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Shtainmetz N, Tesler R, Sharon C, Korn L. Optimizing caesarean section use and feasibility of implementing the Robson classification system: Perspectives of healthcare providers and policymakers. SAGE Open Med 2024; 12:20503121241237447. [PMID: 38533202 PMCID: PMC10964469 DOI: 10.1177/20503121241237447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction and Objective In recent decades, caesarean section rates have increased dramatically worldwide and the reasons for this trend are not fully understood. This continuing trend has raised public health concerns regarding higher maternal and perinatal risks, high costs, healthcare efficiency, and inequality of services. The current study aimed to explore the perspectives and insights of healthcare providers and policymakers in the Israeli health system regarding the factors that drive caesarean section rates and the readiness and feasibility of implementing the Robson Ten Group Classification System for the first time. Methods Semi-structured interviews were conducted (n = 12) with purposefully selected healthcare providers and policymakers in Israel. Data was analysed inductively using a thematic analysis approach. Results The findings reflected the "changing landscape" in childbirth practices and attitudes that contributes to the rising caesarean section rate, including childbirth at older ages, birth planning, and a transition toward a more collaborative decision-making approach to childbirth. The participants emphasized the lack of a standardized classification or consistent data monitoring of caesarean section in the Israeli health system. Additionally, enablers to implement the Robson Ten Group Classification System in Israel (ease of use, data collection and recording, and the allocation of resources and personnel), as well as barriers (concerns over workload, limited resources, budget implications, and technological complexity), were found. Conclusions This study revealed the multifaceted factors shaping caesarean section rates within Israel and underscored the perceived need for evidence-based monitoring and informed decision-making in healthcare practices. Our findings support the conclusion that empirical evidence and clear data are crucial for effective caesarean section use and are currently lacking in Israeli hospitals. Thus, it is recommended to adopt a globally standardized, accepted, and effective tool-the Robson Ten Group Classification System-to accommodate the "changing landscape" in alignment with evolving medical and societal dynamics, which consequently will assist in optimizing caesarean section use.
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Affiliation(s)
- Noa Shtainmetz
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Riki Tesler
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Cochava Sharon
- The Academic College of Law and Science, Hod Hasharon, Israel
| | - Liat Korn
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
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Weber AM, Guo Y, Zhang E, Gruber S, Medina A, Zhou H, Darmstadt GL. Associations of in-hospital postpartum feeding experiences with exclusive breastfeeding practices among infants in rural Sichuan, China. Int Breastfeed J 2023; 18:34. [PMID: 37443078 DOI: 10.1186/s13006-023-00567-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In rural China, exclusive breastfeeding (EBF) prevalence is low and hospitals often fail to attain baby-friendly feeding objectives, such as ≥ 75% of newborns exclusively breastfed from birth to discharge. Empirical evidence for the impact of increased hospital compliance with recommended feeding guidelines on continued EBF in rural China is lacking. We sought to measure and model the association of newborns' in-hospital feeding experiences with EBF practice in infancy to inform policies for EBF promotion. METHODS Data were cross-sectional from 785 caregivers of infants < 6 months of age, collected from November to December 2019 in four underdeveloped counties/districts in Sichuan Province. In-hospital feeding practices were determined, and prevalence of current infant feeding practices was calculated from 24-h recall and categorized according to WHO/UNICEF Infant and Young Child Feeding categories as EBF, breastfed with non-milk liquids, mixed feeding, breastfed with solids, and not breastfed. Relative risk ratios were estimated using adjusted multinomial logistic regression to examine risk factors for non-EBF practices compared to EBF, including in-hospital feeding experiences. The regression model was used to investigate change in EBF prevalence under alternative in-hospital experiences. RESULTS Only 38.1% of under-six-month-old infants were being exclusively breastfed when data were collected; 61.8% and 77.6% had been fed water and infant formula, respectively, in the hospital. Infants who were fed water or formula before discharge were estimated as 2-3 times as likely to be non-EBF than EBF up to age six months. According to our model, EBF prevalence would have increased to 53.7% (95% confidence interval (CI) 46.1, 61.2) had ≥ 75% of infants been exclusively breastfed and water-based feeds eliminated in-hospital. CONCLUSIONS Given the importance of infants' first feeding experiences in the establishment and continuation of EBF, it is imperative that rural Chinese hospitals actively seek to limit infant formula feeds to medically indicated situations and eliminate water-based feeds.
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Affiliation(s)
- Ann M Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, USA.
| | - Yian Guo
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Evelyn Zhang
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | | | - Alexis Medina
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Huan Zhou
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, Section 3, South Renmin Road, Chengdu City, Sichuan Province, 610041, People's Republic of China.
| | - Gary L Darmstadt
- Department Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Ulfa Y, Maruyama N, Igarashi Y, Horiuchi S. Women's experiences of breastfeeding after a cesarean section: A meta-synthesis. Jpn J Nurs Sci 2023:e12534. [PMID: 37186368 DOI: 10.1111/jjns.12534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 05/17/2023]
Abstract
AIM The World Health Organization and United Nations Children's Fund recommend the early initiation of breastfeeding within the first hour postpartum for successful exclusive breastfeeding. However, cesarean section is a risk factor for unsuccessful early initiation of breastfeeding. Herein, we aim to explore women's experiences of breastfeeding after a cesarean section. METHODS We used the Joanna Briggs Institute framework in this meta-synthesis. We searched articles published from 1990 to 2022 on PubMed, CINAHL, Cochrane library, PsycInfo, and EMBASE to identify qualitative studies on women's experiences of breastfeeding after a cesarean section. We used the Critical Appraisal Skills Programme checklist for qualitative studies to assess the quality of the included studies. RESULTS Seven qualitative studies from five countries met the inclusion criteria, representing the views of 194 women who underwent cesarean sections. Six new categories were integrated into the women's experiences of breastfeeding after a cesarean section as follows: (i) Perceived values of breastfeeding, (ii) Emotional vulnerability in breastfeeding, (iii) Physical difficulties in breastfeeding, (iv) Inconvenient conditions in breastfeeding, (v) Inadequate resources for breastfeeding, and (vi) Support systems to enable breastfeeding. CONCLUSIONS We provide evidence showing that knowledge of the specific breastfeeding mechanism and provision of the most appropriate postsurgical care by healthcare providers just after a cesarean section can reduce the barriers to post-cesarean breastfeeding. Moreover, effective hospital policies and family support can result in the initiation of positive breastfeeding outcomes. Future studies that consider the cultural aspects of breastfeeding practice may generate additional insights into providing optimal postpartum care.
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Affiliation(s)
- Yunefit Ulfa
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- National Research and Innovation Agency, Central Jakarta, Indonesia
| | - Naoko Maruyama
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yumiko Igarashi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Sarı E, Güngör Satılmış İ. The effect of acupressure on lactation in non-breastfeeding mothers after preterm cesarean delivery. Health Care Women Int 2023; 44:361-373. [PMID: 36219142 DOI: 10.1080/07399332.2022.2132253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This randomized controlled experimental study was conducted to determine the effect of acupressure on lactation in non-breastfeeding mothers. The sample of the study was comprised of 64 mothers, who were randomly selected among the primipara mothers of premature newborns delivered through cesarean section in a hospital. Before the implementation, the Depression-Anxiety-Stress Scale and the Richards? Campbell Sleep Questionnaire were applied. In post-operative three days, 15-minute acupressure was implemented in the morning/evening, for acupressure-group mothers and pump milking was applied; control group mothers were only milked in the mornings and evenings. Mothers' perceptions of lactation symptoms were evaluated with Visual Analog Scale. Acupressure satisfaction was evaluated with a Visual Analog Patient Satisfaction Scale, and pumped milk quantities were recorded. Indications of lactation such as tension, heat, and pain in breasts were found to be higher in acupressure group.The amounts of milk in acupressure group were significantly higher compared to control group.
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Affiliation(s)
- Esra Sarı
- Depertmant of Midwifery, Faculty of Health Science, Van Yüzüncü Yıl University, Van, Turkey
| | - İlkay Güngör Satılmış
- Department of Women Health and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Lee HK, Joo E, Kim S, Cho I, Lee KN, Kim HJ, Kim B, Park JY. A Comparison of Ultrasound Imaging Texture Analyses During the Early Postpartum With the Mode of Delivery. J Hum Lact 2023; 39:59-68. [PMID: 35272509 DOI: 10.1177/08903344221081866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Breastfeeding is beneficial to infants. However, cesarean section is reported to be a risk factor for unsuccessful breastfeeding. RESEARCH AIMS (1) To extract discriminating data from texture analysis of breast ultrasound images in the immediate postpartum period; and (2) to compare the analysis results according to delivery mode. METHODS A cross-sectional, prospective non-experimental design with a questionnaire and observational components was used. Participants (N = 30) were women who delivered neonates at a center from September 2020 to December 2020. The participants underwent ultrasound examination of bilateral breasts 7-14 days after delivery. Ultrasound images were collected for texture analysis. A questionnaire about breastfeeding patterns was given to the participants on the day of the ultrasound examination. RESULTS No significant differences were found in texture analysis between the breasts of participants who had undergone Cesarean section and vaginal deliveries. The mean volume of total human milk produced in 1 day was significantly greater in the vaginal delivery group than in the cesarean section group (M = 350.87 ml, SD = 183.83 vs. M = 186.20 ml, SD = 184.02; p = .017). The pain score due to breast engorgement measured subjectively by participants was significantly lower in the vaginal delivery group than in the cesarean section group (M = 2.8, SD = 0.86 vs. M = 3.4, SD = 0.63; p = .047). CONCLUSION Texture analysis of breast ultrasound images did not demonstrate difference between the cesarean section and vaginal delivery groups in the immediate postpartum period; nevertheless, cesarean section was independently associated with less successful breastfeeding.
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Affiliation(s)
- Hyun Kyoung Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunwook Joo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seongbeen Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Iseop Cho
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Gyeonggi-do, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Zavala-Soto JO, Hernandez-Rivero L, Tapia-Fonllem C. Pro-lactation cesarean section: Immediate skin-to-skin contact and its influence on prolonged breastfeeding. FRONTIERS IN SOCIOLOGY 2022; 7:908811. [PMID: 36237277 PMCID: PMC9551215 DOI: 10.3389/fsoc.2022.908811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
Mexico has a high rate of cesarean sections and one of the lowest prevalences of exclusive breastfeeding in all of Latin America. There are known factors that can compensate for the disadvantages and drawbacks of cesarean delivery over breastfeeding. In terms of studying the variations of breastfeeding experiences, this work specifically concentrates on exploring different changes in the technique of cesarean section, related to immediate Skin-to-Skin Contact for women with high and low risk pregnancies, which may in turn influence Maternal Satisfaction and the choice of Prolonged Breastfeeding. A convenience sample of (n = 150) women who underwent cesarean section in a private hospital in Mexico between the years 2015-2020 participated in this study, the participants answered a structured interview protocol designed for the specific purposes of this study. The analysis was guided grounded theory. The majority of these participants (n = 121, 82.3%) were in labor before entering a cesarean section. The most common indications for cesarean section were those of active-phase arrest and regarding maternal complications, previous cesarean sections (n = 59) and hypertensive complications (n = 15) were the most frequent. For fetal complications, non-cephalic fetal positions (n = 12) were reported as the most common. Despite the different conditions of their cesarean sections, almost all the women experienced Skin-to-Skin Contact during the cesarean section. Almost all of them managed to breastfeed for more than 6 months and many of them breastfed their babies for up to 2 years. The main factors associated to prolonged breastfeeding and satisfaction were higher education degrees, immediate skin-to-skin contact during surgery and counseling on breastfeeding after the baby was born. Our findings highlight the importance of considering adjustments during and after a cesarean section, making it more focused on women and toward better probabilities of achieving prolonged breastfeeding in Mexican women. This being a first step for future studies of direct interventions in the breastfeeding process, such as the management of skin-to-skin contact and professional support after birth for guided breastfeeding.
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Affiliation(s)
- José Octavio Zavala-Soto
- Programs of Master and Doctorate in Social Sciences, University of Sonora, Hermosillo, Mexico
- Obstetrics Department of the San José Hospital of Hermosillo, Hermosillo, Sonora, Mexico
| | | | - César Tapia-Fonllem
- Programs of Master and Doctorate in Social Sciences, University of Sonora, Hermosillo, Mexico
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Breastfeeding Experience among Mothers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084535. [PMID: 35457403 PMCID: PMC9031857 DOI: 10.3390/ijerph19084535] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 12/22/2022]
Abstract
When health experts declared COVID-19 to be a global pandemic, they recognized the virus as a major environmental factor that could affect the practice of breastfeeding. A few studies focused on the effect of COVID-19 on mothers who gave birth during the pandemic. The purpose of this study is to explore the experience of Saudi Arabian breastfeeding mothers during the COVID-19 pandemic. This study used a descriptive phenomenology qualitative design and a convenience sample of 18 mothers who breastfed their children beginning in March 2020. Data were collected through semi-structured, open-ended phone interviews and analyzed using thematic analysis. The mothers were between 27 and 36 years old, and most of them had previous breastfeeding experience. Four main themes emerged regarding breastfeeding experiences during the COVID-19 pandemic: breastfeeding experience (positive and negative), support, facilitators, and challenges. Most mothers felt their experience with breastfeeding during the pandemic encouraged them to continue. It is important to reassure and educate breastfeeding mothers about the nature of COVID-19 and its mode of transmission. The findings from this study lay the foundation for future research to support the practice of breastfeeding and overcome the challenges that arose during the pandemic.
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Maponya N, Janse van Rensburg Z, Du Plessis-Faurie A. Understanding South African mothers' challenges to adhere to exclusive breastfeeding at the workplace: A qualitative study. Int J Nurs Sci 2021; 8:339-346. [PMID: 34307784 PMCID: PMC8283702 DOI: 10.1016/j.ijnss.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study aimed to gain an in-depth understanding of the experience of South African working mothers in the adherence to exclusive breastfeeding when returning from maternity leave. METHODS The data of the study was collected using face-to-face semi-structured interviews. Eight breastfeeding mothers were purposefully selected from two primary health care clinics in Rustenburg, North West Province, South Africa. The data were coded, categorized, and clustered into themes using Giorgi's phenomenological analysis. Ethical considerations and measures of trustworthiness were adhered to throughout the study. RESULTS The findings revealed three themes: a desire for working mothers to continue the adherence to exclusive breastfeeding, workplace support for breastfeeding mothers in the adherence to exclusive breastfeeding, and an unsuitable workplace environment for the adherence to exclusive breastfeeding. Six sub-themes were identified: the need to return to the workplace soon after baby's birth, psychological responses in the adherence to exclusive breastfeeding, lack of support from employers and co-workers in the adherence to exclusive breastfeeding, lack of or partial implementation of breastfeeding policies in the workplace, the workplace not being supportive for mothers' having to express and the workplace not being supportive for mothers' having to store breastmilk. CONCLUSION Based on the findings, South African government should revisit employment policies to support working mothers who need to continue with exclusive breastfeeding after returning from maternity leave.
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Affiliation(s)
- Nompumelelo Maponya
- Department of Nursing, University of Johannesburg, Johannesburg, South Africa
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Effects of a theory of planned behavior-based intervention on breastfeeding behaviors after cesarean section: A randomized controlled trial. Int J Nurs Sci 2021; 8:152-160. [PMID: 33997128 PMCID: PMC8105542 DOI: 10.1016/j.ijnss.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/21/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To examine the efficacy of an intervention based on the theory of planned behavior (TPB) in improving breastfeeding behavior among women with cesarean sections (C-sections). Methods This research was a randomized controlled trial. Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020. One hundred thirty-two women were divided randomly into the intervention (n = 66) and control group (n = 66) by systematic random sampling. In the intervention group, an intervention project was implemented after the C-section to establish positive breastfeeding attitudes, cultivate supportive subjective norms, enhance perceived behavioral control, and strengthen breastfeeding intention to change behaviors. Those in the control group received routine pre-and post-delivery care. Exclusive breastfeeding rate and breast problem were collected at 5 days, 2 weeks, and 1 month after C-section. The modified Breastfeeding Attrition Prediction Tool (BAPT) on the first day in the hospital, two weeks, and one month after C-section and Numerical Rating Scale (NRS) 24 h postoperatively were used to compare the intervention effect between the two groups. Results After the intervention, the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days (86.4% vs. 60.6%), two weeks (77.3% vs. 57.6%), and one month (74.2% vs. 50.0%) after the C-section. Besides, the intervention group was less likely to have sore nipples at five days (6.1% vs. 18.2% in the control group, P < 0.05) and two weeks (9.1% vs. 12.1% in the control group, P < 0.05). After two weeks of intervention, attitude scores (90.64 ± 8.31 vs. 87.20 ± 8.15, P < 0.05), subjective norm scores (88.07 ± 24.65 vs. 79.42 ± 19.47, P < 0.05)and behavior control scores in the intervention group were significantly higher than those in the control group. After one month of intervention, attitude scores (90.34 ± 10.35 vs. 84.22 ± 10.51, P < 0.05) and behavior control scores (43.13 ± 5.02 vs. 39.15 ± 4.69, P < 0.05)in the intervention group were significantly higher than those in the control group, which resulted in the higher breastfeeding intention in the intervention group. Conclusion This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections.
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