The cost of vaginal birth at home,in a birth centre or in a hospital setting in New South Wales: A micro-costing study

BackgroundWomen want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings.AimThe aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales.MethodsA micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy.FindingsThe median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings.ConclusionIn this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.     

A retrospective comparison of water birth and conventional vaginal birth among women deemed to be low risk in a secondary level hospital in Australia

BackgroundWater birth involves the complete birth of the baby under warm water. There is a lack of consensus regarding the safety of water birth.AimThis study aimed to describe the maternal and neonatal outcomes associated with water birth among labouring women deemed at low risk for obstetric complications and compare these outcomes against women of similar risk who had a standard land birth.MethodA retrospective audit and comparison of women giving birth in water with a matched cohort who birthed on land at Bankstown hospital over a 10 year period (2000–2009).ResultsIn total 438 childbearing women were selected for this study (N = 219 in each arm). Primigravida women represented 42% of the study population. There was no significant difference in mean duration of both first and second stages of labour or postpartum blood loss between the two birth groups. There were no episiotomies performed in the water birth arm which was significantly different to the comparison group (N = 33, p < 0.001). There were more babies in the water birth group with an Apgar score of 7 or less at 1 min (compared to land births). However, at 5 min there was no difference in Apgar scores between the groups. Three of eight special care nursery admissions in the water birth group were related to feeding difficulties.ConclusionThis is the largest study on water birth in an Australian setting. Despite the limitations of a retrospective audit the findings make a contribution to the growing body of knowledge on water birth.     

Experience,perceptions and attitudes of parents who planned home birth in Spain: A qualitative study

BackgroundA woman’s home birth and postpartum experience can have a major impact on her baby’s, partner’s and family’s well being. It is a life-altering event that can help improve or worsen women’s self-esteem and self-confidence.AimThe aim of this study was to describe and understand the experiences, perceptions and attitudes of parents who planned a home birth in Spain.MethodsA qualitative study was conducted based on Gadamer’s hermeneutic phenomenology. Two main methods were used for data collection; narratives and individual in-depth interviews with 14 mothers and 8 fathers who had planned a home birth in the last year. Inductive analysis was used to find themes based on the data obtained.FindingsSix main themes emerged from the data analysis: (1) in search of a natural and personalised birth, (2) breaking with social pressures, (3) experience of home birth for the mother, (4) role of the father in home birth, (5) how does the father experience home birth?, (6) home birth is not available to all mothers and fathers.ConclusionFor the mothers and fathers in this study the home birth experience fulfilled their previous expectations of an intimate and natural moment, making it a highly satisfying experience for both. However, parents expressed experiencing negative feelings such as fear and worry about complications and labor pain. According to our research society in general and public health professionals in particular issue numerous criticisms and value judgments towards mothers and fathers who opt for a home birth in our country. In addition, the study shows the economic and cultural inequalities in access to home birth in Spain.     

The role,practice and training of unregulated birth workers in Australia: A mixed methods study

Background

In Australia, the provision of homebirth services by unregulated birthworkers (doulas, ex-registered midwives, traditional midwives and lay workers) has increased. Accessing a homebirth with a registered midwife via mainstream services is limited. Concern is growing that new legislation aimed at prohibiting unregulated birthworkers practice may result in homebirth going underground.

The imbalance of sex ratio at birth,and its causes and countermeasures in China

This news brief focuses on the sex ratio at birth (SRB) in China, its causes, and remedial efforts. A SRB has been evident since the 1980s. The SRB increased from 108.48 male/100 female births to 116.30 male/100 female births during 1981-94. A normal SRB in China during 1940-94 would have been 107 male/100 female births. The SRB rose every year after 1985, with the exception of 1988. Male births increased, while female births decreased. SRB declined with age. The sex ratio in 1991, was 112.3 for children aged 0-4 years, 108.38 for children aged 5-9 years, and 106.56 for children aged 10-14 years. SRB values were higher in more populous provinces and lower in less populous provinces. SRB values were lower in northwestern China than in southeastern China. SRB values of minorities were lower than the Han ethnic group. A high SRB will increase the proportion single in later years. In 1990, 7.86 million people aged 30-40 years were single, of whom 94.32% were males. The SRB is caused by second, third, or higher birth orders. In 1993, sex ratios were 105.60 for first births, 130.22 for second births, and 126.12 for third births. The imbalance is attributed to a preference for sons as inheritors of blood ties and as family physical laborers. The imbalance is due to strict birth control and people's refusal to report female births. There is a need to increase awareness of the consequences, to increase old-age pensions and social security, to increase women's status, and to prohibit sex determination of a fetus. The family structure should emphasize its consumptive capacity rather than its function as a production unit.     

Fear of birth: Prevalence,counselling and method of birth at five obstetrical units in Norway

BackgroundThere is increasing evidence that fear of birth can have long-term effects on the childbearing woman and the method of birth.AimTo examine differences between five hospitals in Norway in the occurrence of fear of birth, counselling received and method of birth.MethodSource data was from the Norwegian cohort of the Bidens study and retrieved through a questionnaire and electronic patient records from five different hospitals in Oslo, Drammen, Tromsø, Ålesund and Trondheim, which included 2145 women. The Wijma Delivery Expectancy Questionnaire measured fear of birth, and a cut-off of ≥85 was used to define fear of birth.ResultsIn total, 12% of the women reported fear of birth, with no significant differences between the different units. A total of 8.7% received counselling according to hospital obstetrical records, varying significantly from 5.7% in Drammen to 12.7% in Oslo. Only 24.9% of the women with fear of birth had counselling at their hospital. All the units provided counselling for women with fear, but the content varied. Overarching aims included helping women develop coping strategies like writing a birth plan and clearing up issues regarding prior births. A secondary objective was to prevent unnecessary caesarean section. Both primi- and multiparous women who reported fear of birth had a twofold increased risk of a planned caesarean section.ConclusionThere were no differences between five Norwegian hospitals regarding the occurrence of fear of birth. Counselling methods, resources, level of commitment and the number of women who received counselling varied; thus, hospital practices differed.     

民国时期西北地区人口的疾病与死亡--以新疆、甘肃和陕西为例

民国时期影响西北地区人口发展的主要原因是当时一些常见的急性传染病与产妇、婴幼儿疾病，防治这些疾病也成为２０世纪３０年代之后公共卫生的首要任务。民国时期的公共卫生虽然使烈性传染病对人口死亡的影响较以前减弱，但并未改变其他急性传染病和产妇、婴幼儿疾病对人口发展所造成的影响。１９４９年以后，西北地区才发生流行病学转型和人口死亡结构的根本转变。     

Writing the names: Marriage style,living arrangements,and first birth interval in a Nepali society

Using data from a Nepali population, this analysis argues that marriage style and postmarital living arrangements affect coital frequency to produce variations in the timing of first birth after marriage. Event history analysis of the first birth interval for 149 women suggests that women’s autonomy in marriage decisions and marriage to cross-cousins accelerate the pace of entry into first birth. Extended-household residence with reduced natal kin contact, on the other hand, significantly lengthens the first birth interval. These findings are consistent with previous arguments in the literature while offering new evidence for the impact of extended-family residence on fertility.     

中国农村出生登记的微观影响因素分析——陕西省CH县三个村的调查

作者通过在陕西省CH县与出生登记相关的工作人员的访谈和对3个农村社区的问卷调查,分析了中国农村地区儿童出生登记的现状;重点探索了微观层面上影响儿童出生登记的因素;总结了没有按时登记对儿童权益的影响。研究结果表明,儿童出生登记的水平不高,呈现下滑趋势;微观层次上影响农村地区儿童出生登记的因素众多,在各个历史时期不尽相同;儿童未能按时登记,会影响其健康的成长与发展。     

A pixel level evaluation of five multitemporal global gridded population datasets: a case study in Sweden, 1990–2015

Population and Environment - Human activity is a major driver of change and has contributed to many of the challenges we face today. Detailed information about human population distribution is...     

The differential influence of geographic isolation on environmental migration: a study of internal migration amidst degrading conditions in the central Pacific

Population and Environment - This study investigates how geographic isolation interacts with declining environmental and economic conditions in Kiribati, an island nation wherein which limited...     

Timing of hospital admission in labour: latent versus active phase,mode of birth and intrapartum interventions. A correlational study

Background

Hospitalization of women in latent labour often leads to a cascade of unnecessary intrapartum interventions, to avoid potential disadvantages the recommendation should be to stay at home to improve women’s experience and perinatal outcomes.

The pattern of changing trends and the regional differences in the sex ratio at birth: evidence from Korea and Jilin Province,China

"The main purpose of this study is to develop explanations for the pattern of recently changing trends and regional differences in the sex ratio at birth in Korea and for Koreans in Jilin Province and Yanbian Autonomous Prefecture, China.... The findings suggest that, since the mid-1980s, sex ratios at birth have risen remarkably in Korea.... This paper also highlights the recent increase in the sex ratio at birth for the Korean population in China, residing in urban areas densely populated with Koreans. As the key forces behind the regional differences in sex ratios at birth, the effects of son-selective reproductive behaviors, which in turn, are affected by the community characteristics, are stressed."     

“It’s like a bus,going downhill,without a driver”: A qualitative study of how postpartum haemorrhage is experienced by women,their birth partners,and healthcare professionals

ProblemPostpartum haemorrhage [PPH] remains a major cause of maternal morbidity and mortality. Whilst low-resource settings bear the greatest burden of deaths, women live with associated morbidities in all healthcare settings. Limited data exists regarding the experience for women, their partners, or healthcare professionals [HCPs], affected by PPH.AimTo qualitatively investigate the experience of PPH, for women (n = 9), birth partners (n = 4), and HCPs (n = 9) in an inner-city tertiary referral centre. To provide multi-faceted insight into PPH and improve understanding and future care practices.MethodsParticipants were interviewed about their experiences within two weeks of a PPH. Data were analysed using thematic analysis.FindingsFour distinct, but related, themes were identified: ‘Knowledge specific to PPH’; ‘Effective and appropriate responses to PPH’; ‘Communication of risk factors’; and ‘Quantifying blood loss’; which collected around a central organising concept of ‘Explaining the indescribable’.DiscussionPPH was viewed as a ‘crisis-style emergency’, generating respectful fear in HCPs, whilst women and partners had little-to-no prior knowledge. Specific PPH knowledge dictated HCPs’ response and risk communication. PPH risks were typically linked to quantification of blood loss, assessment of which varied with acknowledged questionable accuracy. Women’s and partners’ confidence in HCPs’ ability to deal with PPH was unquestionable. Non-verbal communication was highlighted, with HCP body language betraying professional confidence.ConclusionInformation about blood loss during childbirth must be imparted in a sensitive, timely manner. Whilst training for HCPs results in effective PPH management, consideration should be given to their non-verbal cues and the impact of dealing with this stressful, ‘everyday emergency’.     

Quality of migrant schools in China: evidence from a longitudinal study in Shanghai

As spaces in public schools are limited, a substantial number of migrant children living in Chinese cities but without local hukou are enrolled in private migrant schools. This paper studies the quality of migrant schools using data collected in Shanghai in 2010 and 2012. Although students in migrant schools perform considerably worse than their counterparts in public schools, the test score difference in mathematics has almost been halved between 2010 and 2012, due to increased financial subsidy from the government. We rule out alternative explanations for the convergence in test scores. We also conduct a falsification test and find no relative changes in the performance of migrant school students based on a follow-up survey of a new cohort of students in 2015 and 2016, a period with no changes in financial subsidies to migrant schools.     

Living in a small,crowded room: Scenarios for the future of Mauritius

In this article, future scenarios for Mauritius are described with a special focus on the interaction of different factors which can limit or hinder growth. Mauritius is a small, densely populated island where natural and human resource limits are obvious. The scenarios describe current trends on Mauritius well. They give a finetuned feeling for the differential impacts of labor, land, water, and pollution absorption capacity. They show that at various points in the course of development different limiting factors function, and thus it is necessary to give attention to all major factors of production and limitation in one holistic setting.     

The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study

BackgroundLabour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors.AimTo explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward.MethodsFive months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a ‘Regular’ birthing room (n = 8) or a specially designed, ‘New room’ (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process.FindingsThe analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women’s agency was facilitated.ConclusionInstitutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women’s needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women’s sense of agency.     

Born in another country: Women's experience of labour and birth in Queensland,Australia

BackgroundWomen born outside Australia make up more than a fifth of the Queensland birthing population and like migrants in other parts of the world face the challenges of cultural dislocation and possible language barriers. Recognising that labour and birth are major life events the aim was to investigate the experiences of these women in comparison to native-born English speaking women.MethodsSecondary analysis of data from a population based survey of women who had recently birthed in Queensland. Self-reported clinical outcomes and quality of interpersonal care of 481 women born outside Australia who spoke a language other than English at home were compared with those of 5569 Australian born women speaking only English.ResultsAfter adjustment for demographic factors and type of birthing facility, women born in another country were less likely to be induced, but more likely to have constant electronic fetal monitoring (EFM), to give birth lying on their back or side, and to have an episiotomy. Most women felt that they were treated as an individual and with kindness and respect. However, women born outside Australia were less likely to report being looked after ‘very well’ during labour and birth and to be more critical of some aspects of care.ConclusionIn comparing the labour and birth experiences of women born outside the country who spoke another language with native-born English speaking women, the present study presents a largely positive picture. However, there were some marked differences in both clinical and interpersonal aspects of care.