Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.     

未成年子女姓名权的法律思考

姓名权是自然人决定、使用和变更自己姓名的权利。由于行为能力的限制,未成年子女的姓名决定权和变更权让渡给其监护人行使。但由于监护人意志的冲突,实务中经常发生各式各样的子女姓名纠纷,而现行法对这一问题的涉及则明显不足。为此,针对未成年子女姓名权的特殊性、实务中常见的子女姓名纠纷、现行法对该问题的规定等方面试作探讨,以引出处理此类纠纷的法律原则,并尝试提出些许建议。     

The politics of midwifery education and training in New South Wales during the last decades of the 19th Century

This paper focuses on the introduction and development of midwifery education and training in Sydney during the last decades of the 19th century. The aim of the training, it is argued, was to displace the lay midwives by trained midwifery nurses who would work under medical control. The lay midwives were one of the largest occupational groups among women and two-thirds of births in NSW were being delivered by them in the late 19th century. It was a period of professionalisation of medicine and medical men laid claim to midwifery as a legitimate sphere of their practice and saw it as the gateway for establishing a family practice. The lay midwife stood in the way of their claim. The training programs were established purportedly to control maternal mortality. From the beginning in 1887 medical men were in control of midwifery nurse training. In addition to training at the Benevolent Society Asylum, three more women's hospitals were established in the 1890s in Sydney making it possible to train a stream of midwifery nurses. The midwifery nurses were charged exorbitant fees for their training; the fees contributed substantially towards running the new hospitals that delivered birth services to the poor and destitute women mostly in their homes. The midwifery nurses worked hard in miserable conditions under the guise of clinical experience required for training. When a critical mass of poorly trained midwifery nurses were in the offing, a Bill was introduced into the Parliament in 1895, restricting registration to midwifery nurses and this would have eliminated the lay midwife if passed. It took more than two decades to get a Registration Bill passed in the NSW Parliament.     

Comparing two survey methods for estimating maternal and perinatal mortality in rural Cambodia

PURPOSE: We need solid estimates of maternal mortality rates (MMR) to monitor the impact of maternal care programs. Cambodian health authorities and WHO report the MMR in Cambodia at 450 per 100,000 live births. The figure is drawn from surveys where information is obtained by interviewing respondents about the survival of all their adult sisters (sisterhood method). The estimate is statistically imprecise, 95% confidence intervals ranging from 260 to 620/100,000. The MMR estimate is also uncertain due to under-reporting; where 80-90% of women deliver at home maternal fatalities may go undetected especially where mortality is highest, in remote rural areas. The aim of this study was to attain more reliable MMR estimates by using survey methods other than the sisterhood method prior to an intervention targeting obstetric rural emergencies. PROCEDURES: The study was carried out in rural Northwestern Cambodia where access to health services is poor and poverty, endemic diseases, and land mines are endemic. Two survey methods were applied in two separate sectors: a community-based survey gathering data from public sources and a household survey gathering data direct from primary sources. FINDINGS: There was no statistically significant difference between the two survey results for maternal deaths, both types of survey reported mortality rates around the public figure. The household survey reported a significantly higher perinatal mortality rate as compared to the community-based survey, 8.6% versus 5.0%. Also the household survey gave qualitative data important for a better understanding of the many problems faced by mothers giving birth in the remote villages. There are detection failures in both surveys; the failure rate may be as high as 30-40%. PRINCIPLE CONCLUSION: Both survey methods are inaccurate, therefore inappropriate for evaluation of short-term changes of mortality rates. Surveys based on primary informants yield qualitative information about mothers' hardships important for the design of future maternal care interventions.     

A cross-cultural study on surrogate mother's empathy and maternal–foetal attachment

BackgroundTraditional and gestational surrogate mothers assist infertile couples by carrying their children. In 2005, a meta-analysis on surrogacy was conducted but no study had examined empathy and maternal–foetal attachment of surrogate mothers. Assessments of surrogate mothers show no sign of psychopathology, but one study showed differences on several MMPI-2 scales compared to a normative sample: surrogate mothers identified with stereotypically masculine traits such as assertiveness and competition. They had a higher self-esteem and lower levels of anxiety and depression.Research objectiveTo determine if there is a difference in empathy and maternal–foetal attachment of surrogate mothers compared to a comparison group of mothers.MethodsThree groups of European traditional and gestational surrogate mothers (n = 10), Anglo-Saxon traditional and gestational surrogate mothers (n = 34) and a European normative sample of mothers (n = 32) completed four published psychometric instruments: the Interpersonal Reactivity Index (empathy index), the Hospital Anxiety and Depressions Scale and the MC20, a social desirability scale. Pregnant surrogate mothers filled the Maternal Antenatal Attachment Scale (n = 11). Statistical non-parametric analyses of variance were conducted.FindingsDepending on cultural background, surrogate mothers present differences in terms of empathy, anxiety and depression, social desirability and quality of attachment to the foetus compared to a normative sample.ConclusionsEnvironment plays a role for traditional and gestational surrogacy. Surrogate mothers of both groups are less anxious and depressed than normative samples. Maternal–foetal attachment is strong with a slightly lower quality of attachment. Surrogate mother's empathy indexes are similar to normative samples, sometimes higher.     

The Nuns of Lepers: Compassion,Discipline and Surrogate Parenthood in a Former Leper Colony of Vietnam

This paper focuses on a Christian model of leprosy care overseen by Catholic nuns in Quy Hòa, a leprosarium in South Central Vietnam, from 1929—when the leper colony was established—until 1975, when the American-backed Southern regime collapsed and all of Quy Hòa’s foreign nuns were forced to leave. Drawing on recollections of elderly residents of the former leprosy colony, it describes the close and loving attention that the nuns offered to inmates, an attentiveness that was informed by the nuns’ ethic of Christian sacrifice. The nuns at Quy Hòa successfully built a quasi parent–child relationship with leprosy-afflicted inmates. Their striking devotion to the ‘lepers’ resembles substitute motherhood. However, these recollections of that era also shed critical light on an approach to leprosy care that was premised on hierarchy, strictly enforced segregation from the wider community and pronounced paternalism towards all those who came under the nuns’ rule of care.     

Eating Morality: Food and the Goodness of Care in Northern Aboriginal Australia

This article contributes to anthropological discussions about care, food and morality by considering the gastro-morality of Yolngu people living in Galiwin’ku in the 2000s. I develop the concept of ‘trans-material morality’ to capture the ways that food takes on material, emotive and ontological forms of morality. Food is central to articulating expressions of care, as well to experiencing feelings of being cared for and, inversely, feelings of not being cared for. This is done by way of the meanings of good and bad that are attached to the food itself and by way of eating and acts of sharing and not sharing. I argue that largely because of food’s capacity to exist as trans-material morality, it is a particularly compelling thing with which to moralise, both in the intimate interactions of day-to-day life and in the grander theorising that human beings undertake to paint a picture of moral change.     

The association between social support networks and maternal employment: a comparison of western German,eastern German,and migrant mothers of preschool-aged children

A lack of adequate childcare can delay mothers’ return to the labor market after childbirth. This paper examines whether social support with childcare by kin and friends facilitates maternal employment in the first 72 months after childbirth. Using data from the German Socio-Economic Panel (SOEP) 1993–2009, a comparison of natives (n?=?1409) and migrants (n?=?411) in corporative-conservative western Germany with mothers in former socialist eastern Germany (n?=?528) shows that kinship support is positively associated with maternal employment when public childcare is limited. Western German and migrant mothers return to work sooner if they are surrounded by kin. But kin do not provide support for maternal employment in eastern Germany, where public childcare is more easily accessible and continuous female employment is a prevalent social norm. Friendship networks, by contrast, are most valuable for maternal employment if they complement public childcare.     

‘I couldn’t just entirely be her sister’: the relational and social policy implications of care between young adult siblings with and without disabilities

Research has commonly explored siblings of people with disabilities’ roles in care for their brothers or sisters with disabilities. Social policy has also commonly framed young adult siblings of people with disabilities as ‘young carers’. However, there has been less consideration of the implications of care for the relationship shared between young adult siblings with and without disabilities and of what this may mean for social policy. What do different types of care mean for sibling relationships? What are the relational and social policy implications of care between siblings? Drawing on a qualitative study of 25 siblings with disabilities and 21 siblings without disabilities aged 15–29, this article explores how young adult siblings perceive, talk and act with regard to the different types of care enacted between them. The article identifies how, during young adulthood, some types of care can endanger siblings’ capacity to feel like siblings and discusses ways that young adult siblings talk and act in order to – as best they can – keep their role within the bounds of a normative sibling relationship. The findings are discussed in light of implications for social policy, particularly with regard to seeing siblings of people with disabilities as ‘young carers’.     

Descriptive Analysis of Foster Care Adoptions in New South Wales,Australia

This paper describes the population of children in care in New South Wales, Australia, who were adopted by their foster families (N?=?372) from 2003 to 2014. Data pertaining to 370 of these adoptees were available and obtained from administrative records accompanying adoption applications. Most of these children had been placed with their subsequent adoptive family during infancy. However, adoption orders occurred much later in their lives. According to the available information at the time of adoption, these children did not suffer the high levels of mental health problems typically identified in populations of children in foster care. Though the data do not include follow-up to determine if the contact agreed upon at the time of adoption orders translated into practice, the most frequently postadoption arrangement recorded was face-to-face contact, four times a year with mother and siblings. The high levels of openness and face-to-face contact in Australian adoptions from care are a significant point of difference with other adoption models, and presents a need for research in the area.

IMPLICATIONS

• Following the change of legislation in New South Wales, Australia, that prioritises open adoption over foster care, social workers in the field of child protection are well placed to assist in this process.

• Social workers can assess children entering care to identify those who will benefit from adoption in a timely manner; undertake casework and administrative aspects of the adoption process; work closely with the child, and birth and adoptive families by delivering pre- and post-adoption supports; and conduct longitudinal research on the outcomes for children adopted from care.