Multiparous women's confidence to have a publicly-funded homebirth: a qualitative study

Background

Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Women's confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored.

Aim

The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia.

Methods

Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semi-structured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken.

Results

Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence.

Discussion

Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health system's ability to cope with any complications that may arise.

Implications for practice

Many women may benefit from access to publicly-funded homebirth models of care. This should be further investigated.     

Inclusion and exclusion criteria for publicly-funded homebirth in Australia: A scoping review

BackgroundThere are fifteen publicly-funded homebirth programs currently operating in Australia. Suitability for these programs is determined by a series of inclusion and exclusion criteria.AimThe aim of this scoping review is to identify common inclusion and exclusion criteria for publicly-funded homebirth programs and other related factors that affect access to these programs.MethodsA Google search was conducted for publicly-funded homebirth programs listed on the National Publicly-funded Homebirth Consortium website. Public websites, documents, and policies were analysed to identify inclusion and exclusion criteria for these programs.FindingsEleven of the 15 publicly-funded homebirth programs mention the availability of homebirth on their health service website, with varying levels of information about the inclusion and exclusion criteria available. Two of the programs with no information on their health service website are covered by a state-wide guideline. Additional details were sought directly from programs and obtaining further information from some individual homebirth programs was challenging. Variation in inclusion and exclusion criteria exists between programs. Common areas of variation include restrictions relating to Body Mass Index, parity, age, English language ability, tests required during pregnancy, and gestation at booking to the homebirth program.ConclusionThe inclusion and exclusion criteria for a publicly-funded homebirth program determines women’s access to the program. Limited publicly available information regarding inclusion and exclusion criteria for many publicly-funded homebirth programs is likely to limit women’s awareness of and access to these programs.     

Choosing Aggregation Rules for Composite Indicators

From a formal point of view, a composite indicator is an aggregate of all dimensions, objectives, individual indicators and variables used for its construction. This implies that what defines a composite indicator is the set of properties underlying its mathematical aggregation convention. In this article, I try to revise the theoretical debate on aggregation rules by looking at contributions from both voting theory and multi-criteria decision analysis. This cross-fertilization helps in clarifying many ambiguous issues still present in the literature and allows discussing the key assumptions that may change the evaluation of an aggregation rule easily, when a composite indicator has to be constructed.     

Choosing the best population development goal]

Optimizing goals for controlled population growth and development through mathematical modeling has a practical value and is of important theoretical significance. An integrated model for optimizing multiple interactive targets for population development is proposed. A wide array of user-prioritized (weighted) economic indices or factors may be incorporated into this n-tuple m-dimensional model, by which complex linear and vector space computations are solved and interpreted through conventional mathematics. Although this numerical approach toward problem solving is imperfect, when properly used, the mathematical model presented in this paper is a practical and efficient means for solving multidimensional problems.     

农民工非正规就业选择研究

本文利用2001年中国社会科学院进行的中国城市劳动力市场研究调查数据,对农民工非正规就业的进入条件、就业影响因素以及就业效果进行了研究,结果显示:从事非正规就业的农民工相对具有更狭窄的社会资本和更少的工作初始投入;教育显著提高了农民工从事非正规就业的概率,滞后一期的市场状态对农民工非正规就业选择不会产生显著影响;就业分流并没有导致农民工就业市场出现内部分层,农民工非正规就业存在着强的自选择。     

The President's Council on Bioethics: Choosing Sex of Children

The ideology of eugenics as it arose in the late nineteenth century was concerned with the perceived negative effects of differential fertility on the “quality” and composition—variously defined—of future generations. Quality was to be raised by preventing or discouraging the “less fit” from propagating themselves and by encouraging childbearing among couples seen as carriers of desirable genetic endowments. Thus, this old‐fashioned eugenics was directed, at least by intent and sometimes in practice, to select among parents and influence their procreative behavior. The rules for such selection were typically decided, democratically or otherwise, on the advice of anointed “experts.” By the mid‐twentieth century these programs had come to be thoroughly discredited, both because they were seen to lack scientific validity and, perhaps especially, as a result of Nazi racial policies. Modern technological developments have given rise to, or created the realistic prospect of, a different, “grassroots” eugenics: parents voluntarily choosing qualities they would prefer their offspring to possess. Their right to do so would seem to be a straightforward extension of the principle, endorsed by numerous international declarations, that “all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children.” Parents might exercise that right by seeking to improve their children's chances for a healthy and successful life or merely by following their own prejudices. But the application of this principle tacitly assumes that the aggregate outcome of individual reproductive decisions is in reasonable harmony with the collective interest. The technological means now available for parents to select preferred physical and intellectual characteristics of their children—to improve on the outcome of the natural genetic lottery—are rudimentary. Many of them are still in the domain of science fiction. But in one major instance the technology already exists: selecting the sex of children, especially through early determination of the sex of the fetus, which then may be followed by sex‐selective induced abortion. This option has become widely available in recent years. In societies in which there is strong preference for offspring of a particular sex—usually for boys— the result has been a marked deviation from the normal sex ratio at birth. The social implications of such uncoordinated individual choices are perceived as clearly deleterious, hence the practice of sex‐selective abortion is commonly outlawed even when abortion is otherwise permitted. Invoking a social interest that overrides the right of voluntary parental choice of course raises the question whether other untoward effects of socially unregulated fertility might also be grounds for circumscribing parental freedom of choice in childbearing. Socially undesirable patterns of childbearing could be defined as “non‐responsible.” In the United States, the President's Council on Bioethics, appointed in November 2001, is one of the many committees advising the US President on important social issues. The Council consists of 17 members, including noted scientists, physicians, ethicists, social scientists, legal experts, and theologians. It had the mandate, inter alia, to inquire into the human and moral significance of developments in biomedical and behavioral science and technology and to explore specific ethical and policy questions related to these developments. The Council was chaired by Professor Leon R. Kass, a prominent bioethicist from the University of Chicago. Its report, under the title, Beyond Therapy: Biotechnology and the Pursuit of Happiness, was submitted to the President in October 2003. This massive document, which will also be published in book form by a commercial publishing house, is available online at: http://bioethicsprint.bioethics.gov/reports/beyondtherapy . Reproduced below is a section titled Choosing sex of children from Chapter 2 of the report (titled Better Children,). It offers a penetrating analysis and commentary on issues raised by parental selection of children's sex.     

两性择偶标准的差异研究

通过1989-1999年十年间《女友》杂志中的征婚启事,本文对我国男性和女性的择偶标准的进行了分析。结果表明,女性和男性的择偶标准存在着很大差异:和男性相比,女性在择偶时更重视对方的经济条件、职业及生活地区等方面。而男性对女方外貌性格等方面的要求比较多,他们选择妻     

Choosing the choice: Reflections on modelling decisions and behaviour in demographic agent-based models

This paper investigates the issues associated with choosing appropriate models of choice for demographic agent-based models. In particular, we discuss the importance of context, time preference, and dealing with uncertainty in decision modelling, as well as the heterogeneity between agents in their decision-making strategies. The paper concludes by advocating empirically driven, modular, and multi-model approaches to designing simulations of human decision-making, given the lack of an agreed strategy for dealing with any of these issues. Furthermore, we suggest that an iterative process of data collection and simulation experiments, with the latter informing future empirical data collection, should form the basis of such an endeavour. The discussion is illustrated with reference to selected demographic agent-based models, with a focus on migration.     

Choosing fields in an expansionary era: Comparing two cohorts of baccalaureate degree-holders in the United States and Canada

In an era of expanding postsecondary markets and heightened student and institutional competition, students’ field of study decisions may be becoming an increasingly important point of differentiation in the process of social mobility. Drawing on the two most recent cohorts of the Baccalaureate and Beyond and National Graduates Surveys, this paper examines and compares field of study choices among American and Canadian baccalaureate degree-holders. Consistent with existing research, gender remains an important and consistent predictor of field of study choices. In Canada, the analyses show some evidence that the gender gap for business and management is shrinking, but the engineering and mathematics gap remains significant. In the U.S. the situation was reversed, as the engineering gap shrunk and the business and management gap did not change across cohorts. Moderate family background effects, strong and consistent academic ability effects and growing academic aspiration effects were found across most analyses, lending support to theories that predict family background has direct and indirect effects on higher education choices.