Women’s experiences of decision-making and attitudes in relation to induction of labour: A survey study

BackgroundRates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women’s mode of birth preferences and experiences of shared decision-making for induction of labour.MethodAn antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women’s demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process.ResultsOf 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making.ConclusionA substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.     

Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

IssueFear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions.AimTo conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them.MethodsA meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis.FindingsOne overarching theme “Ownership of Childbirth” and three analytical themes “Facing the fear”, “Feeling empowered”, “Managing the fear with a sense of security” were generated through the synthesis. There were no studies outside of Scandinavia located.DiscussionThis meta-synthesis provides a new way to describe the process of moving from fear to “Ownership of childbirth”. The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff.ConclusionThese findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.     

International Adoption: Counseling and the Adoption Triad

Despite a 60-plus–year history of international adoption (IA) placements, the body of research exploring counseling and psychological interventions for those affected by IA is still in its infancy. This critical review of the state of the literature addresses research, theory, and practice relevant to the international adoption triad (adoptive parents, birth parents, and adoptees). We highlight the lack of empirical attention to the clinical needs of birth parents, the tendency to overlook the clinical needs of adoptive parents both pre- and post-adoption, early childhood vulnerability in international adoptees, and adolescent identity challenges and the attendant clinical issues.     

On an application of the diffusion approximation of the generalized birth and death process for stochastic population projection

Assuming that both birth and death rates are density and time dependent, a diffusion approximation of the generalized birth and death process has been considered in this paper to obtain a suitable stochastic population model describing the population size and its moments. A simple method of estimating the parameters of the model Is discussed. The predictions of the expected size of the population, and the variance are made and compared with the corresponding census figures as well as with another deterministic projection series made for the corresponding period.     

SOJOURN TIMES IN NON-HOMOGENEOUS QBD PROCESSES WITH PROCESSOR SHARING

We study sojourn times of customers in a processor sharing queue with a service rate that varies over time, depending on the number of customers and on the state of a random environment. An explicit expression is derived for the Laplace–Stieltjes transform of the sojourn time conditional on the state upon arrival and the amount of work brought into the system. Particular attention is paid to the conditional mean sojourn time of a customer as a function of his required amount of work, and we establish the existence of an asymptote as the amount of work tends to infinity. The method of random time change is then extended to include the possibility of a varying service rate. By means of this method, we explain the well-established proportionality between the conditional mean sojourn time and required amount of work in processor sharing queues without random environment. Based on numerical experiments, we propose an approximation for the conditional mean sojourn time. Although first presented for exponentially distributed service requirements, the analysis is shown to extend to phase-type services. The service discipline of discriminatory processor sharing is also shown to fall within the framework.     

Social Change and Social Policy in Japan

This paper aims to present and discuss social change and social policy in Japan after the mid-20th century from a sociological viewpoint. Japanese social change and social policy from the mid-20th century onward can be categorized into three models in chronological order: escape from mass poverty by means of industrialization, improvement of the social security system to establish a welfare state, and parallel progress of aspiration for a welfare society and workfare. Defined concretely, these are (1) the period that established and improved social security, which started immediately after the end of World War II and ended in 1973, when Japan began to suffer from low growth after enjoying high growth; (2) the period in which finance for social security was adjusted, halfway through which the country experienced a bubble economy; and (3) the period after the 1990s, in which the structural reform of social security went hand-in-hand with labor policy and the advent of globalization. In each of the three periods, the direction of social policy was affected by factors that caused changes in such areas as industrial structure (the decline of agriculture), demographic structure (an aging society), and family structure and work pattern (the growing trend of nuclear families, single-person households, and irregular employment). In Japan, life security now attracts increasing attention, and employment security rather than social security has been the central issue. As it is greatly affected by globalization, employment security grows less conspicuous and makes the vulnerability of social security grow more conspicuous. Social policy has the potential to become an area with which to struggle for national integration and fissures between social groups.     

The mobility problem in Britain: new findings from the analysis of birth cohort data

Social mobility is now a matter of greater political concern in Britain than at any time previously. However, the data available for the determination of mobility trends are less adequate today than two or three decades ago. It is widely believed in political and in media circles that social mobility is in decline. But the evidence so far available from sociological research, focused on intergenerational class mobility, is not supportive of this view. We present results based on a newly‐constructed dataset covering four birth cohorts that provides improved data for the study of trends in class mobility and that also allows analyses to move from the twentieth into the twenty‐first century. These results confirm that there has been no decline in mobility, whether considered in absolute or relative terms. In the case of women, there is in fact evidence of mobility increasing. However, the better quality and extended range of our data enable us to identify other ‘mobility problems’ than the supposed decline. Among the members of successive cohorts, the experience of absolute upward mobility is becoming less common and that of absolute downward mobility more common; and class‐linked inequalities in relative chances of mobility and immobility appear wider than previously thought.     

Pre-term Foetal Life Times in Scotland

A proportional hazards model was used to evaluate the association between ten categorical covariates and the risk of pre-term delivery for women having their first child and women in subsequent pregnancies. An adaptation of the model for use with grouped survival times made it possible to model foetal life times between 28 and 36 completed weeks of gestation for 67,000 Scottish singleton births in 1981. The use of the model was justified by testing time-dependent effects. For both groups of women age, and a history of abortion, were major factors associated with increased hazard. For women experiencing a second or higher-order birth a history of perinatal death was also associated with substantially increased hazard to the pregnancy.     

Experience,perceptions and attitudes of parents who planned home birth in Spain: A qualitative study

BackgroundA woman’s home birth and postpartum experience can have a major impact on her baby’s, partner’s and family’s well being. It is a life-altering event that can help improve or worsen women’s self-esteem and self-confidence.AimThe aim of this study was to describe and understand the experiences, perceptions and attitudes of parents who planned a home birth in Spain.MethodsA qualitative study was conducted based on Gadamer’s hermeneutic phenomenology. Two main methods were used for data collection; narratives and individual in-depth interviews with 14 mothers and 8 fathers who had planned a home birth in the last year. Inductive analysis was used to find themes based on the data obtained.FindingsSix main themes emerged from the data analysis: (1) in search of a natural and personalised birth, (2) breaking with social pressures, (3) experience of home birth for the mother, (4) role of the father in home birth, (5) how does the father experience home birth?, (6) home birth is not available to all mothers and fathers.ConclusionFor the mothers and fathers in this study the home birth experience fulfilled their previous expectations of an intimate and natural moment, making it a highly satisfying experience for both. However, parents expressed experiencing negative feelings such as fear and worry about complications and labor pain. According to our research society in general and public health professionals in particular issue numerous criticisms and value judgments towards mothers and fathers who opt for a home birth in our country. In addition, the study shows the economic and cultural inequalities in access to home birth in Spain.