Changes in Maternal Characteristics—A Critique of the Research

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Recently, it is apparent that an increasing number of women attending the prenatal classes at the community health unit where I work are over 30 years of age. Unfortunately, it also appears that many of these women are struggling with their commitment to their career and their desire to remain at home following the birth of their child. Based on these assessments, it is probably beneficial to conduct a class to address this concern and, to seek evidence to support these observations a search of the literature was undertaken. This literature search, related to the demographics of pregnant women, resulted in several studies that are useful for the purpose of addressing the concerns for teaching prenatal classes. In particular, one article that was located was particularly valuable. This study (Fell et al., 2005) investigated changes in maternal characteristics in Nova Scotia, Canada from 1988 to 2001.

This document seeks to review the Fell et al. (2005) article with the goal of determining if it, or similar articles, could be used to contribute to a more productive class outline to help these older mothers deal with the issues they may (and in many cases, already are) face. This critique includes identifying the type of study Fell and associates conducted; whether the findings reported are consistent with information/knowledge that I have as a nurse; whether the reported relationships make sense (and how significant they are); if it is feasible to incorporate the findings of this study into the community class I am planning or recommend this study to others; and, finally, to suggest further research question(s) I would develop in relation to this study and/or my other observations.

The study under review (Fell et al, 2005) was quantitative and designed to evaluate data collected from a population-based perinatal database. The study set out to examine data related to maternal age, parity, tobacco use, pre-pregnancy weight, delivery weight and pregnancy weight gain during a 14 year period from 1988 and 2001 (2005, p. 234). There was no small sample size involved with the study, since the data collected included every birth (live and stillborn) during the targeted period by female residents of Nova Scotia, Canada. The data used in the study was collected from the population-based Nova Scotia Atlee Perinatal Database (NSAPD), which started collecting data related to births in Nova Scotia in 1988. The NSAPD receives its data from records complied at hospitals across the province. Therefore, the database used in the Fell et al. study was very exhaustive and also included additional information on the mothers as well as the details of labor and delivery. According to Fell et al. (2005), previous studies have reviewed the database and found it to be reliable and valid.

Regarding the specific results, the study found a statistically significant increase in deliveries by mothers 35 years and older, as well as an increase in the mean age of pregnant women from just over 27 years (in 1988) to just under 29 years (in 2001). Specifically, while only seven percent of pregnancies in 1988 were by women over 35 years, by 2001 that percentage increased to nearly 13 percent. This represents an increase of 84 percent over that time, which is—as mentioned—statistically significant (p<0.0001). Interestingly, there was also a decrease in births among women in two other demographic groups—20-29 years and under 20 years. Finally, according to the data, the largest increase (demographically) in women who had never had a child occurred in the over 35 year group—increasing by 30 percent (Fell et al., 2005). The study also included a great deal of data and analysis related to other factors that are important to mothers and births (e.g., smoking and weight), but none of these are significant for the purposes of this review.

Fell et al. (2005) reported on several reasons why women in Nova Scotia may be delaying the birth of a first child, and their findings are similar to what is reported in many other industrialized countries. For example, factors such as seeking and advanced education, trying to concentrate on a career, or various economic reasons seem to contribute to a decision to delay having a family for many women. While the most births in Nova Scotia were by women in the 20-34 age group, the significant increase in births in older women (>35 years), as commented on by Fell and associates, requires the attention of clinicians and other health care experts. There are, of course, higher risks of complications in older pregnant women, in addition to possible psychological concerns.

One of the studies cited by Fell et al. (2005) examined the perinatal health of Canadian women based on statistics collected from the year 2000 (Health Canada, 2003, cited in Sauve, Molnar-Szakacs & McCourt, 2004). That report also reported similar results as Fell et al. regarding a significant increase in births among women in the over-35 age group (in this case, 35-39). In particular, from a sample study, births among the 30-39 year age group increased from 25.6 to 30.6 percent, while births among women over 40 years increased from 3.5 to 5.1 percent. While these increases are not as large as those reported by Fell and colleagues, they still indicate a trend similar to what that study found.

Additionally, a study conducted in the United States (Maryland) (Martin, Hamilton, Ventura, Menacker, & Park, 2002) also found a significant increase in births among women in older age groups than previously observed. Specifically, that study noted an increase of three to five percent in women in their late twenties and early thirties, as well as women forty and fifty years old. Finally, Fell et al. (2005 cited a study conducted by Astolfi and Zonta (2002) which also reported an increase in births among older mothers, particularly older than 35 years. In fact, that investigation projected that, by the year 2025, approximately one quarter of births will involve women in that older age demographic. Thus, these three studies supported the findings of Fell and colleagues, as well as what I have observed personally in the classes I have conducted in recent months.

In all of these studies, especially in Fell et al. (2005), the relationships between the data analyzed and the conclusions make perfect sense. There is clearly a trend toward women waiting until later in life to give birth, and the study’s analysis indicated strong evidence that this trend is solidly in place and is expected to continue for the foreseeable future. This is certainly what I have observed, so I have no reason to doubt the results. In fact, studies such as this reinforce my motivation for providing a higher level of prenatal class instruction for such women. The strength of the Fell et al. study is primarily the large database that was used, especially the fact that it was population-based. There is little doubt that the results can be generalized to other populations, such as the entire nation of Canada or other developed countries. As mentioned earlier, according to Fell et al., the increase of women over 35 years of age delivering a child was 84 percent over the time considered in the study, which is—as mentioned—statistically significant (p<0.0001).

The literature reviewed—especially the Fell et al. (2005) article—makes it clear that the trend of women waiting longer to have a baby is likely to continue. Three other studies that reported those same results were also included here to support this conclusion. However, there are additional questions that I believe are beneficial to find answers to for such research to truly benefit the class I am planning on conducting. Based on my observations as a nurse directing prenatal classes, it is something more than just the age of these pregnant women that interests me and that I found important. Specifically, as mentioned in the introduction of this review, these women are struggling with their commitment to their career and their desire to remain at home following the birth of their child. Neither the Fell et al. (2005) article, nor the articles cited in that study, addressed these issues specifically. Therefore, moving forward, it is important to develop additional research questions that investigate the reasons behind that behavior.

This document reviewed the Fell et al. (2005) article with the goal of determining if it, or similar articles, could be used to contribute to a more productive class outline to help these older mothers deal with the issues they may (and in many cases, already are) face. Based on this, I propose additional steps toward making this future class successful. Specifically, I would like to find the answers to these questions (or something similar): 1) How do older mothers (over 30 years) feel about their careers?; 2) Do older mothers (over 30 years) think they can have a career and a family?; 3) Are mothers over 30 years old more likely to decide to stay home to raise their child?; 4) Would older mothers (over 30 years) benefit from a prenatal class addressing issues important to older mothers?; 5) What type of information could help older mothers (over 30 years)? 6) Are plans in place to assist with emotional well-being after birth?  I believe research based on these questions could greatly benefit not only my future classes but also others who are concerned with this same issue.

Clearly, the information in the Fell et al. (2005) study is worth including in any planned research that will be developed for my future classes. Additionally, the information and analysis contained in that article confirms what I already know in my capacity as a nurse. Since it is clear that many women are deciding to wait later in life to become mothers, it is vital that the healthcare providers, including nurses, are equipped to assist them with this decision. This brief review has shown that, while the trend is recognized, dealing with the ramifications of it still needs to be addressed. I believe I am now better equipped to conduct these classes, but want to continue adding to my knowledge on the subject.

References

Astolfi, P., & Zonta, L.A. (2002). Delayed maternity and risk at delivery. Pediatric andPerinatal Epidemiology 16, 67-72.

Fell, D. B. et al. (2005). Changes in maternal characteristics in Nova Scotia, Canada from 1988to 2001. Canadian Journal of Public Health 96(3), 234-238.

Martin, J. A., Hamilton, B. E., Ventura , S. J., Menacker, F., & Park, M. M. (2002). Births: Final data for 2000. National Vital Statistics Reports 50(5). Hyattsville, Maryland: National Center for Health Statistics.

Sauve, R. S., Molnar-Szakacs, H., & McCourt, C. (2004). Highlights of the Canadian perinatalhealth report 2003. Pediatric Child Health 9(4), 225-227.