Maternity Protection Research Articles

Maternity protection in pneumology: considerations for a positive list

It seems difficult to continue to employ expectant/breastfeeding mothers in interventional medical fields due to numerous risks involved, such as in handling infectious agents or anaesthetic gases. Pregnancy for female doctors is thus often associated with a ban on employment and is therefore synonymous with a delay in their professional career. The aim of this article was to develop a positive list that allows pregnant women to continue working during their pregnancy at low risk and provides employers with a guide for drawing up risk assessment for specific occasions. The brief narrative overview is based on the recommendations drawn up by both professional associations and the Maternity Protection Committee. It is intended to provide assistance for the preparation of an event-related risk assessment after notification of a pregnancy in the speciality of pneumology in order to be able to continue to employ female doctors working in interventional medicine at low risk.

Demographic challenges in the context of the state policy of the Russian Federation in the sphere of maternity and childhood protection

The article examines current demographic trends in Russia in comparison with population changes based on data from the Federal State Statistics Service of Russia (Rosstat) and the UN Population Division. The specifi cs of the age structure of the population of Russia, formed by a number of demographic waves, are such that changes in the number of births and the size of age groups occur in waves; this trend will continue in the coming decades. The state policy of the Russian Federation in the fi eld of family support, aimed at increasing the total fertility rate from 1.3 to 1.6 by 2030 and to 1.8 by 2036, should provide for the introduction of new health-preserving and reproductive health protection technologies, the development of childhood infrastructure, antenatal clinics and perinatal centers for high-quality and aff ordable medical care for mothers and children.

THE FIRST PEDIATRICIAN OF THE MONGOLIAN PEOPLE’S REPUBLIC

At the present stage, the effective system of maternity and childhood protection of the Mongolian People’s Republic functions thanks to the invested work of Soviet doctors. The article provides updated information about the first pediatrician of Mongolia, a Soviet doctor, a representative of the Buryat people Sergi-Mydyk Tsyrendorzhievna Dasheeva.

The Problem of Protecting the Rights and Legitimate Interests of the Child in the Family and Outside It

Abstract Protecting children's rights and interests, especially within families, is crucial globally. Effective laws and enforcement are needed to ensure their safety and prevent violence, both offline and online. Kazakhstan's efforts in this regard, including legal protection for motherhood and childhood, are important. All of the above allowed for formulating the general purpose of the study – a comprehensive systematic examination of the protection of the subjective rights and legitimate interests of the child in family legal relations and in surrounding society (using the example of the Republic of Kazakhstan). The results were obtained using the tools of theoretical and methodological research of publications devoted to the problems and issues of observance and protection of children's rights and freedoms at the national and global levels, methods of comparative legal and comparative political research, content analysis of official documents, etc. In the study, key issues regarding the protection of children's rights in Kazakhstan were identified, including violence, neglect, and juvenile delinquency. It highlighted the growing number of appeals for the protection of violated children's rights and emphasized the urgent need for improvement in the child protection system. Promising areas for development include enhancing social services, reducing violence in families and institutions, improving legal protection against sexual harassment, and promoting child-friendly activities in preschool education. The study is of both theoretical interest and practical importance for various stakeholders involved in child welfare and protection. The research has practical value and originality in posing individual questions; it is aimed at examining in-depth the most important problems of maternity, family, and childhood protection in modern Kazakhstan.

Self-management Behaviours among Nurses and Midwives during Pregnancy and Associated Factors: A Cross-sectional Study

The high rate of perinatal abnormality among pregnant nurses and midwives attributable to their working environment is a serious international occupational health concern. Self-management behaviours can prevent abnormalities, but nurses and midwives have difficulty carrying out these behaviours during pregnancy. This cross-sectional study aimed to examine self-management behaviours and associated factors during pregnancy among nurses and midwives. The partic­ipants were 232 pregnant or postpartum registered nurses and midwives from four Japanese general hospitals. Participant recruitment and questionnaire distribution were undertaken through hospital management. Data were collected from July to November 2022. Instruments included the Personal Demographic and Obstetric Conditions Questionnaire, the Self-Management Behaviours Questionnaire, the Working Conditions during Pregnancy Questionnaire, the Social and Workplace Support Scale, the Sense of Coherence Scale, and Self-Management Difficulties Scale. Data analysis used univariate and multiple classification analysis. Results indicated that participants demonstrated good compliance with contraindications among self-management behaviours but scored lower in knowledge and self-monitoring, abnormalities prevention, and avoiding burden movements. Multiple classification analyses revealed that parity, profession, overtime, acquisition of maternity protection provisions, managers support, family support, and prioritising the foetus were significantly associated with self-management behaviors. Nursing administrators must provide adequate information and adjust the work of pregnant staff. Policymakers need to propose measures to reinforce maternity protection provisions for pregnant nurses and midwives. Pregnant nurses and midwives need to be proactively educated on occupational health and safety. Learning the importance of acquiring maternity protection provisions, receiving support and prioritising the foetus will contribute to effective self-management practices in them. Further research is needed to promote self-management behaviours among pregnant nurses and midwives.

Gemeinsame Stellungnahme der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC) und des Deutschen Berufsverbandes der HNO-Ärzte (BVHNO) für ärztliches Personal in der Hals-, Nasen- und Ohrenheilkunde/Kopf- und Hals-Chirurgie zum Arbeiten in der Schwangerschaft und Stillzeit

Working during pregnancy and breastfeeding is a special situation for both the employee and the employer/supervisor. The amended version of the Maternity Protection Act (MuSchG), which came into force on January 1st, 2018, protects the health of women and their children while working, training or studying during pregnancy, after giving birth and while breastfeeding. Women should be able to continue their employment or related activities during this time without jeopardising their health or that of their child. This law was furthermore reformed to prevent discrimination against the working mother during this time. In order to create the best and safest possible framework conditions for employment during pregnancy and breastfeeding, the DGHNO-KHC and the BVHNO would like to present a "general positive list" and a "positive list for surgical activities" as part of this statement, which should serve as a guideline for all relevant parties. This agreed positive list is intended to enable pregnant and breastfeeding doctors to carry out patient-related activities as well as head and neck surgeries in accordance with the MuSchG of 2018. Hereby, affected colleagues should have the opportunity to continue working self-determined.

Progress in Peru in the Application of ilo Convention 183 for Maternity Protection

Progress in Peru in the Application of ilo Convention 183 for Maternity Protection

Postnatal social support experiences in primiparous women in Korea: a phenomenological study.

Social support is essential for postpartum well-being, but little is known about the postpnatal social support preferred by primiparous women. This study aimed to comprehensively understand and describe the meaning of postnatal social support experience in primiparous women. The participants were seven primiparous women who were within 1 year after childbirth, recruited through purposive and snowball sampling from an online parenting community. The data were collected through in-depth interviews from November 14 to 28, 2022. Participants were interviewed face-to-face or via phone or online platform, according to their choice. Colaizzi's phenomenological qualitative research method was applied to analyze the meaning of the participants' experience. Five theme clusters and fourteen themes were identified from the data. The five theme clusters are as follows: (1) Shortcomings of the childbirth and postpartum care system I learned through my experience; (2) Government policies focusing on childbirth and child-rearing rather than postpartum recovery; (3) Driving force of postpartum recovery: Shared childbirth process; (4) Childcare on my own; and (5) Conflicted between being a stay-at-home mom and a working mom under inadequate maternity protection policies. Despite postpartum support from the government that was perceived as inadequate, first-time mothers regained confidence and motivation for parenting with the help of family, peers, and social networks. First-time mothers need support from professionals and reliable online communities for postpartum recovery and parenting.

ОХРАНА МАТЕРИНСТВА И ДЕТСТВА В ДЕМОГРАФИЧЕСКОЙ ПОЛИТИКЕ СОВЕТСКОЙ ВЛАСТИ В ГОРНОМ АЛТАЕ

The paper highlights the formation and further development of the system of maternity and childhood protection as one of the most important spheres of the Soviet healthcare in 1920s–30s. The field of child protection in the in Gorny Altai was in particular need of expanding the forms and methods of work, since child mortality rates at the beginning of the 20s were quite high. There was no specialized work on the protection of motherhood and childhood; there were no trained personnel. The development of diseases, and consequently mortality, was facilitated by unfavorable living conditions of the local population, lack of hygienic culture and regular movements of the population throughout the region. The solution to this problem was facilitated by the introduction of Soviet legislation on labor protection for pregnant and lactating women and their children. Since the mid-20s, commissions to promote the protection of motherhood and childhood were formed in the region, which carried out active educational and organizational work. The organization of mobile institutions for the protection of motherhood and childhood played a great role in solving the problem. In addition to a few stationary consultations, mobile institutions assumed the responsibility of providing assistance to the population of the region leading a nomadic and semi-nomadic lifestyle. In large population centers, the consultation stopped for more than a month, conducting surveys and providing ongoing assistance in remote areas of the mountainous terrain. Along with providing medical care, mobile consultation workers provided explanations about religious prejudices and superstitions. The data presented show the features of the formation of stationary institutions, the development of mobile services for mother and child care in the Oirot Autonomous Region. A positive result was a decrease in child and maternal mortality and an improvement in demographic indicators in the country.

Maternity protection and work-family balance support policies: A Korean case study

More Korean women participate in economic and social activities, but also more of them decide not to work or to delay childbirth. This study used data from the Korean Longitudinal Survey of Women & Families (KLoWF) between 2010 and 2018 to examine changes in awareness of the policies on maternity protection and work-family balance support, and the factors behind them. We selected 972 female workers (between 15 and 49 years of age) for this analysis. Using Growth Mixture Modelling (GMM), we identified three types of changes in awareness. Having lower education levels and fewer children, working in production rather than professional management, and having a smaller workforce increase the likelihood of being in the ‘reducing’ type of awareness change. These findings suggest the need for a review of current maternity protection and work-family balance support systems, and guide the future directions for improvement which we identify at the end of the article.

Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find apersonal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to atraffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.

Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find apersonal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to atraffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.

Predictors of the return to work for pregnant employees on preventive leave: Patients from an occupational medicine consultation in Switzerland.

According to the Swiss legislation on maternity protection in the workplace (OProMa), if pregnant workers are exposed to occupational hazards and no protective measures are taken, a gynecologist will prescribe a certificate of preventive leave and the women must stop working. Returning to work is only possible if job adjustments are made. This study aims to evaluate the burden of absences on companies and to examine the predictors of the return to work for pregnant workers on preventive leave, by examining both the probability of return to work and the time required to return to work. The study sample includes data on 258 workplaces of pregnant workers on preventive leave, collected during an occupational medicine consultation aimed at supporting the implementation of the OProMa. Information is available on the worker (age, date of consultation), the hazards to which she is exposed, the company's knowledge of the OProMa and whether a risk analysis exists. Descriptive statistics and multivariate regression analysis are carried out. In 58% of the workplaces, it was not possible to return to work before the end of the pregnancy. This corresponds to an average absence of 4.5 months. In 42% of the workplaces, a return to work was possible thanks to workplace adaptations. A conforming risk analysis and a full knowledge of the OProMa for companies, and an early visit to the occupational medicine consultation for workers are good predictors of the likelihood of returning to work. Younger age and exposure to certain types of risks are factors that influence the duration of preventive leave. The implementation of OProMa in Switzerland poses serious challenges, but early identification of occupational hazards and practices that anticipate compliance with the law in the company increase the return to work in safety for pregnant workers.

Economic Relevance of Preventable Prohibitions of Employment in Bavarian Schools

According to the Maternity Protection Act, an occupational risk of infection (e. g. in childcare) - combined with individual immunity gaps - can result in an irresponsible risk for pregnant women in the workplace. If this risk cannot be eliminated by any other means, the employer must impose a prohibition of employment (PE) for the pregnant woman concerned. We classified PE as preventable if the underlying immunity gaps could have been closed by immunisation prior to pregnancy. From 01.09.2016 to 25.03.2020, 1922 pregnant employees of Bavarian state schools obtained medical counselling on their occupational risk of infection as part of a research project. If the individual combination of occupational-risk profile and immunity status resulted in an irresponsible risk for the pregnancy, a PE was recommended by the attending physician. We determined the proportion of PE that would have theoretically been preventable by full immunisation prior to pregnancy and approximated the resulting - theoretically preventable - loss of working hours and personnel costs. In 425 cases (22%), a PE was deemed necessary by the attending physician, whereby 193 (45%) were retrospectively classified as theoretically preventable. Of these cases, 53 PE (27%) were temporary (valid until the 20th week of pregnancy) and 140 were long-term (valid for the complete duration of the pregnancy). Based on these results, we approximated a loss of 2,746 working weeks for our collective, which entails theoretically preventable personnel costs totalling 5,763,305 € for the observation period of our study (3.6 years). We then extrapolated estimates for all employees of Bavarian state schools and found a loss of 4,260 working weeks and theoretically preventable personnel costs amounting to almost 8,941,000 € per year during our observation period. Theoretically preventable PE caused by immunity gaps can entail a considerable loss of working hours and high personnel costs. Therefore, we should step up measures aimed at improving vaccination rates in women and increasing their willingness to be vaccinated. In view of the changes in legal and regulatory conditions in Germany since 2020, new investigations should be made as soon as there is sufficient data after the general employment prohibitions due to the SARS-CoV-2-pandemic have been lifted.

Differential diagnosis of acute flaccid paralysis in children with Guillain—Barré syndrome and neuromyelitis optica spectrum disorder: Clinical cases

Background. Acute flaccid paralysis is a clinical syndrome characterized by a sudden onset of weakness in one or more limbs with decreased or absent tendon reflexes in the affected limbs. This condition may be a manifestation of such pathologies as Guillain-Barré syndrome and neuromyelitis optica spectrum disorder. Clinical cases description. We describe two clinical cases of Guillain-Barré syndrome in patient M., 7 years old, and neuromyelitis optica spectrum disorder in patient D., 3 years old. In both children, the main clinical manifestation was acute flaccid paralysis. Patient M. was admitted to the Neurological Department of the Moscow Regional Center for Maternity and Childhood Protection with complaints of sharp pronounced weakness in the limbs, inability to walk. According to the disease history, the patient had an acute respiratory viral infection in October 2022. The conducted neurologic examination revealed decreased muscle tone and muscle strength in all limbs, absence of reflexes from the lower limbs. A liquor test was conducted, which revealed increased protein contents. Electroneuromyography detected a pronounced axonal lesion of all motor fibers in the arms and legs. The formulated diagnosis was “Guillain-Barré syndrome, variant of acute motor axonal neuropathy.” The treatment with plasmapheresis and intravenous immunoglobulins showed positive dynamics. In the second case, patient D. was admitted to the Pediatric Infectious Disease Department of Naro-Fominsk Hospital with similar complaints of sharp weakness in the limbs. Neurological examination showed a diffuse decrease in muscle tone, absence of reflexes from all limbs. Elevated protein contents were determined in the liquor. MRI of the cervical spinal cord showed myelitis of segments C3–C7. Negative antibodies to aquaporin-4 were found. The patient was treated with ceftriaxone, methylprednisolone, and plasmapheresis. Then he was transferred to the Neurological Department of the Moscow Regional Center for Maternity and Childhood Protection, where a repeated MRI of the cervicothoracic spinal cord revealed, in addition to myelitis at the level of C3–C7, a lesion of segments from the level of C2 to the medulla oblongata. The formulated diagnosis was “Neuromyelitis optica spectrum disease, seronegative form. Flaccid tetraparesis.” The continued treatment with prednisolone and intravenous immunoglobulin produced positive effect. Conclusion. The presented clinical cases will help neurologists to improve timely diagnosis and treatment of causes of acute flaccid paralysis in children, thereby reducing possible complications, disability, and mortality.

Pregnancy and maternity protection in cardiology and in pediatric and adolescent cardiology

Pregnancy and maternity protection in cardiology and in pediatric and adolescent cardiology

Enhancing maternity protection at work: assessing the contribution of a specialized occupational medicine consultation for pregnant employees in Switzerland

Abstract Aim Occupational exposures may harm the health of pregnant workers and their future children. While Switzerland has established specific regulations to safeguard pregnant employees while enabling them to pursue their job, there are limitations in implementing these provisions. This study aims to evaluate the contribution of an occupational medicine consultation (PregOH-consultation) in protecting pregnant workers and facilitating their safe return to work. Pregnant employees were referred to the consultation by their attending physicians in need of support in applying pregnancy protective legislation. Subject and methods Between 2015 and 2021, indicators were collected from pregnant workers who sought the consultation, as well as from their employers. Descriptive and correlational statistical analyses were performed. Results Out of the 328 work situations analysed, 98% presented at least one occupational hazard. Among the 272 companies contacted, only 14% had conducted a risk analysis, and 39% had implemented job adaptations. Among the pregnant workers whose employers were involved in the PregOH-consultation, 44% were able to return to work safely. Early referral to the consultation and pre-existing preventive measures within the company were identified as potential predictors of successul of the consultation in terms of safe return to work. The impact of the consultation was found to be less pronounced for women of foreign nationality. Conclusion The observed companies have insufficient measures in place to adequately protect pregnant employees, potentially jeopardizing their health or leading to premature job withdrawal. The PregOH-consultation serves as an effective intervention by facilitating hazard identification and enabling pregnant workers to safely continue their employment.

Внутриутробная хирургическая коррекция урином у плодов: анализ исходов

Aim: to analyze the outcomes of intrauterine fetal surgery of urinoma and discuss obstetric tactics Patients and Methods: in the conditions of the Research Institute of Maternity and Infancy Protection, 12 cases of fetal urinoma were diagnosed in the period from 2018 to 2021. Ultrasound and doppler ultrasound of the kidneys were performed on all fetuses, and MRI was additionally used. In the postnatal period, a complete clinical laboratory and ultrasound examination of fetuses was performed to assess the preservation of kidney function Results: the mean gestation period at the time of urinoma diagnosis was 20.9±1.9 weeks. The period of admission to the hospital was 24.8±2.3 weeks. The average size of the detected urinoma in fetuses: longitudinal — 57.5±2.75 mm, transverse — 36.5±2.7 mm (maximum size 94×71 mm). In all cases, compression of adjacent organs was observed with large amounts of urinoma. When assessing renal blood flow, it was visualized only in 25% of cases. All patients with large urinomas in the fetus underwent intrauterine bypass surgery using the SDE-MED stent with the original pigtail shape (utility model patent No. 152166, 2015). In 72.7% (8) of cases, chronic renal failure was formed in the born children, and only in 27.3% (3) of cases, fetal renal function with urinomas remained intact. Conclusion: in the early diagnosis of obstructive malformations in the fetal urinary system, the intrauterine bypass surgery in the renal cavitary system prevents the urinoma occurrence and preserves kidney function, which reduces the risk of renal failure in an infant. In urinoma in the fetus, especially large ones, intrauterine bypass surgery is necessary to decompress adjacent organs and preserve kidney function. However, it is worth noting that kidney function after the birth of an infant with this pathology can be preserved only in a quarter of all cases KEYWORDS: congenital genitourinary anomalies, kidney function, obstructive uropathy, fetal urinoma, intrauterine bypass surgery, renal failure. FOR CITATION: Kosovtsova N.V., Fedorova N.A., Pospelova Ya.Yu. Intrauterine fetal surgery of urinomas: outcome analysis. Russian Journal of Woman and Child Health. 2024;7(2):104–109 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-3.

A Study on the Awareness of Dental Hygienists on Maternity Protection and Work-Family Balance Assistance Policy

A Study on the Awareness of Dental Hygienists on Maternity Protection and Work-Family Balance Assistance Policy

Exploration of the Rural Maternity Protection System under the Active Reproductive Policy ---- Take the example of Delay Town, Shanxi Province

The twentieth National Congress of the Communist Party of China noted that "Chinese-style modernization is modernization with a huge population". Population and development are closely related, and since the reform and opening up, the demographic dividend has provided a core power source for China's economy to shift to a high-quality development stage. However, at the end of 2022, China's population will experience its first negative growth in 61 years, and the problem of population aging is serious. To promote the long-term balanced development of the population, the State has successively optimized and improved the fertility policy, but after the implementation of the policy, a large number of studies have found that the policy adjustments have not produced obvious effects, and falling into the "low fertility trap" is still a major challenge for us. In terms of maternity protection, the problem of unfairness and irregularity is still prominent, and a large number of policies are directed at urban salaried women, with less coverage of rural women's rights and interests. In this paper, research was conducted in the town of Danzi, Shanxi Province, to compare the differences between urban and rural maternity protection in Shanxi Province, to investigate the maternity needs of rural women, and to put forward targeted policy recommendations. At the same time, this study will help to enrich the research content in related fields, explore the fertility needs of fertile families, and release the kinetic energy of fertility, so that rural residents can "afford to give birth to children, and even more affordable to raise them".