Comparing the course of anxiety in women receiving their first or repeated caesarean section: A prospective cohort study

BackgroundAround 30% of births are through caesarean section and repetition rates for receiving a caesarean section are high.AimThe aim of the prospective study was to compare the course of anxiety in women undergoing their first caesarean section and women experiencing a repeated caesarean section.Participants304 women with an indication for an elective caesarean section took part. 155 received their first caesarean section and 149 received a repeated caesarean section.MethodsIn order to measure the course of anxiety on the day of the caesarean section subjective anxiety levels were measured and saliva samples for cortisol determination were taken at admission, during skin closure and two hours after the surgery. Blood pressure and heart rate were documented at skin incision and skin closure.ResultsWomen experiencing their first caesarean section displayed significantly higher anxiety levels compared to women with a repeated caesarean section. Scores of the STAI-State and visual analogue scale for anxiety differed significantly at admission (p = .006 and p < .001) and heart rate and alpha amylase levels were significantly higher at skin closure (p = .027 and p = .029).ConclusionThe results show that previous experience with a caesarean section has a soothing effect. The study aims to sensitize surgeons, anesthetists, nurses and midwives when treating women receiving a caesarean section and encourage them to incorporate soothing interventions, especially for women receiving their first caesarean section to reduce anxiety levels and consequently improve postoperative recovery and patients’ satisfaction.     

Inside stories: Maternal representations of first time mothers from pre-pregnancy to early pregnancy

BackgroundAccording to the psychoanalytical literature, it is during pregnancy that maternal representations of the mother–infant relationship become activated. Midwives who are engaged with the mother and the baby have not drawn upon this concept in their practice. In order for this to happen, it is important to understand better the nature of maternal representations and when they are activated from empirical studies.QuestionThe research question is: what are the maternal representations of a group of first time mothers from pre-pregnancy, early pregnancy and to the first ultrasound.MethodA narrative approach was used to gain insight into the maternal representations of first time pregnant womens’ account of their representations. The analysis method was based on thematic approach.ParticipantsFifteen women aged between 23 and 38 years.SettingA midwives clinic attached to a tertiary hospital in Melbourne, Australia.FindingsFirst-time pregnant women's maternal representations were activated when a woman begins to plan her pregnancy (‘the time is right’), again at the onset of physical changes to her body as a result of conception (‘my body is changing’), and at the first early ultrasound at around twelve weeks (‘it’ is a real baby).ConclusionMaternal representations are important for the midwife and pregnant women because this concept provides another understanding in relation to the psychological dimension of pregnancy.     

Vaginal birth after caesarean: Views of women from countries with low VBAC rates

Problem and background

Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women’s views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low.

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions

AimTo determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth.MethodsThis single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or “show”. The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann–Whitney and Chi–square tests. The level of statistical significance was set as p < 0.05.FindingThere were significant differences between the intervention and control groups in the number of caesarian section (CS) (p < 0.001). Two groups had a statistically significant difference in amniotomy (p = 0.003), augmentation by oxytocin (p < 0.001), number of vaginal examinations (p < 0.001) and fundal pressure (p < 0.001).ConclusionsUsing a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.     

Ecological analysis of adolescent birth rates in Brazil: Association with Human Development Index

BackgroundAdolescent pregnancy is a multidimensional public health problem. It is known that every year in Brazil approximately 1.1 million adolescents become pregnant and around 20% of all newborns are born to teenage mothers.AimThis ecological study describes the spatio-temporal patterns of the percentages of live births to adolescent mothers between the years of 2010 and 2016 in Brazil and their associations with human development indexes in the meso-regions where they reside.MethodsPercentages of live births to adolescent mothers are the ratio between the number of live births to women aged 10–19 years old and total number of live births in each Brazilian meso-regions during the study period. A spatio-temporal Bayesian model was used to associate the percentages of live births to adolescent mothers with the human development index of each meso-region. Moran’s index was used to measure the spatial autocorrelation between the meso-regions at an aggregate level, whereas the local indicator of spatial auto-correlation measured local correlation.FindingsPercentages of live births to adolescent mothers for the whole country were 19.3% in 2010 and 17.5% in 2016. There is a heterogeneous spatial distribution pattern for these percentages, being the highest percentages in the North region (24.8% in 2016) and the lowest percentages in the Southeast region of the country (14.3% in 2016). The Bayesian model showed that meso-regions with lower human development index values have higher percentages of live births to adolescent mothers.ConclusionOur findings suggest that adolescent pregnancy is deeply associated with environmental characteristics.     

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.

Intergenerational transmission of age at first birth in the Netherlands for birth cohorts born between 1935 and 1984: evidence from municipal registers

Whereas most research on the intergenerational transmission of fertility behaviour has focused on transmission of the number of children, this paper studies the transmission of the timing of first births. Specific attention is paid to changes in the strength of transmission across cohorts. Theoretically, it is unclear whether the strength of intergenerational transmission of entry into parenthood can be expected to increase or to decrease across cohorts. Event history analyses of data in Dutch registers show a substantial degree of intergenerational transmission in the age at which people have their first child. The degree of transmission from mothers to children increases for successive cohorts. Intergenerational transmission becomes weaker the longer children postpone entry into parenthood. At young ages transmission from mothers to children is stronger than from fathers to children.     

Race differences in age at first birth and the pace of subsequent fertility: Implications for the minority group status hypothesis

We examine race differences in the effects of age at first birth on the pace of subsequent fertility. If race differences in the pace of fertility persist net of age at first birth and socioeconomic variables, they will be taken as new support for the minority group status hypothesis. Data from the 1973 National Survey of Family Growth are analyzed with the finding that race differences in the pace of fertility are real, giving support to the hypothesis. Implications are drawn suggesting that the proper points at which to examine group differences in fertility are the different stages in the process which culminates in completed fertility, rather than limiting investigation to the final product.     

Expectancy of life at birth in 36 nationalities of the Soviet Union: 1958-60

In the 36 nationalities of the Soviet Union the estimated expectancy of life at birth ranged from 50·0 years for Chechens to 71·1 years for Latvians with a median of about 67·5 years for Russians.

In essence, the life table function e₀ was generated from the child-woman ratios with the use of intricate equations based on empirical data obtained from official Soviet publications. A modified version of Bourgeois-Pichat's model was used to estimate life expectancies at birth among the 36 nationalities on the basis of their crude death rates and the percentage of population aged 65 years and over. The 1959 U.S.S.R. Census of Population provided information pertaining to the older age groups. The crude death rates were estimated separately with the aid of second-degree polynomials fitted to the crude demographic measures for 109 administrative areas of the Soviet Union for 1960.

Information about recent improvements in public health, as well as conjectural evaluations of economic advancement in recent years were examined and related to the past and present level of mortality among the Russian people and the remaining population of minorities.     

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital

BackgroundThere is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.AimThe aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.MethodsA retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.ResultsData for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p = 0.002) and spontaneous vaginal birth (38% vs. 22.4% p = <0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p = 0.050) and caesarean sections (18.8% vs. 22.5% p = 0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.ConclusionStrategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.     

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.     

Premarital first births: The influence of the timing of sexual onset versus post-onset risks in the United States

Motivated by long-standing debates between abstinence proponents and sceptics, we examine how socio-economic factors influence premarital first births via: (i) age at first sexual intercourse and (ii) the risk of a premarital first birth following the onset of sexual activity. Factors associated with an earlier age at first intercourse will imply more premarital first births owing to increased exposure to risk, but many of these same factors will also be associated with higher risks of a premarital first birth following onset. Our analyses confirm previous findings that women from disadvantaged backgrounds are younger at first intercourse and have higher premarital first-birth risks than women from more advantaged backgrounds. However, differences in onset timing have a strikingly smaller influence on premarital first-birth probabilities than do differences in post-onset risks. Our findings thus suggest that premarital first births result primarily from differences in post-onset risk behaviours as opposed to differences in onset timing.     

医疗保障:农村老年保障的重点

随着人口老龄化的加速 ,农村老年人的医疗服务需求日趋增长。因农村合作医疗解体而造成的农村医疗保障制度的缺损严重影响了农村老年保障医疗服务需求的满足。政府和社会应采取有效措施 ,建立和完善农村老年医疗保障制度 ,以满足农村老人的医疗服务需求。     

气候变化背景下荒漠草原牧民退牧意愿及其影响因素分析--以张掖市平山湖乡为例

近年来,气候变化对自然生态环境造成了极大破坏,特别是对原本生态环境脆弱,自然灾害频发的荒漠草原更是雪上加霜,严重影响了牧民的生产生活。只有鼓励更多牧民参与退牧还草项目,才能促使当地经济快速发展。基于此,本文利用甘肃省张掖市平山湖乡全乡牧民的调查数据,首先采用Logistic回归模型分析牧民退牧意愿的影响因素,然后运用解释结构模型分析各影响因素之间的关系。研究表明：牧民受教育程度、家庭拥有的饲草地面积、牧民对气候变化的认知、牧民对草原荒漠化的认知、牧民对退牧补贴政策的认知,对牧民退牧意愿呈现出正向影响,而家庭拥有的羊只数量对牧民退牧意愿呈现出负向影响,牧民年龄和外出务工率对牧民退牧意愿影响不显著。其中,文化程度、羊只数量、饲草地面积是深层原因;对退牧补贴政策的认知和对草原荒漠化的认知是间接原因;对气候变化的认知是直接原因。     

我国出生性别比失衡区域的识别、特点及成因——基于县(市)级层面的分析

本文采用地理信息系统(GIS)的空间分析技术,利用地理信息系统分析软件(ARCView GIS)、探索性空间分析技术软件(GeoDA)、社会科学统计软件包(SPSS)等软件,对1982年、1990年和2000年三次全国人口普查的县域截面数据进行了分析。通过空间分析,识别出我国高出生性别比聚集的热点区域,并进一步对其分布、演变特点和成因进行了较深入研究,试图找到热点区域分布及变化的规律性特点。在此基础上,提出了热点区治理和跨区域治理相结合的政策思路。