Improving child and family outcomes following complicated births requiring admission to neonatal intensive care units

This paper reviews current research regarding the impact of birth complications, such as preterm labour, on parents and the nuclear family system. Specifically, how parents cope with the neonatal intensive care unit (NICU) experience and the associated decision-making tasks required during complicated births will be investigated. Consequences of poor adaptation to prematurity for the parent, family and infant relationships will also be discussed. The importance of informed decision-making, perceived control, self-esteem and the benefits of certain strategies, such as kangaroo care (skin-to-skin contact), in the facilitation of greater levels of attachment and improved relationships, will be highlighted. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Parental decision-making surrounding complicated births: the impact on parent-infant and infant-marital relationships

This paper reviews current research regarding the impact of birth complications on parental decisionmaking, and the resulting effects on parent-infant and infant-marital relationships. It discusses the importance of informed decision-making on parental satisfaction of the birthing experience, and the benefits of certain strategies, such as kangaroo care, in the facilitation of greater levels of attachment and improved relationships. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Mode of delivery and problems in subsequent births : a register-based study from Finland

Objective

The purpose of this study was to investigate the effects of delivery on problems in subsequent births.
Study design

This was a cohort study that used register data for 73,104 mothers who had their first birth from 1987 to 1989 and subsequent births from 1987 to1998. Three analyses were performed: (1) examination of second births by mode of delivery in the first birth, with adjustment for confounders, (2) same parameter, with exclusion of women with persistent problems, and (3) examination of third births for women with a first birth vaginal delivery.
Results

More complications and poorer infant outcome were found at later births when the first or second birth was by cesarean delivery than after a first spontaneous vaginal delivery, even when women with persistent problems were excluded. Women with instrument first births had a similar rate of complications in the second birth to women with spontaneous vaginal births, but some infant outcomes were poorer.
Conclusion

Problems that are subsequent to cesarean delivery are unlikely to be explained entirely by indications for cesarean delivery.

Probability distributions of number of children and maternal age at various order births using age-specific fertility rates by birth order

In this study, a simple analytical framework to find the probability distributions of number of children and maternal age at various order births by making use of data on age-specific fertility rates by birth order was proposed. The proposed framework is applicable to both the period and cohort fertility schedules. The most appealing point of the proposed framework is that it does not require stringent assumptions. The proposed framework has been applied to the cohort birth order-specific fertility schedules of India and its different regions and period birth order-specific fertility schedules, including the United States of America, Russia, and the Netherlands, to demonstrate its usefulness.

Ritual power : illuminating the blind spot of births, deaths and marriages in news media research

This article conceptualises the role and place of the newspaper births, deaths and marriages column in Western societies and its relationship to news media. It identifies the births, deaths and marriages notices as a ‘blind spot’ within journalism and media research generated by powerful cultural norms and conventions shaping the field. This is exemplified by the ‘mythical’ divide between political economy and culturalist approaches to media studies that has created a gap where people’s everyday practices or the social value of ‘commercial’ content tends to be overlooked in discussions about news media. Drawing more deeply from cultural studies and scholarship around media power and rituals, the births, deaths and marriages column provides a compelling unique illustration of the ways newspapers – especially at the local level – continue to be perceived as central to the social in this changing media world. A qualitative research project into the future of small commercial newspapers in Australia provides rich data for exploring these key ideas.

Association of birth weight and current body size to blood pressure in female twins

It has been proposed that low birth weight is associated with high levels of blood pressure in later life. The aim of this study was to assess the relationship of blood pressure to birth weight and current body size during growth and adulthood. A total of 711 female multiple births, with one group of 244 in their growth phase mean age 12.0 (2.3)(SD) years and the other of 467 adults (mean age 35.2 (12.6) years), had height, weight and both systolic (SBP) and diastolic (DBP) blood pressures measured, and self-reported their birth weight. Regression analyses were performed to assess the cross-sectional and within-pair associations of blood pressure to birth weight, with and without adjustments for current body size. Within-pair analysis was based on 296 twin pairs. Cross-sectionally, a reduction in birth weight of 1 kg was associated with 2 to 3 mm Hg higher age-adjusted SBP, which was of marginal significance and explained about 2% of the population variance. Adjustment for body mass index did not significantly change this association. Within-pair analyses found no association between birth weight and SBP or DBP,even after adjusting for current body size. After age, current body size was the strongest predictor of systolic BP. The weak association of blood pressure to birth weight cross-sectionally is of interest, but any within-pair effect of birth weight on blood pressure must be minimal compared with the effect of current body size.

Negotiating motherhood: the struggles of teenage mothers

Aims. This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.

Background. Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.

Design. This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.

Findings. The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.

Conclusions. It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.

Twisting the knife: discrimination in the law

Of the many different variations that can occur in human sexual formation, transsexualism no doubt remains the least understood by the wider Australian community. As a consequence, the process of attaining human rights to legal status, privacy, dignity and freedom from discrimination for those who experience this unusual condition has been a slow and sometimes frustrating one. The article seeks to introduce the reader to some of the more recent developments in the international jurisprudence of transsexualism and the underlying medical evidence that has supported them. It also offers criticism of the belated attempt by the State of Victoria,  with the Births, Deaths & Marriages Registration (Amendment) Act 2004, to establish certain statutory rights in this regard. While the legislation was enacted with the stated and very laudable purpose of providing for the  correction of birth records on the Register of Births of those people with transsexualism who have altered their phenotypic sex by hormonal  medication and surgery, the article argues it has also served to remove other equally important rights already won and proposes that a final remedy will only be found, as on previous occasions, in the courts.

More? You want more?..of course I do! Transsexualism and birth certificates-changing records or attitudes?

In 2004, the Victorian Government enacted legislation allowing people treated for transsexualism to correct the record of their sex on the Register of Births, Deaths and Marriages and obtain a new certificate reflecting their contemporaneous circumstances. It was the last of all the States and Territories to do so.

The legislation gave effect to some important changes to the law and was generally couched in terms more sensitive than those already in place in the other jurisdictions. In the view of the author, however, its proponents failed to both understand the import of the expert medical evidence adduced in, and to implement the common law position enunciated by, the Family Court in Re Kevin (validity of marriage of transsexual) [2001] FamCA 1074 and subsequently confirmed on appeal two years later by the Full Court.

The author argues that, while a welcome improvement to the human rights record of successive Victorian Governments, the result is still a largely disappointing piece of legislation. Rather than being truly 'beneficial' to all who need security of their personal identities, it perpetuates some of the very worst discrimination directed at people with transsexualism and their families by continuing to portray them as psychologically deluded rather than physiologically atypical and denying a small number of them their rights on the basis of legal reasoning which is no longer regarded as tenable. She asserts the legislation serves as a clear demonstration that prejudices and misconceptions about transsexualism stilI abound and explains much more is needed if real human rights, acceptance and freedom from discrimination are to be eventually obtained by those affected by the phenomenon.

Aspects of the ecology of swamp antechinus (Antechinus minimus maritimus) on a Bass Strait island

The swamp antechinus (Antechinus minimus maritimus) is a small insectivorous marsupial inhabiting closed heath and tussock grassland in south-eastern Australia. The species is considered 'Near Threatened' on the
Australian mainland. Populations persist on coastal islands off Wilsons Promontory, but their current status is unknown. This study investigated the density, diet and reproduction of the swamp antechinus on Kanowna Island.
Data were collected by live trapping in different vegetation types during four trips between August 2003 and January 2004. Higher animal densities (47-129 ha^-1) were found for Kanowna Island than for previously studied mainland populations (1-18 ha^-1). Examination ofscats showed that this species eats a wide variety ofprey types, with moth larvae a major dietary component, particularly during the breeding season. Births were estimated to have occurred between 28 June and 8 August, which is a longer period than reported for other populations of this species. Factors including reduced predation, restricted dispersal and increased food availability may be responsible for supporting this dense population.

Creating ambiguity, creating social change

Current government policy in Victoria, as elsewhere, is seeking to change the provision of maternity care from an obstetric-led system to a flatter, more collaborative system that brings midwives to the front line as primary carers, at least in the public sector.

However, dominant medical discourses continue to exert a sedimentary effect on contesting claims from midwives that deny the high-risk nature of the majority of births and which valorise the competence of the female body. Although there have been modifications in maternity arrangements (and the incumbent government is currently considering more), medical discourses continue to legitimate obstetric power via legal and professional structures, fortify the obstetric ‘habitus’, infect mainstream popular consciousness and undermine autonomous midwifery practice. Drawing from research material gleaned from in-depth interviews with nine obstetricians and thirty midwives conducted in 2004 and 2005, I argue that alternative discourses may strategically undermine obstetric dominance. Specifically, reversing stereotypes; inverting the binary opposition and privileging the subordinate term (or substituting the negative for positive); and defamiliarizing what is perceived to be fixed and given, all play on the ambiguities of representation and present social activists (midwives, childbirth educators and women) with valuable opportunities to challenge fundamentalist medical orthodoxies.

Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005

OBJECTIVE—Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for the development of type 2 diabetes in the mother and is  responsible for morbidity in the child. To better identify women at risk of developing GDM we examined sociodemographic correlates and changes in the prevalence of GDM among all births between 1995 and 2005 in Australia's largest state.
RESEARCH DESIGN AND METHODS—A computerized database of all births (n = 956,738) between 1995 and 2005 in New South Wales, Australia, was used in a multivariate logistic regression that examined the association between sociodemographic characteristics and the occurrence of GDM.
RESULTS—Between 1995 and 2005, the prevalence of GDM increased by 45%, from 3.0 to 4.4%. Women born in South Asia had the highest adjusted odds ratio (OR) of any region (4.33 [95% CI 4.12–4.55]) relative to women born in Australia. Women living in the three lowest socioeconomic quartiles had higher adjusted ORs for GDM relative to women in the highest quartile (1.54 [1.50–1.59], 1.74 [1.69–1.8], and 1.65 [1.60–1.70] for decreasing socioeconomic status quartiles). Increasing age was strongly associated with GDM, with women aged >40 years having an adjusted OR of 6.13 (95% CI 5.79–6.49) relative to women in their early 20s. Parity was associated with a small reduced risk. There was no association between smoking and GDM.
CONCLUSIONS—Maternal age, socioeconomic position, and ethnicity are important correlates of GDM. Future culturally specific interventions should target prevention of GDM in these high-risk groups.

Ecology of arboreal marsupials in a network of remnant linear habitats

Linear strips of vegetation set within a less-hospitable matrix are common features of landscapes throughout the world. Depending on location, form and function, these linear landscape elements include hedgerows, fencerows, shelterbelts, roadside or streamside strips and wildlife corridors. In many anthropogenically-modified landscapes, linear strips are important components for conservation because they provide a large proportion of the remaining wooded or shrubby habitat for fauna. They may also function to provide connectivity across the landscape. In some districts, the linear strips form an interconnected network of habitat. The spatial configuration of remnant habitat (size, shape and arrangement) may influence habitat suitability, and hence survival, of many species of plant and animal in modified landscapes. Near Euroa in south-eastern Australia, the clearing and fragmentation of temperate woodlands for agriculture has been extensive and, at present, less than 5% tree cover remains, most of which (83%) occurs as linear strips along roads and streams. The remainder of the woodland occurs as relatively small patches and single isolated trees scattered across the landscape. As an assemblage, arboreal marsupials are woodland dependent and vary in their sensitivity to habitat loss and fragmentation. This thesis focusses on determining the conservation status of arboreal marsupials in the linear network and understanding how they utilise the landscape mosaic. Specifically, the topics examined in this thesis are: (1) the composition of the arboreal marsupial assemblage in linear and non-linear woodland remnants; (2) the status and habitat preferences of species of arboreal marsupial within linear remnants; and (3) the ecology of a population of the Squirrel Glider Petaurus norfolcensis in the linear network, focusing on population dynamics, spatial organisation, and use of den trees. The arboreal marsupial fauna in the linear network was diverse, and comprised seven out of eight species known to occur in the district. The species detected within the strips were P. norfolcensis, the Sugar Glider Petaurus breviceps, Common Brushtail Possum Trichosums vulpecula, Common Ringtail Possum Pseudocheirus peregrinus, Brush-tailed Phascogale Phascogale tapoatafa, Koala Phascolarctos cinereus and Yellow-footed Antechinus Antechinus flavipes. The species not detected was the Feathertail Glider Acrabates pygmaeus. Survey sites in linear remnants (strips of woodland along roads and streams) supported a similar richness and density of arboreal mammals to sites in non-linear remnants (large patches or continuous tracts of woodland nearby). Furthermore, the combined abundance of all species of arboreal marsupials was significantly greater in sites in the linear remnants than in the non-linear remnants. This initial phase of the study provided no evidence that linear woodland remnants support a degraded or impoverished arboreal marsupial fauna in comparison with the nonlinear remnants surveyed. Intensive trapping of arboreal marsupials within a 15 km linear network between February 1997 and June 1998 showed that all species of arboreal marsupial (except A. pygmaeus) were present within the linear strips. Further analyses related trap-based abundance estimates to measures of habitat quality and landscape structure. Width of the linear habitat was significantly positively correlated with the combined abundance of all arboreal marsupials, as well as with the abundance of P. norfolcensis and T. vulpecula. The abundance of T. vulpecula was also significantly positively correlated with variation in overstorey species composition, Acacia density and the number of hollow-bearing trees. The abundance of P. norfolcensis was positively correlated with Acacia density and canopy width, and negatively correlated with distance to the nearest intersection with another linear remnant. No significant variables were identified to explain the abundance of P. tapoatafa, and there were insufficient captures of the remaining species to investigate habitat preferences. Petaurus norfolcensis were resident within the linear network and their density (0.95 -1.54 ha-1) was equal to the maximum densities recorded for this species in continuous forest elsewhere in south-eastern Australia. Rates of reproduction were also similar to those in continuous forest, with births occurring between May and December, a mean natality rate of 1.9, and a mean litter size of 1.7. Sex ratios never differed significantly from parity. Overall, the population dynamics of P. norfolcensis were comparable with published results for the species in contiguous forest, clearly suggesting that the linear remnants currently support a self-sustaining, viable population. Fifty-one P. norfolcensis were fitted with radio transmitters and tracked intermittently between December 1997 and November 1998. Home ranges were small (1.3 - 2.8 ha), narrow (20 - 40 m) and elongated (322 - 839 m). Home ranges were mostly confined to the linear remnants, although 80% of gliders also utilised small clumps of adjacent woodland within farm paddocks for foraging or denning. Home range size was significantly larger at intersections between two or more linear remnants than within straight sections of linear remnants. Intersections appeared to be important sites for social interaction because the overlap of home ranges of members of adjacent social groups was significantly greater at intersections than straight sections. Intersections provided the only opportunity for members of three or more social groups to interact, while still maintaining their territories. The 51 gliders were radiotracked to 143 different hollow-bearing trees on 2081 occasions. On average, gliders used 5.3 den trees during the study (range 1-15), and changed den trees every 4.9 days. The number of den trees used by each glider is likely to be conservative because the cumulative number of den trees continued to increase over the full duration of the study. When gliders shifted between den trees, the mean distance between consecutive den sites was 247 m. Den trees were located throughout a glider's home range, thereby reducing the need to return to a central den site and potentially minimising energy expenditure. Dens were usually located in large trees (mean diameter 88.5 cm) and were selected significantly more often than expected based on their occurrence within the landscape. The overall conclusion of this thesis is that the linear network I studied provides high quality habitat for resident populations of arboreal marsupials. Important factors influencing the suitability of the linear remnants appear to be the high level of network connectivity, the location on soils of high nutrient status, the high density of large trees and an acacia understorey. In highly fragmented landscapes, linear habitats as part of the remaining woodland mosaic have the potential to be an integral component in the conservation of woodland-dependent fauna. The habitat value of linear strips of vegetation should not be underestimated.

Interannual variation in pup production and the timing of breeding in benthic foraging Australian fur seals

¯Large interannual variations in reproductive success caused by fluctuations in oceanography and prey availability are common to many species of air breathing epipelagic predators. In contrast, little is known about variation in benthic foragers such as Australian fur seals (Arctocephalus pusillus doriferus). Between 1997 and 2007, pup production was assessed in 9 yr, while the timing of breeding and adult female condition was assessed in 5 yr at Kanowna Island in Bass Strait, southeastern Australia. Pup production was variable ( ¯x = 1,726 ± 42, range = 1,386–2,301), but without temporal trend, as was median birth date ( ¯x = 23 November±1, range = 21–25 November) and pupping synchrony (period of 90% births: ¯x = 28 ± 2 d, range = 23–31 d). Pup production was negatively correlated with median birth date and positively correlatedwith female condition,winter sea-surface temperature (SST) and zonal wind strength within Bass Strait. Pup production was also negatively correlated with SST in the previous summer within Bass Strait and in the eastern Great Australian Bight upwelling region. The results suggest that the reproductive success of Australian fur seals is influenced by oceanography but less so than in otariids foraging epipelagically in major upwellings. Despite spanning several El Niño events, no correlation between pup production and the Southern Oscillation Index was observed.