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.     

Adaptive designs for IVPT data with mixed scaled average bioequivalence

In vitro permeation tests (IVPT) offer accurate and cost-effective development pathways for locally acting drugs, such as topical dermatological products. For assessment of bioequivalence, the FDA draft guidance on generic acyclovir 5% cream introduces a new experimental design, namely the single-dose, multiple-replicate per treatment group design, as IVPT pivotal study design. We examine the statistical properties of its hypothesis testing method—namely the mixed scaled average bioequivalence (MSABE). Meanwhile, some adaptive design features in clinical trials can help researchers make a decision earlier with fewer subjects or boost power, saving resources, while controlling the impact on family-wise error rate. Therefore, we incorporate MSABE in an adaptive design combining the group sequential design and sample size re-estimation. Simulation studies are conducted to study the passing rates of the proposed methods—both within and outside the average bioequivalence limits. We further consider modifications to the adaptive designs applied for IVPT BE trials, such as Bonferroni's adjustment and conditional power function. Finally, a case study with real data demonstrates the advantages of such adaptive methods.     

Unfinished modernity or another modernity? The South Korean case

South Korea has experienced “compressed capitalist development” over the last five decades, characterized by unprecedented levels of industrialization and democratization, with other distinctive features. This development experience causes some scholars to view the country as a site for a new modernity, following the Western prototype. Concerning the underlying nature of emerging modernity in South Korea, however, there have been controversial insights: some scholars argue that the country is now experiencing a Western type of modernity, and others refute this, saying that it has not at all been modernized. This paper investigates the dynamics and contradictions of capitalist development in South Korea from a perspective of vertical modernization. It considers the origins, process, and outcomes of modernization mainly in terms of democracy, economic growth, and welfare. We assume that there are “different sites and forms of modernity” in the world, and that South Korea would be a good candidate to examine for non-Western modernity. Yet it is our contention that the country’s modernity has been distorted and unbalanced in the development of society, culture, politics, and economy. Historically, South Korea has progressed through traditional unmodernity, colonial undermodernity, and Western modernity. A clear examination of the country’s development experience reveals to no small degree the complex nature of modernity, in that tradition, modernity, and postmodernity coexist in the present time. We conclude that South Korean modernity is an incomplete project still in progress.     

Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature

ObjectiveTo undertake a systematic review of the literature to determine whether Asian ethnicity is an independent risk factor for severe perineal trauma in childbirth.MethodOvid Medline, CINAHL, and Cochrane databases published in English were used to identify appropriate research articles from 2000 to 2010, using relevant terms in a variety of combinations. All articles included in this systematic review were assessed using the Critical Appraisal Skills Programme (CASP) ‘making sense of evidence’ tools.FindingsAsian ethnicity does not appear to be a risk factor for severe perineal trauma for women living in Asia. In contrast, studies conducted in some Western countries have identified Asian ethnicity as a risk factor for severe perineal trauma. It is unknown why (in some situations) Asian women are more vulnerable to this birth complication. The lack of an international standard definition for the term Asian further undermines clarification of this issue. Nevertheless, there is an urgent need to explore why Asian women are reported to be significantly at risk for severe perineal trauma in some Western countries.ConclusionCurrent research on this topic is confusing and conflicting. Further research is urgently required to explore why Asian women are at risk for severe perineal trauma in some birth settings.     

Korean Social Work Students’ Attitudes Toward Homosexuals

For this article, the Hudson and Ricketts Index of Attitudes toward Homosexuality (IAH) was used to measure levels of homophobia in a convenience sample of 124 students enrolled in social work programs in two major universities in the Republic of South Korea. The results indicated that BSW and MSW Korean students had high levels of homophobia, particularly in comparison to U.S. samples. In-class discussion of homosexuality was found to be significantly associated with lower levels of homophobia. The authors review these and other research findings and discuss implications for social work education in South Korea and the United States.     

Muslim Political Activism or Political Activism by Muslims? Secular and Religious Identities Amongst Muslim Arab Activists in the United States and United Kingdom

Scholarship on Muslim political mobilisation in the West has developed as an important counterpoint to public discourse, which has tended to cast Muslims as a threat to social cohesion, liberal democracy, and national security. But even as scholarly literature has shed light on civic participation among Muslims, it has sidelined the diversity of political identities and values that motivate them. Most, if not all, Muslims in the West find their identities politicised in some way, but the question of whether this leads to a consensus amongst Muslims about the role of religion in public life often remains unexamined. In this article we draw on interviews with seventy-eight activists in Britain and the United States who are both Muslim and Arab to complicate ideas about the political mobilisation of Muslims in the West. Respondents, we show, are far from unified in their views on religion as a basis for political action and mobilisation. Some are keen to place Islam squarely in mainstream political spaces; most, however, are insistent that Islam should remain a private faith and identity and that political mobilisation should take place under the aegis of Arabness or other ‘secular’ identities. Using theoretical perspectives on the public sphere, we explain the complexity of our respondents' political identities and activism. Our overall aim is to broaden perspectives on the ways in which people from Muslim backgrounds participate in public, political life in Western contexts.     

Explicit Versus Implicit Family Decision-Making Strategies Among Mexican American Caregiving Adult Children

Changing U.S. demographics make it increasingly vital to investigate experiences of Latinos caring for aging parents, with specific emphasis on how these families, who often value family closeness, make decisions about caregiving. This study investigates relationships among use of implicit versus explicit decision-making strategies, generation since immigration, and orientation toward family. Findings suggest that those with more recent immigration to the United States were more likely than those who immigrated longer ago to describe family decision making about their parents' care as implicit. Those that were classified as using predominately implicit decision making were also found to be not significantly different from those classified as predominantly explicit with regard to their overall support of a collective orientation toward family. There were exceptions to this, however, regarding two specific aspects of orientation toward family: engagement in shared activities with family members and avoiding family conflict by making choices that are consistent with the family values. In both cases those categorized as implicit expressed stronger endorsement of these specific values. These findings suggest that the relationship between family decision-making strategies, generation since immigration, and orientation toward family is more complex than suggested previously in the literature. Implications for future research and practice are offered.