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.

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.

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.

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.

혼전과 혼후 임신의 조기분만 발행에 관한 연구: 2008-2012년 인구동태통계

박상화 ( Sang Hwa Park ),천대우 ( Dae Woo Chun ),한정호 ( Jung Ho Han ),임달오 ( Dar Oh Lim ) 서울대학교 인구의학연구소 2014 人口醫學硏究論集 Vol.27 No.-

The objective of this study is to describe the association of preterm birth(PTB) in pre-marital pregnancy (shorgun birth) & post-marital pregnancy (marital birth) by analyzing 2008-2012 birth certificated data (1,143,466 primiparous singleron births) from Korea Statistics. Odds ratio and 95% confidence intervals of PTB were calculaced from logistic regression analysis. The rate of shotgun birth increased from 15.7 percent to 18.9 percent during 2008-2012. There was no difference in the rate (4.1 percent) of PTB associated with pre or post-marital pregnancy. The mean of gestational age was 39.08 weeks in shtgun birth and 39.04 weeks in marital birth. After adjustment by logistic regression for infantile gender, maternal age, maternal education & occupation and year of birth, odds ratio of PBT was slightly higher in shotgun birth (1.03, 95% confidence interval: 1.00-1.05, p<0.05)than that of marital birth group. By the maternal age groups, the risk of PBT in shotgun birth were significantly higher (1.09. 95% C1: 1.05-1.14) compared with the marital birth only in 30-39 years old group. There was a slight excess of PTB in shotgun birth versus marital birth.

다태아 출산 연령 분포가 다태 조기분만아 출생률에 미치는 기여 효과; 1997~98, 2014~15

박상화,임달오 한국모자보건학회 2017 한국모자보건학회지 Vol.21 No.3

Purpose: To figure out the contribution of maternal age distribution to the preterm birth (PTB) rate of multiple births between 1997~98 and 2014~15. Methods: Multiple birth certificate data of Korea Statistics were used for this analysis. There were 18,557 births in 1997~98 and 30,992 births in 2014~15. Kitagawa’s decomposition method was used to examine the contribution of age-specific PTB rate and maternal age distribution of multiple births to overall increment of PTB rate in multiple births between 1997~98 and 2014~15. Results: PTB rate of multiple births increased from 32.40 percent to 58.22 percent (odds ratio: 1.80, 95% confidence interval: 1.76~1.84) during 1997-2015. PTB rate of multiple births greatly increased for women aged 25~29 years (odds ratio: 2.09) during the same period. The rates increased 1.88 times for women aged ≤24 years, followed by women aged 30~34 years (OR: 1.65), women aged 35~39 years (1.54), and women aged ≥40 years (1.36). Most (78.7%) of the overall increment in PTB rate of multiple births was attributable to the increase in the dimension of women aged 30~34 years, and 49.9 percent for women aged 35~39 years. Conclusion: The total increment in the PTB rate of multiple births was explained by increase the proportion and the PTB rate of women aged 30~39 years. More research is needed to comprehend the contributing age factors to PTB rate of multiple births.

연구 : 자기 주도적 출산 (Self-Directed Birth) 경험: 새로운 자아탄생

김정현 ( Kim Jeong Hyeon ) 연세대학교 김모임간호학연구소 2003 간호학탐구 Vol.12 No.1

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.

한국에서 부모의 출신국이 출산결과에 미치는 효과, 2010~2012년

최세문 한국보건사회학회 2016 보건과 사회과학 Vol.0 No.41

The objective of this study is to compare the birth outcomes of Korean-born parent family (KBPF), foreign-born father family (FBFF), and foreign-born mother family (FBMF) and to investigate whether parental foreign-born status confers a protective effect on birth outcomes among singleton births in Korea. The main data were Korean Birth Registries collected between 2010 and 2012. We analyzed 678,290 first-order newborns and 503,892 second-order newborns. Birth outcomes included birth weight and low birth weight (<2,500g). Adjusting for gender, gestational age, parental age group and educational status, and paternal occupation, we conducted multivariate linear regressions and logistic regressions by birth order and year. While newborns of FBFF are 42.24g heavier than those of KBPF, newborns of FBMF are 17.53g lighter. For first-order births, being born from FBFF has lower odds of low birth weight (OR 0.83, 95% CI: 0.70-0.97) than being born from KBPF and being born from FBMF is not significantly different. For second-order births, being born from FBMF protects against low birth weight by 24%(95% CI: 0.68-0.85) compared to those born from KBPF. Newborns of Chinese-born mother family are heavier and have lower odds of low birth weight compared to those born from KBPF regardless of birth-order. First-order newborns of Philippine and Japanese mother family have lighter birth weight and higher odds of low birth weight than those born from KBPF. Except Philippine and Japanese mother family, we found the epidemiological paradox in birth outcomes of the second-order newborns from FBMF. In Korea, parental foreign-born status is significantly associated with birth outcomes and its impacts vary by type of family, parents’ country of origin, and birth order. This study implies that government programs to support multinational families should be customized considering these factors. 1990년대 이후 한국에서 다문화가족이 증가하면서 다문화가족의 출생아 또한 급증했다. 이 연구의 목적은 다문화가족과 한국인가족의 출산 결과를 비교해서, 다문화가족의 특성이 출산 결과에 어떤영향을 미치는지 살펴보는 것이다. 이 연구에는 부모의 귀화 여부 및 출신 국가명이 기록된 2010년부터 2012년까지의 출생자료가 사용되었다. 단태아 중 첫째 아이 678,290명과 둘째 아이 503,892명을 분석하였다. 다문화가족 부모의출신 국가 정보를 이용하여, 출생 시 체중은 다중회귀분석을 저체중은 로지스틱회귀분석을 출생순위별 연도별로 실시하였다. 출생 시 체중의 경우, 남성 결혼이민자가족의 첫째 아이는 한국인가족보다 42.24그램 더 나갔으며, 여성 결혼이민자가족의 첫째 아이는 17.53그램 적게 나갔다. 저체중의 경우, 남성 결혼이민자가족의 첫째 아이는 저체중 위험성이 낮고(OR 0.83, 95% CI: 0.70-0.97) 여성 결혼이민자가족의 첫째 아이는 한국인가족과 유의한 차이가 없었다. 여성 결혼이민자가족에서 태어난 둘째 아이는 다른가족 유형에 비해서 저체중 위험이 유의하게 적었다(OR 0.76, 95% CI: 0.68-0.85). 여성 결혼이민자가족의 출산결과는 어머니의 출신 국가에 따라 달랐다. 중국 출신의 여성 결혼이민자가족은 출생순위에 관계없이 출생 시 체중이 높고 저체중 위험이 한국인가족보다 낮았다. 필리핀을 제외한 동남아시아 출신 여성 결혼이민자가족의 첫째 아이는 한국인가족과 유의한 차이가 없었고, 둘째 아이는한국인가족보다 출산결과가 우수한 역학역설이 나타났다. 필리핀과 일본 출신의 여성 결혼이민자가족에서 출생한 첫째 아이의 출생 시 체중은 한국인가족에서 출생한 첫째 아이보다 적게 나가고, 저체중위험이 높았으나, 둘째 아이는 한국인가족의 둘째 아이와 유의한 차이가 없었다. 이 연구는 다문화가족 유형에 따라 출산 결과가 다르다는 것을 실증적으로 보여주는 첫 연구다. 한국에서는 역학역설이 여성 결혼이민자의 출신국과 출생순위에 따라 다르게 나타났는데, 이는 일부여성 결혼이민자가족이 임신과 출산을 경험할 때 어려움을 겪고 있다는 것을 의미한다. 이 연구 결과는 다문화가족 부모의 출신 국가와 출생순위에 따른 세분화된 지원정책이 필요하다는 것을 시사한다.