• 농촌의학ㆍ지역보건
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• 제1권1호
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• pp.29-36
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• 1976

Introduction Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding development in this field is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife. Taking into account the shortage of professional person i11 rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future, It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions. it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so. The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child hoalth through the replacement of untrained relatives as birth attendants with educated and trained maternity aides. We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health centre level. Problems of MCH in rural Korea The field of MCH is not only the weakest point in the medical field in our country hut it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large proportion of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge. The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%. Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10,000 live births). Prenatal care Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit Game after 4 months of gestation. Delivery conditions This field is lagging behind other public health problems in our country. Namely, more than 95% of the women deliveried their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by laymen was 78% while those receiving no care at all was 16%. For instruments used to cut the umbilical corn, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%. The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total. Child health The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28,43,60,81 and 91% respectively, and even after the next pregnancy still continued lactation. The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were very low and insufficient. Infant death rate was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%. Methods of improvement in the MCH field 1. Through the activities of village health workers (VHW) to detect pregnant women by home visiting and. after registration. visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities. they refer them to the public health nurse or midwife. Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination. 2. Through the midwife or public health nurse (aid nurse) Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old. 3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy. First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic disease that might disturb the continuity of the pregnancy. Second, if the pregnant woman shows any abnormalities the physician must examine and treat. Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course. the medical care of both the mother and the infants are responsible of the physician. Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a parttime worker.

• Journal of Nutrition and Health
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• 제30권10호
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• pp.1195-1202
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• 1997

Iodine-rich seaweed soup has been traditionally supplied to postpartum women in Korea. This dietary habit might introduce over-intake of iodine above the recommended requirements, and might provoke postpartum thyroid dysfunction. Although the response to excess iodine intake is highly variable, goiter, hyperthyroidism, hypothyroidism, and thyroiditis could follow the daily intake of 1,500$\mu\textrm{g}$ of iodine. A few studies are available concerning iodine toxicity in Korea. The purpose of this study was to investigate the relationships between the dietary intake of iodine and thyroid function change as well as the incidence of postpartum thyroiditis. One hundred and thirty-seven postpartum women who had experienced normal deliveries were studied. Dietary intake of iodine and excretion concentration of iodine in breast milk and maternal urine were measured . Serum T$_3$, T$_4$, TSH, anti-thyroglobulin antibody, and anti-microsomal antibody were anlayzed 1 week before delivery and 1, 6, 12, and24 weeks after delivery. Iodine intake was analyzed by one-to-one interviews using 24-hr recall and a food frequncy questionnaire. The result showed that the intake of dietary iodine before delivery and 1 and24 weeks after delivery were 483$\mu\textrm{g}$/day, 3367$\mu\textrm{g}$/day, and 1069$\mu\textrm{g}$/day, respectively. The concentration of iodine in urine at the first week after delivery was 63$\mu\textrm{g}$/dL, and 23.9$\mu\textrm{g}$/dL in breast milk . The levels of serum T$_3$ and T$_4$ before delivery were 2.01ng/mL and 11.49$\mu\textrm{g}$U/dL, respectively, showing that the levels were gradually dropping to normal values after delivery. Positive serum anti-thyroglobulin antibody and anti-microsomal antibody appeared in 3 cases. After a 24 week follow-up period , 6 women(10.3%) experienced cases of postpartum thyroiditis, 5 of which were cases of hyperthyroidism and one of which was a case of hypothyroidism. These figures of postpartum thyroiditis are similar to those of other countries.

• 여성건강간호학회지
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• 제5권1호
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• pp.5-20
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• 1999

This study was conducted to examine primiparas' perception of delivery experience and identity as the mother("Myself as the Mother" and "My Baby") according to delivery methods such as normal delivery and cesarean section. The result of this study summarized as follows. 1. The primiparas' perception of delivery experience according to delivery methods showed that the primipars who had normally delivered perceives the delivery experience more positively than those by cesarean section(t=4.88, p=0.000). This fact supported hypothesis 1 that "the primiparas group by normal delivery should perceive the delivery experience more positively that by cesarean section." 2. The primiparas who had delivered by cesarean section were more positive in the SD-Self score than those who had normally delivered at the time when four weeks passed after delivered, and there was a significant difference(t=-4.21, p\0.000). Therefore, hypothesis 2-1 that "the primiparas group who had normally delivered should be more positive in the SD-Self 1-2 days and 4 weeks after delivery than one who delivered by cesarean section" was rejected. 3. It was shown that the primiparas who had delivered normally were more positive in the SD-Baby 1-2 days 4 weeks after delivery than those who delivered by cesarean section(after-delivery 1-2 days : t=3.10, p=0.002 and after-delivery 4 weeks : t=2.15, p=0.034). Based on this fact, hypothesis 2-2 that "the primiparas group who had delivered normally should be more positive in the SD-Baby 1-2days and 4 weeks after delivery than those who had delivered by cesarean section"was supported. 4. Primiparas who had delivered by cesarean section appeared to have a positive identity as the mother by showing a more significant difference (t=7.96, p=0.000) 4 weeks after delivery than 1-2 days after delivery. In conclusion, we see that primiparas' perception of delivery experience and identity as the mother were different according to delivery methods. Thus, it is required to devise a nursing in tervention strategy to expand support from the health care system and opportunities to provide pre. post-delivery programs so that primiparas can have a positive perception of delivery experience and a positive identity as the mother. Based on conclusion stated above, the following suggestions are made. 1. As this study compared the perception of delivery experience and identity as the mother between prmiparas who had delivered normally and ones who had delivered by cesarean section, the further study on comparison between multiparas who had delivered normally and ones who had delivered by cesarean section is needed. 2. According to the results of this study, longitudinal study is needed to examine the difference and change in the formation of maternal identity. 3. According to the result of this study, a study is also needed to determine interaction between time for maternal identity and delivery methods.

• 여성건강간호학회지
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• 제7권1호
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• pp.7-17
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• 2001

The purpose of this study was to evaluate the effects on maternal-fetal attachment and self efficacy for delivery using the Taekyo-oriented prenatal class. This class is for 2 hours/week for 4 weeks. The program covers the contents of fetal growth and development including their responding ability, the importance of the uterine environment, sharing the motive and purpose of pregnancy, sharing experiences about pregnancy, sharing of prejudices against delivery, training of maternal-fetal interaction, understanding delivery, relaxation breathing techniques, maternity exercises, writing letters or prayers to the baby, and declaration of loving the baby. This study took place from March 4th to June 15th, 2000, in a university hospital and community care center, and was done by with a pretest-posttest design, with 55 pregnant women who were within 32-36 weeks pregnant and who agreed to participate in this study. Data was measured twice by self-report by the Cranley's Maternal-fetal Attachment Scale(MFAS, 1981), and the Shin's(1997) Self Efficacy for Delivery Scale at the beginning and at the completion of the class. Data was analyzed by SAS. The study results were: 1. The score of maternal-fetal attachment was significantly increased after the Taekyo perspective prenatal class than before the class. (t=7.389, p=0.000) 2. The score of self efficacy for delivery was significantly increased after the Taekyo perspective prenatal class than before the class. (t=8.885, p=0.000) The above results proved that the present Taekyo perspective prenatal education program was effective in increasing maternal-infant attachment and self efficacy for delivery. Therefore, it is concluded that the existing prenatal class should include Taekyo perspective elements. However, further study is needed to compare the effects with preexisted prenatal class.

• Macromolecular Research
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• 제11권1호
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• pp.19-24
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• 2003

Polymeric gene delivery system attracts profound attention as it shows less toxicity, versatility, and reasonable gene expression efficiency. Terplex system, a synthetic biopolymeric gene delivery system consisting of stearyl poly-L-lysine (stearyl-PLL) and low density lipoprotein (LDL) was evaluated for its body distribution of gene expression of exogenously administered pDNA after tail-vein injection in mice. Kidney and spleen are two major organs with highest gene expression, whereas liver and heart showed marginal gene expression among the organs examined. Hemolytic effect of the terplex system was evaluated using human red blood cells, where terplex system did not cause significant hemolysis at the concentrations above the experimental ranges, although unmodified PLL or stearyl-PLL without LDL did. Serum stability of terplex system against enzymatic degradation was also significantly enhanced, presumably due to the steric stabilization from the polymers. Based on these findings and along with its high in vitro transfection efficiency, terplex system could serve as a safe and efficient polymeric gene delivery system with many applications for the in vivo gene therapy.

• 여성건강간호학회지
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• 제16권1호
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• pp.29-36
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• 2010

Purpose: This study aimed to identify the scores of postpartum depression(PPD) on the first day, 1st week, and 6th week after the delivery and to explore their related factors before and after delivery in postpartum women. Methods: With a survey design, 293 postpartum women were recruited from a postpartum unit, Ilsin Christian hospital in Pusan via convenience sampling and were followed at 1st week and 6th week in the outpatient clinic. Results: Results showed that the scores of PPD(EPDS score) were low at postpartum 1st day, 1st week and 6th week but prevalence of PPD(EPDS ${\geq}13$)was 3.1%at 1st day, 8.2%at 1st week and 7.5%at 6th week, respectively. The pre-delivery factors were experience of depression, and the post-delivery factors were baby's sex(1st day), no caregiver for baby(1st week), and no help and concern for taking care of baby from husband and family(1st day and 6th week). The greater satisfaction with becoming a mother and her life, and greater maternal attachment were related to lower level of PPD at the three time points. Conclusion: Regular screening for postpartum depression and supportive and informative education is needed for postpartum women visiting the outpatient clinic for follow-up.

• 대한간호학회지
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• 제33권6호
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• pp.753-761
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• 2003

Purpose: The study was done to examine the effects of San- Yin-Jiao(SP6) acupressure treatment on subjective labor pain, length of delivery time in women during labor. Method: The study design was a randomized controlled clinical trial study using a double-blinded method. Data were collected using a structured questionnaire, a subjective labor pain scale and measurement of delivery time. The experimental group(n=29) was received SP6 acupressure and control group(n=29), SP6 touch for the duration of each uterine contraction, during 30 minutes after 3cm dilatation of cervical os. Result: The subjective labor pain scores was significantly different between the two groups(p=0.042). The total length of delivery time in the group which had the SP6 acupressure was shorter than SP6 touch group (p=0.036). Conclusion: These findings showed that SP6 acupressure was effective related to labor pain, length of time for delivery. SP6 acupressure during labor could be applied as an effective nursing treatment.

• 대한간호학회지
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• 제24권4호
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• pp.696-705
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• 1994

This study was done to provide a basis for home health care management for women following Cesarean delivery. Furthermore it was initiated as an possible application of home health care in the future. In this study, client selection criteria was developed by the researcher and assessment tools for home health care, recording system and problem oriented recording system were revised from Jun's(1993) methods. The selection criteria tool for home health care for women who had a Cesarean delivery was structured and consisted of five areas : physical status, functional status, psychological-emetional status, educational needs status and environmental status. The structured assessment tool consisted of general items, obstetric history, past medical history, methods of feeding, medications taken before ad-mission, laboratory results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of women and their newborns. The visit note consisted of the date : nursing problems : nursing process including initial assessment : nursing goals : visit plan : health status of the postpartum women and their newborn : nursing diagnoses : nursing implementation evaluation : summary : next visit plan and revision. The problem oriented recording system consisted of the date, problem numbers, nursing diagnoses, problem appearance date, problem resolution date. The results of the research are as follows : The seven cases having had a Cesarean delivery were discharged on an average on the 5th day after the Cesarean birth. The total number of home visits was 13. According to Cordon's functional health patterns the total possible nursing diagnoses was 34 diagnoses for the methers and their newborns. Among the 34 diagnoses, there were 13 diagnoses in the health perception /management pattern, 7 in the psychosocial health perception / management pattern, 8 in the psychosocial self-perception, 2 in the nutrition / metabolism pattern of physical function, 2 in the knowledge deficit of newborn management, anxiety related to newborn management, knowledge deficit related to disease process of new-born, anxiety related to disease process of newborn anxiety related to prognosis of baby's condition, knowledge deficit related to newborn jaundice each appeared once. The changes in the number of nursing diagnoses was related to not the number of visits but to the number of nursing diagnoses decreasing. The con-tent of the home health care was categorized ac-cording to assessment, direct care, counseling, education, family care. The recommendation based on the results of this research are Home health care nurses for Cesarean postpartum women and their neonates requires comprehensive knowledge of pregnancy, delivery, and the postpartum period and of the neonate so that they can provide appropriate care and holistic views. Most of cases terminated after the second visit, this outcome may be related to the subjects being discharged on the 5th day after delivery. Therefore, study done with earlier discharge after delivery may have different outcome. It is very hard to assess psychological aspects that need follow-up and to develop communication channels.

• 여성건강간호학회지
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• 제11권1호
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• pp.38-45
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• 2005

Purpose: This study was to examine the degree of prenatal emotional status, preparation for delivery, postpartum social support, and postpartum blues and to investigate the relationship of the above variables in postpartum women. Method: The subjects were 131 postpartum women. Selection criteria were women who were 2 to 8 weeks post delivery. After Informed consent was obtained, they were asked to fill out a self-administered questionnaire. The instrument was a Postnatal Depression & Anxiety check list. Result: The mean age of the subjects was 29.3 years, and 63.4% of subjects delivered their children by vaginal birth. 18.3 percent had felt depressed during their pregnancy. The mean score of the postpartum blues was 19.2. 61.8 percent of the subjects had postpartum blues and 8.4 percent experienced postpartum depression. Monthly income was negatively correlated to postpartum blues (r=-.189, p<.05), but the emotional status during pregnancy had a significant and positive relationship. However, preparation for delivery had no significant correlation with postpartum blues. While husband support and social support had a tendency to have a negative correlation. Conclusion: Further research is needed to identify the factors that affect the emotional status during pregnancy with various scales. Also, intervention programs to increase emotional support for pregnancy and husband support are needed.

• 여성건강간호학회지
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• 제4권1호
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• pp.67-83
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• 1998

A quasi-experiment, repeated measures design with non-equivalent control group was used to test the influence of cold therapy on the perineal discomfort and the healing state of the postpartum women undergoing vaginal delivery with episiotomy. Experiment was carried out from July 28, through October 2, 1996 with 40 postpartum women conveniently sampled from one university hospital located in Seoul. The 40 postpartum women undergoing vaginal delivery with episiotomy were as signed to experimental and control groups evenly(20 each). The instrument of measurement of perineal discomfort was 0-10 rating scale that was made by researcher and that of perineal healing state was Davidson's REEDA tool. The perineal discomfort and the healing state level were measured before and after each treatment. The treatment using ice glove that was given for the only experimental group was carried out at three points ; as soon as returning to the recovery room, 3 hours after returning to the recovery room and 6 hours after returning to the recovery room. The data was analysed by using t-test, chi-square test to determine the similarity between experimental and control groups. The hypotheses were tested using repeated measures ANOVA. The results of this study are summarized as follows; 1. The first hypothesis that the perineal discomfort level of the experimental group will be significantly lower than that of the control group(df(1,38), F=24.12, p=.0001) was supported. 2. The second hypothesis that the perineal healing state of the experimental group wil be better than that of the control group(df(1,38), F=0.48, p=.49) was not supported. Based on the results of this study, could therapy was turned out to have significant effect on the perineal discomfort of the postpartum women undergoing vaginal delivery with episiotomy.