The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study

BackgroundThe national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises.AimTo compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations.MethodA multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders.FindingsBoth countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers’ fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised.ConclusionWe recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.     

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.     

The long-term effects of time-dependent maternity behavior

Using the integral population model of Sharpe and Lotka, it is demonstrated that if the time variation of the maternity function is assumed to only affect the parent population, then standard methods of obtaining the long-term behavior may still be used. Further, if the net maternity function has explicit time dependence, in contrast to age dependence, only for time less than the minimum age of childbearing, the standard techniques still may be used. It is shown that the recent extensions of Cerone and Keane to include exponential time dependence may be applied, together with the above observations, to define piecewise time-dependent net maternity functions and to determine the resulting long-term asymptotic behavior of the population. The population management problem of determining the time path of change needed to approach a given population also is considered in some detail.     

Lesbian emancipation in The Netherlands

In this article the emancipation of lesbian women as a group is reviewed from a historical viewpoint. Their gradual emancipation, along with women in general, is demonstrated by the increasing alliances and support afforded to women over the years. The growth of a unified lesbian movement is evident in publications and the formation of autonomous organizations in the 20th century.     

Steering Towards Happiness in The Netherlands

As in many other countries, the economic crisis is being felt in the Netherlands. Is that a good moment for a government to develop a policy to increase happiness? Is it actually possible to raise the level of happiness in the Netherlands? The Dutch are after all already happy, and the objective quality of life in the Netherlands is also high, so there would seem to be little scope for making them even happier. It is also questionable whether the government should be playing the role of a ‘happiness machine’, which seeks to promote individual happiness, or whether it would do better to act as a ‘misfortune mitigator’ which seeks to minimise the negative elements in people’s lives. In this article we attempt to answer these questions on the basis of Dutch initiatives designed to promote happiness in the areas of municipal policy, welfare, health care, work and education. We come to the conclusion that happiness policy is already deeply embedded in Dutch society. The Dutch government is indeed a happiness machine. It could act rather more as a misfortune mitigator, given the gains to be made at the bottom of the ‘happiness ladder’, in particular. Mental resilience emerges in all initiatives as an important factor in increasing happiness. Programmes to boost mental resilience can be started as early as primary school.     

The cohort feedback model with symmetric net maternity

"In this paper we consider the simplest and most widely used demographic feedback model, the birth-response cohort feedback model. In the case of symmetric net maternity, we put the model into a form in which one of the rare global bifurcation theorems in the mathematical literature can be brought to bear. As a consequence, we prove that the model has solutions with period exactly twice the mean age of net maternity for at least a specified range of parameter values which include cycles of non-infinitesimal amplitude." (SUMMARY IN FRE)     

Operationalising caseload midwifery in the Australian public maternity system: Findings from a national cross-sectional survey of maternity managers

Background

Despite high-level evidence of the benefits of caseload midwifery for women and babies, little is known about specific practice arrangements, organisational barriers and facilitators, nor about workforce requirements of caseload. This paper explores how caseload models across Australia operate.

A research into homosexuality in The Netherlands

This article presents varying ideologies regarding homosexuality. The history of homosexual research is reviewed from a clinical and sociological perspective. Centers for research in the area of homosexuality in The Netherlands are described in terms of their area of study as well as their differing ideological views. In conclusion, the increased awareness of the Dutch Government and the governance of the Dutch universities of the importance of research into homosexuality is described.     

The multiregional net maternity function and multiregional stable growth

This paper extends recent efforts to generalize Lotka's integral equation to the case of a multiregional population that experiences internal migration. It develops the concept of a multiregional net maternity function and considers the relationships between a multiregional population's schedule of fertility, mortality, and migration and its stable growth properties.     

Women's perspective of maternity care in Cambodia

BackgroundConsideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care. Women's satisfaction with maternal services is poorly understood in many developing countries, including Cambodia in South East Asia. The objective of this study was to investigate women's perceptions and experiences of private and public skilled birth attendants, including midwives, during childbirth in Cambodia.MethodsA qualitative design using a naturalistic inquiry approach was undertaken to seek sensitive personal issue. Thirty individual in-depth interviews were conducted with women who had recently given birth at private and public health facilities in one province in Cambodia. Data were analysed using a thematic approach.FindingsWomen's choice of health facility was influenced by their perceptions of safety and staff attitudes. Reported barriers to the effective utilisation of public maternity services were costs associated with the birth, staff attitudes and a lack of supportive care during labour and in the postpartum period. Although private health care is more expensive than public health care, some women reported a preference for private birth attendants as they perceived them to provide safer and more supportive care in labour.ConclusionWomen expect, but do not always receive humane, professional, supportive and respectful treatment from public skilled birth attendants. While the removal of unexpected costs and geographical barriers are important to increasing public maternity care and service utilisation, improvements in maternity services should focus on addressing provider attitudes and enhancing communication skills during labour, birth and the immediate postpartum period.     

The fertility impact of changes in the timing of childbearing in the developing world

This study examines the role of tempo effects in the fertility declines of less developed countries. These effects temporarily inflate the total fertility of a population during periods when the age at childbearing declines and deflate it when childbearing is postponed. An analysis of data from the World Fertility Surveys and the Demographic and Health Surveys demonstrates that fertility trends observed in many less developed countries are likely to be distorted by changes in the timing of childbearing. In most countries women are delaying childbearing, which implies that observed fertility is lower than it would have been without tempo changes. This pattern is most clearly documented in Taiwan, where accurate birth statistics from a vital registration system make it possible to estimate the tempo components of fertility annually from 1978 to 1993. The small but unexpected rise in the total fertility of Colombia in the early 1990s is attributed to a decline in the negative tempo distortion that prevailed in the 1980s. Similar interruptions of ongoing fertility declines may occur in the future in other countries when existing negative tempo effects are removed.     

Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines

BackgroundMood disorders arising in the perinatal period (conception to the first postnatal year), occur in up to 13% of women. The adverse impact of mood disorders on mother, infant and family with potential long-term consequences are well documented. There is a need for clear, evidence-based, guidelines for midwives and other maternity care providers.AimTo describe the process undertaken to develop the Australian Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period and to highlight the key recommendations and their implications for the maternity sector.MethodUsing NHMRC criteria, a rigorous systematic literature review was undertaken synthesising the evidence used to formulate graded guideline recommendations. Where there was insufficient evidence for recommendations, Good Practice Points were formulated. These are based on lower quality evidence and/or expert consensus.FindingsThe quality of the evidence was good in regards to the use of the Edinburgh Postnatal Depression Scale and psychological interventions, but limited as regards medication use and safety perinatally. Recommendations were made for staff training in psychosocial assessment; universal screening for depression across the perinatal period; and the use of evidence based psychological interventions for mild to moderate depression postnatally. Good Practice Points addressed the use of comprehensive psychosocial assessment – including risk to mother and infant, and consideration of the mother–infant interaction – and gave advice around the use and safety of psychotropic medications in pregnancy and breastfeeding. In contrast to their international counterparts, the Australian guidelines emphasize a more holistic, woman and family centred approach to the management of mental health and mood disorders in the perinatal setting.ConclusionThe development of these Guidelines is a first step in translating evidence into practice and providing Australian midwives and other maternity care providers with clear guidance on the psychosocial management of women and families.     

The maternity experiences of women seeking asylum in high-income countries: a meta-ethnography

ProblemThe maternity care experiences and perinatal outcomes of women seeking asylum in high-income countries (HICs) are poorer than the general population of pregnant women in that HIC. There is a paucity of literature on the maternity experiences of women seeking asylum in HICs.BackgroundThere is an increasing number of women seeking asylum in HICs due to escalating violence and human rights abuses. Asylum-seeking women are a distinct group whom are likely to have different needs to refugees or migrants as a result of their undocumented status.AimThis literature review aimed to explore the emotional, physical and health information needs of women seeking asylum in the perinatal period in HICs, to provide insights to better address their maternity needs.MethodA meta-ethnography described by Noblit and Hare, was applied to analyse the studies, to reflect the voices of women seeking asylum, hosted in HICs in their perinatal period.FindingsEight studies were included in the review. The overarching theme was ‘just having to survive.’ Four sub-themes were revealed which highlighted the vulnerability of asylum-seeking women. They included: ‘I was never sure if I had understood’, ‘feeling ignored and alone’, ‘ongoing dislocation and recurrent relocation’ and ‘knowing there’s someone who cares for you’.DiscussionImproved maternity care for women seeking asylum requires culturally appropriate respectful maternity care and supportive strategies such as consistent access to language services.ConclusionIt is recommended that future research is targeted to explore the maternity experience of women seeking asylum in HICs, such as Australia.     

The experiences of Burmese healthcare interpreters (Iam) in maternity services in Thailand

Background

Interpreters (lam in Thai) have been employed in maternity services in Thailand due to increasing numbers of Burmese women migrating to Thailand. Access to healthcare interpreters is crucial for health professionals and Burmese migrant women using Thai maternity services but no studies have examined the role of the lam.

The momentum of population growth with time dependent net maternity function

The momentum of population growth problem of Keyfitz is generalized to contain a gradual change of the age-specific birth rate ro the level of bare replacement. Assuming a time dependence for the net maternity function of the form (formula: see text) R being the net reproductive rate, we show that for the Malthusian model the asymptotic birth rate is increased by exp (r/lambda), where r is the rate of increase of the population before t = 0. A numerical method for obtaining the asymptotic birth rate for a general net maternity function with the same time dependence is outlined.     

The uncertain lifetime and the timing of human capital investment

I examine the effects of mortality decline on fertility and human capital investment decision of parents taking into account the uncertainty about child survival. I propose a model, where parents decide on their fertility before the uncertainty is realized, but they choose to invest only in human capital of their surviving children. The model implies a positive relationship between mortality and fertility and a negative one between mortality and educational investment. It has been argued elsewhere that as, in reality, most of the mortality decline occurred in infancy, it should not affect the human capital investment decision, which comes later in life. Thus, increased survival chances should not promote growth by raising the human capital investment. This paper argues the contrary and proposes a mechanism where mortality decline at any age before the teen years can promote growth by raising human capital investment regardless of the timing of the educational investment.      

The impact of the labour market on the timing of marriage and births in Spain

This paper investigates how education and the labour market affect Spanish individual decisions on the timing of marriage and births, using a Cox hazard approach. It disentangles men and women, and two groups, Cohort 1945–1960 and Cohort 1961–1977. Results show that female employment delays marriage in Cohort 1945–1960, but it has a reverse effect in Cohort 1961–1977. We also find evidence that employment is a barrier for family formation since employed women postpone births in both cohorts. The precarious Spanish labour markets, captured by female unemployment rates, delay family formation, especially by putting off marriage. Male unemployment, at the individual level, impacts negatively on fertility only through delaying marriage.