Actual Births Research Articles

The Impact of COVID-19 on Fertility in Spain

We study the effect of the first wave of COVID-19 and the accompanying containment measures on fertility in Spain. We use earlier years to predict births in the absence of the pandemic and then compare our prediction to actual births. We document a large fall in births in December 2020 and January 2021 and a complete catch-up during the rest of 2021. The fall in fertility was moderate among native women, with a substantial rebound and a positive net effect of 5% by the end of 2021, while the decline in births among foreign women started early and was persistent.

Impact of COVID-19 pandemic on marriage, divorce, birth, and death in Kerman province, the ninth most populous province of Iran

This study examined the impact of the COVID-19 pandemic on marriage, divorce, birth, and death rates using the Poisson regression model and an interrupted time-series Poisson regression model. Before the pandemic, marriage and birth rates were decreasing, while divorce and death rates were increasing, with only the trend in birth rates being statistically significant. The immediate effect of the pandemic was a significant decrease in the divorce rate, but there were non-significant effects on birth and marriage rates. However, in the months following the onset of the pandemic, there was a statistically significant sustained effect on increasing death and divorce rates. Forecasts based on pre-pandemic data showed that by the end of 2020, marriage, divorce, death, and birth rates were higher compared to pre-pandemic levels. In conclusion, the pandemic has greatly impacted society, particularly in terms of death and divorce rates. Birth rates were not immediately affected to the time lag between decisions and actual births. Fear of COVID-19 may have increased death rates as people avoided seeking medical help. Vaccination and effective treatment strategies are vital in reducing the pandemic's impact on mortality. Supporting families financially is important due to the role of economic issues in couples’ decisions.

Folate: Deja vu – all over again

Folate: Deja vu – all over again

Grass greenness flush can influence breeding phenology and fertility in equatorial thoroughbred mares in the absence of photoperiod variation.

Reproductive phenology is an important trait subjected to natural selection. Current horses in America belong to the Palearctic original populations after being introduced by European colonizers. Photoperiod variation is the main environmental factor for the adjustment of reproductive timing in horses, but is absent in equatorial areas. Here we hypothesize that seasonality of green-grass availability may influence breeding phenology in equatorial regions. We used data of 929 services to mares from 2006 to 2011 in a thoroughbred equine exploitation in Ecuador that experienced strong grass seasonality. Actual births could not be used to infer natural phenology because they were influenced by management decisions. Instead, we used variations in the probability of pregnancy after a service as a measure of the natural tendency of mares to show breeding phenology. We found that although managers tended to schedule pregnancies in two periods within the year, mares were more prone to become pregnant after the increase in grass greenness that takes place at the beginning of the year (February). Our finding has potential applications to improve the success of services and the welfare of animals, by providing green-grass stimuli in the appropriate season.

Is unplanned out-of-hospital birth managed by paramedics \u2018infrequent\u2019, \u2018normal\u2019 and \u2018uncomplicated\u2019?

BackgroundUnplanned out-of-hospital birth is often perceived as precipitate in nature, ‘infrequent’, ‘normal’ and ‘uncomplicated’. However, international studies report unplanned out-of-hospital birth is associated with increased rates of maternal and neonatal morbidity and mortality. This research describes intrapartum, immediate postpartum and neonatal care provided by paramedics in Queensland, Australia. The objectives were to (1) determine the number of cases where the paramedic documented birth or imminent birth during the study period (2) to describe the incidence of births prior to or during paramedic care (3) to detail any risk factors and/or complications recorded by paramedics during these cases, (4) identify paramedic pain management practices for intrapartum care, and (5) to examine the maternal and neonatal outcomes as documented by paramedics.MethodA retrospective analysis of Queensland Ambulance Service (QAS) de-identified patient care records, generated from clinical case data between the 1st of Jan 2010 and 31st of Dec 2011, was undertaken. Descriptive analysis and x2 tests were used to test associations between categorical variables, and the Wilcoxon rank-sum for associates between continuous variables which were not normally distributed. Content analysis was utilised to code free text fields.ResultsSix thousand one hundred thirty-five records were identified as intrapartum cases. This represented approximately 0.5% of the annual QAS caseload; 5722 were classified as maternal records and 413 were neonatal records. Paramedics recorded antenatal and/or intrapartum complications in 27.3% (n = 1563) of cases. Abnormal maternal vital signs were recorded in 30.1% (n = 1725) of cases. Of the 5722 women attended by paramedics during their labour, a birth occured in 10.8% (n = 618) of cases. Parity was documented in 41.4% (n = 256) of mothers who birthed. Neonatal records were available for 66.8% (n = 413) of actual births, 60.0% (n = 248) recorded a full set of neonatal vital signs and an Apgar score. When an Apgar score was recorded, 21.8% (n = 91) scored ≤7 out of 10.ConclusionsThe research described intrapartum, immediate postpartum and neonatal care provided by paramedics and identified factors that may complicate paramedic clinical management of labouring and birthing women. Further research is required to determine if there are opportunities to improve the paramedic management of such cases.

Determinants of Contraceptive Usage among Married Women in Shiraz, Iran

Background & aim: Contraceptive usage is a central part of the quality of care in the provision of family services. Currently, this issue has gained much importance since the Iranian policy makers are changing their policies about family planning and contraceptives accessibility. Regarding this, the aim of this study was to determine the rate of contraceptive usage and the factors affecting contraceptive use among the married women of reproductive age in Shiraz County, Iran. Methods: This cross-sectional study was conducted on 626 married women of reproductive age (i.e., 15-49 years) living in Shiraz County (including Shiraz city and the rural areas) using the quantitative survey method. Sampling was performed using multi-stage cluster and purposive sampling techniques. The sample size was determined based on the Krejcie and Morgan’s formula. The data were collected through a questionnaire filled out by some interviewers. Data analysis was performed both descriptively (i.e., frequency and percentage) and analytically (i.e., Chi-square and logistic regression tests) using the SPSS version 20. Results: According to the results of this study, the main predictors of contraceptive usage were couple agreement on contraception method, the number of actual births, women’s authority, knowledge and positive attitude about contraceptives, and the number of desired children. Conclusion: Regarding the new population policies, the Iranian policy makers should be aware of the different aspects of family planning programs, particularly those targeting the contraceptive usage.

Quantification of Blood Loss Using Simulation

Postpartum hemorrhage continues to be a leading cause of maternal death in the United States. In evaluating adverse outcomes in our hospital, we recognized blood loss was underestimated, poorly communicated, and inconsistently documented. Understanding these shortcomings, we agreed to focus on quantification of blood loss (QBL), improved documentation, and enhanced communication. A multidisciplinary team at Baylor University Medical Center recognized the need to implement QBL for all births as a vital step in preventing adverse outcomes related to hemorrhage. The group felt they could utilize the Simulation Training and Research Program to effectively plan and operationalize the process. The team used the Simulation Training and Research Program by creating in-situ simulations of births, which allowed them to test the processes, identify barriers, and opportunities while in a safe, well-controlled environment. From the drills, a proposed process was tried with key members of the team during actual births. The intent was to assess the equipment and tools and ensure that the process was seamless and noncumbersome to the health care providers. Feedback from the pilot study allowed the team to make necessary changes to ensure a more robust QBL process. Once the team finalized the process, simulation education was provided to ensure a smoother rollout and provide staff with a sense of comfort. Involvement of bedside staff at the inception of the project, use of simulation, and a pilot study helped identify barriers and develop a proposed process to provide a more successful transition.

Place Matters: Outcomes for Planned Out-of-Hospital Births

In recent years the likelihood of planned and actual births outside of hospital settings has increased, driven partly by some women's desire to avoid

Always, already-medicalized: Women’s prenatal knowledge and choice in two Canadian contexts

Women’s childbirth choices occur within contested discourses about medical, natural, and woman-centered births. All three perspectives, to slightly differing degrees, presume an autonomous female subject who makes childbirth choices. Thus informed choice is posed as a crucial corrective to the increasing medicalization of childbirth. This article employs a critical feminist analysis to examine how women learn about childbirth and make choices long before the moment of informed choice. Interviews with 40 pregnant and recently birthing women in two cities in Alberta, Canada illustrate how media, family and friends, and prenatal courses comprised core pre-birth knowledge systems informing women’s decision-making. The interviews exposed how medicalization is naturalized in these knowledge systems, so that women approached their actual births with an already-medicalized set of perceptions. This already-medicalized knowledge foreclosed women’s choices, a finding that complicates arguments over improving informed choice during childbirth as a means of reducing childbirth medicalization.

Age at Birth of First Child and Fecundity of Women Survivors of Childhood Acute Lymphoblastic Leukemia (1987−2007): A Study of the Childhood Cancer Registry of the Rhône-Alpes Region in France (ARCERRA)

We studied the fecundity of 174 successive ALL (1987–2007) in females of the Childhood Cancer Registry of the Rhône-Alpes Region (ARCERRA) with a median age at follow-up of 25.6 years (18.0–37.4). We distinguished five treatment groups: Group Ia, chemotherapy only (n = 130); Ib, chemotherapy with cranial radiotherapy (n = 10); II, TBI conditioning allograft (n = 27); III, chemotherapy conditioning allograft (n = 4); IV, TBI conditioning autograft (n = 3).Twenty-three women had their first child at the mean age of 25.8 ±3.0 years, i.e., 2.0 ±2.9 years earlier than the general population of the Rhône-Alpes region (P = 0.003).The standardized fertility ratio (SFR), expressed as the number of actual births observed (O) to the number that would be expected in women of the same age in the general population (E) (SFR = O/E) was decreased for Group Ia (0.62; 95%CI, 0.52–0.74) and collapsed in Group II (0.17; 0.11–0.25).In univariate analysis, TBI (P = 0.013) and alkylating agents (P = 0.01) were negatively correlated with fecundity, but not with the age at diagnosis or the anthracyclines doses. In multivariate analysis including TBI and alkylating agents, we still found a negative correlation between TBI (P = 0.035), as well as alkylating agents (P = 0.028), and fecundity. More precisely, fecundity was negatively correlated with cumulative cyclophosphamide equivalent dose (P = 0.001), with a fecundity decreased for ≥1g/m2, but without any dose effect; results not found in the Group Ia.Age at first child seems younger but the young median age of the cohort not allows concluding; fecundity is collapsed after fractionated total body irradiation and decreased after chemotherapy without any demonstrable cause. A delay of fertility is not excluded.

Addendum--adolescent pregnancy: current trends and issues.

The purpose of this addendum is to update pediatricians and other professionals on recent research and data regarding adolescent sexuality, contraceptive use, and childbearing since publication of the original 2005 clinical report, “Adolescent Pregnancy: Current Trends and Issues.”1 There has been a trend of decreasing sexual activity and teen births and pregnancies since 1991, except between the years of 2005 and 2007, when there was a 5% increase in birth rates. Currently, teen birth rates in the United States are at a record low secondary to increased use of contraception at first intercourse and use of dual methods of condoms and hormonal contraception among sexually active teenagers.2 Despite these data, the United States continues to lead other industrialized countries in having unacceptably high rates of adolescent pregnancy, with over 700 000 pregnancies per year, the direct health consequence of unprotected intercourse.3 Importantly, the 2006–2010 National Survey of Family Growth (NSFG) revealed that less than one-third of 15- to 19-year-old female subjects consistently used contraceptive methods at last intercourse.4 Most pregnancies among adolescents in the United States are unintended (unwanted or mis-timed). In fact, 88% of births to teenagers 15 to 17 years of age were the result of unintended pregnancies.5 Births to 15- to 19-year-old female subjects peaked in 1991 at 61.8 per 1000 female subjects; subsequently, the rate decreased annually, except for a slight increase in 2005–2007, to reach its nadir at 39.1 per 1000 female subjects in 2011.6 Birth rate statistics are not the same as pregnancy rate statistics. Birth rate statistics underestimate actual adolescent pregnancy rates. The birth rate numerator includes the number of actual births per 1000 individuals in that age group, but the pregnancy rate includes actual births, abortions, and best estimates of fetal loss per 1000 adolescents in that …

Local use of geographic information systems to improve data utilisation and health services: mapping caesarean section coverage in rural Rwanda

To show the utility of combining routinely collected data with geographic location using a Geographic Information System (GIS) in order to facilitate a data-driven approach to identifying potential gaps in access to emergency obstetric care within a rural Rwandan health district. Total expected births in 2009 at sub-district levels were estimated using community health worker collected population data. Clinical data were extracted from birth registries at eight health centres (HCs) and the district hospital (DH). C-section rates as a proportion of total expected births were mapped by cell. Peri-partum foetal mortality rates per facility-based births, as well as the rate of uterine rupture as an indication for C-section, were compared between areas of low and high C-section rates. The lowest C-section rates were found in the more remote part of the hospital catchment area. The sector with significantly lower C-section rates had significantly higher facility-based peri-partum foetal mortality and incidence of uterine rupture than the sector with the highest C-section rates (P < 0.034). This simple approach for geographic monitoring and evaluation leveraging existing health service and GIS data facilitated evidence-based decision making and represents a feasible approach to further strengthen local data-driven decisions for resource allocation and quality improvement.

The Impact of Relationship Quality on Childbearing in Finland

Using the data from the 2008 Finnish Well-Being and Social Relationship Survey I examine how relationship quality is associated with childbearing. The respondents are 25-44-year-old married and cohabiting Finns with no or one children in 2008 and who were followed up with register data in 2011. The combined data (N=1402) gives an opportunity to examine the effect of relationship quality to actual births during the period 2008-2011. Different perceptions of current relationship, relationship satisfaction and frequency and reasons of arguing are included to analysis. The independent variables controlling for structural factors include number of children, age and education, both partners childbearing intention and duration of current relationship. Results indicate that childless men in medium and high quality relationships are most likely to have children. Men (who have a child) in medium quality relationships are most likely to have more children. Relationship quality can shape childless womens childbearing in two ways. Higher relationship quality can strengthen womens intention to have a child and so impact positively on childbearing. Also high relationship quality can result less births among childless women. Women with an earlier child in medium or high quality relationships are most likely to have more children.

The need for public involvement when operating a regionalized neonatal care system at maximum capacity

Regionalization of neonatal and perinatal care is a widely used strategy to provide access to optimal care for a geographically dispersed population while using resources effectively (1). Despite being highly regionalized, the Canadian system is experiencing mounting pressure on neonatal intensive care unit (NICU) beds due to a combination of increasing overall birth rates (Figure 1), increasing rates of late preterm birth, and increasing survival rates of previously nonviable premature and term infants. The rise in birth rate is the result of two colliding events: the baby boomers’ children are now giving birth to their own children, and rising fertility rates due to delayed child-bearing. We present an argument in support of the need for public involvement in decisions regarding health care resource allocation (2). Figure 1) Annual births in British Columbia, 1971 to 2007. Note: Plotted line shows actual annual births; solid line shows linear regression. Since 2001, there has been a rise in the birth rate as a result of the baby boom generation’s children now having ...

Should Nursing Students Be Required to Participate in Actual Births During Their Obstetric Clinical Experience?

Should Nursing Students Be Required to Participate in Actual Births During Their Obstetric Clinical Experience?

Should Nursing Students Be Required to Participate in Actual Births During Their Obstetric Clinical Experience?

In Brief How do you feel about nursing students never even witnessing a birth during their obstetric clinical rotations?

Do birth certificate data accurately reflect the number of CNM-attended births? An exploratory study

The number of midwife-attended births is increasing as reported on birth certificates in the United States. However, there is some evidence that births attended by certified nurse-midwives (CNMs) may not be accurately recorded. In this exploratory study, data on birth attendants for those clients giving birth during the study period were compared by using four sources: the client’s hospital chart, the CNM birth log, hospital birth certificate records, and state vital statistics records. Researchers sought to determine the accuracy of birth attendant data as reflected in these four sources and whether other providers were listed as the birth attendant for actual CNM-attended births. During the study period, the CNM birth log showed that CNMs attended 97 vaginal births, whereas the client hospital charts for these same births noted 92 births as attended by CNMs (the other five were operative vaginal births). Hospital birth certificate and state vital statistics data during the study time period credited 88 and 82 of the client’s births, respectively, to the CNMs. Exploration of the inaccurately reported birth attendant data, implications for practice, and recommendations for accurately recording birth certificate data are discussed.

The ART pandemic of multiple pregnancies. Multiple births but not multiple pregnancies is a disease of age

Objective: The goal of all quality IVF programs should be to reduce the number of twin and triplet births while maintaining a high overall pregnancy rate. It is industry standard to transfer more embryos to older patients in an effort to maximize live births. Multiple implantations are common in older patients and may not be a disease of age. However, knowing if multiple implantations necessarily follow through as multiple births would be extremely helpful when deciding how many embryos to transfer to older patients. The objectives of this study were to evaluate 1) the frequency of multiple implantations as related to patient age and 2) to correlate multiple implantations with actual multiple live births.

Sex ratio and birthweight outcome when considering blastocyst expansion, multiple gestation, and facility.

Objective: Skewing of the sex ratio is convincingly demonstrated by domestic-animal in vitro embryo culture systems (Avery et al., 1991; Xu et al., 1992). Even though approximately 60% of in-vitro-produced bovine blastocysts tend to be male, reports of increased numbers of male calves born are less convincing (Berg et al., 1992). Alteration of the sex ratio is not typically seen in day 2/3 human in vitro fertilization programs (Ng et al., 1995). However, in vitro culture of domestic-animal embryos usually consists of 7 days of culture to the blastocyst stage. Recently, an altered sex ratio has been reported when transferring human blastocysts (Ménézo et al., 1999). The objective of this study was to determine if the skewing towards males can be confirmed as actual births in a human blastocyst transfer program, and if so, if it is related to blastocyst expansion, multiple gestations and/or facility.

Variation in home-birth rates between midwifery practices in the Netherlands

Objective: to examine the reasons for the variation in home-birth rates between midwifery practices.Method: multi-level analysis of client and midwife associated, case-specific and structural factors in relation to 4420 planned and actual home or hospital births in 42 midwifery practices.Findings: women's choice of birth location and the occurrence of complications that lead to referral to specialist care before or during labour, were found to be the main determinants of the home-birth rate. Yet, about 64% of the variation between midwifery practices is explained by midwife and practice characteristics. Higher home-birth rates were associated with a positive attitude to home-birth, a critical attitude to hospital birth for non-medical reasons, and good co-operation between midwifery practices and hospital obstetricians.Conclusions: the proportions of planned hospital birth and of referral to specialist care are the most important predictors of the actual hospital-birth rate of women receiving midwifery care. Both can be influenced by the midwife through a positive attitude to home-birth, a critical approach to non-medical reasons for hospital birth, and good co-operation with specialist obstetricians. It is, therefore, important for midwives to be aware of the influence that their own attitudes may have on the choices their clients make about home or hospital birth.