Functional discomfort and a shift in midwifery paradigm

ObjectiveTo determine and critically examine maternity attitudes surrounding labour pain and how midwives can best facilitate women navigating intrapartum discomfort without relying on ‘pain-relief’ strategies or immediate recourse for analgesic assistance.ApproachThis article examines current literature using seminal research and wider international perspectives, exploring the complex and fluctuating needs of women negotiating the composite factors of labour discomfort are investigated.FindingsFactors such as birth environment, fear, midwifery presence, and self-efficacy, have a significant impact on the uptake of intrapartum analgesia. A holistic view of intrapartum discomfort is needed to shift the current paradigm of pathologising labour pain into one which situates it as a source of positive physiology and functional discomfort.ConclusionContinuing to practice with a pharmacological outlook, aiming to rid the labouring body of discomfort, is reductionist for both midwives and women. Midwives must seek to employ a new lexicon with which to communicate and facilitate women within the dynamic and continually changing territory of labour. If this conceptual shift is realised, the subsequent positive sequalae of women rediscovering their innate birthing capabilities could create a situation where birth can be considered as an aesthetic peak experience, improving satisfaction on both sides of the midwife-mother diad.     

“I guess baby was just too comfy in there…”: A qualitative study of women's experiences of elective late-term induction of labour

BackgroundThe frequency of induction of labour (IOL) in late-term pregnancy has increased significantly, but little is known about how women with uncomplicated pregnancies experience IOL for late-term indication alone.AimTo explore how women with uncomplicated pregnancies experienced late-term IOL.MethodsQualitative interviews were conducted with 23 women who all had labour induced on late-term indication only. Participants were recruited from two Danish hospitals who offered an outpatient induction regime. The women were interviewed 4–8 weeks after birth. Data were analysed using thematic analysis.ResultsAll women had hoped for a spontaneous birth. Prolonged pregnancy was understood as the body/baby “not being ready”, but generally, the women were not worried at that point. Most women felt adequately informed about the reasons for IOL, but some requested more information and time to consider their options. The majority considered IOL to be both an offer and a recommendation. One-third of the participants were initially hesitant but chose/accepted IOL because of weariness from pregnancy and the impatience to deliver a healthy child. The opportunity of outpatient induction was generally appreciated as it allowed the women to continue everyday activities while waiting for labour to begin. Nineteen women reported having a good birthing experience. Two women felt that negative birthing experiences were partly related to IOL.ConclusionsMost women considered the late-term IOL to be a positive experience. Some women requested more information and time to consider alternatives. These women should be provided with supported opportunities to consider the options.     

Incorporating heterogeneous intercourse records into time to pregnancy models

Information on the timing of intercourse relative to ovulation can be incorporated into time to pregnancy models to improve the power to detect covariate effects, to estimate the day-specific conception probabilities, and to distinguish between biological and behavioral effects on fecundability, and therefore the probability of conception in a menstrual cycle. In this paper, Bayesian methods are proposed for joint modeling of intercourse behavior and biologic fecundability. The model accommodates a sterile subpopulation of couples, general covariate effects, and heterogeneity among fecund couples in menstrual cycle viability and in frequency of unprotected intercourse. Methods are described for incorporating cycles with varying amounts of intercourse information into a single analysis. A Markov chain Monte Carlo algorithm is outlined for estimation of the posterior distributions of the unknowns. Themethods are applied to data from a North Carolina study of couples attempting pregnancy.     

陶渊明年寿问题辨证

陶学研究者对史书记载的陶渊明年寿提出了质疑并各创新说。除史书所言渊明63岁外,其余诸说多是从陶渊明诗文中找到证据,并推断渊明年岁。但诸说均忽略了渊明居处遇火对其诗文保存与写作的影响,并以其诗中不能确指的数字作为推论的原点。陶渊明年寿的可靠资料应是《宋书.隐逸传》、颜延之的《陶征士诔》和萧统的《陶渊明传》,而袁行霈先生的一些说法就很难成立。陶渊明年寿仍应以＂六十三＂岁为妥。     

综合治理出生性别比偏高工作的考核评估——基于6省24县市区的调研分析

通过对全国6个省24个县市区综合治理出生性别比考核评估工作进展情况的实地调研发现,针对考核评估,各地已经建立起了统计监测和考核评估制度,还对考核方案进行了内容指标、保障机制、考核方式方面的创新性改进。同时也发现,国家级和省、市级的考核评估方案还存在顶层设计、目标任务、数据依据、考核指标设计等不符合实际的问题。据此提出了完善考核指标体系、改进考核工作机制、创新考核方式方法、提高考核实际效果四项建议。     

我国生育政策对二孩生育间隔影响的分层模型研究

我国不同生育政策类型地区二孩生育间隔的差异,既受到地区经济、社会和生育政策的影响,又受到育龄妇女个人和家庭因素的影响。分层模型结果表明,地区间生育间隔差异占我国二孩生育间隔总差异的30．54％。我国生育政策对不同政策类型地区二孩生育间隔差异的影响程度基本在20％以下,不同地区经济和社会发展的不平等状况是导致地区间二孩生育间隔差异的主要原因。     

Space,place and the midwife: Exploring the relationship between the birth environment,neurobiology and midwifery practice

BackgroundResearch indicates that midwives and their practice are influenced by space and place and that midwives practice differently in different places. It is possible that one mechanism through which space and place influence midwifery practice is via neurobiological responses such as the production and release of oxytocin, which can be triggered by experiences and perceptions of the physical environment.AimTo articulate the significance of space and place to midwifery and explore the relationship between the birth environment, neurobiology and midwifery practice.DiscussionQuality midwifery care requires the facilitation of trusting social relationships and the provision of emotionally sensitive care to childbearing women. The neuropeptide oxytocin plays a critical role in human social and emotional behaviour by increasing trust, reducing stress and heightening empathy, reciprocity and generosity.Principle conclusionThrough its role as a trigger for oxytocin release, the birth environment may play a direct role in the provision of quality midwifery care.     

性别视角下的迁移历程研究——基于中国1930～1969年出生队列的分析

利用2014年中国健康与养老追踪调查生命历程数据,探究中国1930～1969年出生队列的迁移历程及其性别差异,运用事件史分析方法解释重要生命事件(教育、就业、婚姻、生育)对男性和女性迁移历程的影响。研究结果表明,不同出生年代人口的迁移历程呈现明显的队列差异和性别差异;与1940～1949年和1950～1959年出生队列相比,1930～1939年和1960～1969年出生队列在迁移高峰年龄(20～24岁)时的政策限制较少而终身累计迁移频率更高,性别差异也更显著;教育和非农就业转移会促进终身迁移机会,较早结婚和较多生育的作用则相反;非农就业转移对女性的多次迁移有更明显的促进作用,会缩小男女之间的迁移差距;结婚和生育会降低迁移概率,而离婚会增加迁移概率,这些事件对女性的影响更大。