浙江临安市生育文化变迁的调查与研究--关于浙江省临安市5561对双农独女户的调查与分析

本文通过走访、座谈和问卷调查等方式对临安市的生育文化变迁作了深入的研究。首先对临安生育文化变迁的现象进行了描述,然后,从经济、文化、社会等多角度对临安生育文化变迁的原因进行了宏观和微观的分析;最后,我们从社会保障、独生子女优惠措施的落实、计划生育工作等方面对临安生育文化建设提出了一些建议。     

Bayesian prediction of waiting times in stochastic models

The authors show how saddlepoint techniques lead to highly accurate approximations for Bayesian predictive densities and cumulative distribution functions in stochastic model settings where the prior is tractable, but not necessarily the likelihood or the predictand distribution. They consider more specifically models involving predictions associated with waiting times for semi‐Markov processes whose distributions are indexed by an unknown parameter θ. Bayesian prediction for such processes when they are not stationary is also addressed and the inverse‐Gaussian based saddlepoint approximation of Wood, Booth & Butler (1993) is shown to accurately deal with the nonstationarity whereas the normal‐based Lugannani & Rice (1980) approximation cannot, Their methods are illustrated by predicting various waiting times associated with M/M/q and M/G/1 queues. They also discuss modifications to the matrix renewal theory needed for computing the moment generating functions that are used in the saddlepoint methods.     

Perinatal factors related to post-traumatic stress disorder symptoms 1–5 years following birth

BackgroundThe relationship between perinatal variables and post-traumatic stress disorder (PTSD) symptoms was studied. However, the role of some variables in PTSD symptoms is unclear.AimDetermine the prevalence of PTSD symptoms after 1 year postpartum and their relationship with perinatal variables.MethodsA cross-sectional study with 1531 puerperal women in Spain. Data were collected on socio-demographic variables, perinatal variables (maternal characteristics, procedures during labour and birth, birth outcomes and time since birth) and the newborn. An online questionnaire was used, which included the Perinatal Post-traumatic Stress Questionnaire (PPQ). Crude and adjusted odds ratios (OR) were calculated using binary logistic regression.Findings7.2% (110) of the women were identified as being at risk for probable PTSD symptoms. Protective factors were having a birth plan respected (aOR 0.44; 95%CI 0.19−0.99), use of epidural analgesia (aOR 0.44; 95%CI 0.24−0.80) and experiencing skin-to-skin contact (aOR 0.33; 95%CI 0.20−0.55). Risk factors were instrumental birth (aOR 3.32; 95%CI1.73−3.39), caesarean section (aOR 4.80; 95%CI 2.51–9.15), receiving fundal pressure (aOR 1.72; 95%CI 1.08–2.74) and suffering a third/fourth degree perineal tear (aOR 2.73; 95%CI 1.27–5.86). The area under the model’s ROC curve was 0.82 (95%CI 0.79−0.83).ConclusionsWomen who experience a normal birth, are psychologically prepared for birth (for example, through use of a birth plan), experience skin-to-skin contact with their newborn, and had a sense of physical control through the use of epidural analgesia, are less likely to experience childbirth as traumatic.     

Traditional birth attendants’ roles and homebirth choices in Ethiopia: A qualitative study

BackgroundIn Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all.ObjectiveThis study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site.MethodA qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants’ responses, sorted and categorized as per the topic guide, and presented in narrative form.FindingsThe study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed.ConclusionsThere is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.     

Caesarean section by country of birth in New South Wales,Australia

ObjectiveTo determine rates of caesarean section by country of birth and by obstetric risks.MethodsWe analysed the New South Wales Perinatal Data Collection data of women giving birth between January 2013 and December 2015. Obstetric risk was classified using the Robson’s 10-group classification. Multilevel logistic regression with a random intercept was used to measure the variation in caesarean section rate between immigrants from different countries and between regional immigrant groups.ResultsWe analysed data from 283,256 women, of whom 90,750 had a caesarean section (32.0%). A total of 100,120 women were born overseas (35.3%), and 33,028 (33.0%) had a caesarean section. The caesarean section rate among women from South and Central Asia ranged from 32.6% for women from Pakistan to 47.3% for women from Bangladesh. For South East Asia, women from Cambodia had the lowest caesarean section rate (19.5%) and women from Indonesia had the highest rate (37.3%). The caesarean section rate for North Africa and the Middle East ranged from 28.0% for women from Syria to 50.1% for women from Iran. Robson groups that accounted for most of the caesarean sections were women who had previous caesarean section (36.5%); nulliparous women, induced or caesarean section before labour (26.2%); and nulliparous women, spontaneous labour (8.9%).ConclusionsThe caesarean section rate varied significantly between women from different countries of birth within the same region. Women from some countries of birth had the higher caesarean section rates in some Robson groups.     

Negotiating who gives birth and the influence of fear of childbirth: Lesbians,bisexual women and transgender people in parenting relationships

BackgroundFear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied.AimThe aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC.MethodsSeventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis.ResultsFOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care.ConclusionsIt is important that healthcare staff address both partners’ prenatal expectancies and postnatal experiences.     

The effect of antenatal screening for depression on neonatal birthweight and gestation

BackgroundAntenatal depression has been associated with poor perinatal outcomes such as preterm birth and low birth weight. Universal screening of perinatal depression has been recommended to improve maternal and pregnancy outcomes.Hypothesis and aimWe hypothesise that screening for antenatal depressive symptoms may reduce the risk of preterm birth and low birth weight. To assess the hypothesis, we explore the association between antenatal depression screening using the Edinburgh Postnatal Depression Scale and neonatal outcomes.MethodsA retrospective analysis of state-wide population-based health administrative data. Inclusion criteria were pregnant women who gave birth to a singleton in Queensland in the second half of 2015 (29,543 women). Logistic regression analyses were run in 27,817 women with information in all variables. Main outcomes were preterm birth (<37 weeks of gestation) and low birth weight (<2500 grs).ResultsWomen who did not complete the screening had increased odds of preterm birth (AOR, 1.56; 95% CI, 1.39–1.74; p < 0.001) and low birth weight (AOR, 1.48; 95% CI, 1.30–1.68; p < 0.001) before and after adjustments for relevant confounders when compared to women who completed the screening. Sensitivity analyses performed in women with spontaneous labour and in women without a diagnosis of depression showed similar results.Conclusion(s)We found an association between screening for depressive symptoms during pregnancy and better neonatal outcomes. However, this result does not necessarily infer causality. Any association may represent a previously unknown benefit to screening, which could support the case for universal antenatal depression screening.     

The Potential for Reducing Mortality in Russia

This article attempts to assess current national and regional reserves for reducing the mortality rate in Russia. It explores the potential to reduce the mortality rate in comparison to comparable international benchmarks in rates of growth and gains in life expectancy at birth, identifies a range of circumstances that have an adverse impact on the population’s health in post-Soviet Russia, and shows that the main reserve for reducing mortality remains the “lost health capital” that preceded the collapse of the Soviet Union and continued in the 1990s. Finally, it assesses the current regional potential for lowering the mortality rate, which is “hidden” in differences between regions leading in life expectancy (with the exception of extremes) and the country’s remaining territories. The conclusion presents data revealing the life expectancy of men and women.     

A non‐linear model of fecundability,postpartum amenorrhea,and sterility*

This paper proposes a convolution model of fecundability, controling for the effects of postpartum amenorrhea and unobserved heterogeneity in fecundability. Simulation analysis was used to assess the validity and reliability of estimates derived from the model. Analysis showed that the model captured the mean and standard deviation of age at the onset of sterility in simulated populations where sterility followed either a Gompertz, a gamma, or a lognormal distribution. The model performed well when sterility was specified by either a lognormal or a gamma distribution. The model also accurately estimated fecundability and postpartum amenorrhea. Next, the model was found to fit data from 17th and 18th century French Canadian birth histories. In this French Canadian sample the mean age at sterility was found to be 46.3 years using a gamma model. The decline in fecundability was almost linear after age 30. Thus, fecundability at age 40 had declined to about one‐third of that observed at age 30. Variability in individual fecundability was quite high. For example, women with fecundability one standard deviation above the mean had about 2.3 times as high fecundability as women one standard deviation below the mean.