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Gutiérrez NO, Cobo J, Calsina SP, Esteve YC, Oliva JC, Tricas JG. The Effects of Accompaniment on Maternal Anxiety During Elective Cesarean Delivery: A Quasi-experimental Study. Matern Child Health J 2023:10.1007/s10995-023-03677-6. [PMID: 37227622 DOI: 10.1007/s10995-023-03677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND In Spain, allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice. Going through this experience alone, not only deprives women from the opportunity of sharing the birth with their partners, but also, forces them to face, on their own, one of the most stressful experiences during pregnancy. OBJECTIVE To analyze whether significant differences exist in levels of anxiety of women who receive an elective cesarean delivery, according to whether they are allowed to be accompanied by their partners. DESIGN Quasi-experimental, longitudinal, prospective study, comparing a group of 31 women receiving elective cesarean deliveries, without the presence of their partners, with a group of 33 women with elective cesarean deliveries who were accompanied by their partners. Anxiety levels were assessed using the STAI-State/Trait scale. Participants were given a questionnaire to assess their level of satisfaction with the care received. RESULTS Anxiety measured via total scores on the STAI-S scale was significantly lower (p < 0.004) among the women who were accompanied by their partners during the elective cesarean delivery (median = 25), compared to the group who were not (median = 50). The differences were also significant (p < 0.003) considering the impact of accompaniment upon the group with high scores in the STAI-S (> 31) and continue to be significant when using the cut-off point of very high scores on the STAI-S (> 45). CONCLUSIONS Presence of partners during elective cesareans is a key factor for decreasing the anxiety caused by the surgery and for improving the overall experience of cesarean deliveries.
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Affiliation(s)
- Noemí Obregón Gutiérrez
- Obstetric and Gynecology Department, Parc Taulí University Hospital, Consorci Corporació Sanitària Parc Taulí, Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
- Departament of Public Health, Mental Health and Child and Maternal Nursing, University of Barcelona, Barcelona, Spain
| | - Jesus Cobo
- Mental Health Department, Consorci Corporació Sanitària Parc Taulí - I3PT - CIBERSAM, Parc Taulí, 1, 08208, Sabadell, Spain.
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Belaterra, Spain.
| | - Salut Puig Calsina
- Obstetric and Gynecology Department, Parc Taulí University Hospital, Consorci Corporació Sanitària Parc Taulí, Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
| | - Yolanda Canet Esteve
- Obstetric and Gynecology Department, Parc Taulí University Hospital, Consorci Corporació Sanitària Parc Taulí, Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
| | | | - Josefina Goberna Tricas
- Departament of Public Health, Mental Health and Child and Maternal Nursing, University of Barcelona, Barcelona, Spain
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Johansson M, Alvan J, Pettersson A, Hildingsson I. Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis. BMC Pregnancy Childbirth 2023; 23:210. [PMID: 36978038 PMCID: PMC10044365 DOI: 10.1186/s12884-023-05471-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women's and clinicians' attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS. METHODS The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual. RESULTS The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000-2022), involving 242 women and 141 clinicians. From the women's perspectives, two themes arose: women regarded CS as the safest mode of birth; and women's rights to receive support and acceptance for a CS request. From the clinicians' perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women's rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options. CONCLUSION Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman's birth preferences, they also felt the need to resist a woman's request for CS and encourage her to give birth vaginally due to the associated increases in health risks.
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Affiliation(s)
- Margareta Johansson
- Department of Women’s and Children’s Health, Uppsala University, Akademiska University Hospital, SE- 751 85 Uppsala, Sweden
| | - Jonatan Alvan
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Ingegerd Hildingsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Bottemanne H, Charron M, Joly L. [Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:542-552. [PMID: 35288367 DOI: 10.1016/j.gofs.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.
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Affiliation(s)
- Hugo Bottemanne
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neurosciences, Sorbonne University/Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France.
| | - Morgane Charron
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neurosciences, Sorbonne University/Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lucie Joly
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neurosciences, Sorbonne University/Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Larsson B, Elfving M, Vesterlund E, Karlström A, Hildingsson I. Fulfilment of expectations on birth and the postpartum period - A Swedish cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100748. [PMID: 35728347 DOI: 10.1016/j.srhc.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The fulfilment of birth expectations is important to women and strongly related to birth satisfaction. OBJECTIVE The aim of this study was to investigate women's expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled. METHODS A longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences. RESULTS The majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women's expectations and experiences. Most likely to be fulfilled were women's expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled. CONCLUSIONS Pregnant women's expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.
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Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Elin Vesterlund
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
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Thirukumar P, Henry A, Coates D. Women's Experiences and Involvement in Decision-Making in Relation to Planned Cesarean Birth: An Interview Study. J Perinat Educ 2021; 30:213-222. [PMID: 34908820 PMCID: PMC8663766 DOI: 10.1891/j-pe-d-20-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Actively engaging women in decision-making about their own care is critical to providing woman-centered maternity care. The aim was to understand women's mode-of-birth preferences and shared decision-making experiences during planned cesarean birth (CB). Semi-structured telephone interviews were conducted with 33 women who had planned CB at eight Australian metropolitan hospitals. Inductive thematic analysis was conducted using NVivo-12. Many women preferred a vaginal birth but were willing to have a CB if the clinician recommended. Most women looked to their clinicians for information and guidance. Although many women reported receiving enough information to make informed decisions, others felt pressured into having or not having a CB, or expected to make decisions themselves. Women wished for longer consultation times, more information, and care continuity.
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Coates D, Donnolley N, Thirukumar P, Lainchbury A, Spear V, Henry A. Women's experiences of decision-making and beliefs in relation to planned caesarean section: A survey study. Aust N Z J Obstet Gynaecol 2020; 61:106-115. [PMID: 32964450 DOI: 10.1111/ajo.13255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The caesarean section (CS) rate is over 25% in many high-income countries, with a substantial minority of CSs occurring in women with low-risk pregnancies. CS decision-making is influenced by clinician and patient beliefs and preferences, and clinical guidelines increasingly stipulate the importance of shared decision-making (SDM). To what extent SDM occurs in practice is unclear. AIMS To identify women's birth preferences and SDM experience regarding planned CS. MATERIAL AND METHODS Survey of women at eight Sydney hospitals booked for planned CS. Demographic data, initial mode of birth preferences, reason for CS, and experiences of SDM were elicited using questions with multiple choice lists, Likert scales, and open-ended responses. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Responses of women who perceived their CS as 'requested' vs 'recommended' were compared. RESULTS Of 151 respondents, repeat CS (48%) and breech presentation (14%) were the most common indications. Only 32% stated that at the beginning of pregnancy they had a definite preference for spontaneous labour and birth. Key reasons for wanting planned CS were to avoid another emergency CS, prior positive CS experience, and logistical planning. Although 15% of women felt pressured (or were unsure) about their CS decision, the majority reported positive experiences, with over 90% indicating they were informed about CS benefits and risks, had adequate information, and understood information provided. CONCLUSIONS The majority (85%) of women appeared satisfied with the decision-making process, regardless of whether they perceived their CS as requested or recommended.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Maridulu Budyari Gumal, The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, New South Wales, Australia
| | - Natasha Donnolley
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Purshaiyna Thirukumar
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, New South Wales, Australia
| | - Anne Lainchbury
- Royal Hospital for Women, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Virginia Spear
- Royal Hospital for Women, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, New South Wales, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, UNSW Medicine, Sydney, New South Wales, Australia
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Mirabal-Beltran R, Strobino DM. Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution. Womens Health Issues 2020; 30:7-15. [DOI: 10.1016/j.whi.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022]
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Sun N, Yin X, Qiu L, Yang Q, Shi X, Chang J, Feng L, Gong Y. Factors associated with Chinese pregnant women’s preference for a cesarean section based on the theory of planned behaviour. Trop Med Int Health 2019; 25:209-215. [DOI: 10.1111/tmi.13323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Na Sun
- Department of Social Medicine and Health Management School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Lei Qiu
- Department of Social Medicine and Health Management School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Qin Yang
- Department of Social Medicine and Health Management School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Xinwei Shi
- Department of Obstetrics and Gynecology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Jun Chang
- Department of Obstetrics and Gynecology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Ling Feng
- Department of Obstetrics and Gynecology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yanhong Gong
- Department of Social Medicine and Health Management School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan China
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Fobelets M, Beeckman K, Buyl R, Healy P, Grylka-Baeschlin S, Nicoletti J, Canepa M, Devane D, Gross MM, Morano S, Daly D, Begley C, Putman K. Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries. Midwifery 2019; 79:102536. [PMID: 31561129 DOI: 10.1016/j.midw.2019.102536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Women who have had a caesarean section may have a preference for birth mode during their subsequent pregnancy, either 'vaginal birth after caesarean' (VBAC) or 'elective repeat caesarean section' (ERCS). A mismatch between the preferred and actual birth mode may result in an impaired postnatal Health Related Quality of Life (HRQoL). This study examined the associations between antenatal birth mode preferences, the actual birth mode and postnatal HRQoL in women with one previous caesarean section in three European countries. DESIGN Prospective longitudinal survey, as a part of a cluster randomised trial (OptiBIRTH) SETTING: Fifteen maternity units in three European countries: Germany (5), Ireland (5) and Italy (5). PARTICIPANTS Women (≥ aged 18 years) living in Germany, Ireland and Italy with one previous caesarean section. The sample consisted of 862 women with complete antenatal and postpartum data. MEASUREMENTS Women's preference for birth mode after one previous caesarean section was assessed at inclusion to the trial, and HRQoL was assessed antenatally and at three months postpartum using the Short-Form Six-Dimension health survey. Based on women's preferences and actual birth mode six groups were determined: "match VBAC-VBAC" (preference for vaginal birth, actual mode of birth vaginal birth), "match ERCS-ERCS" (preference for caesarean section, actual mode of birth elective repeat caesarean section), "match ERCS-EMCS" (preference for caesarean section, actual mode of birth emergency repeat caesarean section), "mismatch VBAC-ERCS" (preference for vaginal birth, actual mode of birth elective repeat caesarean section), "mismatch VBAC-EMCS" (preference for vaginal birth, actual mode of birth emergency repeat caesarean section) and "no preference". Associations between the preferred and actual birth mode were examined using univariate and multivariate analyses. FINDINGS Women with preference for vaginal birth but who gave birth by elective repeat caesarean section (mismatch VBAC-ERCS) had a lower postnatal HRQoL compared to women with a preference for vaginal birth who actually had a birth vaginally (match VBAC-VBAC, p = 0.02). Poor antenatal HRQoL scores (p < 0.01) and maternal readmission postpartum (p = 0.03) are cofounding factors for poorer postnatal HRQoL scores. KEY CONCLUSIONS The results show that women with a preference for a vaginal birth who gave birth by an elective repeat caesarean section had a significantly lower HRQoL at three months postnatal. The long-term consequences and psychological health of women who do not achieve a vaginal birth after caesarean require further consideration and research. IMPLICATIONS FOR PRACTICE Attention should be given to the long-term impact of a mismatch in preferred and actual mode on the psychological health of women.
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Affiliation(s)
- Maaike Fobelets
- Department of Public Health, I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium; Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium.
| | - Katrien Beeckman
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Nursing and Midwifery, Nursing and Midwifery research group, Universitair Ziekenhuis Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ronald Buyl
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Susanne Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jane Nicoletti
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Matilde Canepa
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sandra Morano
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Koen Putman
- Department of Public Health, I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium
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Lindstad Løvåsmoen EM, Nyland Bjørgo M, Lukasse M, Schei B, Henriksen L. Women's preference for caesarean section and the actual mode of delivery - Comparing five sites in Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:206-212. [PMID: 29804768 DOI: 10.1016/j.srhc.2018.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/06/2018] [Accepted: 04/16/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The caesarean (CS) section rate varies among hospitals in Norway, and little is known about whether this is influenced by women's preferences. The aim of this study was to investigate the differences in women's preferred mode of delivery during pregnancy between five hospitals in Norway, and to relate this to the actual mode of delivery. STUDY DESIGN A prospective cohort study of 2,177 unselected pregnant women in five hospitals in Norway. Women were recruited at their standard ultrasound examinations, and data was collected through questionnaires and electronic patient charts. The exposure was a CS preference and the main outcome measure was the actual mode of delivery. RESULTS In total, 3.5% of the primiparous women and 9.6% of the multiparous women reported a preference for CS. This was associated with fear of childbirth and education between 10 and 13 years in both groups, symptoms of depression and an age over 35 years old among the primiparous women, and a previous CS and/or negative birth experience among the multiparous. The multiparous women in Drammen and Tromsø were less likely to prefer a CS, and none of the primiparous women in Tromsø preferred a CS. A total of 67.8% of those who preferred a CS gave birth with this mode of delivery. CONCLUSION There were significant differences between the hospitals according to the CS preference. This preference was associated with the previous obstetric history and psychological factors. Therefore, creating good birth experiences and offering women counselling may reduce the CS preference rate.
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Affiliation(s)
- Elin Marie Lindstad Løvåsmoen
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Mari Nyland Bjørgo
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway.
| | - Berit Schei
- Department of Public Health and General Practice at the Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Håkon Jarls gate 11, N-7489 Trondheim, Norway; Department of Gynaecology at the Women's Clinic, St.Olavs Hospital, Trondheim University Hospital, Postbox 3250 Sluppen, N-7006 Trondheim, Norway.
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway; Division of General Gynaecology and Obstetrics, Oslo University Hospital, P.O Box 4950 Nydalen, N-0424 Oslo, Norway.
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Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. HEALTH ECONOMICS REVIEW 2018; 8:7. [PMID: 29525909 PMCID: PMC5845483 DOI: 10.1186/s13561-018-0190-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/02/2018] [Indexed: 05/23/2023]
Abstract
Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.
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Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
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12
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Olieman RM, Siemonsma F, Bartens MA, Garthus-Niegel S, Scheele F, Honig A. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth 2017. [PMID: 28629393 PMCID: PMC5477251 DOI: 10.1186/s12884-017-1371-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Obstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression. METHODS We searched on PubMed, PsychoInfo and Embase. Studies were included with primary data on anxiety and/or depression postpartum in women with childbirth fear who had requested an ECS. After full-text evaluation of 65 papers and quality analysis of four papers, three papers were included. Of one paper additional and yet unpublished data were provided. Studies varied in outcome measures, hence no meta-analysis was performed. RESULTS Women who requested an ECS had higher antepartum depression and anxiety levels but no different postpartum depression levels than women who delivered vaginally. One study of good quality examined the effect of vaginal delivery in women preferring ECS: These women had significantly higher symptom levels of post-traumatic stress disorder (PTSD) and depression than women with normal vaginal delivery. CONCLUSIONS The prospect of an ECS does not lower antepartum anxiety and/or depression levels in women requesting an ECS. If women resolutely persist in wishing an ECS despite adequate counselling and/or psychiatric treatment, the risk of developing depressive and PTSD symptoms in case of vaginal delivery should be taken into account, and an ECS may be considered as a valid alternative.
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Affiliation(s)
- Renske M Olieman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Siemonsma
- Department of Obstetrics and Gynaecology, OLVG Hospital Location West, Amsterdam, The Netherlands
| | - Margaux A Bartens
- Department of Psychiatry, OLVG Hospital Location West, Amsterdam, The Netherlands
| | - Susan Garthus-Niegel
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway. .,Institute and Outpatient Clinics of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG Hospital Location West, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG Hospital Location West, Amsterdam, The Netherlands
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Afshar Y, Wang ET, Mei J, Esakoff TF, Pisarska MD, Gregory KD. Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery. Birth 2017; 44:29-34. [PMID: 27859592 DOI: 10.1111/birt.12263] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan. METHODS This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed. RESULTS In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls. CONCLUSION Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.
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Affiliation(s)
- Yalda Afshar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica T Wang
- Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jenny Mei
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Tania F Esakoff
- Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margareta D Pisarska
- Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Ryding EL, Lukasse M, Kristjansdottir H, Steingrimsdottir T, Schei B. Pregnant women's preference for cesarean section and subsequent mode of birth - a six-country cohort study. J Psychosom Obstet Gynaecol 2016; 37:75-83. [PMID: 27269591 DOI: 10.1080/0167482x.2016.1181055] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women's preferences may vary across countries for psychosocial or obstetric reasons. METHODS A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records. RESULTS A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02-2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only. CONCLUSIONS Women's preference for CS often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women's preferences.
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Affiliation(s)
- Elsa Lena Ryding
- a Department of Women's and Children's Health, Division of Obstetrics and Gynecology , Karolinska Institutet , Stockholm , Sweden
| | - Mirjam Lukasse
- b Department of Health, Nutrition and Management , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Hildur Kristjansdottir
- c Department of Midwifery, Faculty of Nursing , Landspitali University Hospital , Reykjavik , Iceland ;,d Department of Obstetrics and Gynecology , Landspitali University Hospital , Reykjavik , Iceland
| | - Thora Steingrimsdottir
- d Department of Obstetrics and Gynecology , Landspitali University Hospital , Reykjavik , Iceland
| | - Berit Schei
- e Department of Public Health and General Practice , Norwegian University of Science and Technology , Trondheim , Norway ;,f Department of Obstetrics and Gynecology , St. Olav's University Hospital , Trondheim , Norway
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Shi Y, Jiang Y, Zeng Q, Yuan Y, Yin H, Chang C, Pang R. Influencing factors associated with the mode of birth among childbearing women in Hunan Province: a cross-sectional study in China. BMC Pregnancy Childbirth 2016; 16:108. [PMID: 27185247 PMCID: PMC4869289 DOI: 10.1186/s12884-016-0897-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An unnecessary Caesarean section (CS) can cause increased maternal and perinatal morbidity and other adverse short- and long-term outcomes. However, countries worldwide have witnessed an increasing trend toward the use of CS. Our objectives were to explore the influencing factors associated with the mode of birth among childbearing women in Hunan Province and to provide evidence and suggestions for the improvement and further understanding of vaginal birth (VB) in China. METHODS A total of 977 childbearing women (375 pregnant women and 602 mothers of infants) were enrolled in this study using a two-stage cluster sampling method, and a self-administered questionnaire was used to collect data relating to the mode of birth. A t-test and χ (2)-test were used to analyse the differences between groups, and logistic regression analysis was used to explore the factors that influenced the mode of birth. RESULTS The VB ratio was 46.2 %, while the CS ratio was 53.8 % in Hunan Province. Among women whose preference was VB, only 69.4 % gave birth by VB. Among women whose preference was CS, 98.1 % gave birth by CS. The top four reasons for preferring CS were a lack of confidence in VB (37.3 %), an abnormality in the prenatal examination (36.6 %), the notion that the baby would suffer fewer risks (34.8 %) and the fear of pain from VB (32.7 %). Age, prenatal examination, and doctors' suggestion were significantly associated with women's mode of birth preference, while place of household registration, husband's preference, prenatal examination and doctors' suggestion had a significant influence on women who changed their choice from VB to CS. CONCLUSIONS The percentage of CS in Hunan was extremely high. Medical factors, such as abnormalities in prenatal examinations, and non-medical factors, such as a lack of confidence in VB, the fear of pain during VB, the desire to select the time of birth and healthy birth systems, should be seriously considered. Targeted health promotion interventions should be implemented to improve the performance of VB.
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Affiliation(s)
- Yuhui Shi
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China
| | - Ying Jiang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China
| | - Qingqi Zeng
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China
| | - Yanfei Yuan
- Chinese Center for Disease control and Prevention, Beijing, 102206, China
| | - Hui Yin
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China.
| | - Ruyan Pang
- Maternal and Child Health Care of China Association, Beijing, 100080, China
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Rajabi A, Maharlouei N, Rezaianzadeh A, Rajaeefard A, Keshavarzi S, Lankarani KB, Gholami A. Non-medical factors affecting antenatal preferences for delivery route and actual delivery mode of women in southwestern Iran. J Matern Fetal Neonatal Med 2016; 29:3622-8. [PMID: 26753876 DOI: 10.3109/14767058.2016.1140137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Abdolhalim Rajabi
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Maharlouei
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Department of Epidemiology, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolreza Rajaeefard
- Department of Epidemiology, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Keshavarzi
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran, and
| | - Kamran B. Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Gholami
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
- Department of Public Health, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
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17
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Predictors of childbirth fear among pregnant Chinese women: A cross-sectional questionnaire survey. Midwifery 2015; 31:865-70. [DOI: 10.1016/j.midw.2015.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 11/22/2022]
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Teixeira C, Silva S, Severo M, Barros H. Socioeconomic position early in adolescence and mode of delivery later in life: findings from a Portuguese birth cohort. PLoS One 2015; 10:e0119517. [PMID: 25799142 PMCID: PMC4370463 DOI: 10.1371/journal.pone.0119517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/30/2015] [Indexed: 11/23/2022] Open
Abstract
Objective This study assessed the influence of socioeconomic position at 12 years of age (SEP-12) on the variability in cesarean rates later in life. Methods As part of the Portuguese Generation XXI birth cohort we evaluated 7358 women with a singleton pregnancy who delivered at five Portuguese public hospitals serving the region of Porto (April/2005–September/2006). Based on the twelve items that described socioeconomic circumstances at age 12, a latent class analysis was used to classify women’s SEP-12 as high, intermediate and low. Multiple Poisson regression was used to estimate adjusted risk ratio (RR) and respective 95% confidence interval (95% CI). Results The cesarean rates in high, intermediate and low SEP-12 were, respectively, 40.9%, 37.5% and 40.5% (p = 0.100) among primiparous women; 14.2%, 11.6% and 15.5% (p = 0.04) among multiparous women with no previous cesarean and 78.6%, 72.2% and 70.0% (p = 0.08) among women with a previous cesarean. A low to moderate association between SEP-12 and cesarean rates was observed among multiparous women with a previous cesarean, illustrating that women from higher SEP-12 were more likely to have a surgical delivery (RR = 1.12;95%CI:1.01–1.24 comparing high with low SEP-12 and RR = 1.03:95%CI:0.94–1.14 comparing intermediate with low SEP-12) not explained by potential mediating factors. No such association was found either in primiparous or in multiparous women without a previous cesarean. Conclusions The association between SEP-12 and cesarean rates suggests the effect of past socioeconomic context on the decision concerning the mode of delivery, but only among women who experienced a previous cesarean. Accordingly, it appears that early-life socioeconomic circumstances drive cesarean rates but the effect can be modified by lived experiences concerning childbirth.
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Affiliation(s)
- Cristina Teixeira
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
- * E-mail:
| | - Susana Silva
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Milton Severo
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Henrique Barros
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Dweik D, Girasek E, Mészáros G, Töreki A, Keresztúri A, Pál A. Non-medical determinants of cesarean section in a medically dominated maternity system. Acta Obstet Gynecol Scand 2014; 93:1025-33. [DOI: 10.1111/aogs.12466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/17/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Diána Dweik
- Department of Obstetrics and Gynecology; University of Szeged; Szeged Hungary
| | - Edmond Girasek
- Health Services Management Training Centre; Semmelweis University; Budapest Hungary
| | - Gyula Mészáros
- Department of Obstetrics and Gynecology; University of Szeged; Szeged Hungary
| | - Annamária Töreki
- Department of Obstetrics and Gynecology; University of Szeged; Szeged Hungary
| | - Attila Keresztúri
- Department of Obstetrics and Gynecology; University of Szeged; Szeged Hungary
| | - Attila Pál
- Department of Obstetrics and Gynecology; University of Szeged; Szeged Hungary
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Hildingsson I. Swedish couples’ attitudes towards birth, childbirth fear and birth preferences and relation to mode of birth – A longitudinal cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:75-80. [DOI: 10.1016/j.srhc.2014.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/04/2014] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
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Wu E, Kaimal AJ, Houston K, Yee LM, Nakagawa S, Kuppermann M. Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery. Am J Obstet Gynecol 2014; 210:440.e1-6. [PMID: 24246523 DOI: 10.1016/j.ajog.2013.11.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/18/2013] [Accepted: 11/13/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode. STUDY DESIGN We conducted a longitudinal study of mode of delivery preferences among women who were <36 weeks' pregnant. Participants completed a sociodemographic and clinical questionnaire and were asked if they preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode were obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery. RESULTS Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (interquartile range, 0.50-0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (adjusted odds ratio [aOR], 0.08; 95% confidence interval [CI], 0.02-0.39) or who delivered an infant ≥4000 g (aOR, 0.04; 95% CI, 0.01-0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR, 1.54; 95% CI, 1.01-2.34 for every 0.2 increase on the 0-to-1 scale). CONCLUSION Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone.
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Sydsjö G, Möller L, Lilliecreutz C, Bladh M, Andolf E, Josefsson A. Psychiatric illness in women requesting caesarean section. BJOG 2014; 122:351-8. [PMID: 24628766 PMCID: PMC4322480 DOI: 10.1111/1471-0528.12714] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/28/2022]
Abstract
Objective To compare psychiatric in- and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period. Design Prospective, population-based register study. Setting Sweden. Sample Women giving birth for the first time between 2002 and 2004 (n = 64 834). Methods Women giving birth by caesarean section on maternal request (n = 1009) were compared with all other women giving birth (n = 63 825). The exposure of interest was any psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ninth revision, ICD–9, 290–319; tenth revision, ICD–10, F00–F99) in The Swedish national patient register during the 5 years before first delivery. Main outcome measures Psychiatric diagnoses and delivery data. Results The burden of psychiatric illnesses was significantly higher in women giving birth by caesarean section on maternal request (10 versus 3.5%, P < 0.001). The most common diagnoses were ‘Neurotic disorders, stress-related disorders and somatoform disorders’ (5.9%, aOR 3.1, 95% CI 1.1–2.9), and ‘Mood disorders’ (3.4%, aOR 2.4, 95% CI 1.7–3.6). The adjusted odds ratio for caesarean section on maternal request was 2.5 (95% CI 2.0–3.2) for any psychiatric disorder. Women giving birth by caesarean section on maternal request were older, used tobacco more often, had a lower educational level, higher body mass index, were more often married, unemployed, and their parents were more often born outside of Scandinavia (P < 0.05). Conclusions Women giving birth by caesarean section on maternal request more often have a severe psychiatric disease burden. This finding points to the need for psychological support for these women as well as the need to screen and treat psychiatric illness in pregnant women.
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Affiliation(s)
- G Sydsjö
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Gynaecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden
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Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study. Midwifery 2014; 30:242-7. [DOI: 10.1016/j.midw.2013.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/29/2012] [Accepted: 01/04/2013] [Indexed: 11/23/2022]
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Shahoei R, Rezaei M, Ranaei F, Khosravy F, Zaheri F. Kurdish women's preference for mode of birth: a qualitative study. Int J Nurs Pract 2013; 20:302-9. [PMID: 24889003 DOI: 10.1111/ijn.12150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Choosing between a normal delivery and Caesarean section is a matter of critical importance for a pregnant woman. The third trimester is the time for her to think about methods of delivery. The study aims to gain insight into Kurdish pregnant women's birth preference and their perception of factors influencing this choice. In this qualitative study, 22 pregnant Kurdish women were interviewed during the third trimester of their pregnancies. The setting for the study included three public health-care centres of Kurdistan University of Medical Sciences in Sanandaj, a centre of the Kurdistan province at the western part of Iran. Study participants were recruited from maternity units of health-care centres. A purposive sample was used initially and then theoretical sampling was used towards the end of the data analysis. Sample size was not predetermined but was determined when interviewing reached saturation, that is, when no new data emerged about categories. The sample size was restricted to 22, as no new data were generated after the 20th interview. The criteria required for inclusion in the study were being Kurdish women, being in the third trimester of pregnancy, no physical disability, no history of Caesarean section and interest in the study. A qualitative design was chosen, as it is particularly suited to studying complex phenomena or processes that are less understood. This study revealed that of the 22 participants, 18 preferred vaginal delivery and only four preferred Caesarean section. The reasons for choosing the vaginal delivery method were grouped into four categories: safety of baby, fear, previous experience and social support. This finding does not support the rate of Caesarean section among Kurdish women in Sanandaj. It might reflect the effect of other factors such as social, institutional, professional and quality of care on women's choice for delivery method.
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Affiliation(s)
- Roonak Shahoei
- Department of Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran
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First-time mothers' wish for a planned caesarean section: Deeply rooted emotions. Midwifery 2013; 29:447-52. [DOI: 10.1016/j.midw.2012.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 02/23/2012] [Accepted: 02/27/2012] [Indexed: 11/24/2022]
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Maharlouei N, Moalaee M, Ajdari S, Zarei M, Lankarani KB. Caesarean delivery in south-western Iran: trends and determinants in a community-based survey. Med Princ Pract 2013; 22:184-8. [PMID: 22922349 PMCID: PMC5586814 DOI: 10.1159/000341762] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/05/2012] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess trends in caesarean delivery and its associated factors in south-western Iran. SUBJECTS AND METHODS This cross-sectional study was conducted from January 2007 to January 2010 in Fars province, Iran. All deliveries recorded in public and private hospitals were included. The Mann-Whitney U test, χ2 test and multivariate logistic regression models were used for analysis of data. A p value less than 0.05 was considered significant. RESULTS The rate of caesarean section for the whole sample of 139,159 increased from 51.6% in 2007 to 53.3% in 2009, which was statistically and clinically significant. The rate of caesarean delivery was significantly higher in primiparous compared to multiparous mothers. The rate increased steadily with the mother's age. The most prevalent recorded reason for caesarean delivery was maternal request. Logistic regression analysis showed that maternal age, previous abortions, underlying maternal disease, gestational age and number of living children were key contributing factors to the choice of mode of delivery. CONCLUSION This study showed an increasing rate of caesarean delivery which should draw the attention of policymakers to factors associated with this mode of delivery.
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Affiliation(s)
- Najmeh Maharlouei
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoureh Moalaee
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Ajdari
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maasoumeh Zarei
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B. Lankarani
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- *Kamran B. Lankarani, MD, Health Policy Research Center, Building No. 2, 8th Floor, School of Medicine, Zand Avenue, PO Box 71345-1877, Shiraz (Iran), Tel. +98 711 230 9615, E-Mail
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Waldenström U, Gottvall K, Rasmussen S. Caesarean section in nulliparous women of advanced maternal age has been reduced in Sweden and Norway since the 1970s: a register-based study. BJOG 2012; 119:1591-6. [PMID: 23078602 DOI: 10.1111/j.1471-0528.2012.03510.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate rates of caesarean delivery in Sweden and Norway from 1973 to 2008 in relation to advanced and very advanced maternal age. DESIGN Register study. SETTING Sweden and Norway. SAMPLE All nulliparous women aged over 30 years with a singleton pregnancy, with the fetus in a cephalic presentation, and delivering at term between 1973 and 2008 were evaluated. The study population comprised 329 824 women in Sweden and 127 810 women in Norway. METHODS Data from the national Medical Birth Registers were used to describe caesarean section rates in three age groups: 30-34 years (reference group); 35-39 years (advanced age group); and ≥ 40 years (very advanced age group). Logistic regression analyses estimated the risk in each age group over four decades, in each of the two national samples. RESULTS Caesarean delivery decreased from 1973-1979 to 2000-2008 in the two oldest age groups in Sweden (35-39 years, OR = 0.53, 95% CI = 0.50-0.58; ≥ 40 years, OR = 0.36, 95% CI = 0.30-0.43) and Norway (35-39 years, OR = 0.61, 95% CI = 0.54-0.68; ≥ 40 years, OR = 0.45, 95% CI = 0.34-0.58), but increased in women aged 30-34 years. The caesarean delivery rate in the two oldest groups peaked in the second half of the 1970s. Regardless of time point, the caesarean delivery rate was always highest in women aged ≥ 40 years, followed by women aged 35-39 years and lowest in women aged 30-34 years. CONCLUSIONS Caesarean delivery in nulliparous women of advanced and very advanced age peaked by end of the 1970s in Sweden and Norway. The subsequent reduction was contemporaneous with the introduction of electronic fetal monitoring and a more consistent use of the partogram, suggesting that more effective surveillance of labour increased the chance of a vaginal birth in these high-risk women.
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Affiliation(s)
- U Waldenström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Bagheri A, Masoudi Alavi N, Abbaszadeh F. Iranian obstetricians' views about the factors that influence pregnant women's choice of delivery method: a qualitative study. Women Birth 2012; 26:e45-9. [PMID: 23083642 DOI: 10.1016/j.wombi.2012.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 09/16/2012] [Accepted: 09/18/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caesarean section is a commonly performed childbirth procedure. While caesarean section is undeniably a lifesaving procedure for some mothers and babies, it can also be an unnecessary procedure for others. Different factors may be involved in the rate of birth by caesarean section. QUESTION This qualitative study was conducted in Kashan city, Iran, to explore obstetrician's views of what might influence pregnant women's choice of delivery method. METHODS Obstetricians' views and experiences were collected using semi-structured interviews. Interviews were conducted in a clinic or hospital, based on the preference of the 18 physicians who agreed to participate in the study. All interviews were recorded and transcribed. Participants were asked key questions, including: "Why do some women prefer caesarean section?"; "What kind of delivery did you have and why?"; "What kind of delivery would you recommend to pregnant women and why?" Inductive qualitative content analysis was undertaken using the method described by Morreti with 120 initial codes categorized into six categories. FINDINGS The six categories developed from the initial codes were: factors relating to women, obstetricians, delivery conditions, complications, society's beliefs and the health system. CONCLUSION A qualitative study conducted in Iran showed that most of the factors identified by participants facilitated the choice of caesarean section. Vaginal birth was anticipated as a painful and lengthy process, with low cultural acceptance and resulting in less income for obstetricians.
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Affiliation(s)
- Azam Bagheri
- Kashan University of Medical Sciences, Midwifery Department, Iran
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Orfali K. Beyond numbers: the multiple cultural meanings of rising cesarean rates worldwide. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:54-56. [PMID: 22694038 DOI: 10.1080/15265161.2012.680544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Haines H, Rubertsson C, Pallant JF, Hildingsson I. Womens' attitudes and beliefs of childbirth and association with birth preference: a comparison of a Swedish and an Australian sample in mid-pregnancy. Midwifery 2011; 28:e850-6. [PMID: 22098781 DOI: 10.1016/j.midw.2011.09.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 09/11/2011] [Accepted: 09/24/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND the rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event. OBJECTIVES to compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy. PARTICIPANTS women from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123). METHODS questionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care. RESULTS the Australian sample was less likely than the Swedish sample to agree that they would like a birth that: 'is as pain free as possible' OR 0.4 (95% CI: 0.2-0.7), 'will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1-0.8), 'will least affect my future sex life' OR 0.3 (95% CI: 0.2-0.6), 'will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2-0.7) and 'is as natural as possible' OR 0.4 (95% CI: 0.2-0.9). They were also less likely to agree that: 'if a woman wants to have a caesarean she should be able to have one under any circumstances' OR 0.4 (95% CI: 0.2-0.7) and 'giving birth is a natural process that should not be interfered with unless necessary' OR 0.3 (95% CI: 0.1-0.7). Four attitudinal subscales were found: 'Personal Impact of Birth', 'Birth as Natural Event', 'Freedom of Choice' and 'Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of 'Birth as a natural event'. KEY CONCLUSIONS the Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.
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Affiliation(s)
- Helen Haines
- Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala Universitet, 751 85 Uppsala, Sweden.
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Karlström A, Nystedt A, Johansson M, Hildingsson I. Behind the myth – few women prefer caesarean section in the absence of medical or obstetrical factors. Midwifery 2011; 27:620-7. [DOI: 10.1016/j.midw.2010.05.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/28/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
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Hildingsson I, Nilsson C, Karlström A, Lundgren I. A Longitudinal Survey of Childbirth‐Related Fear and Associated Factors. J Obstet Gynecol Neonatal Nurs 2011; 40:532-43. [DOI: 10.1111/j.1552-6909.2011.01274.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample. Midwifery 2011; 27:560-7. [DOI: 10.1016/j.midw.2010.05.004] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 04/27/2010] [Accepted: 05/02/2010] [Indexed: 11/17/2022]
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Wangel AM, Molin J, Ostman M, Jernström H. Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first-time mothers. Acta Obstet Gynecol Scand 2011; 90:238-44. [PMID: 21306317 DOI: 10.1111/j.1600-0412.2010.01056.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association with emergency cesarean section (CS) in nulliparous women. MATERIAL AND METHODS This was a population-based study using an EMR system, set in the catchment area of Malmö University Hospital in Sweden. Of 10,662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006, 6,467 women with complete EMRs were selected. A free-text search of markers for mental ill-health was carried out, and results were analysed by multivariate logistic regression. Eleven markers for mental ill-health were tested with Cohen's kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. RESULTS Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress, adjusted OR 1.66 (95% CI 1.34-2.06); sleep, adjusted OR 1.57 (95% CI 1.14-2.16); and worry, adjusted OR 1.41 (95% CI 1.10-1.79). CONCLUSION Free-text words in medical records that indicated stress, sleep disturbances or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women's reporting of their mental health status could have a predictive bearing on delivery outcomes.
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Affiliation(s)
- Anne-Marie Wangel
- Faculty of Health and Society, Malmö University, Malmö Department of Obstetrics and Gynecology, Sweden.
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Hildingsson I, Rådestad I, Lindgren H. Birth preferences that deviate from the norm in Sweden: planned home birth versus planned cesarean section. Birth 2010; 37:288-95. [PMID: 21083720 DOI: 10.1111/j.1523-536x.2010.00423.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Opting for a home birth or requesting a cesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study was to compare background characteristics of women who chose these very different birth methods and to see how these choices affected factors of care and the birth experience. METHODS This descriptive study employed a secondary data analysis of a sample of women who gave birth from 1997 to 2008, including 671 women who had a planned home birth and 126 women who had a planned cesarean section based on maternal request. Data were collected by means of questionnaires. Logistic regression with crude and adjusted odds ratios (OR) with a 95 percent confidence interval (95% CI) was calculated. RESULTS Women with a planned home birth had a higher level of education (OR: 2.3; 95% CI: 1.5-3.6), were less likely to have a high body mass index (OR: 0.1; 95% CI: 0.01-0.6), and were less likely to be smokers (OR: 0.2; 95% CI: 0.1-0.4) when compared with women who had planned cesarean sections. When adjusted for background variables, women with a planned home birth felt less threat to the baby's life during birth (OR: 0.1; 95% CI: 0.03-0.4), and were more satisfied with their participation in decision making (OR: 6.0; 95% CI: 3.3-10.7) and the support from their midwife (OR 3.9; 95% CI: 2.2-7.0). They also felt more in control (OR: 3.3; 95% CI: 1.6-6.6), had a more positive birth experience (OR: 2.9; 95% CI: 1.7-5.0), and were more satisfied with intrapartum care (OR: 2.3; 95% CI: 1.3-4.1) compared with women who had a planned cesarean section on maternal request. CONCLUSIONS Women who planned a home birth and women who had a cesarean section based on maternal request are significantly different groups of mothers in terms of sociodemographic background. In a birth context that promotes neither home birth nor cesarean section without medical reasons, we found that those women who had a planned home birth felt more involvement in decision making and had a more positive birth experience than those who had a requested, planned cesarean section.
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Karlström A, Rådestad I, Eriksson C, Rubertsson C, Nystedt A, Hildingsson I. Cesarean section without medical reason, 1997 to 2006: a Swedish register study. Birth 2010; 37:11-20. [PMID: 20402717 DOI: 10.1111/j.1523-536x.2009.00373.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code. METHODS Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data. RESULTS The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p<0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables. CONCLUSIONS The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.
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Affiliation(s)
- Annika Karlström
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Kringeland T, Daltveit AK, Møller A. How does preference for natural childbirth relate to the actual mode of delivery? a population-based cohort study from Norway. Birth 2010; 37:21-7. [PMID: 20402718 DOI: 10.1111/j.1523-536x.2009.00374.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Norway, intervention in childbirth has increased from 3 percent in 1967 to 37 percent in 2006. The objectives of this study were, first, to estimate to which extent women who expressed a preference for natural birth actually were delivered vaginally without interventions, and second, to estimate the influence that emotions and maternal background factors have on the mode of delivery. METHODS We used data from 39,475 pregnancies of participants in the Norwegian Mother and Child Cohort Study in which the pregnant woman had expressed a preference for natural birth, and linked these data with the pregnancy outcome as registered in the population-based Medical Birth Registry of Norway during 2000 to 2006. The influence of maternal factors on the mode of delivery was estimated with log-binomial regression models, stratified by parity. RESULTS Among primiparas, 29.3 percent delivered vaginally without interventions (natural birth), 56.1 percent gave birth vaginally with interventions, and 14.5 percent had a cesarean section. The strongest predictor for actually having a natural birth was age below 25 years, having more than 12 years' education, carrying a single fetus, and having a low score for anxiety and depression. Among multiparas, 61.1 percent gave birth vaginally without interventions, 30.6 percent vaginally with interventions, and only 8.3 percent had a cesarean section. The effects of maternal age, education, and anxiety or depression on the outcome were smaller for multiparas than for primiparas. CONCLUSIONS The chance of actually having a natural birth for women with a preference for a natural birth is much greater for multiparas than for primiparas. The factors that influence the chance of having a natural birth are different for primiparas and multiparas.
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Milne J, Gafni A, Lu D, Wood S, Sauve R, Ross S. Developing and pre-testing a decision board to facilitate informed choice about delivery approach in uncomplicated pregnancy. BMC Pregnancy Childbirth 2009; 9:50. [PMID: 19874628 PMCID: PMC2774286 DOI: 10.1186/1471-2393-9-50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 10/30/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The rate of caesarean sections is increasing worldwide, yet medical literature informing women with uncomplicated pregnancies about relative risks and benefits of elective caesarean section (CS) compared with vaginal delivery (VD) remains scarce. A decision board may address this gap, providing systematic evidence-based information so that patients can more fully understand their treatment options. The objective of our study was to design and pre-test a decision board to guide clinical discussions and enhance informed decision-making related to delivery approach (CS or VD) in uncomplicated pregnancy. METHODS Development of the decision board involved two preliminary studies to determine women's preferred mode of risk presentation and a systematic literature review for the most comprehensive presentation of medical risks at the time (VD and CS). Forty women were recruited to pre-test the tool. Eligible subjects were of childbearing age (18-40 years) but were not pregnant in order to avoid raising the expectation among pregnant women that CS was a universally available birth option. Women selected their preferred delivery approach and completed the Decisional Conflict Scale to measure decisional uncertainty before and after reviewing the decision board. They also answered open-ended questions reflecting what they had learned, whether or not the information had helped them to choose between birth methods, and additional information that should be included. Descriptive statistics were used to analyse sample characteristics and women's choice of delivery approach pre/post decision board. Change in decisional conflict was measured using Wilcoxon's sign rank test for each of the three subscales. RESULTS The majority of women reported that they had learned something new (n = 37, 92%) and that the tool had helped them make a hypothetical choice between delivery approaches (n = 34, 85%). Women wanted more information about neonatal risks and personal experiences. Decisional uncertainty decreased (p < 0.001) and perceived effectiveness of decisions increased (p < 0.001) post-intervention. CONCLUSION Non-pregnant women of childbearing age were positive about the decision board and stated their hypothetical delivery choices were informed by risk presentation, but wanted additional information about benefits and experiences. This study represents a preliminary but integral step towards ensuring women considering delivery approaches in uncomplicated pregnancies are fully informed.
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Affiliation(s)
- Jill Milne
- School of Nursing, University of Victoria, British Columbia, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics and the Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Diane Lu
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - Stephen Wood
- Departments of Obstetrics and Gynaecology, University of Calgary, Calgary, Canada
- Departments of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Reg Sauve
- Departments of Community Health Sciences, University of Calgary, Calgary, Canada
- Departments of Paediatrics (Neonatology), University of Calgary, Calgary, Canada
| | - Sue Ross
- Departments of Community Health Sciences, University of Calgary, Calgary, Canada
- Departments of Paediatrics (Neonatology), University of Calgary, Calgary, Canada
- Department of Family Medicine, University of Calgary, Calgary, Canada
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