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The purpose of this retrospective study was to determine the feasibility of using the end-to-end anastomosis (EEA) stapling device transrectally for managing distal colonic disease in clinical veterinary cases. Ten animals met the criteria of having distal colonic or rectal resection and anastomosis with the EEA stapling device. The only complications seen after discharge from the hospital were colonic stricture at the anastomosis site in two animals and transient colitis in two animals. The stapled anastomosis has good success when properly applied, and the incidences of stricture formation, leakage, and other potential complications can be kept to a minimum.

Background: Exclusive breastfeeding in the hospital is predictive of postpartum breastfeeding patterns. Although breastfeeding rates are similar for Hispanic and white women in the United States, evidence shows that more acculturated Hispanic mothers have lower rates of breastfeeding than those less acculturated. To date, no studies have examined whether this pattern exists in the immediate postpartum period., Methods: We used medical record data from 1,635 participants in the San Diego Birth Center Study, a cohort study of low-income, low-risk pregnant women. We applied a proxy measure of acculturation to categorize participants into a low acculturation (Hispanic, Spanish speaking [n = 951]); high acculturation (Hispanic, English speaking [n = 408]); or white, English speaking (n = 276) group. Logistic regression was used to examine the relationship between acculturation and exclusive breastfeeding at the time of hospital discharge while controlling for potential confounders., Results: Exclusive breastfeeding rates were significantly different across acculturation groups (p < 0.01). After adjusting for available confounding variables, women in the low acculturation group were more likely to breastfeed exclusively at discharge than those in the high acculturation group (OR = 1.36, 95% CI = 1.01-1.84). Women in the white, English-speaking group also had greater odds of exclusive breastfeeding when compared with those in the high acculturation group (OR = 1.49, 95% CI = 1.02-2.19)., Conclusions: This cross-sectional study provides evidence of a correlation between acculturation and immediate postpartum breastfeeding, where higher acculturation is associated with lower odds of exclusive breastfeeding. Additional research is needed to understand how the process of acculturation may affect short- and long-term breastfeeding behavior.

Objectives: Examine the association of acculturation and cesarean section after adjusting for clinical and non-clinical factors that could influence clinical discretion in performing the surgery., Methods: A sample of 2102 low-risk, low-income primarily Mexican Latinas in San Diego County was divided into two groups: primiparas and multiparas. For each parity group, logistic regression was used to assess the association of acculturation and cesarean section., Results: Among multiparous Latinas, the risk of cesarean section for highly acculturated women exceeded the risk for the less-acculturated women, but the result was reverse for primiparous women. The adjusted relative odds of cesarean section were twice as high [OR 2.1, 95%CI 1.1-4.1] for multiparous US-born Latinas relative to multiparous Spanish-speaking women born in Mexico. While for primiparous women this same comparison showed US-born Latinas to be approximately half as likely to have a cesarean delivery [OR 0.4, 95%CI 0.2-0.7]., Conclusions: In order to reduce the chances of unnecessary cesarean sections among Latinas, the role of acculturation in women who have and have not already given birth needs to be investigated further.

Objective: We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care., Methods: We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care., Results: Major antepartum (adjusted risk difference [RD] = -0.5%; 95% confidence interval [CI] = -2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = -2.4, 4.0), and neonatal (adjusted RD = -1.8%; 95% CI = -3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = -1.3%; 95% CI = -3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = -35.7%; 95% CI = -39.5, -31.8)., Conclusions: For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.

The BirthPlace program in San Diego, California, is an example of a successfully "mainstreamed" alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse-midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public-funded, Hispanic population, with certified nurse-midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family-centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost-effectiveness while ensuring family-centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever-changing health care system, balancing these issues will remain a constant challenge as we reshape our maternity care services.