출산의례와 생명의식

이향만(Lee, Hyang Man) 서강대학교 생명문화연구소 2013 생명연구 Vol.29 No.-

인간은 의례적 존재이다. 인간의 출생이 의례로 시작됨은 이를 잘 대변해 주고 있다. 동아시아에서는 특별히 생명의 시작인 출산의례를 매우 중시하였고 이를 통해 생명의식을 고양시켜왔다. 전통적인 출산의례는 단지 출산과정의 의례가 아니라 한 생명의 탄생를 위한 준비과정인 수태와 출산과 양육에 이르는 전 과정을 아우르고 있다. 이점에서 혼인식은 출산의례의 시작이라고 할 수 있다. 실질적인 출산의례는 아이를 갖게 되면서 시작되는 태교로 부터, 태어날 아이의 삶을 예견하는 태몽, 출산과 금기, 아기의 수명을 비는 첫 잔치인 백일, 아기가 장차 할 일을 예견하는 돌잡이, 정상적인 가족 구성원이 되는 세 돌을 맞이하며 끝나게 된다. 태교는 동아시아문화권에서 특별히 중요하게 여기는 태내 아이의 양육방식이다. 태교의 내용을 잘 정리한 책이 사주당 이씨의 『태교신기』이다. 『태교신기』는 여러 전적에서 태교와 관련된 부분을 발췌 인용하여 전통적인 태교의 방법을 요약 서술한 것이다. 태몽이란 아기가 잉태될 조짐을 알려주거나 그 아기의 운명을 예시하는 꿈이다. 태몽은 가족공동체의 염원을 담고 있고 아이를 통하여 태몽이 해석되는 과정을 보여준다. 따라서 한 아이의 출생은 아이를 통하여 드러날 새로운 세계의 탄생을 의미하고 있다. 그러나 오늘날 생명문화는 위기를 맞고 있다. 새 생명이 태어나자마자 기아와 같은 생존의 위기에 처하는 불행 못지않게 쾌락과 충동에 의하여 생겨나 생명의 존엄성을 존중받지 못하고 희생되는 새 생명이 늘어 가고 있다. 새 생명의 상실은 새로운 세계의 상실이며 인간 존엄성 상실이다. 이점에서 출산의례의 회복은 생명의식의 회복의 일환이 될 수 있다. In many ways human is ritual being. It is very well represented in the rituals related with human birth. In East Asia, it is very important, to start a life by performing birth rituals. The birth rituals are concerned with the consciousness and origin of life. Traditional birth rituals are not just rites of the birth process but it encompasses the entire process from conception to birth and parenting preparation for a conception of life. From the ritual point of view we can regard the marriage as a part of birth ritual. The birth rites are practically include and concerns the prenatal education, the precognitive dreams about the birth of a child, the birth, taboos related to birth, the first one hundred days fest for the child, choosing things by the kids from the table deliberately kept there on the first birthday, and third birthday celebrations for becoming a real member of a family. The prenatal education is particularly important in East Asian cultures. A well-organized book on prenatal was the Lady Lee's Prenatal Summary (胎敎新記, 1800). This book has several narrative summary on the traditional prenatal ways well quoted from the Confucian Classics. The precognitive dreams about the birth illustrates the fate of the baby and contains the aspirations of the family of baby. Therefore, the birth of a baby means the new world revealed through the baby. Today, however, the culture of life is growing through many crisis, because of hunger and misery many New lives are getting sacrificed at the time of birth. But more New lives stand on the brink of death because of increasing attitude of enjoyment and impulse. Many number of children are being sacrificed without respect or the dignity of life. The loss of New Life is the loss of the New World, likewise the loss of human dignity. At this point, the rejuvenation the birth rituals can contribute in the recovery of the rituals of life.

출산 연령에 따른 쌍태아의 출생체중 불일치 수준

박상화,임달오 한국모자보건학회 2017 한국모자보건학회지 Vol.21 No.1

Purpose: To compare the relationship between intertwin birth weight discordance and maternal age at birth. Methods: There were 51,726 pairs of twins born from 2007 to 2014 according to the birth certificate data of Korea Statistics (3,701,806 births). The data were excluded due to extra marital births, home births, and teenage births. Birth weight discordance rate (%) was calculated according to the following formula: (larger birth weight - smaller birth weight)/(birth weight of the larger twin) ×100. The odds ratio of intertwin birth weight discordance rate (≥25%) in maternal age at birth was calculated by logistic regression adjusted by the year of birth, gestational age, maternal education, infantile gender and paternal age. Results: The mean birth weight of the heavier twin and that of the lighter twin were 2.536 kg and 2.254 kg, respectively. The mean birth weight difference of intertwins was 0.282 kg. The mean birth weight discordance rate by maternal age was 10.5 percent for maternal ages between 20 and 29 years, 11.0 percent for between 30 and 34 years, and 11.4 percent for 35 years and older. The frequency of birth weight discordance level of ≥25 percent increased as the maternal age increased. The rate of birth weight discordance (≥25%) was 7.7 percent for maternal ages between 20 and 29 years, 8.3 percent for between 30 and 34 years, and 8.7 percent in for 35 years and older. Compared with women from 20 to 29 years of age, the odds ratio of ≥25 percent discordance was 1.094 (95% confidence interval: 1.005~1.190) for 30 to 34 years, and 1.164 (1.401~ 1.301) for 35 years and older. The odds ratio of ≥25 percent discordance for the different-sexed twins was higher than that of the same-sexed twins in overall maternal age groups of 20 to 29 years, 30 to 34 years, and 35 years and older. Conclusion: The risk of birth weight discordance level of ≥25 percent was associated with the older maternal age. More research is required to understand the risk factors of intertwin birth weight discordance for older women.

Comparison of the number of live births, maternal age at childbirth, and weight of live births between Korean women and immigrant women in 2018

( Sun-hee Kim ),( Sooyoung Kim ),( Byeongje Park ),( Seokmin Lee ),( Sanghee Park ),( Geum Hee Jeong ),( Kyung Won Kim ),( Sook Jung Kang ) 한국여성건강간호학회 (구 여성건강간호학회) 2021 여성건강간호학회지 Vol.27 No.1

Purpose: This study compared maternal age at childbirth, the number of live births, and the weight of live births between Korean women and immigrant women using statistical data from the Republic of Korea for the period of 2008-2018. Methods: The analysis was conducted using data from the Microdata Integrated Service of Statistics Korea (https://mdis.kostat.go.kr/index.do). Results: Korean women and immigrant women showed a higher age at childbirth in 2018 than in 2008. The percentage of newborns of Korean women with a birth weight of less than 2.5 kg increased slightly for 3 consecutive years from 2016 to 2018, whereas for immigrant women, this percentage increased in 2017 compared to 2016 and then decreased again in 2018. Very low birth weight (less than 1.5 kg) became more common among immigrant women from 2016 to 2018. Birth at a gestational age of fewer than 37 weeks increased both among Korean and immigrant women from 2016 to 2018. In both groups, the percentage of women who had their first child within their first 2 years of marriage decreased from 2008 to 2018. Conclusion: Immigrant women had higher birth rates than Korean women, while both groups showed an increasing trend in preterm birth. Greater attention should be paid to the pregnancy and birth needs of immigrant women, and steps are needed to ensure health equity and access in order to prevent preterm births. It is also necessary to identify factors that affect preterm birth and birth of very low birth weight infants among immigrant women in the future.

Recent Trends in the Incidence of Multiple Births and Its Consequences on Perinatal Problems in Korea

최선희,박영실,심계식,최용성,장지영,한원호,배종우 대한의학회 2010 Journal of Korean medical science Vol.25 No.8

The aim of this study was to survey multiple birth data and to analyze the recent trends of multiple births and its consequences on perinatal problems in Korea from 1991 to 2008. Data were obtained from the Korean Statistical Information Service. The total number of multiple births showed increasing trends. The multiple birth rate was maintained within less than 10.0 for the decade from 1981 to 1990. However, it increased gradually to reach 27.5in 2008. The maternal age for multiple births was higher than for total live births. The mean birth weight of the total live births was 3.23 kg; for the multiple births it was 2.40 kg in 2008. The incidence of low birth weight infants (LBWI) among total live births was 3.8% in 2000 and 4.9% in 2008. For multiple births it was 49.2% and 53.0% during the same years. The incidence of preterm births among total live births was 3.8% in 2000 and 5.5% in 2008; for the multiple births it was 38.3% and 51.5% during the same years. The incidence of multiple births and its consequences on perinatal problems (preterm, LBWI, and advanced-maternal age) have been increased steadily over the last two decades in Korea.

우리나라 다태아 출생률 추이에 관한 연구: 1981–2017

박상화,임달오 한국모자보건학회 2019 한국모자보건학회지 Vol.23 No.3

Purpose: To determine the secular trend of the multiple birth rate in Korea from 1981 to 2017. Methods: This study used birth certificate data covering the years 1981–2017 (20,948,901 births), provided by Statistics Korea. The impact of assisted reproductive technologies (ART) on multiple birth was analyzed by examining data prior to and after the introduction of ART and the national support program for infertile couples in South Korea. The odds ratio (OR) and 95% confidence intervals were calculated to describe the secular trend in the multiple birth rate per 100 births. Results: During this period, the multiple birth rate per 100 births increased by 277 percent from 1.031 to 3.891, the twin birth rate increased from 1.013 to 3.807 (275%), and the triplet birth rate increased from 0.018 to 0.084 (363%). The secular trend of the multiple birth rate remained in the 1.000 level during 1981–1991, but has been rising steadily since 1992. The average increment of the multiple birth rate was 3.9% annually from 1981 through 2017 (peaking at more than 10 percent during 2006–2007). Prior to the introduction of ART in Korea (1981–1984), the multiple birth rate was 1.007, but after its introduction, the multiple birth rate was 1.005 in 1985–1989 (OR, 0.998; 95% confidence interval, 0.982–1.014), 1.084 in 1990–1994 (1.007; 1.060–1.094), 1.891 in 2000–2004 (1.894; 1.866–1.922), 3.127 in 2010–2014 (3.173; 3.129–3.217), and 3.811 in 2015–2017 (3.893; 3.835–3.952). Conclusion: Over the past three decades, multiple births have risen dramatically in Korea, primarily due to the increasingly widespread use of fertility therapies, and the delayed age of childbearing. There is a need for more research to understand the factors contributing to multiple births, and the national birth registration systems ought to be reformed to monitor whether multiple births originated spontaneously or from assisted-conception.

출산 연령에 따른 출생아의 출생 결과; 1997-98, 2014-15년 출생통계를 중심으로

박상화 ( Sang Hwa Park ),김종석 ( Jong Seok Kim ),임달오 ( Dar Oh Lim ) 한국보건정보통계학회 2017 보건정보통계학회지 Vol.42 No.3

Objectives: To compare the secular trend of preterm birth (PTB) rate, low birth weight (LBW) rate and multiple birth rate by maternal age at birth. Methods: We used 1997-98 (1,872,720 births) and 2014-15 (1,280,348 births) birth certificate data of Korea excluding extra-marital birth cases. Odds ratio (OR) and 95% confidence intervals were calculated from logistic regression analyses to investigate the secular trend (1997-98 and 2014-15) of maternal age specific PTB rate, LBW rate and multiple birth rate (ie three indicators) adjusted by socio-demographic variables. Results: Between 1997- 98 and 2014-15, the birth rate of women aged 25-29 years decreased from 54.8 percent to 22.0 percent. The rate of maternal age at birth increased 2.2 times in aged 30-34 years, 3.9 times in aged 35-39 years, and 4.3 times in aged 40-44 years. The mean age at birth increased from 27.9±3.8 years to 31.7±4.1, mean gestational age decreased from 39.4±1.4 weeks to 38.6±1.6 weeks, and mean birth weight was 3.27±0.45kg and 3.21±0.46kg, respectively. The rate of three indicators during the period increased from 3.3 percent to 6.7 percent in PTB rate, from 3.3 percent to 5.6 percent in LBW rate, and from 1.4 percent to 3.6 in multiple birth rate. After adjustment by socio-demographic variables, the odds ratio of three indicators in birth year of 2014-15 were 2.21 (95% confidence interval: 2.16-2.26) for multiple birth, 1.73 (1.70-1.75) for PTB, and 1.36 (1.34-1.38) for LBW, compared with 1997- 98. If maternal age distribution in 2014-15 was similar to that in 1997-98, the rates of three indicators would be 11.9 percent lower in preterm birth (5.9% compared with 6.7%), 12.5 percent lower in low birth weight (4.9% vs. 5.6%), and 25.0 percent in multiple birth (2.7% vs. 3.6%). During the period, the ratio of fluctuation (maximum rate/minimum rate) in three indicators decreased from 2.7 to 1.8 in PTB and from 2.2 to 1.7 in LBW, and increased from 2.3 to 5.5 in multiple birth. Between 1997-98 and 2014-15, the highest increment of three indicators by maternal age was women aged 20-24 years for PTB (OR: 2.06), aged 20-24 years for LBW (1.56), and women aged 30-34 years for multiple birth (2.44). The lower increment of three indicators was observed in terms of maternal age at 35 years and older. Conclusions: Advanced maternal age in women was associated with the risk factors for an adverse child`s birth outcomes (PTB, LBW and multiple birth). The risk of increment of PTB and LBW during the period was higher in women age 20-29 years than that of aged 35 years and older. Well designed intervention programme on prenatal care available and accessible to all aged women, and is the ways to reduce adverse child`s birth outcomes.

우리나라 단태아 및 다태아에서 임신 기간별 세분화된 조기분만율의 변화 추이: 1997-98, 2013-14

박상화 ( Sang Hwa Park ),김종석 ( Jong Seok Kim ),임달오 ( Dar Oh Lim ) 한국보건정보통계학회 2017 보건정보통계학회지 Vol.42 No.1

Objectives: To compare the secular trend (1997-2014) of gestational age specific preterm birth rate in singleton and multiple birth. Methods: The birth certificate data of Statistics Korea was used for this study (1997-98: 1,292,336 births, 2013-14: 849,779 births). The data of extra-marital birth and missing information cases (gestational age, maternal age and other variables) were excluded from all analyses. Odds ratio and 95% confidence intervals were calculated from logistic regression to describe the secular trend of very preterm birth (≤31 weeks), moderate preterm birth (32-33 weeks), late preterm birth rate (34-36 weeks) in singleton and multiple birth adjusted by maternal age (15, 20, 25, 30, 35, 40, 45), birth order (1st=1, 2nd=2, 3rd=3), infantile gender (male=1, female=0), and education (≤middle=1, high=2, college/university=3). Results: The rate of preterm birth increased 1.9 times, from 3.31% to 6.44%, during 1997-2014. After adjustment by logistic regression for infantile gender, parity and maternal age, and type of birth, the odds ratio of preterm birth of phase II was 1.69 (95% confidence interval: 1.66-1.71), compared with phase I. During the period, preterm birth rate increased 2.71 times in multiple birth, whereas the rate was 1.57 times increment in singleton birth. 47.2% of the overall increase in the preterm birth rate was attributable to the increase of preterm birth in multiple birth during the period. The odds ratio of very preterm birth, moderate preterm birth and late preterm birth rate in singleton birth for phase II were, respectively, 1.37 (95% confidence interval: 1.30-1.44), 1.08 (1.03-1.14), and 1.68 (1.65-1.72), compared with preterm birth rate of phase I. Comparing the preterm birth rate of phase I, the odds ratio of preterm birth in multiple birth of phase II was 2.61 (2.32-2.93) for very preterm birth, 1.35 (1.22-1.49) for moderate preterm birth and 2.78 (2.64-2.92) for late preterm birth rate. Conclusions: The rate of gestational age specific preterm birth increased higher in multiple birth than that of singleton birth during the period. The remainder of the total increment in the preterm birth between phase I & II was explained by increase the multiple birth and late preterm birth. There is a need for close attention in this area to understand the contributing factors to late preterm birth and to reduce preterm birth rate for multiple birth.

우리나라 쌍태아의 임신기간별 출생체중 불일치 수준에 관한 연구; 2007-2014

박상화 ( Sang Hwa Park ),조진만 ( Jean Man Jo ),임달오 ( Dar Oh Lim ) 한국보건정보통계학회 2016 보건정보통계학회지 Vol.41 No.3

Objectives: To compare the relationship between gestational age and inter twin birth weight discordance level. Methods: We used the 2007-2014 birth certificated data of Statistics Korea 51,783 pairs of twins. The data of unmatched twin cases, extra-marital birth and non-hospital birth cases were excluded. Birth weight discordance rate was calculated as (birth weight difference between larger and smaller birth weight/birth weight of heavier twin) x 100. Odds ratio and 95% confidence intervals were calculated from logistic regression analyses to describe the birth weight discordance (≥25%) of gestational age adjusted by year of birth, infantile gender, maternal age, maternal education, and age difference between couples. Results: The inci-dence of inter twin birth weight discordance was 55.3 percent in discordance of ≤9 percent, 10.9 percent in discordance of 20-29 percent, and 4.4 per-cent in discordance of ≥30 percent. The frequency of more than 25 percent discordant set demonstrated polynomial relationship to gestational age (Y=-82.294+6.226X-0.101X², R²=0.77, p<0.01). Overall incidence of birth weight discordance more than 25 percent was 8.3 percent. The frequency of discordance level (≥25%) by gestational age was 10.7 percent in extremely preterm (≤27 weeks), 14.3 percent in very preterm (28-31 weeks), 13.1 per-cent in moderate preterm (32-33 weeks), 8.7 percent in late preterm (34-36 weeks), and 5.8 percent in full and late term (≥39 weeks). The rate of discor-dance level of ≥25 percent decreased with increasing gestational age. Compared with discordance level (≥25%) of full and late term, odds ratio of dis-cordance level (≥25%) was 2.76 (95% confidence interval; 2.05-3.70) in very preterm, 2.48 (1.86-3.31) in moderate preterm, 1.97 (1.37-2.83) in extremely preterm, and 1.56 (1.19-2.05) in late preterm. Conclusions: The risk of discordance level of ≥25 percent increased significantly with very preterm and moderate preterm birth. There is a need to understand the contributing factors and close attention to reduce the risk of discordance level of ≥25 per-cent in gestational age from 28 to 33 weeks.

우리나라 가정 및 병원 분만 추이에 관한 연구

임달오 ( Oar Oh Urn ),김종석 ( Jong Seok Kirn ),천대우 ( Oae Woo Chun ),한정호 ( Jung Ho Han ),박상화 ( Sang Hwa Pank ) 서울대학교 인구의학연구소 2012 人口醫學硏究論集 Vol.25 No.-

Based on the birth certificate data from National Statistical Office for 2010, this study is aimed at analyzing the secular trends of home and hospital births, and pregnancy outcomes of home vs hospital births in Korea. Over the past two decades, the percent distribution of home birth decreased from 7.7 percent in 1991 to 1.3 percent in 2010, and hospital birth increased from 89.8 to 98.0 percent. In 2010, Jeju province had the highest percentage of home births (2.1 percent), followed by Jeonbuk province (1.9 percent), Gwangju metropolitan city (1.8 percent) and Jeonman province (1.7 percent). In contrast, the lowest percent of home births was observed in Ulsan metropolitan city (0.8 percent) and Daegu metropolitan city (1.0 percent). Home births are more common among women aged 35 and over, among women with several previous children, and lower education level (under middle school). Home births have a higher risk profile than hospital births, with higher preterm and higher low birth-weight. The pose term birch races (42 weeks and over) was also significantly higher in home births (1.1 percent) than that of hospital births (0.3 percent).

우리나라 월별 출생 빈도의 변동에 관한 연구, 2000-2012

박상화 ( Sang Hwa Park ),한정호 ( Jung Ho Han ),임달오 ( Dar Oh Lim ) 한국보건정보통계학회 2014 보건정보통계학회지 Vol.39 No.1

Objectives: The objective of this study was to analyze the monthly variation of birth by year of birth (2000-2012), birth order and marital status. Methods: The analysis was based on birth data of Korea (634,501 births in 2000, 435,301 births in 2005, 470,171 births in 2010 and 484,550 births in 2012). As the percent distribution in monthly number of births appears to be influenced by the different number of day of month, we used the index of birth occurrence (IBO) for analyzing of monthly variation in birth. IBO is defined as a ratio of the average number of births per day of the month to the average number of births per day of the year, with the base set at 100. Results: The monthly distribution of births was bimodal, with a major peak extending from January to March, a minor peak from October to September, and a major trough in December. During the 2000-2012, IBO was highest for January (111), and lowest for December (89). The IBO in first birth order was highest for January (112), and lowest for June (89), and the variations of IBO in first birth order showed wide fluctuation as compared with the IBO of non-first birth order. The monthly pattern of IBO for extramarital births showed lower fluctuation from a peak of 107 to a trough of 92 than for the marital births. The pattern of the IBO for first births, showed a major peak in January-February (wedding in April-May: index of marriage occurrence: 126-127) and a minor peak in October-November (wedding in September-December: 126-143). The monthly distribution of first births appeared to be influenced to some extent by a monthly pattern of marriage. Conclusions: There was a bimodal pattern in birth seasonality: a major peak in January-March, a trough in June-July, a minor peak in October-September, and a trough around December.