Maternal motives behind elective cesarean sections

Effects of the web-based birth preparation programme and motivational interviews on primigravida women: Randomized-controlled study

AIM

This study aimed to identify the effects of a web-based birth preparation programme based on the Health Belief Model and supported by motivational interviews on fear of childbirth, self-efficacy and the labour process in primigravida women.

METHODS

The study was conducted in a single-blind, randomized controlled design with 73 pregnant women. The Birth Health Belief Scale, the Wijma Delivery Expectation/Experience Questionnaire A-B, the Childbirth Self-efficacy Scale and the Labour Process Assessment forms were used to collect data. Five sessions of motivational interviews were held with the pregnant women in the experimental group, while those in the control group were administered placebo education.

RESULTS

Fear of birth was lower, and the birth self-efficacy total score was higher in the experimental group. None of the groups indicated significant differences in terms of their mode of delivery.

CONCLUSION

Health Belief Model-based web-based birth preparation programme and motivational interviews were found to reduce the fear of birth, increase self-efficacy and positively affect the birth process in primigravida women.

Mother's education and infant survival in Ethiopia

OBJECTIVE

Few studies in Ethiopia have explored the impact of the mothers' education on infant survival. Therefore, this study aimed to identify and analyze the proximate factors in the relationship between maternal education and infant survival in Ethiopia.

METHODS

This study used the nationally representative 2016 Ethiopian Demographic and Health Survey dataset. It analyzed a sample of 3831 newborn children using Cox regression models.

RESULTS

The findings revealed that infants born to educated mothers had lower odds of infant mortality than those born to mothers without formal education. Specifically, infants whose mothers had completed secondary school and had a better antenatal care attendance rate had 49.9% lower odds of infant mortality than those born to mothers with no formal education and a poor antenatal care attendance rate. Furthermore, infants whose mothers had at least some postsecondary education and who used delivery by health-care professionals, clean drinking water, and improved toilet facilities had 65.3%, 56.3%, and 68.6% lower odds of infant mortality, respectively, than those born to mothers with no formal education and who did not use those facilities.

CONCLUSIONS

This study concluded that the mothers' educational disparity is intimately tied to infant mortality, and that access to formal education, mainly for women, increases infant survival in Ethiopia. Future research should focus on mothers without formal education who do not have access to antenatal care visits for safe pregnancy, delivery by health-care professionals, clean drinking water, and improved toilet facilities in Ethiopia and elsewhere in Sub-Saharan Africa.

Does Obesity Influence Women's Decision Making about the Mode of Delivery?

Introduction: The ratio of cesarean deliveries (CDs) has been increasing worldwide, with a growing problem of cesarean delivery on maternal request (CDMR) and an alarmingly increasing rate of CD in the private sector. There are numerous factors influencing women’s preferences for the mode of delivery and their opinion about shared decision making (SDM). Material and method: The study was designed as an online survey, filled in by 1040 women. The questionnaire included questions about women’s preferences for the mode of delivery, their opinions about CDMR and the process of decision making regarding the mode of delivery. Results: There were no statistically significant differences found between women with a BMI ≤ 25 kg/m2 and >25 kg/m2, nor with a BMI ≤ 30 kg/m2 and >30 kg/m2, on the subject of the preferred method of delivery, and the opinion regarding SDM and CDMR without medical indications. More than 85% of women in all groups, who preferred CD as the mode of delivery, wanted to have CDMR. Conclusion: We have not found obesity and overweight to be a factor influencing women’s preferred mode of delivery, their opinion about SDM and their preference for CDMR without medical indications. However, the sample size of women with morbid obesity with a BMI ≥ 35 kg/m2 was too small for the results to be considered significant in this group, and it will therefore be subject to further studies.

Predictors of planned caesarean section births in a sample of Romanian women

OBJECTIVES

Romania has one of the highest incidences of births by caesarean section (CS) in the European Union (EU). The present study aims to identify the possible predictors of planned caesarean section (PCS) in a convenience sample of Romanian women.

METHODS

This is a secondary analysis of the cross-sectional data collected as part of the EU-level Babies Born Better online survey from 1908 Romanian women who gave birth between 2013 and 2018. Univariable and multivariable logistic regression models were performed to identify the potential individual and health system-level predictors of PCS.

RESULTS

PCS was reported by 36.7% (n = 657) of the women. In the multivariable regression model, older maternal age (aOR: 1.10, 95% CI: 1.07-1.14) and presence of medical or non-medical problems during pregnancy (adjusted odds ratio [aOR]: 1.67, 95% CI: 1.31-2.12) were significantly associated with PCS. Conversely, birth at a very high level of competence hospital was inversely associated with PCS (aOR: 0.48, 95% CI: 0.30-0.76).

CONCLUSIONS

Our findings indicate that PCS may be associated with both individual and health system-level variables. Our results are significant because they could be used to inform decision-making processes aimed at lowering PCS incidence.

When Fear Surrounding Childbirth Leads Women to Request a Planned Cesarean Birth

Fear surrounding childbirth requires a more in-depth understanding from women’s perspectives, especially those who request a planned cesarean due to that fear. Therefore, we explored primiparous and multiparous women’s lived experiences of fear surrounding childbirth in relation to their decision to request a planned cesarean birth. We used Colaizzi’s (1978) phenomenological method to interview 16 women from 4 provinces and to analyze the data. Women expressed numerous fears and most experienced more than one fear. Most feared their baby/babies being injured or dying during childbirth or developing complications themselves. Others feared experiencing a traumatic birth. Women described numerous emotional and physical manifestations of fear, and all believed that a planned cesarean birth would provide more control over the birth process. For some, the birth of their healthy baby/babies began a healing process, whereas others noted that their fear subsided or resolved upon confirmation that they would have a planned cesarean.

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.

The effect of practicing yoga during pregnancy on labor stages length, anxiety and pain: a randomized controlled trial

BACKGROUND

Anxiety and fear of labor pain has led to elevated cesarean section rate in some countries. This study was conducted to investigate the effect of yoga in pregnancy on anxiety, labor pain and length of labor stages.

METHODS

This clinical trial study was performed on 84 nulliparous women who were at least 18 years old and were randomly divided into two groups of yoga and control groups. Pregnancy Yoga Program consisting of 6 60-min training sessions was started every 2 weeks from week 26 of pregnancy and continued until 37 weeks of gestation. Anxiety severity at maternal admission to labor was measured by the Spielbergers State-Trait Anxiety Inventory, and labor pain was measured by Visual Analogue Scale (VAS) at dilatation (4-5 cm) and 2 h after the first measurement. Data were analyzed using Chi-Square and t-test.

RESULTS

Intervention group reported less pain at dilatation (4-5 cm) (p=0.001) and 2 h after the first measurement (p=0.001) than the control group. Stat anxiety was also lower in intervention group than the control group (p=0.003) at the entrance to labor room. Subjects in the control group required more induction compared to intervention group (p=0.003). Women in intervention group experienced shorter duration of the first phase of the labor than the control group (p=0.002). Also, the total duration of two stages of labor was shorter in intervention group than the control group (p=0.003).

CONCLUSIONS

Practicing yoga during pregnancy may reduce women's anxiety during labor; shorten labor stages, and lower labor pain.