Older lesbians receiving home care: formal and informal dimensions of caregiving

Older lesbians face the triple jeopardy of ageism, sexism, and heterosexism, and their experiences are largely invisible. This qualitative, exploratory study examines the formal and informal caregiving experiences of 20 lesbians, 65 and older, who had utilized home care services due to acute illness or chronic disabilities. Half of those not partnered reported some level of isolation from support networks. Nearly all study participants eventually found home care workers with whom they were satisfied and even quite connected. Practice implications are discussed in context of study participants’ views of how being lesbian affects their aging process and day-to-day lives.     

Are pregnant women with asthma receiving guideline-recommended antenatal asthma management? A survey of pregnant women receiving usual care in Australia

BackgroundAsthma affects 12.7% of pregnant women in Australia. Key recommendations for asthma management during pregnancy include: 4–6 weekly review of lung function, medications, written asthma action plan, inhaler device technique, current asthma control and triggers; smoking cessation and vaccination advice. It is unknown if these key recommendations are provided to pregnant women with asthma in Australia.AimTo explore usual antenatal asthma management (usual care) in Australia and the inclusion of key recommendations.MethodPregnant women with asthma were invited to complete an online survey distributed in 2 antenatal clinics and via social media platforms from July 2017-Jan 2019.ResultsThe survey was completed by 142 pregnant women with asthma. 87(61%) were enrolled in an asthma management clinical trial and were therefore not receiving ‘usual’ care. Data presented is from 55(39%) women receiving usual care at survey completion. Of these women, 36% did not have their asthma reviewed during their pregnancy, 31% had a written asthma action plan, 11% had lung function assessed, 38% had an asthma medication review and 35% had their inhaler technique reviewed. 65% were not questioned about their asthma symptoms, 85% were not asked about asthma triggers, 96% were not given information about vaccinations and 95% did not receive smoking cessation information.ConclusionsOverall, the key recommendations for antenatal asthma management were not always provided for this sample of pregnant women receiving usual care. Improved knowledge and implementation of these key recommendations by health professionals may alter this situation and improve maternal and infant outcomes.     

What are the experiences of women with obesity receiving antenatal maternity care? A scoping review of qualitative evidence

ProblemObesity is a major public health problem and is rising in prevalence in child-bearing women. The complications of pregnancy in women with obesity are well documented. Pregnant women with obesity require different maternity care considerations to normal weight women. How women respond to the care of health professionals, determines how likely they will be to engage with it, and thus research into the current care experiences of women with obesity is valuable.ObjectiveThe purpose of this scoping review was to examine the evidence of the antenatal maternity care experiences of women with obesity (BMI ≥ 30 kg/m²).MethodA systematic literature search was conducted for English language publications 2008–2018 using Medline, Scopus, PsycINFO and CINAHL. Following critical appraisal, and a search of the reference lists of primary articles, 17 articles resulted for this review. A thematic synthesis process was used to collate the findings.FindingsFour major themes were identified: 1) inconsistent or absent information regarding weight management, 2) the stigma and stereotyping associated with their obesity, 3) medicalisation and depersonalisation of pregnant women with obesity, and 4) a desire for information and need for change.ConclusionThe findings suggested that based on women’s experiences there is a need for improved education and communication for health care professionals when caring for pregnant women with obesity. Some conflicting information from women in the studies highlight the need for further research in the area, and the implementation of individualised care and continuity of care for pregnant women with obesity.     

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 relationality of maternity care: A diffractive analysis of maternity care experiences

ProblemPervasive polemics of differing approaches to and values of maternity care limit possibilities of nuanced and productive understandings of how maternity care is experienced.AimTo explore how maternity care identities (midwife, obstetrician, childbearing woman) are shaped by binarised conceptualisations of childbirth.MethodsThe diffractive analysis of data gathered in collective biography research groups.Findings and discussionMaternity care identities are not complete, pre-established entities, but rather are, ‘in the making’, remade in every maternity care encounter.ConclusionMaternity care identities are defined by their encounters with other maternity care identities, and therefore, each maternity care identity plays a role in which experiences of maternity care come into being.     

A comparison of midwife-led care versus obstetrician-led care for low-risk women in Japan

BackgroundContinuity of midwife-led care is recommended in maternity care because of its various positive outcomes. In Japan, midwife-led care is receiving broad attention as well. In order to popularise midwifery care within the entire system of perinatal care in Japan, there is a need to show evidence that continuity of midwife care for women will bring about positive outcomes.AimThe objectives of this study were to compare the health outcomes of women and infants who received midwife-led care with obstetrician-led care in Japan.MethodsThis was an observational study using non-random purposive sampling with a survey questionnaire. Settings where midwife-led care and obstetrician-led care were chosen by purposive samples. Participants were low-risk women who received antenatal care and delivered a term-singleton-infant at the participating settings during the research period. Measurements were: Women-centred care pregnancy questionnaire, Stein's maternity blues questionnaire, and Edinburgh Postnatal Depression Scale.FindingsMidwife-led care was perceived by women to be beneficial and had no adverse outcomes compared to obstetrician-led care. Main findings are: (1) Perception of Women-centred care was higher; (2) Less premature rupture of membranes, and the Apgar scores of the infants were similar; (3) Exclusively breast-feeding during hospitalisation and at one-month postpartum; (4) Stein's maternity blues scale scores was lower in women who received midwife-led care than those who received obstetrician-led care.ConclusionsContinuity of midwife-led care was perceived by women to be beneficial and had no adverse outcomes. Therefore, midwife-led care in low-risk pregnancy could be applicable and recommended.     

Self-employment and providing child care

This paper considers self-employment and providing child care as occupational strategies that can lower the cost of child care. If the ability to care for one's own children while engaged in market work is important to mothers with young children, we predict that women with young children will be more likely to choose to be self-employed or to be a child care provider than women without young children. The analysis provides strong support for this hypothesis. The results show that the presence of young children is an important factor in choosing self-employment and in choosing to be a child care provider. Finally, simulations are presented which show that a woman's choice among these sectors is quite sensitive to the number and ages of her young children.     

Child care and employment turnover

This paper explores how the responsibilityof caring for children affects employment stability by studying the relationship betweenthe characteristics and stability of substitute caregivers and the risk of leaving of job. Thedata come from the 1990 National Child Care Survey (NCCS), a nationally representative surveyof households with children under age 13 conducted in late 1989 and early 1990, and AProfile of Child Care Settings (PCS), a nationally representative survey of center-based programsand licensed family day care homes in the U.S., conducted at the same time and in the same 144counties. The results show that the availability of care affects the job stability of all employedmothers. Other effects differ by maternal wage. The cost of care affects the employment exits ofmoderate-wage mothers (who earn $6 to $8 per hour), the stability of care affects the employmentexits of moderate- and high-wage mothers, and the flexibility of care affects the employmentexits of low-wage mothers. These results are discussed in the context of current public policies.     

Trends in intercountry adoption: Analysis of data from 20 receiving countries, 1998–2004

The implications of developments in intercountry adoption worldwide in the early years of the twenty-first century are explored, based on analysis of data from 20 receiving countries. Between 1998 and 2004, intercountry adoption increased by 42 per cent. Problems in data collection and analysis are examined, as is the reliability of estimates of numbers of children sent by countries of origin when derived from data provided by receiving countries. Also considered are various measures of standardization which can be used to facilitate comparison between countries and show trends over time. The potential for more detailed comparative analysis is explored.     

西部失缀学大龄女童接受非正规教育的状况——中英大龄女童合作伙伴项目甘肃点调查

新农村建设中女性的参与是不可忽视的,当前西部贫困地区女童的教育状况令人堪忧,对排除在农村义务教育资源之外的失辍学的大龄女童进行非正规教育的培训,一方面可为其提供进入劳动力市场的机会,更重要的是提供一种生存发展的禀赋。     

Philippines: total maternal care programme

The Total Maternity Care Programme, launched in June 1975 by the University of the Philippines at the Philippine General Hospital, aims at complete care for both mother and baby. Since the program began, requests for female postpartum sterilization have exceeded capacity. The postpartum ligation rate increased from 14% to 30% in a 6-month period. Reasons for this increase are word of mouth publicity, growing consciousness of the disadvantages of large families, and diseases contraindicating pregnancy. Reasons why women declined sterilization are mentioned. Based on the success of the program so far, it is recommended that Total Maternity Care Programmes be extended to the other maternity hospitals in metropolitan Manila.     

Paternal child care and children's development

This paper uses the NLSY-Child data to assess the effects on cognitive and social-emotional development of father care as a child care arrangement among children in two-parent families with working mothers. Our results show that father care for infants is no better or worse than other types of arrangements. However, toddlers in non-paternal modes of child care (e.g., relatives, family day care or center care) have slightly better cognitive outcomes than those whose fathers provided care. Although our analyses do not provide a definitive explanation for this finding, there is a substantial influx of fathers in our data who provide child care in years 2 and 3 and these fathers appear compositionally different from fathers who provided care during a child's infancy. In particular, there is some indication that these fathers who are newly providing care during a child's toddler years may be temporary care providers due to changing economic circumstances. The research was supported by NICHD grant #HD30944. Responsible editor: Deborah Cobb-Clark.     

State regulations and child care choice

While government regulations are designed to safeguard the health and well-being of children, they may also alter the cost and availability of child care, thus affecting parental use of such services. This paper investigates the total effects of regulation on parental choice of child care and the indirect effects of regulation through the price, quality, and availability of care. In our analysis of data from the National Child Care Survey 1990 we find strong evidence that state regulations requiring center-based providers to be trained are associated with a lower probability that parents choose a center, while state inspections are associated with more parental choice of center and home care. We end by discussing the policy implications of our findings.     

The dwelling space of postnatal care

BackgroundThis paper considers the dwelling space of postnatal care, how being-there feels for the woman going through the experience of matrescence. The research takes a hermeneutic approach and draws on philosophical notions from Heidegger. Question: ‘What is the nature of the dwelling space of valued postnatal care?’.MethodsAppropriate ethics approval was gained. Participants were midwives, nurses, women, and other relevant stakeholders. There were 4 focus groups involving 11 participants and 19 individual interviews. Data collection was conducted over a one week period by a team of three researchers. An interview schedule had been organised by the administrator at the Centre. Participants chose whether to come to the centre to be interviewed, or be interviewed in their own homes. Most interviews were an hour. All interviews were tape recorded and transcribed, with the participant's permission. Data was analysed through a hermeneutic process set in the context of related literature.FindingsWhen women are invited into a dwelling space that strengthens them they feel ‘mothered’: being listened to, have their needs anticipated, and are cared for in a loving manner. In such a way they grow confidence. A child health nurse reported the difference such care made to on-going mothering at home.Implications for practiceAll women deserve a dwelling space in their early days of matrescence. Small birthing centres perhaps achieve such care and ambience more easily than large institutional units. Nevertheless, wherever the place, practices need to be enabled that foster the spirit of dwelling.     

生殖健康与男性保健

维护与促进男性生殖健康,不仅将使男性受益、妇女及家庭受益,而且有利于社会乃至整个民族的利益。