PURPOSE: To examine the effect of Taegyo-focused prenatal classes on maternal-fetal attachment and self-efficacy related to childbirth. METHODS: Over 4 weeks, 49 women, 20 to 36 weeks of gestation participated in a prenatal program led by the nurse who developed it. In addition to Lamaze content it included; understanding ability of fetus to respond, sharing motivation, purpose of pregnancy, and preconceptions of experiencing childbirth, training in maternal- fetal interaction, writing letters and making a declaration of love to unborn baby. Using a pre- experimental design, data were collected by self-report, before and after program, using Cranley's Maternal-Fetal Attachment Scale (1981), and Shin's (1997) Labor Self-Efficacy Measurement. RESULTS AND CONCLUSION: Paired t-test showed significant changes in scores of maternal-fetal attachment (t=6.91. p<.001) and self-efficacy related to childbirth (t=10.19, p<.001). Taegyo opens the possibility of integrating Western ideas with Korean traditional health behavior. Incorporation of Taegyo into existing prenatal classes is recommended.
Adult ; Attitude to Health/ethnology ; Curriculum ; Female ; Health Education/organization & administration ; Health Knowledge, Attitudes, Practice ; Humans ; Love ; Maternal-Child Nursing/organization & administration ; Maternal-Fetal Relations/*ethnology ; *Medicine, East Asian Traditional ; *Mothers/education/psychology ; Motivation ; Nurse Midwives/organization & administration ; Nursing Evaluation Research ; Nursing Methodology Research ; Object Attachment ; Parturition/*ethnology ; Pregnancy ; Prenatal Care/*organization & administration ; Program Evaluation ; Questionnaires ; *Self Efficacy ; Writing

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. THE SPECIFIC OBJECTIVES WERE: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i) FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the medically supervised deliveries, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. STUDY DESIGN: The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum "package" program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and "before and after" surveys were conducted to measure the change. SERVICE INPUT: This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. METHOD OF EVALUATION: a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed. b. Neverthless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the "intergration process" itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltructure, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable. Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. SUMMARY OF FINDINGS: A) PROGRAM EFFECTS AND IMPACT. 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 78% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller. 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) & delivery care (45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregnancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) EFFECTS ON INTERACTIVE LINKAGE. 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in carrying for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, 85-90% of the services provided by the health workers were other than FP/MCH, mainly for immunization such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs. 31%) and for more combined care (45% vs. 23%). C) ORGANIZATION FACTORS (ADMINISTRATIVE INTEGRATIVE ISSUES). 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub-center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwives's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea). 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through planning practice. 2) Goal consensus in FP/MCH should be made among the health workers & administrators, especially to emphasize the need of care of "wanted" child. But there is a long way to go to realize the "real" integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (ii) there should be a health sub-center director who can provide leadership training for managing the integrated program. There is a need for "organizational support", if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the management of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Workers, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.
Abortion, Induced ; Administrative Personnel ; Child ; Child Health ; Chungcheongnam-do ; Cohort Studies ; Community Health Workers ; Consensus ; Contraception ; Cooperative Behavior ; Delivery of Health Care ; Encephalitis ; Family Characteristics ; Family Health ; Family Planning Services* ; Female ; Hand ; Health Personnel ; Health Services ; House Calls ; Humans ; Immunization ; Infant ; Infant Mortality ; Insurance Benefits ; Clinical Trial* ; Jurisprudence ; Korea* ; Leadership ; Live Birth ; Local Government ; Midwifery ; Organization and Administration ; Parturition ; Population Growth ; Postnatal Care ; Pregnancy ; Prenatal Care ; Primary Health Care ; Referral and Consultation ; Social Control, Formal ; Specialization

this study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less opportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the sicioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child heath, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean- while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision a s the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendant (8%) by maternity aid in study area. But, I expect that more maternity aids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I an sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if such facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and past-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a "notification" system instead of formal registration system, it would be improved significantly compared to present system. B. Effect of the project. Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't wont to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculation, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate int he former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.
Birth Rate ; Cause of Death ; Child ; Child Health* ; Child* ; Communicable Diseases ; Contraception ; Surveys and Questionnaires ; Family Planning Services* ; Female ; Follow-Up Studies ; House Calls ; Humans ; Infant ; Infant Mortality ; Korea ; Mortality ; Mothers ; Motivation ; Organization and Administration ; Parturition ; Persuasive Communication ; Pneumonia ; Population Growth ; Pregnancy ; Pregnant Women ; Prenatal Care ; Tetanus

this study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less opportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the sicioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child heath, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean- while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision a s the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendant (8%) by maternity aid in study area. But, I expect that more maternity aids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I an sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if such facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and past-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a "notification" system instead of formal registration system, it would be improved significantly compared to present system. B. Effect of the project. Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't wont to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculation, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate int he former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.
Birth Rate ; Cause of Death ; Child ; Child Health* ; Child* ; Communicable Diseases ; Contraception ; Surveys and Questionnaires ; Family Planning Services* ; Female ; Follow-Up Studies ; House Calls ; Humans ; Infant ; Infant Mortality ; Korea ; Mortality ; Mothers ; Motivation ; Organization and Administration ; Parturition ; Persuasive Communication ; Pneumonia ; Population Growth ; Pregnancy ; Pregnant Women ; Prenatal Care ; Tetanus

OBJECTIVES: The aims of the study show the effect of cardiac disease of pregnant women on the perinatal complications and pregnancy outcomes. METHODS: From Jan. 2001 to Nov. 2005, 29 cases of pregnant women with cardiac disease were enrolled and classified by the NYHA (New York Heart Association) classes under the supervision of cardiologist and cardiothoracic surgeon. The average age of all cases is 29.9 years olds and it consists of 13 primigravida and 16 multigravida. For the examination of cardiac function during the pregnancy, the echocardiography was performed. We evaluated the cardiac disease of pregnant woman with the underlying causes, clinical manifestations during the pregnancy, delivery mode, gestational age at birth, birth weight, Apgar score and perinatal complication. RESULTS: All 29 cases with cardiac diseases are composed of 21 cases of NYHA class I (72.7%), 4 case of NYHA class II (13.7%) and 4 cases of NYHA class III (13.7%). There are 11 cases with congenital heart disease (37.9%), 6 cases with acquired heart disease (20.6%), 9 cases with arrhythmia (31.0%), and 3 cases with other cardiac disease (10.3%). Before the pregnancy, 6 cases of 11 cases with congenital heart disease and 5 cases of 6 cases with acquired heart disease performed the corrected cardiac surgery. Echocardiography was performed on 24 cases. It showed average ejection fraction in left ventricle of NYHA class I (13 cases) and NYHA class II, III (8 cases) were 61.5% and 52.6%, respectively. 7 cases of NYHA class I and 1 case of class II was done on the vaginal delivery. 14 cases of class I pregnant woman were performed the cesarean section according to obstetric indications but 3 cases of class II were performed the cesarean section for the prevention of cardiac risks. 4 cases of class III were performed the cesarean section according to obstetrics indications (2 cases) and for the prevention of cardiac risks (2 cases). For gestational age at birth, the average of NYHA class I was 38.1 weeks and the average of NYHA class II, III was 35.4 weeks. The average birth weight showed 3,022 gm in class I and 2,446 gm in class II and class III. Preterm birth were 3 cases (class II; 1 case, class III ; 2 cases). Low birth weight infant were 5 cases (class I; 3 cases, class II 2 cases). Intrauterine fetal death was a case (class I). Congenital abnormalities at birth were not observed in our study. Although no maternal mortality was observed, 2 cases of pulmonary edema caused by cardiomyopathy in NYHA class III and 1 case of Eisenmenger Syndrome caused by PDA in NYHA class II were developed during the labor. CONCLUSION: In this study, the majority of pregnant women with cardiac disease had the congenital heart diseases. It also showed that they can expect good perinatal outcomes by the adequate prenatal care including cardiac surgery before the pregnancy.
Apgar Score ; Arrhythmias, Cardiac ; Birth Weight ; Cardiomyopathies ; Cesarean Section ; Congenital Abnormalities ; Echocardiography ; Eisenmenger Complex ; Female ; Fetal Death ; Gestational Age ; Heart ; Heart Defects, Congenital ; Heart Diseases* ; Heart Ventricles ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Maternal Mortality ; Obstetrics ; Organization and Administration ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnant Women* ; Premature Birth ; Prenatal Care ; Pulmonary Edema ; Thoracic Surgery