Birth In Australia Research Articles

The early days of IVF outside the UK

In this article the history of IVF in geographical regions outside the UK are traced by pioneers of that time. Following the birth of Louise Brown in 1978, live births after IVF occurred in Australia in 1980, in the USA in 1981 and in Sweden and France in 1982. Following the first IVF birth in Australia, the Government of Victoria established a review of IVF research and practice which led to the proclamation of the Infertility (Medical Procedures) Act 1984, the first legislation to regulate IVF and its associated human embryo research. Despite such restriction, IVF doctors and scientists from Victoria, especially those under the leadership of Carl Wood, Alan Trounson and Ian Johnston continued to initiate new treatments for infertility and new methods for delivering this treatment. In the USA IVF research began on animals as early as the 1930s, when Pincus and Enzmann at Harvard were involved in attempts at IVF in the rabbit. In the 1940s, John Rock attempted human IVF with 138 human oocytes without success. In 1965, Bob Edwards was with Georgeanna and Howard Jones at Johns Hopkins where attempts were made to fertilize oocytes in vitro. Clinical IVF began in earnest in the USA in 1980 with the first birth in 1981 achieved by the use of HMG--a first successful use with IVF. In France, two groups Frydman and Testart (Clamart) and Cohen, Mandelbaum and Plachot (Sevres) focused their research in particular directions. In 1981, the Clamart group developed a plasma assay for the initial rise in LH. The Sevres group developed a transport technique. Plachot produced a long series of cytogenetic analyses of oocytes and human embryos. Mandelbaum described the microstructures of the human oocyte. The start of IVF in France benefited from the help of animal researchers from the Institut National de la Recherche Agronomique. The first babies were born in Clamart in February 1982 and in Sèvres in June 1982. Important contributions to the development of IVF from the Nordic countries include techniques for ovarian stimulation, sonographic techniques for monitoring and vaginal oocyte retrieval and also unique possibilities for monitoring IVF safety. These developments, in combination with relatively permissive laws for the practice of reproductive medicine and relatively generous reimbursement policies, as well as a general public confidence in IVF, have led to an exceptionally high availability of IVF, within international comparison.

Benefits and challenges brought by improved results from in vitro fertilization

Abstract In vitro fertilization (IVF), in which preimplantation-stage embryos are produced after ovarian stimulation and retrieval of preovulatory oocytes, now accounts for almost 2% of all births in Australia. For clinics performing in the top quartile of national results, the chance of a live birth for a woman under 35 years from one round of egg retrieval and IVF treatment is greater than 50%, albeit still with a greater than 20% risk of twins or higher order multiple pregnancy. Similar or better live birth rates are now obtainable with the elective transfer of a single embryo at the stage of blastocyst (5-6 days in culture), a policy that if adopted for younger women can reduce the risk of twins in a clinic to less than 15%. Current developments centre around improvements to embryo culture and the testing of embryos for chromosomal normality and other genetic and epigenetic variables before transfer, made possible by licences for embryo research protocols now being issued under the Commonwealth's Research Involving Human Embryos Act 2002.

The Mental Health of Filipino-Born Women 5 and 14 Years after they have given Birth in Australia: A Longitudinal Study

It has been suggested that ‘Filipino brides’ may be ‘at risk’ of social isolation and mental health impairment after migrating to Australia to marry Australian men. This paper examines the mental health of a cohort of Filipino and Australian-born women who became mothers in Australia, and investigates the relationship between place of birth, social network size and symptoms of poor mental health. The data was taken from the Mater-University of Queensland Study of Pregnancy (MUSP), a longitudinal study of mothers and children instigated in 1981. Symptoms of anxiety and depression and social network size were assessed at their first clinic visit (FCV), and followed up at 5 and 14 years. Filipino-born mothers had smaller social networks at the birth of their child, and reported more symptoms of anxiety and depression at FCV and 5 years follow-up (F/U), but did not differ from their Australian counterparts 14 years later. We conclude that Filipino-born migrants experience greater distress and poorer social networks than Australian-born mothers in the early years after they have given birth to a child in Australia. Further, that over a period of time, the decrease in mental health symptoms indicates the adaptation of Filipino-born women to their new environment.

Factors associated with the initiation and duration of breastfeeding by Chinese mothers in Perth, Western Australia.

To identify determinants of the initiation and duration of breastfeeding by Chinese Australian mothers, a cross-sectional survey of 506 Mandarin-speaking women in Perth, Western Australia, was conducted. Doctors' support of breastfeeding was positively associated with the initiation of breastfeeding both in the mothers' home countries (odds ratio [OR], 9.94; 95% confidence interval [CI], 3.17-31.18) and in Australia (OR, 16.78; 95% CI, 7.12-39.55) and with duration. Mother's level of education was positively associated with the initiation of breastfeeding in the mother's home country (OR, 3.04; 95% CI, 1.36-6.80) and positively associated with the duration of breastfeeding both in the mother's home country and Australia. Father's preference for breastfeeding was positively associated with the initiation of breastfeeding of the mother giving birth in Australia (OR, 4.96; 95% CI, 1.93-12.66). Health professionals can provide invaluable support for mothers initiating and continuing breastfeeding in this population. Prenatal education also needs to emphasize the ways in which fathers can support and contribute to breastfeeding.

The voices and concerns about prenatal testing of Cambodian, Lao and Vietnamese women in Australia

Objectives: to examine how Cambodian, Lao and Vietnamese women experience prenatal testing and to examine their knowledge and communication with health-care providers. Setting: Melbourne Metropolitan Area, Victoria, Australia. Design: an ethnographic study of childbearing and childrearing among women born in South-east Asia and now living in Melbourne, Australia reporting in-depth interviews with 67 women who had given birth in Australia. Findings: nearly all the women had prenatal testing as advised by their doctors and their main concerns were about their unborn baby and the need to follow doctors' advice. The women felt ‘indifferent’ towards prenatal testing, perceiving it as a normal part of antenatal care in Australia. Despite agreeing to undertake prenatal testing, the women did not have adequate understanding of the tests. This may be due to lack of information per se or inadequate communication between health providers and women. Implications for practice: inevitably, the onus rests with the health-care provider to ensure that all options available to women are understood, so that women can make a positive and informed choice regardless of their social or cultural background. This will lead to women's increased satisfaction with care during pregnancy.

Mothers in a New Country: The Role of Culture and Communication in Vietnamese, Turkish and Filipino Women's Experiences of Giving Birth in Australia

ABSTRACT There are few population based studies which explore the views immigrant women have of the maternity care they receive in their new homelands. Three hundred and eighteen Vietnamese, Turkish and Filipino women who gave birth in three major city hospitals in Melbourne, Australia were interviewed about their experiences of maternity care. Outcomes and experiences for women with different levels of English fluency were studied, as were women's needs and preferences for assistance with interpreting. Observance of traditional cultural practices surrounding birth and the impact of not being able to observe such practices on women's experiences of care were also explored. Women in the study not fluent in English experienced problems in communicating with their caregivers and these were reflected in less positive experiences of care. Women were less concerned that caregivers knew little about their cultural practices than they were about care they experienced as unkind, rushed, and unsupportive. Maternity care for immigrant women is only likely to improve when barriers to effective communication are addressed and attention is paid to raising standards of care.

Perinatal Death Associated With Planned Home Birth in Australia

Blackwood, Australia; Department of Obstetrics and Gynaecology, Flinders University of South Australia, Flinders Medical Centre, Adelaide, Australia; Australian Institute of Health and Welfare, National Perinatal Statistics Unit, University of New South Wales, Australia Br Med J 1998;317:384-388

The experiences of postpartum hospital stay and returning home among Thai mothers in Australia

Objective: to describe the experience of postpartum care among Thai women in Melbourne, Australia. Design: ethnographic interviews and participant observation with women in relation to postpartum care and practices. Setting: Melbourne Metropolitan Area, Victoria, Australia. Participants: 26 Thai born women who gave birth in Australia. Findings: the Thai women had varying views about the length of time they should spend in hospital and the care they received. Ten of the twelve women who had had a caesarean birth stayed in hospital for six or more days, consistent with the hospital practice. However, most of those who had had a vaginal delivery opted to go home earlier than the standard hospital practice of four days stay. This was because they were unhappy about specific hospital practices, the hospital environment, or because there are several Thai confinement customs, which, traditionally, a new mother must observe in order to maintain good health and avoid future ill health and which they were not able to follow in hospital. Nevertheless, most women were satisfied with their postpartum care. Most women were aware of the Thai cultural beliefs and practices. However, they showed varying ways of coping with the hospital environment in relation to their varying social situations. Implications for practice: Thai women are diverse in their needs, perceptions and experience of postpartum care. Therefore, it is appropriate neither to stereotype all Thai women as requiring to follow traditional confinement practices nor to require them to adjust to standard hospital practices. Rather an environment of caring concern whereby each woman's individual needs can be solicited, understood and, where possible, attended to as required. The challenge is in achieving this.

Perinatal death associated with planned home birth in Australia: population based study

abstractObjective : To assess the risk of perinatal death in planned home births in Australia.Design : Comparison of data on planned home births during 1985-90, notified to Homebirth Australia, with...

Late-onset infections of infants in neonatal units.

To examine regional variations in the incidence of late-onset neonatal infections in Australian and New Zealand neonatal units. A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late-onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993. Data were available on 24535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were early-onset; 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1OOOg, but 0.6% over 2000g. Coagulase negative staphylococci were the commonest cause of late-onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late-onset sepsis. The mortality from late-onset sepsis was 7.7%. Coagulase-negative staphylococci are the commonest cause of late-onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.

Radiological abnormalities in children born as a result of assisted conception.

Over 15,000 children are born each year as a result of the various techniques of assisted conception. In 1991, there were 2083 live births in Australia and New Zealand as a result of these techniques. Radiological abnormalities relating to the increased rate of prematurity, a probable increase in the risk of congenital malformations and a number of cases of neural crest tumours seen in these infants will be presented.

Maternal screening for Down's syndrome

Down's syndrome is the most common chromosomal disorder, with an incidence of about 1.2 per 1,000 births in Australia.

Perinatal mortality in twins, Australia, 1973-1980: I.

The perinatal outcome of twin births in Australia is described from 1973 to 1980. Over that period, the perinatal mortality rate declined more slowly in twins than singletons. The stillbirth rate actually increased in twins due to a rise in antepartum deaths. An increasing proportion of monozygotic twins may have contributed to this trend. The overall perinatal mortality rate was 82.85/1,000 for twins and 16.49/1,000 for singletons, giving a relative risk of 5.0.

Seasonal distribution of births in Australia.

Seasonal variations of births in Australia from 1911 to 1940 and 1962 to 1979 are analysed using stepwise periodic regression analysis. It is shown that the seasonality pattern has changed significantly from a September peak in the early 1960s to a February-March peak in the late 1970s. There also appears to be a significant geographical trend in seasonality of births with a February-March peak in the more northern States of Australia giving way to a September-October peak in the southernmost States. The seasonality of Australian births in 1976 to 1979 is shown to be independent of legitimacy and birth order but dependent on maternal age. The evidence suggests that environmental factors play a more important role than sociocultural factors in the causation of seasonal variations in births.

Multiple pregnancy and fetal abnormalities in association with oral contraceptive usage.

1,000 multiple births were examined in relation to maternal exposure to an oral contraceptive before conception. There was a significantly higher rate of monozygotic twinning among pregnancies which took place within 6 months of cessation of the contraceptive. In the monozygotic group there was a significant increase in the incidence of congenital abnormalities (P less than 0.01) when conception occurred within 3 months of cessation of the contraceptive.

A rejoinder to Miss Spencer's Comments on Pre-Marital Pregnancies and Ex-Nuptial Births in Australia, 1911-66

A rejoinder to Miss Spencer's Comments on Pre-Marital Pregnancies and Ex-Nuptial Births in Australia, 1911-66

Multiple births in Australia, 1944–63

SummaryFrom statistics on Australian confinements during the period 1944–63 it seems that the following conclusions can legitimately be drawn:(1) The proportion of multiple births increases with increasing age of mother up to about age 37, turns, and decreases thereafter.(2) The proportion of multiple births increases with increasing age of father up to about age 34–38 and is fairly constant thereafter.(3) The variation with age of father, however, only arises because of the high correlation with age of mother which is the determining factor.(4) The proportion of multiple confinements increases with birth order. This effect holds for all ages of mother except those over 40 where there is no significant variation.(5) The proportion of multiple confinements decreases from the first year of marriage to the second, then increases steadily to a maximum after about 15 years of marriage and then decreases slightly.(6) The proportion of binovular twins increases steadily with increasing age of mother up to about age 37, turns, and thereafter decreases steadily.(7) The proportion of monovular twins increases slightly with increasing age of mother up to about age 37 and is fairly constant thereafter.(8) From the small amount of data it appears that the proportion of triplets also increases with increasing age of mother.

Pre-marital Pregnancies and Ex-Nuptial Births in Australia, 1911- 66 — A comment

Pre-marital Pregnancies and Ex-Nuptial Births in Australia, 1911- 66 — A comment

Factors influencing the sex ratio at birth in Australia, 1902-65.

SummaryUsing Australian records of human births for the first six decades of the twentieth century, the proportions of male and female births are studied in relation to the mother's age, the father's age, the parents' ages in combination, and certain other factors. The principal data used relate to the years 1931–55, during which over 3 million children were born, yet even so the significant features are not easy to discern.Masculinity tends to fall as the age of either parent increases. But it is only average or below if one parent is old while the other is young. For high masculinity, both parents must be young.The Australian data are available in a form which enables the sex ratio to be studied also in relation to (a) the season of the year; (b) urban and rural areas; (c) the different states of the Commonwealth; (d) births inside and outside marriage; and (e) single and multiple births. When the influence of the parents' ages is eliminated, however, it does not appear as though the sex ratio varies significantly with any of these factors.

Pre-marital Pregnancies and Ex-nuptial Births in Australia, 1911-66

Pre-marital Pregnancies and Ex-nuptial Births in Australia, 1911-66