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Background: This study investigated the surrogates' birth experiences, their levels of emotional struggle at relinquishment, how often they thought about the surrogacy children, and the surrogate–parent relationship dynamics during pregnancy and post‐birth. Methods: Data were collected from 06/2016 to 02/2017 using an anonymous questionnaire. Participants were Canadian gestational surrogates who had completed the process with or without a successful live birth, and who were at various stages of an ongoing surrogacy. For this paper, only a subgroup of cases with a successful live birth was selected for analysis. Results: The data set included 131 births involving 90 surrogates who delivered 157 babies (105 singletons and 26 sets of twins). Their mean age at the time of surrogacy was 31.7 ± 5 years (range: 21‐47y). More than one‐third (37.4%) of the cases were for intended parents who were same‐sex male couples and single men. Surrogates assisting Canadian‐resident intended parents had an overall better birthing experience compared with those assisting nonresidents. There was none or very little struggle with the relinquishment of the baby in 96.9% of cases. Continued contact with parents after the births was reported in 93.0% of cases. Surrogates were significantly more likely to have frequent post‐birth contact with same‐sex and single fathers compared with heterosexual parents and single mothers (76.6% vs 54.3%). Conclusions: Same‐sex male couples and single men can develop a long‐lasting relationship with their surrogates even when no intended female partners are involved. The development of institutional practice guidelines in standardizing surrogacy birth practice is paramount in optimizing surrogates' care. [ABSTRACT FROM AUTHOR]

Attitudes drive practice, perhaps more than evidence The objective of this study was to determine if the new generation of Canadian obstetricians has attitudes differing from those of their predecessors. Employing a cross-sectional, Internet, and paper-based survey, we conducted an in-depth study of obstetricians responding to the Canadian National Maternity Care Attitudes Survey. Of the 800 Canadian obstetricians providing intrapartum care, 549 (68.6%) responded. Participants were stratified by age less than or equal to 40 years compared with those over 40 years; 81 percent of those 40 years or younger were women versus 40 percent over 40 years of age. Younger obstetricians were significantly more likely to favor use of routine epidural analgesia and believed that it did not interfere with labor or lead to instrumentation; were more concerned and feared the perineal and pelvic floor consequences of vaginal birth compared with cesarean section; and were significantly less supportive of vaginal birth after prior cesarean section, home birth, birth plans, routine episiotomy, and routine electronic fetal monitoring as providing maternal or fetal benefits. They were less positive than the older generation about a range of approaches to reducing the cesarean section rate, the importance of maternal choice and role in their own birth, and peer review, and they were more likely to believe that women having a cesarean section were not missing an important experience. No significant generational differences were found for ambivalent attitudes to vaginal breech birth. Younger obstetricians were more evidence-based for some issues and less for others. In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth. They saw cesarean section as a solution to many perceived labor and birth problems. Results suggest a need to examine how obstetricians acquire their favorable attitudes to birth technology in normal birth. (BIRTH 38:2 June 2011) [ABSTRACT FROM AUTHOR]

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sutcliffe k., caird j., kavanagh j., rees r., oliver k., dickson k., woodman j., barnett-paIge e. & thomas j. (2012) Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. Journal of Advanced Nursing 68(11), 2376-2386. Abstract Aims. A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians. Background. A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed. Data sources. Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed. Review methods. A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion. Results. Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified. Conclusions. For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care. [ABSTRACT FROM AUTHOR]

New procedures are developed in this article for estimating parameters of the Pearsonian Type I curve which are particularly adaptive to factors influencing the pattern of age-specific fertility rates. It is shown that with this model the number of parameters required for the graduation and simulation of these rates can be reduced to only three--total fertility rate, mean and modal ages of fertility. The reduction in the number of fertility parameters offers considerable operational and analytical advantages, and makes the Pearsonian Type I curve particularly appropriate for the construction of a parametric model for fertility projections. In light of the results of empirical tests based on fertility data for Canada, the model's potential for birth projections appears quite promising. [ABSTRACT FROM AUTHOR]

The mandatory travel for birth experienced by Indigenous women living in rural and remote areas of Canada is examined using an emergent lens of Indigenous reproductive mobilities. Current evacuation practices are contextualized within the historic and ongoing systems of oppression experienced by Indigenous people in Canada. Indigenous feminist and decolonial theoretical approaches are used to outline one way in which Indigenous women counter settler colonialism to assert sovereignty over their birth experiences – through the resurgence of culturally-based doulas or birth workers. A further contribution of these analyses is the inclusion and centering of the voices and experiences of those previously neglected within this particular body of scholarship, shifting the power relations underpinning reproductive mobilities. [ABSTRACT FROM AUTHOR]

A so-called birth tourist travels to a country with birthright citizenship to give birth so that her child will be a citizen of that country. In Canada, hostility towards birth tourism has simmered since 2012. Situating this hostility within a history of Sinophobia, I analyze birth tourism websites, arguing that those who can access Canadian citizenship via birth tourism already possess network capital, a position that is not enabled but enhanced by their child's citizenship. I argue that public concern about birth-tourism in Canada turns on the willfulness of birth tourists as strangers who impose themselves upon the state. Birth tourists combine their reproductive capacity and their capacity for mobility to subvert the sovereignty of the Canadian state: their reproduction is inherently nationalized and produces citizens who have not been vetted by the Canadian state. In this way, birth tourists invoke mobility to access citizenship without commitments and without state sanction, creating strangers within the state. [ABSTRACT FROM AUTHOR]

Increases in opioid-related mortality have contributed to declines in life expectancy at birth in the United States and British Columbia. Canadian national mortality data from 2000 to 2016 were analyzed to determine the contribution of poisoning-related mortality to changes in life expectancy at birth by age group and sex. From 2000 to 2016, life expectancy at birth increased by almost three years; however, mortality due to unintentional poisonings, including those involving opioids, curbed this increase by 0.16 years. Although a national decrease in life expectancy at birth has not been observed in Canada during this period, current trends suggest that the national opioid overdose crisis will continue to attenuate gains to life expectancy. [ABSTRACT FROM AUTHOR]

Primipara women may require greater informational and emotional support than multipara women. Supportive communication, including informational and emotional support, can help to build a strong caregiver-patient relationship and can alleviate the difficulties associated with first-time birth. The objective of this study was to explore first-time mothers' experiences of labor and birth. Three hundred primipara women completed self-report questionnaires. Qualitative analysis of one open-ended question about the women's experience was conducted. Nine themes emerged from the data. Eight themes reflected informational and emotional support needs, whereas the final theme reflected instrumental support needs. The study concluded that informational and emotional supports are important factors of supportive communication and influence the birthing experience of primipara women. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to describe contemporary practice patterns in the timing of caesarean delivery in relation to cervical dilation, overall and by indication for caesarean. Our secondary objective was to examine how commonly caesarean delivery was performed for labour dystocia at dilations below 4 cm or without the use of oxytocin, overall and between hospitals.Design: Retrospective, population-based cohort study.Setting: Ontario, Alberta, and British Columbia, Canada, 2008-2012.Population: Nulliparous women in labour who delivered term singletons in cephalic position.Methods: Histograms were used to examine the distribution of cervical dilation at time of caesarean delivery, overall and by indication for caesarean. Funnel plots were used to illustrate variation in hospital-level rates of caesarean deliveries for labour dystocia that were performed early (<4 cm dilation) or without the use of oxytocin.Main Outcome Measures: Cervical dilation (in centimetres) at time of caesarean delivery.Results: The population-based cohort comprised 392 025 women, of whom 18.8% had a caesarean delivery. Of first-stage caesareans for labour dystocia in women who entered labour spontaneously, 13.6% (95% CI 12.9, 14.2) had dilations <4 cm [hospital-level inter-quartile range (IQR): 6.2% to 20.0%] and 29.5% (95% CI 28.6, 30.4) did not receive oxytocin to treat their dystocia (hospital-level IQR: 22.1-54.6%).Conclusions: The proportion of caesareans done before 4 cm dilation or without oxytocin varies substantially across hospitals and suggests the need for institutions to review their practices and ensure that management of labour practice guidelines are followed.Tweetable Abstract: Many caesareans for labour dystocia are performed early during labour (<4 cm dilation) or without oxytocin. [ABSTRACT FROM AUTHOR]

Background Rates of interventions in labor and birth should be similar across a country if evidence-based practice guidelines are followed. This assumption is tested by comparison of some practices across the 13 provinces and territories of Canada. The objective of this study was to describe the wide provincial and territorial variations in rates of routine interventions and practices during labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods A sample of 8,244 eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census. The sample was stratified by province and territory. Computer-assisted telephone interviews were conducted with participating birth mothers by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took an average of 45 minutes and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%). Results Provincial and territorial variations in rates of routine intervention used during labor and birth are reported. The percentage range of mothers' experience of induction (range 30.9%), epidural (53.7%), continuous electronic fetal monitoring (37.9%), and medication-free pain management during labor (40.7%) are provided, in addition to the use of episiotomy (14.1%) or 'stitches' (48.3%), being in a 'flat lying position' (42.2%), and having their legs in stirrups for birth (35.7%). Wide variations in the use of most of the interventions were found, ranging from 14.1 percent to 53.7 percent. Conclusions Rates of intervention in labor and birth showed considerable variation across Canada, suggesting that usage is not always evidence based but may be influenced by a variety of other factors. ( BIRTH 39:3 September 2012) [ABSTRACT FROM AUTHOR]

Evidence-based guidelines regarding intrapartum fetal surveillance from three countries (United States, Canada, and Australia/New Zealand) were reviewed. The similarities in the three national guidelines (purported etiology, management of periodic changes, and intermittent auscultation for low-risk women) are understandable. Differences in recommendations (role of fetal admission test, amnioinfusion for variable decelerations, scalp pH, umbilical arterial acid-base status, and education in interpretation of fetal heart tracing) are not explained. The likelihood of recommendations being categorized as level A differed for the countries: United States, 41% (7/17); Canada, 18% (3/17); and Australia and New Zealand, 17% (2/12). Only one publication was cited by all three guidelines. To avoid confusion and possibly enhance their quality, national guidelines should acknowledge the presence of others on the same topic, and if there are differences then provide explanations for dissimilarities. [ABSTRACT FROM AUTHOR]

This article provides an analysis of the evolution of the division of labour in participatory ergonomics (PE) programmes in two worksites. The analysis is based on interviews and field observations in the worksites. In both settings there was meaningful participation by both worker and management members of ergonomic change teams (ECTs) in the hazard assessment and solution identification stages, but as the teams moved to the implementation stage, worker representatives were marginalised and the participatory nature of the programmes was severely curtailed. The removal of workers from the process was the outcome of the interplay among the type of activities pursued in the implementation stage, the skills and knowledge required to carry out those activities, and workers’ limited influence in the organisational hierarchies. Findings highlight the salience of the social context in which participatory programmes are located and the importance of examining participatory programmes as they evolve over time. Statement of Relevance: This article contributes to a growing literature on the process and implementation of PE programmes. The article's focus on social and organisational factors that affect the division of labour and attention to the evolution of involvement over time extend current understandings of participation in ergonomics programmes. [ABSTRACT FROM PUBLISHER]

The purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada. A purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women. Women experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration. Maternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women. [ABSTRACT FROM AUTHOR]

Health care reform in Canadian hospitals has resulted in increased workloads and bureaucratization of patient care contributing to the development of a new economy of care. Interviews with nurses and visible (non-white) minority women who have given birth in institutions undergoing health care reform revealed that nurses felt compelled to avoid interactions with patients deemed too costly in terms of time. Overwhelmingly, these patients were members of culturally marginalized populations whose bodies were read by nurses as potentially problematic and time consuming. As their calls for assistance go unanswered, visible minority women complained of feeling invisible. Taken in context of historical and contemporary interethnic relations, these women regarded such avoidance patterns as evidence of racism. Obstetrical nurses, too, understood that the new economy of care wrought by health care restructuring has altered nursing practice and patient care to the detriment of minority women. [ABSTRACT FROM AUTHOR]

Presents letters to the editor responding to past articles in the magazine. Maternity leave for adoptive parents in Ontario; Discussion of a humorous article which psychoanalised the characters of A.A. Milne's Hundred Acre Wood characters; Diabetes in Canada's First Nations; Reducing the rates of inappropriate labor induction.

The approach underlying the model proposed in this article constitutes a considerable departure from the conventional methods used for the projection of birth series. Instead of following the customary procedure of directly projecting the age-specific fertility rates, they can be derived with this model from only three relatively simple fertility measures, namely, total fertility rate, mean age of fertility, and modal age of fertility. In order to calculate the number of births in any given year, one merely multiplies the number of women at each age by the fertility rate of the corresponding age, and then sums the products which are obtained. The model has been submitted to a series of empirical tests using data for Canada. Thus, the annual number of births for the period 1926-1970, that is, for all the years for which the required data are available, were generated from the model and compared with the actual number of births for the same period. Although the data are limited to only one country, they nevertheless reflect demographic conditions of considerable diversity. During the course of the period examined, Canadian women experienced great changes in their fertility level and age pattern. The results of the tests presented in the above section lead to the conclusion that instead of following the conventional procedure of obtaining the annual number of births by directly projecting age specific fertility rates, it is more advantageous to obtain them by using the model.

Earlier studies on the seasonality of births indicate that a major peak occurs in August and September and a minor peak in January and February. This study uses the 1984 Canadian Fertility Survey data on reproductive history to examine birth and pregnancy seasonalities, and shows that the ‘worst’ months for births are January and February and the ‘best’ months are March, April and May. There is no systematic pattern in the seasonality of pregnancies, possibly because effective birth control allows couples to plan the timing of births. [ABSTRACT FROM PUBLISHER]

The article discusses tips and techniques, as well as considerations for clinical assessment for instrumental birth, focusing on universal lessons across three different continents that include Ireland, Canada and Australia. It presents a compilation of clinical experience from respected teachers on how to accurately assess the second stage of labour and offer safe and effective instrumental birth to women and care for their babies.