab results, assuring medical records are complete,; performing or scheduling screenings, including developmental assessments and that as ordered by the physician as well as Assisting physicians with examinations and procedures”

In seeking determination of the prevalence of incidents of physical abuse and oftentimes emotional/psychological/sexual and other forms of accompanying abuse study is vital in dealing with the low birth-weight infant and the health implications assigned to low birth-weight in terms of the future health aspects that accompany being a LBW individual. The specific responsibility and one of the most vital factors is the critical assessment of the nurse, nurse practitioner and the treating physician of the pregnant women who is a victim of abuse. The pursuit of conducting a study or monitoring abuse of women cannot be a conclusive study if the nurse specifically does not critically monitor patients that the data applies to in terms of abuse such as socio-economic factors, educational attainment level, age, and other indicators not as readily evident. It is the nurse who assess the patient / expectant mother, and the nurse who will ultimately impact the lives of the mother and the infant either positively or negligently depending on the focus and perceptional ability of the nurse, nursing practitioner, or personal physician. The difficulty appears to lie within the structure of the medical system, which the most needy of patients as to age, risks factors and nutritional imbalances are perpetuated among due to low socioeconomic status on a societal level. Becker, Patricia & Grunwald, Patricia (2000) the Journal of Perinatal & Neonatal Nursing article entitled “Contextual Dynamics of Ethical Decision Making in the NICU” states that: The manner in which the contextual dynamics of the neonatal intensive care unit (NICU) culture influence decisions around withholding and withdrawing treatment for very low birth weight infants is examined based on sociological studies of the NICU culture. The influence of these dynamics on nurse and parent participation in treatment decisions is discussed. Steps toward increasing nurses’ role in decision making and ability to empower the participation of parents include (a) using an understanding of the dynamics of the individual NICU to establish a collaborative team culture, and (b) demonstrating that data obtained through relationship with the infant make an important and valid contribution to ethical decision making. The Maternal and Neonatal Health Program at John Hopkins University for Education on Gynecology and Obstetrics (p.12) contains a published wall chart that outlines the responsibilities as well as actions that various responsibilities and action that various actors need to take in order to ensure that pregnancy, childbirth and the post-partum period are all successful According to one report there were approximately 4 million newborn infants died during the year 2003. Many times simple intervention is the crucial factor that makes the difference between life and/or death and lifelong health problems and complications for the infant. That is the precise multi-variable role tasked to the nurse whose specialization field is delivery nurse or infant caretaker nurse in today’s healthcare provision services. To understand the structure of this task viewing time-oriented factors this is the time of the pregnancy described as follows:

The vulnerable period for mothers and their newborns is during the period immediately following delivery which is the time when over 60% of maternal deaths occur, or during the six weeks after birth’ and Implications for the Validity of this Research

Approximately “two-thirds neonatal deaths occur in the first week of life with two-thirds of that same group’s death occurring in the first 24 hours of life according to one expert in the field and as well the same source states that,” “Recent research on maternal and newborn health has demonstrated that many interventions to protect a mother’s health also benefit the newborn, and vice versa. In light of the evidence in this literature review then it is of great import that monitoring of the health of pregnant women is vital in reference to LBW infants not only in the sense of present terms but as well to lifelong health considerations for the LBW infant which is probably why stated further is: “Given the relative neglect that mothers and newborns have suffered, their centrality to the Millennium Development Goals, and the cost-effectiveness of maternal and newborn health interventions, a greater emphasis on safe motherhood and newborn health is clearly needed within many health sectors.” (JHPIEGO, 2003)

Literature Review

Stated in the publication “Shaping Policy for Maternal and Newborn Health: A Compendium of Case Studies (2003) is that: “The health of a newborn is inextricably linked to the health of the mother; the majority of newborn deaths are caused by the poor health of the mother during pregnancy, or by the poor care she and her newborn receive during and immediately after childbirth.” (JHPIEGO, 2003) Bohn, et al. (2004) reports the conduction of a study that makes an examination of the influence of socioeconomic factors such as “status, education, ethnicity, and age” in the area of spousal abuse or “intimate partner abuse” before/during/after pregnancy.

The design in this study was through “respective correlational analysis. Data was collected at post-partum maternity meetings with 1.004 women of six different ethnicities with the measure being the commonplaceness of partner abuse and violence. Results were reported as “15.9% reported physical abuse by their partner and 5.2% reported abuse during the course of pregnancy.” Findings in the study state that “decreased income, not having a high school education and ethnicity were significantly related to current abuse as well as abuse during the course of the pregnancy performed through use of bivariate analyses. Furthermore, the findings in this study point toward the abuse of women who are disadvantaged as being more prevalent than in those who are not considered to be disadvantaged. There is a great lack of information of a comprehensive nature on the relationship that exists between domestic abuse, both physical and emotional violence, and pregnancy outcomes. This study was a systematic review of available literature in examination of the evidence in relation to the connection between physical and emotional type abuse and outcomes in pregnancy. In this case study 296 articles were located, case reports and articles that did not satisfy the study inclusion criteria were removed from the study and results were stated finding that: “Overall, adverse pregnancy outcomes, including low birth weight, maternal mortality and infant mortality are significantly more likely among abused than non-abused” individuals. (Salihu, 2004)

The study reported by Salihu (2004) informs of the fact that pregnant mothers who suffered abuse were more likely to suffer “kidney infections, gain less weight during pregnancy, and are more likely to undergo operation delivery.” Further stated is that: “Fetal morbidity, such as low birth weight, pre-term delivery, and small size for gestational age are more frequent among abused expectant mothers than those who are not abused. Abused mothers of the black race are three to four times more likely to suffer death, as are white abused mothers.

This study concluded that violence by an intimate partner is many times an event that is ‘life-threatening’ both to the fetus and the mother. Implications are stated that for further research based on the fact that ‘the heightened level of fetal — maternal morbidity and mortality as well as providing justification for further and routine systemic screening for the abuse present during pregnancy. (Salihu, 2004)

In a separate study that was conducted by University Texas School of Public health the cross-sectional study investigates the associations between physical violence and/or emotional abuse and the pregnancy outcomes including the factors of low birth weight, pre-term delivery as well as perinatal death.”(Coker, 2004) 755 women who had reported a live birth or late fetal death were surveyed. Of those 14.7% gave indication that an intimate partner was violent or abusive to them while they were in the course of pregnancy equaling 274 of 1862 pregnancies. Findings were that abuse during pregnancy was associated in a significant way with increased risks of perinatal death among live births with low birth-weight both term and pre-term. Finally that frequency of abuse being accelerated was associated with perinatal death and low birth weight in newborn infants. (Coker, et al., 2004)

In another study entitled “Effects of Domestic Violence on Pre-term Birth and Low Birth Weight” stated is the recognition that domestic violence has the potential to be a “modifiable risk factor” in adverse outcomes of pregnancy. The study was conducted in or to evaluate that existing relationship between the abuses suffered in a pregnancy or within the last year and low weight and pre-term birth.” Methods used in the study were those of a screening tool for the assessment of emotional, physical and/or sexual abuse. Injury due to physical abuse. There were 3,013 reports of abuse in the index pregnancy and of these women emotional abuse was reported by 26.6% with 18.87% reporting physical abuse. In the past 12 months while 10.3% of the women stated they had been beaten, bruised, threatened with a weapon or being permanently injured. Conclusions of the study state that indications are that injuries due to abuse of an emotional greatly enhanced the chances of low birth-weight as well as re were enhanced greatly by 5.9% of the women. (Neggers, et al., 2004)

In the study entitled, “Health Behaviors as Mediators for the Effect of Partner Abuse on Infant birth-weight” stated is that there is a link, which has been identified by low birth-weight and abuse of the mother during the course of pregnancy. Furthermore women who are abused tend to report more instances of substance abuse, poor nutrition, and as well as demographic risks for factors for poor outcomes of birth. Factors identified in this subject are inclusive of recent and/or psychological abuse as to the effects on birth-weight in this sample. Conclusions state it is warranted to perform prospective studies in relation to nursing care and in improvement of bit outcomes as well as in the promotion of maternal well being. (Kearney, et al., 2004)

The study entitled “Physical, Psychological, Emotional and Sexual Violence during Pregnancy as a Reproductive-Risk Predictor of low Birth-weight in Costa Rica” states that the objective of the study was to make determination as to the prevalent nature of physical, psychological, emotional, and sexual violence experience during the course of a pregnancy as to the links that violence and low birth-weight have. In this study 118 women who delivered between September 1998 and November 1998 were examined through a questionnaire as to the violence suffered during their pregnancy. A validated questionnaire with closed questions, as well as a multiple linear regression model was used in adjusting the average (weights of the newborns in alignment with the mother’s characteristics in terms of age, years of schooling, marital status, desire for the pregnancy, habits of smoking, and drinking alcohol, number of prior pregnancies or childbirths as well as birth interval, physical stature, total weight increases during pregnancy and gestational illnesses. Stated is that “a logistic regression model was used to measure the direct effect of violence on low birth-weight.” Results indicate the need for investigations of this subject more thoroughly and implications for training of health workers in the area of violence to women as being that of a ‘reproductive-risk’ factor as well as formation of groups on this subject in development of” specialized protocols for the early identification of pregnant women subject to violence.” (Nunez-Rivas, et al., 2003)

2003 study in relation to the impact of police-reported intimate partner violence during the course of pregnancy. The method of the study was through conduction of a population-based, retrospective, cohort study in Seattle, Washington through use of Seattle police data and Washington State birth certificate files for the period of January 1995 through September 1999. The conclusion of this study is stated to be a ‘critical need’ for identification of pregnancy among women with reported incidents of abuse. This study concluded that Increased risks of birth outcomes are associated with partner violence during pregnancy. The need is one which is critical in the provisions of “women health, social services. (Lipsky, et al., 2003) study performed by Altarac and Strobino entitled “Abuse During Pregnancy and Stress Because of Abuse During Pregnancy and Birth-weight the stated objective is the determination of whether there is an independent association between abuse of a physical nature during pregnancy and birth-weight after having adjusted for behavioral, psychosocial, demographic, and medical variables. The method of research was through a cross-sectional study of 808 low-income women above the age of 18 years of age and who had given birth to single infants from pregnancies of 20 weeks gestation or longer. The results of the study are that Physical abuse during the pregnancy was NOT associated with low birth weight. This study concludes that, ” Stress because of abuse during pregnancy was associated with both LBW and lower and mean birth-weight after adjusting for behavioral, psychosocial, demographic, and medical variables.” (Altarac & Strobino, 2002)

Focus of assessment as to abuse experienced during the course of a pregnancy increases the low birth-weight possibilities for infants. Through methodology of random selection among 101 newborns all born the same day in a hospital in a -base case-control study in Nicaragua and the newborns’ birth rate being under 2500 g. Stated in the work is that the:

Anthropometry of the newborns was done immediately after birth and background information relative to abuse and experiences of violence as well as “potential confounders were obtained through private interviews with the mothers of the babies. Crude and adjusted odds ratios and population -attributable proportions were calculated for exposure.” (Valladares E. et al., 2002)

The study utilized “multivariate logistic regression analysis to partner abuse in relation to LBW or low-birth weight. Reported results of this study were that “Seventy-five percent of LBW “newborns were small for gestational age and 40% were pre-term. Physical intimate partner abuse had been experienced by 22% of the mothers of LBW infants. Stated in the case study entitled “Battering During Pregnancy: A Role for Physicians” is that the battering or physical abuse of pregnant women by their husband or partners is a serious problem as well as a major public health problem. (Saltzman, 1990). Furthermore stated by Saltzman, 1990 is that “battering during pregnancy affected 4 to 8% of pregnant women. Thus the Standardized protocols established by the American College of Obstetricians and Gynecologists to assist hospital personnel in identification of battered women. Battering is stated to be associated with adverse pregnancy outcomes such as “low birth-weight infants, handicapped children secondary to trauma received during antenatal period and miscarriage.”

Intervention strategies include the following: Physically abused women are provided information about women’s rights, available community resources, and strategies dealing with abusive relationships; and Community prevention programs. In a separate study in relation to the prevalence and complications of physical violence to pregnant women the stated objective was the assessment of the incidence of self-reported physical violence in pregnancy as well as the description of the association of that physical violence with foeto-maternal complications and birth outcome.

Pregnant women numbering 75,100 women over a three-year period were assessed for self-reported physical violence. The results of the study were that “the prevalence of physical violence was 21%. Those most likely to be hospitalized ante-natally for material complication due to kicks or blows on the pregnant abdomen, abruption-placenta, pre-term labor and kidney infections were those women reporting and experiencing physical violence. A positive association exists between physical violence during pregnancy and cesarean section, abruption-placenta, fetal distress, and pre-maturity. Conclusion of the study states that “physical violence during pregnancy is common and is associated with adverse materno-fetal outcome.”(Kramek, et al., 2001)

In the work entitled “Maternal Experiences of Racism and Violence as Predictors of Pre-term Birth: Rationale and Study Design” states that Women who have been the targets of racism or personal violence may be at particularly high risk of pre-term delivery” (Rich-Edwards, 2001) the stated aims of this study are stated to be the examination of the extent to which: 1) Maternal experiences of racism of violence in childhood, adulthood, or pregnancy are associated with the risk of pre-term birth; and 3) CRH levels are associated with past and current maternal experiences of racism or violence. We have begun to examine these questions among women enrolled in Project Viva, a Boston-based longitudinal study of 6000 pregnant women and their children. The study states that the risk of pre-term delivery due to the raising levels of placental corticotropic-releasing hormone (CRH) due to chronic psychological stress. (Rich-Edwards, 2001) study in relation to whether physical assault is “independently associated with an adverse obstetric outcome compared the perinatal outcomes of 32 indigent women who were physically abused during pregnancy with the outcomes of 352 control subjects who stated that they had never been assaulted. Classifications of patients into the appropriate category were performed to estimate the relative risk of adverse outcome while adjusting for confounders. The results of the study found that women assaulted during pregnancy were two times as likely to have pre-term labor as compared to those who had not been assaulted.

Furthermore, “crude odds ratios” revealed a twofold-increased risk of chorioamnionitis in assault victims. There was no noticeable difference between abused and non-abused women noted in the prevalence of pre-term delivery, pregnancy-induced hypertension, cesarean section, meconium staining, infant birth weight, Apgar scores, intrauterine growth retardation, fetal distress, fetal death, neonatal seizures, sepsis, or admission to the intensive care unit. The study concluded that physical assault screening, particularly for ongoing assault should be adopted into routine prenatal care in identifying women at risk of complications during pregnancy. (Berenson, et al., 1994)

Birth Outcomes and Maternal Morbidity in Abused Pregnant Women with Public vs. Private Health Insurance” (Kearney, et al., 2003) writes that the purpose in the conducted study was the comparison of the effects of recent intimate partner abuse on maternal and infant health in publicly vs. privately insured pregnant women. The study was an exploratory analysis involving 13 prenatal care clinics in 13 Massachusetts locations in relation to medical records of 2,052 pregnant women who were screened during the course of pregnancy for domestic violence through use of a Abuse Assessment Screening test. Following delivery, the prenatal and birth outcome data as well as abuse screening data were extracted from the women’s medical records by project staff. Odd ratios were used in the comparison of maternal and infant health indicators in abused and non-abused women. The data in relation to women with public insurance was examined separately from those with private insurance coverage using logistic regression to control for low education and single marital status while examining the odds of adverse sample, as whole, recently abused women were more likely to:

Be Publicly insured;

Unmarried,

Have less than 12 years of formal education,

Abuse increased the odds of low infant Apgar scores

Poor nutrition,

Hyperemesis,

Hypertension; and Substance abuse in publicly insured women.

Abuse increased the odds of poor nutrition and bleeding during pregnancy for publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for women with private insurance. The study concluded that the correlations of abuse in publicly and privately insured women may be important for the clinicians who care for these women. And that screening for abuse and provision of other services related to abuse screening are indicated for women who are pregnant.

A study conducted in 1999 found that certain behaviors among pregnant women as well as experiences of these women may result in adverse reproductive outcomes such as birth-weight, infant morbidity and mortality in maternal. (Colley, 1999) There is a need, relates this study to: “monitor trends over time, to increase understanding of maternal behaviors and experiences and how these relate to outcomes for the mother and infants as well as for development and assessment of programs and policies that have been designed with the intent of reduction of adverse outcomes of women who are pregnant and their infants.

The Pregnancy Risk Assessment Monitoring Surveillance System was designed for the collection of information on maternal behaviors that were reported by the mothers in terms of violence experiences that occurred during the pregnancy. The method used was through a 14-page questionnaire wherein the responses are collected over the calendar year and then combined with birth certificate information and then examined and assigned specific evidential weight representing all mothers who gave live birth to an infant in the state. The data examined was collected from 13 states. The results are stated to be that: “The prevalence of unintended pregnancy resulting in life-born infants ranged from 33.9% to 50.0% in those 13 states during the period from 1993 to 11997.

The information specific to domestic abuse during pregnancy by an intimate partner ranged from 2.4% to 5.6% with more women lacking a high school education as well as those who were Medicaid recipients reporting abuse. The interpretation assigned to the findings indicates that many women are reporting abuse during their pregnancy. There were several groups of women that were specifically noted to be more likely to report these behaviors or abuse and those were the women who were “younger, less educated, and Medicaid recipients. These findings are noted to be useful for the purpose of state agency monitoring of trends in relation to behaviors and experiences and as well for utilization in the designing of public health programs and policies. ((Colley, 1999)

In another study that addresses physical abuse to pregnant women and the links with prenatal low birth-weight stated is that the study was conducted for the purpose of examination of whether physical abuse to pregnant women results in low birthrate infants. The design was that of a case-control study and was conducted at the Department of Gynecology and Obstetrics at University Hospital of Trondheim in Norway. The study was one in which 86 women who gave birth to a low birth-weight infant were studied through an in-depth interview which was given either in the maternity ward after birth or one year following delivery. Findings were that 17% of the women had experienced abuse inflicted by a partner and another 7% reported abuse at some time other than during their pregnancy. With only one reporting abuse during the pregnancy. It was found that more mothers of low birth-weight infants were abused, or 20% compared with the controls future of 15%. Important is the fact that abused women were much more likely not be unemployed, to smoke, and to consume alcohol during the pregnancy with no differences in education, marital status, income, mean age at delivery, or mean pre-pregnancy weights.” Abuse was not found to be linked to low birth-weight in this study and remained low a with findings that the association between abuse and low birth-weight in infants was not conclusive. (Cokkinides, 1999) in the work entitled “Abuse During Pregnancy: Effects on Maternal Complications and Birth Weight in Adult and Teenage Women” it is stated that: “One in five teens and one in six adult women experience (d) abuse during pregnancy and that abuse is related to LBW (low birth-weight) in infants and late entry into prenatal care. Documentation of abuse may be done through a late entry into prenatal care as well a short abuse assessment screening and then implementations of intervention will be imitated at that time. The method in this study was screening for abuse among African-American, Hispanic, and white urban female residents were screened for abuse during the first appointment and thereafter during the second and third trimester of their pregnancy. Findings were the abused teens, and indeed women overall and in general both the teens and adults were more likely than were non-abused women to wait until the third trimester to enter prenatal care. Conclusions of the study were as initially stated that one in five teens and one in six adult women experienced abuse during their pregnancy. Further noted is the abuse is related to low birth-weight infants as well as late entry to prenatal care. Godfrey & Barker (2001) conducted a study that showed that “low birthweight is now know to be associated with increased rates of coronary heart disease and the related disorders of stroke, hypertension, and non-insulin dependent diabetes. These associations have been extensively replicated in studies and are not resulting from the effect of any confounding variables but extend across the range of what is considered normal in terms of birthweight and “depend on lower birthweights in relation to the duration of gestation rather than the effects of premature birth.” (Godfrey & Barker, 2001) it is believed that the associations are due to ‘programming’, “whereby a stimulus or insult at a critical sensitive period of early lives has permanent effects on structure, physiology and metabolism.” (Godfrey & Barker, 2001) Adaptations are believed to be invoked when the materno-placental nutrient supply fails to match the fetal nutrient demand are thought to be that which ‘programs the fetus’. (Godfrey & Barker, 2001) There are strong indications to the importance of the composition of the maternal body as well as balance in the diet during pregnancy in relation to low birthweight and disease tendency.

Another interesting factor that a study conducted in 2000 (Godfrey & Barker, 2001) in relation to the impact of birthweight on the racial disparity in end-stage renal disease noted is that “Blacks have a high rate of end-stage renal disease (ESRD) as well as low birthweight. In fact, both factors are more prevalent among black individuals than among white individuals. In comparisons of birthweights among 858 black and 372 white patients with 4260 controls matched in relation to age, sex, and race. Findings were that among black patients with ESRD birthweight was lower in blacks than in whites. LBW was more common in black than white individuals with ESRD with the risk for ESRD linked with LBW being greater for blacks than whites. The study concluded that LBW was a contributing factor to the prevalence of ESRD in blacks more so than among those who are white; LBW may be a contributing factor to a greater risk for ESRD in black individuals than in white individuals; and this preliminary study of the subject indicates that further research is needed due to the fact that the links between LBW and ESRD could “be instructive in understanding the racial health disparities. (Godfrey & Barker, 2001) in a study of child abuse, and its’ relationship to birthweight, Apgar scores and developmental settings Goldson, et al., (1978) with 52 abused and 23 non-abused children who were all from a low socioeconomic group which were studied in a focus on “birthweight, five-minute Apgar scores, and developmental quotients an association was found between low Apgar scores, low birthweight and poor performance on developmental testing, and of child abuse” (Goldson, et al., 1978) Findings also show that children with normal birthweights those who are abused and develop subsequent poor performance may be related to the socioeconomic status and the” characteristics the child brings to the parent-child relationship and to the abusive environment.” (Goldson, et al., 1978)

Findings of This Study

In seeking determination of the prevalence of incidents of physical abuse and oftentimes emotional/psychological/sexual and other forms of accompanying abuse study is vital in dealing with the low birth-weight infant and the health implications assigned to low birth-weight in terms of the future health aspects that accompany being a LBW individual. The specific responsibility and one of the most vital factors is the critical assessment of the nurse, nurse practitioner and the treating physician of the pregnant women who is a victim of abuse. The pursuit of conducting a study or monitoring abuse of women cannot be a conclusive study if the nurse specifically does not critically monitor patients that the data applies to in terms of abuse such as socio-economic factors, educational attainment level, age, and other indicators not as readily evident. It is the nurse who assess the patient / expectant mother, and the nurse who will ultimately impact the lives of the mother and the infant either positively or negligently depending on the focus and perceptional ability of the nurse, nursing practitioner, or personal physician. The difficulty appears to lie within the structure of the medical system, which the most needy of patients as to age, risks factors and nutritional imbalances are perpetuated among due to low socioeconomic status on a societal level.

Recommendations

Further research in relation to domestic abuse, specifically as to the detection of, the treatment and prevention of abuse to women and infants during pregnancy is a vital matter particularly in light of the implications that low birthweight may contribute to a lifetime of health problems in individuals and that the problems may be of various types of medical complications and the development of disease in the LBW individual.

Bibliography

Krieger N. & Smith, G.(2004) Bodies County and body counts: Epidemiology and embodying inequality. Epidemiological Review Journal 200:26:92-103

Coker, AL et al. (2004) Partner Violence During Pregnancy and Risk of Adverse Pregnancy Outcomes. Pediatrics Perinatal Epidemiology 2004 Jul; 18 (4): 260-9. University of Texas School of Public Health.

Bohn, D.K. et al. (2004) Influences of Income, Education, Age, and Ethnicity on Physical Abuse before and During Pregnancy. Journal Obstetrics Gynecology Neonatal Nursing 2004 Sep-Oct; 33(5): 561-71.

Salihu, Boy a. (2004) Intimate Partner Violence and Birth Outcomes: A Systematic Review International Journal of Fertility Women’s Medicine 2004 Jul-Aug; 49(4): 159-64. Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Alabama.

Neggers, Y. et al., (2004) Effects of Domestic Violence on Pre-term Birth and Low Birth Weight. Acta Obstet Gynecol Scand May; 83(5):455-60. Dept Obstetrics and Gynecology and Human Nutrition.

Kearney, MH et al. (2004) Health Behaviors as Mediators for the Effect of Partner Abuse on Infant Birth Weight. Nurs Res 2004 Jan-Feb; 53(1):36-45.

Nunez-Rivas, HP. Et al (2003) Psychological, emotional, and sexual violence during pregnancy as a Reproductive-Risk Predictor of low Birth-weight in Costa Rica Rev Panam Publica 2004 Aug; 14(2): 75-83.

Lipsky S. et al. (2003) Impact of Police-Reported Intimate Partner Violence During Pregnancy on Birth Outcomes. Obstetrics & Gynecology 2003 Sep;102(3):557-64.

Altarac, M. & Strobino, D. (2002) Abuse during Pregnancy and Stress Because of abuse during Pregnancy and Birthweight Journal American Medical Womens Association, 2002 Fall;57(4):208-14. John Hopkins University School of Hygeine and Public Health.

Saltzman, LE (1990) Battering During Pregnancy: A Role for Physicians. Atlanta Medical Journal 1990 Fall; 64(3): 45-8

Rich-Edwards, J. (2001) Maternal Experiences of Racism and Violence as Predictors of Pre-term Birth Rationale and Study Design. Pediatrics Perinatal Epidemiology. 2001 Jul; 15 Suppl 2:124-35.

Berensen, AB et al. (1994) Perinatal Morbidity Associated With Violence Experienced by Pregnant Women. American Obstetrics and Gynecology 1995 May: 172(5): 1644-5.

Cokkinides, VE et al., (1999) Physical Vioence During Pregnancy: Maternal Complications and Birth Outcomes:” Obstetrics Gynecology. 1999 May; 93 (5 Pt I):661-6. Instititue for Families in Society. Department of Edemiologyl and Biostatistics School of Public Health, Unvieristy of South Carolina.Becker

Patricia & Grunwald, Patricia (2000) “Contextual Dynamics of Ethical Decision Making in the NICU” Journal of Perinatal & Neonatal Nursing. 14(2):58-72, September 2000. 2000 by Aspen Publishers, Inc. www.jpnnjournal.com/pt/re/jpnn/abstract.00005237- http://www.jpnnjournal.com/pt/re/jpnn/abstract.00005237- 200.htm;jsessionid=C516H88b31DOttYT1F2 44WI3 6ot3DRc6y rCnPwFPsICRSlu9X985!-111031944!-949856032!9001!-1

LBW and Abuse

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• Any deadline
• Skilled, Experienced Native English Writers
• Subject-relevant academic writer
• Adherence to paper instructions
• Ability to tackle bulk assignments
• Reasonable prices
• 24/7 Customer Support
• Get superb grades consistently

Online Academic Help With Different Subjects

Literature

Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.

Finance

Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!

Psychology

While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.

Engineering

Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.

Nursing

In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.

Sociology

Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.

Business

We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!

Statistics

We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.

Law

Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

• When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
• We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

• The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
• We will have a different writer write the paper from scratch.
• Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY!!!