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Yin A, Shi Y, Heinonen S, Räisänen S, Fang W, Jiang H, Chen A. The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: A prospective cohort study in Shanghai, China. J Affect Disord 2024; 347:183-191. [PMID: 38007102 DOI: 10.1016/j.jad.2023.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding. METHODS We conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires. RESULTS Among 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00-2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09-2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16-0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21-0.91, p = 0.028). LIMITATIONS The long-term implications of FOC beyond the immediate postpartum period were not explored in the study. CONCLUSIONS High-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women.
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Affiliation(s)
- Anxin Yin
- School of Public Health, Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Yunmei Shi
- Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Räisänen
- School of Health, Tampere University of Applied Sciences, Tampere, Finland
| | - Wenli Fang
- Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Hong Jiang
- School of Public Health, Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China.
| | - An Chen
- School of Public Health, Zhejiang Chinese Medical University, Zhejiang, China; Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Cai D, Villanueva P, Lu H, Zimmermann B, Horsch A. What matters to migrant women during labor and birth: Chinese mothers' experiences in Switzerland. BMC Pregnancy Childbirth 2024; 24:69. [PMID: 38245713 PMCID: PMC10799396 DOI: 10.1186/s12884-024-06271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND In Switzerland, foreigners account for 25.3% of the permanent resident population, and the fertility rate of migrant women is higher than that of Swiss women. However, migrant women from non-European countries are more likely to report having negative childbirth experiences than Swiss women. For example, during pregnancy, Chinese migrant mothers often felt dissatisfied with the follow-up pregnancy complications and lacked information on medical procedures and prenatal courses. In this paper, we explored their childbirth experiences in Swiss hospitals and how Swiss healthcare providers supported them. METHOD A qualitative study employing in-depth, semi-structured interviews was conducted with 14 Chinese mothers and 13 family members. All interviews were audio-recorded, transcribed, and translated into English for data analysis. Thematic analysis was employed to generate a detailed description. RESULTS Three main themes were extracted from the transcripts: (1) Sense of security, (2) Intrapartum care, and (3) Postpartum needs. CONCLUSIONS Our study shows Chinese migrant mothers prioritized giving birth in a physically and psychologically safe environment, with pain control and practical and emotional support from their intimate partners. They desired a physiological labor and birth with minimal obstetric interventions. Our research also reveals their postpartum needs, emphasizing the importance of postpartum support and obtaining culturally sensitive care during their postpartum hospital stay. The study adds new knowledge of specific migrant studies in Switzerland, as called for by the Swiss Federal Office of Public Health. The results call for the transcultural care skills training of Swiss healthcare providers to enable migrant women to have a more positive childbirth experience.
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Affiliation(s)
- Dingcui Cai
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, 1011, Switzerland
| | - Paulina Villanueva
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, 1011, Switzerland
| | - Hong Lu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Basile Zimmermann
- Confucius Institute, University of Geneva, Rue du Général-Dufour 24, Geneva, 1211, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, 1011, Switzerland.
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, 1011, Switzerland.
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Meng X, Ye J, Qiao P, Ren T, Luo Q, Hu LQ, Zhang J. Labor Neuraxial Analgesia and Its Association With Perinatal Outcomes in China in 2015-2016: A Propensity Score-Matched Analysis. Anesth Analg 2023; 137:1047-1055. [PMID: 37862597 DOI: 10.1213/ane.0000000000006435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND The use of labor neuraxial analgesia (NA) in China has increased significantly in the past decade, and the current rate of use is unknown. This study aimed to describe the epidemiology of NA based on a large multicenter cross-sectional survey, the China Labor and Delivery Survey (CLDS) (2015-2016), and to evaluate the association between NA and intrapartum caesarean delivery (CD) and maternal and neonatal outcomes. METHODS The CLDS was a facility-based cross-sectional investigation with a cluster random sampling scheme conducted from 2015 to 2016. A specific weight was assigned to each individual based on the sampling frame. Logistic regression was adopted to analyze the factors associated with the use of NA. A propensity score matching scheme was used to analyze the associations between NA and intrapartum CD and perinatal outcomes. RESULTS A total of 51,488 vaginal deliveries or intrapartum CD were included in our study, excluding prelabor CDs. The weighted NA rate was 17.3% (95% confidence interval [CI], 16.6-18.0) in this survey population. Nulliparous, previous CD, hypertensive disorders, and labor augmentation were associated with higher use of NA. In the propensity score-matched analysis, NA was associated with reduced risks of intrapartum CD, especially intrapartum CD by maternal request (adjusted odds ratio [aOR], 0.68; 95% CI, 0.60-0.78 and aOR, 0.48; 95% CI, 0.30-0.76, respectively), 3rd or 4th degree perineal laceration (aOR, 0.36; 95% CI, 0.15-0.89), and 5-minute Apgar score ≤3 (aOR, 0.15; 95% CI, 0.03-0.66). CONCLUSIONS The use of NA may be associated with improved obstetric outcomes, including fewer intrapartum CD, less birth canal trauma, and better neonatal outcomes in China.
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Affiliation(s)
- Xi Meng
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangfeng Ye
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Qiao
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tai Ren
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Luo
- Department of Research Service, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Ling-Qun Hu
- Department of Obstetric Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jun Zhang
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Research Service, Hainan Women and Children's Medical Center, Haikou, Hainan, China
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Albarqouni L, Abukmail E, MohammedAli M, Elejla S, Abuelazm M, Shaikhkhalil H, Pathirana T, Palagama S, Effa E, Ochodo E, Rugengamanzi E, AlSabaa Y, Ingabire A, Riwa F, Goraya B, Bakhit M, Clark J, Arab-Zozani M, Alves da Silva S, Pramesh CS, Vanderpuye V, Lang E, Korenstein D, Born K, Tabiri S, Ademuyiwa A, Nabhan A, Moynihan R. Low-Value Surgical Procedures in Low- and Middle-Income Countries: A Systematic Scoping Review. JAMA Netw Open 2023; 6:e2342215. [PMID: 37934494 PMCID: PMC10630901 DOI: 10.1001/jamanetworkopen.2023.42215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
Importance Overuse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures. Objectives To assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs. Evidence Review We searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions. Findings Of 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle-income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders. Conclusions and Relevance This systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Majdeddin MohammedAli
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Sewar Elejla
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, Palestine
| | | | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Sujeewa Palagama
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Emmanuel Effa
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kismu City, Kenya
- Centre for Evidence-Based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eulade Rugengamanzi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yousef AlSabaa
- Faculty of Medicine, Al-Azhar University of Gaza, Gaza Strip, Palestine
| | - Ale Ingabire
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Francis Riwa
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Burhan Goraya
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - C. S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Korenstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Born
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Tabiri
- Department of Surgery, University for Development Studies–School of Medicine and Tamale Teaching Hospital, Tamale, Ghana
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Faculty of Clinical Sciences, College of Medicine of the University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos
| | - Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Zaiden L, Nakamura-Pereira M, Gomes MAM, Esteves-Pereira AP, Matos CPD, Barros LDA, Takemoto MLS, Leal MDC. Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study. CIENCIA & SAUDE COLETIVA 2022; 27:2741-2752. [PMID: 35730843 DOI: 10.1590/1413-81232022277.20632021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022] Open
Abstract
Collaborative models (CM) focused on intrapartum care shared between both midwives and obstetricians have been proposed as a strategy to reduce these rates. Our aim was to compare use of evidence-based practices, obstetric interventions and c-section rates in two settings: a maternity hospital that applies a CM of care (MRJ) and data from a pool of maternity hospitals included in the Birth in Brazil Survey (NB) that do not adopt a CM. Data was abstracted from medical and administrative records in MRJ and from medical records and face-to-face interviews in NB. Differences were compared using chi-square test, with significance level set at p<0.05. MRJ showed a higher frequency of labour companionship, labour care provided by nurse midwives, non-pharmacological pain relief methods, food intake during labour, and less use of oxytocin, analgesia and amniotomy. More women also had second stage assisted by a nurse midwife and in a vertical position, as well as lower use of episiotomies and vacuum-extractor/forceps. The c-section rate was lower at MRJ. Shared care between midwives and obstetricians can be an effective strategy to improve quality of intrapartum care.
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Affiliation(s)
- Laura Zaiden
- Faculdade de Medicina de Petrópolis, Universidade Faculdades Arthur Sá Earp Neto. Av. Barão do Rio Branco 1003, Centro. 25680-120 Petrópolis RJ Brasil. .,Maternidade Escola, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro RJ Brasil
| | - Maria Auxiliadora Mendes Gomes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro RJ Brasil
| | | | - Caio Pereira de Matos
- Faculdade de Medicina de Petrópolis, Universidade Faculdades Arthur Sá Earp Neto. Av. Barão do Rio Branco 1003, Centro. 25680-120 Petrópolis RJ Brasil.
| | - Lucas de Araujo Barros
- Faculdade de Medicina de Petrópolis, Universidade Faculdades Arthur Sá Earp Neto. Av. Barão do Rio Branco 1003, Centro. 25680-120 Petrópolis RJ Brasil.
| | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
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Long Q, Zhang Y, Zhang J, Tang X, Kingdon C. Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys. BMJ Open 2022; 12:e059208. [PMID: 35418438 PMCID: PMC9014066 DOI: 10.1136/bmjopen-2021-059208] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Since 2009, China has introduced policies, principally targeting health professionals, to reduce caesarean section (CS) overuse. In 2016, China endorsed a universal two-child policy. Advanced maternal age and previous CS may indicate changes in obstetric risks, which raise concerns on the need for and safety of CS. This study investigated changes in CS rates in 2008-2018, and factors associated with CS use during the period of transition from the one-child to two-child policy era. DESIGN We used births data from the cross-sectional National Household Health Services Surveys in 2013 and 2018. SETTING Population-based national survey. PARTICIPANTS Women who had the last live birth within 5 years before the survey. PRIMARY OUTCOME MEASURE CS rate. RESULTS Overall CS use increased from 40.9% in 2008 to 47.2% in 2014 with significant increase in rural areas and the western region, and slightly decreased to 45.2% in 2018 with the greatest decrease among nulliparous women. Maternal request for CS by urban nulliparous women decreased from 36.8% in 2008-2009 to 22.2% in 2016-2018, but this change was not statistically significant in rural areas. Maternal age over 35 years old (OR 2.40, 95% CI 1.72 to 3.35) and births that occurred at a private hospital (OR 1.52, 95% CI 1.25 to 1.86) were associated with CS use among nulliparous women in 2016-2018. The CS rate among multiparous women increased over time. Individual socioeconomic factors associated with CS use among multiparous women. CONCLUSIONS The CS rate rise in China in 2008-2018 is attributable to increased use in rural areas and the less developed western region. The population policy shift, alongside facility policies for unnecessary CS reduction, are likely factors in CS reduction in urban areas. The challenge remains to reduce unnecessary CS, at the same time as providing safe, universal access to CS for women in need.
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Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yaoguang Zhang
- Centre for Health Statistics and Information, National Health Commission of the People's Republic of China, Beijing, China
| | - Jing Zhang
- Nursing School, Hangzhou Normal University, Hangzhou, China
| | - Xiaojun Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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Veringa‐Skiba IK, de Bruin EI, van Steensel FJA, Bögels SM. Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness-based childbirth and parenting with enhanced care as usual. Birth 2022; 49:40-51. [PMID: 34250636 PMCID: PMC9292241 DOI: 10.1111/birt.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether mindfulness-based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes. DESIGN Randomized controlled trial. SETTING Midwifery settings, the Netherlands, April 2014-July 2017. POPULATION Pregnant women with high FOC (n = 141) and partners. METHODS Allocation to MBCP or ECAU. Hierarchical multilevel and intention-to-treat (ITT) and per-protocol (PP) analyses. MAIN OUTCOME MEASURES Primary: pre-/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self-requested cesarean birth (sCB), unmedicated childbirth, and 1- and 5-minute newborn's Apgar scores. RESULTS MBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43-0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36-0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23-3.20]). Newborn's 1-minute Apgar scores were higher in MBCP (DM -0.39, 95% CI [-0.74 to -0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1-minute Apgar. CONCLUSIONS MBCP for pregnant couples reduces mothers' fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care.
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Affiliation(s)
- Irena K. Veringa‐Skiba
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
| | - Esther I. de Bruin
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands,UvA‐mindsAcademic Center of the University of AmsterdamAmsterdamthe Netherlands
| | - Francisca J. A. van Steensel
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
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Mehri Z, Moafi F, Alizadeh A, Habibi M, Ranjkesh F. Effect of acupuncture-like transcutaneous electrical nerve stimulation on labor pain in nulliparous women: a randomized controlled trial. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Urgent Need of Continuing Medical Education: The Key for Patient Awareness of Labor Epidural Analgesia – A Survey of Chinese Perinatal Care Providers. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Zhao P, Cai Z, Huang A, Liu C, Li H, Yang S, Hu LQ. Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers. PLoS One 2021; 16:e0251345. [PMID: 34019570 PMCID: PMC8139447 DOI: 10.1371/journal.pone.0251345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/23/2021] [Indexed: 12/29/2022] Open
Abstract
Objective China has a high cesarean delivery (CD) and low labor epidural analgesia (LEA) rate. This online survey was conducted to explore the reasons behind this phenomenon and potential solutions. Methods A voluntary, anonymous survey was distributed via both WeChat and professional websites for 4 months amongst groups of Chinese perinatal professionals. Data was collected and analyzed using a Chi-square test and presented as percentages of respondents. Results 1412 respondents were recorded (43% anesthesiologists, 35% obstetricians, 15.5% midwives or labor and delivery nurses, and 6.5% others), and 1320 respondents were care providers. It was found that 82.7% (1092/1320) of the provider respondents used CD per patient request in fear of lawsuits or yinao/yibao and 63.4% (837/1320) used CD for respecting superstitious culture. The number one reason (noted by 60.2% (795/1320) of all the three specialties) for low LEA use was lack of anesthesia manpower without statistical difference among specialties. The most recommended solution was increasing the anesthesia workforce, proposed by 79.8% (1053/1320) of the three specialties. However, the top solution provided by the two non-anesthesia specialties is different from the one proposed by anesthesiologists. The later (83%, 504/606) suggested increasing the incentive to provide the service is more effective. The answers to questions related to medical knowledge about CD and LEA, and unwillingness of anesthesiologists, parturients and their family members to LEA were similar for the most part, while the opinions regarding low LEA use related to poor experiences and unwillingness of obstetricians and hospital administrators were significantly divided among the three specialties. In the providers’ point of view, the unwillingness to LEA from parturient’s family members was the most salient (26.1%, 345/1320), which is more than all care providers, hospital administrators, and parturients themselves (16.8%, 222/1320). Conclusion The reasons for high CD rate and low LEA use are multifactorial. The sociological issues (fear of yinao/yibao and superstitious culture) were the top two contributing factors for the high CD rate in China, while lack of anesthesia manpower was the top response for the low LEA use, which contributes to its being the most recommended solution overall from the three specialties. An incentive approach to providers is a short-term solution while training more perinatal care providers (especially among anesthesiologists and midwives), improving billing systems, and reforming legal systems are 3 systemic approaches to tackling this problem in the long-term.
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Affiliation(s)
- Peishan Zhao
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Zhenyu Cai
- Department of Obstetrics and Gynecology, Aviation General Hospital, China Medical University, Beijing, P.R. China
| | - Anna Huang
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Chunyuan Liu
- Department of Anesthesiology, Liangping County People’s Hospital, Chongqing, P.R. China
| | - Huiling Li
- Department of Obstetrics and Gynecology, The People’s Hospital, Peking University, Beijing, P.R. China
| | - Shuwei Yang
- No Pain Labor & Delivery—Global Health Initiative (China Chapter), ApgarCARE International, Inc., Xi’an, Shaanxi, P.R. China
| | - Ling-Qun Hu
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail:
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11
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Liu M, Xue M, Yang Q, Du W, Yan X, Tan J, Duan T, Hua J. Association between migration status and caesarean section delivery based on a modified Robson classification in China. BMC Pregnancy Childbirth 2021; 21:215. [PMID: 33731060 PMCID: PMC7971954 DOI: 10.1186/s12884-021-03708-6] [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: 02/08/2020] [Accepted: 03/10/2021] [Indexed: 11/11/2022] Open
Abstract
Background China has one of the highest caesarean section (C-Section) rates in the world. In recent years, China has been experiencing a massive flow of migration due to rapid urbanization. In this study, we aimed to differentiate the rates of C-Section between migrants and residents, and explore any possible factors which may moderate the association between migrant status and C-Section rates. Methods We conducted a retrospective cohort study in Shanghai, China. All deliveries were classified using the modified Robson Classification. The association between women’s migrant status and C-Section rates was assessed using the Poisson regression of sandwich estimation, after adjusting for possible factors. Results Of the 40,621 women included in the study, 66.9% were residents and 33.1% were internal migrants. The rate of C-Section in migrants was lower than that of residents in all subjects (39.9 and 47.7%) and in group 1 subjects (based on the Robson Classification) using a modified Robson Classification. There was an association between migrant status and caesarean delivery on maternal request that was statistically significant (RR = 0.664, p < 0.001), but the association was weakened after adjusting for such factors as maternal age at delivery (aRR = 0.774, p = 0.02), ethnicity (aRR = 0.753, p < 0.001), health insurance (aRR = 0.755, p < 0.001), and occupation (aRR = 0.747, p = 0.004), but had no significant changes when adjusting for health conditions (aRR = 0.668, p = 0.001) and all considering variables (aRR = 0.697, p = 0.002). In group 1 subjects, the effect of migrant status on maternal requested intrapartum C-Section was also statistically significant (RR = 0.742, p = 0.004). Conclusion C-Section rates are lower among migrant women than residents, especially on maternal request. The medical practitioners should further reinforce the management of elective C-Section in resident women. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03708-6.
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Affiliation(s)
- Ming Liu
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China.,The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Mengqi Xue
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China
| | - Qing Yang
- Songjiang Maternity & Child Health Hospital of Shanghai, Shanghai, 200042, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Xiaoling Yan
- The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Jing Tan
- The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Tao Duan
- The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Jing Hua
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China.
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12
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Schantz C, Lhotte M, Pantelias AC. [Moving beyond the ethical tension of caesarean section on maternal request]. SANTE PUBLIQUE 2021; 32:497-505. [PMID: 33723955 DOI: 10.3917/spub.205.0497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In a legal context focused on the right and autonomy of the patient, some women wish to be able to choose their mode of childbirth. As midwives are primary care-givers for pregnant women with a physiological pregnancy, we wanted to find out whether it was ethically acceptable for them to accompany a woman in her decision to have a caesarean section.Purpose of research: This survey is an ancillary study of the CESARIA research program validated by the Comité de Protection des Personnes Sud Méditerranée IV and declared to the CNIL. Thirty-seven semi-directive interviews were conducted with midwives and women. RESULTS The majority of women and midwives share a vision of childbirth as “natural” and consider the request for caesarean section as a pathology. When formulated, this request places midwives in a situation of ethical tension. On the one hand, midwives wish to refer women to vaginal birth as the norm, and this choice embodies the ethical principles of beneficence and non-maleficence. On the other hand, midwives express a desire to respect patient choice and freedom, illustrating the ethical principle of respect for autonomy. CONCLUSIONS The ethical issue of caesarean section on demand lies not so much in the decision to accept or not to accept a caesarean section but rather in listening to the request. Taking into consideration a medical indication more broadly than the simple obstetrical indication makes it possible to ethically support these requests while respecting the pregnant woman’s autonomy.
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Liu Y, Li T, Guo N, Jiang H, Li Y, Xu C, Yao X. Women's experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China. BMC Pregnancy Childbirth 2021; 21:151. [PMID: 33607963 PMCID: PMC7893951 DOI: 10.1186/s12884-021-03638-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women's experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience. METHODS The study is a cross-sectional survey of 4192 women who had natural birth from March-June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women's experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used. RESULTS In this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes' postpartum guidance. Negative satisfaction was seen with perineal pain and edema. CONCLUSION Women in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact.
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Affiliation(s)
- Ying Liu
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Tengteng Li
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Nafei Guo
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China.
| | - Yuehong Li
- Delivery Room, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Chenying Xu
- Delivery Room, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
| | - Xiao Yao
- Delivery Room, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204, China
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Ran L, Chen X, Peng S, Zheng F, Tan X, Duan R. Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction. BMJ Open 2020; 10:e036702. [PMID: 33033013 PMCID: PMC7542935 DOI: 10.1136/bmjopen-2019-036702] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Although China has done a lot in strengthening the primary healthcare system, the high turnover intention is still a social problem to be reckoned with. The objective of this study is to explore the mediating effect of satisfaction between job burnout and turnover intention. DESIGN Cross-sectional study. METHODS A cross-sectional study was conducted to make sense of the job burnout, satisfaction and turnover intention among primary healthcare workers in central China. Structural equation modelling (SEM) was performed to study the mediating effect of satisfaction between job burnout and turnover intention with maximum likelihood estimation. The mediation effect test was carried out by using the bootstrap method. RESULTS SEM showed that job burnout was positively related to the turnover intention with the standard path coefficient of 0.845 (C.R.=34.055, p<0.001). The partial mediating effect of satisfaction was 0.047, making up 5.32% of the total effect. The goodness-of-fit was acceptable (Goodness of Fit Index=0.947, Comparative Fit Index=0.975, root mean square error of approximation=0.067, Non-Normed Fit Index=0.971, Incremental Fit Index=0.975). Age, education level, monthly income, hire form and night shift were also found significantly correlated with turnover intention, and no difference was found between physicians and nurses. CONCLUSIONS The turnover intention is significantly affected by job burnout, satisfaction and demographical characteristics including age, education level, monthly income, hire form and night shift. Satisfaction can be regarded as a mediator between job burnout and turnover intention. Relative measures can be taken to promote enthusiasm and satisfaction thus decreasing the turnover rate.
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Affiliation(s)
- Li Ran
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xuyu Chen
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Shuzhen Peng
- Department of Health Management, Huangpi People's Hospital, Wuhan, China
| | - Feng Zheng
- Department of Health Managment, Health Committee of Huangpi District of Wuhan, Wuhan, China
| | - Xiaodong Tan
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
- School of Nursing, Wuchang University of Technology, Wuhan, China
| | - Ruihua Duan
- Department of Health Management, Huangpi People's Hospital, Wuhan, China
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Abstract
Introduction: The health implications of Caesarean section are a significant factor in evaluating the use of Caesarean section as a method of completing childbirth. The increased rate of Cesarean section augmenting in a statistical way the health implications of the use of Cesarean section as a way of operative technique of childbirth finalization. Aim: To investigate the incidence of health implications on mother and child after Cesarian section in comparison to vaginal delivery. Methods: In our study, which was conducted as a retrospective-prospective and targeted study, the observed research period is from 2007 to 2019. The data sources are: medical histories, birth protocols and neonatal medical histories. Group A: represents the number of surveyed patients with a Cesarean section in a one-year period (2018) in General Hospital „Prim.dr A. Nakaš“. Group B: represents a control group of the same number of patients born by Caesarean section in 2007 in General Hospital „Prim.dr A.Nakaš“ with all parameters and variables detected in the research group. Evaluation of the examinee’s findings includes: anamnestic data, sonographic data, gynecological finding, colposcopic finding. PAPA test, HPV typing and laboratory findings due to the extensiveness of the study. Results: A comparison of the number of Caesarean sections in BiH before and now shows a statistically significant increase from about 6 caesareans per year to almost 21 Cesarean section per year (p<0.05). This increase led to a statistically significant decrease in perinatal mortality from 30 per thousand per year to only 6 per thousand per year (p<0.05). Complications after Cesarean section during both observed periods are dominated by subjective problems, followed by early complications after Cesarean section. According to the types of complications after Caesarean section, hemorrhages were the most numerous during both examined years, with 1 case of other complications and without a statistically significant difference between the observed years. There were no statistically significant differences in the duration of hospitalization, although in 2007 somewhat longer stay in the hospital after Caesarean section was recorded. Conclusion: Our study has shown that one of the most visible trends in modern perinatology is a significant increase in number of Cesarean sections. This is the basis of long-term side effects of Caesarean section, the frequency of which correlates with the increase in this surgical procedure.
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Affiliation(s)
- Nenad Miseljic
- Department of Gynecology and Obstetrics, General Hospital "Prim.dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
| | - Sead Ibrahimovic
- Department of Gynecology and Obstetrics, General Hospital "Prim.dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
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Ngai FW, Xiao X. Perceptions of paternal involvement and labour pain management in Chinese couples during childbirth: A qualitative study. Women Birth 2020; 34:288-295. [PMID: 32222355 DOI: 10.1016/j.wombi.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/22/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Labour pain is an individual experience embedded in a socio-cultural context. In childbirth, the father's involvement provides important support to the mother during labour. However, few published studies have evaluated couples' experiences of paternal involvement and labour pain management in the Chinese context. AIM This study aimed to understand the experience of labour pain management and the father's involvement in childbirth from the perspectives of women and their partners in Hong Kong. METHODS An exploratory qualitative design was adopted. A purposive sample of 45 Chinese parents was recruited at the postnatal unit of a regional hospital. Data were collected through semi-structured face-to-face interviews within 1 month after birth. The data were subjected to content analysis. FINDINGS The findings revealed six major themes: the mothers' experience of labour pain, effectiveness of pain relief measures, mothers' perceptions of support from their partners, mothers' perceptions of support from healthcare professionals, fathers' experience of involvement in childbirth and suggested improvements to maternity services. DISCUSSION Chinese mothers experienced intense labour pain and used various pain relief measures. Both parents considered the involvement of fathers and support from healthcare professionals to be highly significant during childbirth. CONCLUSIONS This study highlights the need for a family-centred model of care during childbirth that involves both parents in the decision-making process. Chinese maternity services should implement individualised birth plans that acknowledge both parents' expectations and preferences, thus promoting a positive childbirth experience for the parents.
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Affiliation(s)
- Fei-Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, HKSAR.
| | - Xiao Xiao
- School of Nursing, The Hong Kong Polytechnic University, HKSAR.
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17
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Zheng H, Zheng BX, Lin XM. The Trend of Labor Analgesia in the World and China: A Bibliometric Analysis of Publications in Recent 30 Years. J Pain Res 2020; 13:517-526. [PMID: 32214842 PMCID: PMC7082621 DOI: 10.2147/jpr.s232132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/19/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose Labor analgesia is part of the most important tasks an anesthesiologist needs to deal with. With the “two-child policy” in China, the number of parturients has increased significantly, labor analgesia more should be valued. There has been a tremendous change on labor analgesia research in China and around the world; however, broader trends in the prevalence and scope of labor analgesia research remain underexplored. The current study quantitatively analyzes trends in labor analgesia research publications in the past 30 years. Methods A bibliometric approach was used to search Scopus, PubMed, Web of Science and the China National Knowledge Infrastructure for all labor analgesia-related research articles. The research progress and growing trend were quantitatively analyzed by total publications, research types, research institutions, journal impact factors, and author’s contribution. Total citations frequency, average citations per item and h-index were used for evaluating literature quantity. Results From 1988 to 2018, over 8000 documents in labor analgesia research field were published worldwide. According to Scopus, 68.2% papers of all documents were articles. The USA published the largest number of articles (2204, 27.45%). China had published 175 articles (2.18%), ranking the 11th. According to WOS, there were 221 research categories for labor analgesia articles all over the world. The total citations were 76,207, average 9.086 citations per item, and the h-index was 114, average 14 citations per item worldwide. The total citations and h-index of papers published in China were as follows: 353 total citations, 7.06 citations per item, and 10 h-index. High contribution journals, authors, institutions and the top 10 most cited articles on labor analgesia in the world and China were also listed. Conclusion Labor analgesia research has grown markedly during the 1988–2018 period. Although China had made remarkable achievements, there was a gap in the high-quality studies between China and other leading countries.
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Affiliation(s)
- Huan Zheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, People's Republic of China.,Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, People's Republic of China
| | - Bi-Xin Zheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, People's Republic of China.,Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,Department of Pain Management, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Xue-Mei Lin
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, People's Republic of China.,Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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Deng Y, Li H, Dai Y, Yang H, Morse AN, Liang H, Lin Y. Are there differences in pain intensity between two consecutive vaginal childbirths? A retrospective cohort study. Int J Nurs Stud 2020; 105:103549. [PMID: 32199151 DOI: 10.1016/j.ijnurstu.2020.103549] [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: 03/11/2019] [Revised: 02/01/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pain assessment is crucial for in-labour pain management. Even though women's self-rated pain intensity is the standard for pain relief or analgesic administration, multiparas appear to receive worse in-labour pain management than primiparas do. The discrepancy in pain perception between primiparas and multiparas remains unclear. Healthcare providers tend to think that multiparas endure the pain and report less pain because they have experienced childbirth. OBJECTIVE To retrospectively analyse the intensity of in-labour pain during first and second vaginal childbirth within the same group of women and explore whether parity may be an influential factor in labour pain intensity. DESIGN Retrospective cohort study. SETTING Labour and delivery in a large academic specialized hospital in Guangzhou, China. PARTICIPANTS Women were included if they had two consecutive vaginal childbirths with singleton cephalic presentations and cervical dilation ≤ 3 cm for the first childbirth and ≤ 2 cm for the second childbirth. The final study sample consisted of 417 women. METHODS All childbirth case records between January 2015 and August 2018 were scanned using a structured electronic medical system. Maternal and neonatal demographics as well as obstetric and neonatal outcomes were extracted. The in-labour pain for each childbirth was compared between first and second births. Paired t-tests, McNemar's chi-square tests and mixed-effects modelling were applied to compare the differences in labour pain intensity between the two vaginal childbirths and explore the factors that influenced maximum labour pain scores during the second childbirth. RESULTS Four hundred seventeen women were included, with an average birth interval of 1.7 years. The average maximum labour pain score during the latent phase was 6 (5,6) for the first childbirth and 5 (4,6) for the second childbirth (paired t =-6.13, P <0.001). Pain scores decreased in 28.1% (117/417) of women and increased in 13.7% (57/417) of women from the first to the second childbirth. More than half of the women in our study experienced the same maximum labour pain score during the first and second labour. Mixed-effects modelling revealed that parity, education and pregnancy complications were independently associated with maximum labour pain scores. CONCLUSIONS From a clinical point of view, in-labour pain is not clinically different for women when comparing their first and second labours. Health care professionals may underestimate in-labour pain in primiparas when comparing them with nulliparas. More studies are warranted to explore options for achieving better pain management for women with more childbirths.
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Affiliation(s)
- Yongfang Deng
- Dlivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China
| | - Huixian Li
- Statistician, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Dai
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Yang
- Department of Pediatric operation room, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Abraham N Morse
- Department of Urogynecology, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China.
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing Administrative Office, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China.
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Kang L, Ye S, Jing K, Fan Y, Chen Q, Zhang N, Zhang B. A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016. Risk Manag Healthc Policy 2020; 13:245-253. [PMID: 32256135 PMCID: PMC7092689 DOI: 10.2147/rmhp.s230923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022] Open
Abstract
Objective This study evaluated change in caesarean section rate with reform of birth planning policy in China from one-child to two-child policy. Methods Study data were collected from patient-level hospital records of 59,668 pregnant women who visited three major urban hospitals in Jiangsu Province and Inner Mongolia Autonomous Region of China between January 2012 and December 2016. A segmented logistic regression approach was developed to evaluate the changes in caesarean section rate in these regions with the launch of China's new partial and universal two-child policies in January 2014 and January 2016, respectively. Results Jiangsu Province had a significantly lower non-emergency caesarean rate (Jiangsu 8.15% vs Inner Mongolia 34.03%, p < 0.001) and a much lower percentage of minority population (Jiangsu 6.99% vs Inner Mongolia 21.76%, p < 0.001) than Inner Mongolia Autonomous Region. In Jiangsu Province, no change in caesarean section rate was detected with the two-child policies (all p-values > 0.05), although the unadjusted trend change (0.038, 95% confidence interval or CI: [0.016, 0.060], p < 0.001) in log odds after the implementation of the partial two-child policy was statistically significant. In Inner Mongolia Autonomous Region, an immediate jump in caesarean section rate was discovered by the segmented logistic regression with the implementation of both the partial (unadjusted level change 0.297, CI: [0.105, 0.489], p = 0.002) and universal two-child policies (unadjusted level change 1.945, CI: [1.277, 2.614], p < 0.001); but the rate reverted to the previous level thereafter. Ethnicity, maternal age, maternal reproduction history, insurance coverage type, infant weight, and infant gender were the significant factors associated with caesarean section rate (for odds ratios, all p-values < 0.05). However, the significance of infant gender may stem from the large sample size of the study and is not clinically meaningful. Conclusion Change in caesarean section rate was not observed with the launch of two-child policy in China.
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Affiliation(s)
- Lili Kang
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu, People's Republic of China.,School of Health Management, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Shangyuan Ye
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Kangzhen Jing
- Department of Medical Affair, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Qihui Chen
- Center for Food and Health Economic Research, College of Economics and Management, China Agricultural University, Beijing, People's Republic of China
| | - Ning Zhang
- Department of Health Policy and Management, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.,Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Reasons for Increased Caesarean Section Rate in Vietnam: A Qualitative Study among Vietnamese Mothers and Health Care Professionals. Healthcare (Basel) 2020; 8:healthcare8010041. [PMID: 32098136 PMCID: PMC7151040 DOI: 10.3390/healthcare8010041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022] Open
Abstract
The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%-15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were 'request for Caesarean section,' 'mental strain of obstetricians,' and 'decision-making process.' To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.
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Sha X, Hu H, Yang J, Fang D, Li W, Zhang H, Coonrod V, Liu H. Interventions to reduce the cesarean delivery rate in a tertiary hospital in China. J Matern Fetal Neonatal Med 2019; 35:30-38. [PMID: 31875731 DOI: 10.1080/14767058.2019.1706475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: High cesarean delivery rate has been a global public health concern. This study assesses the effect of medical interventions and societal changes on cesarean delivery rates in a Chinese tertiary hospital.Material and methods: A retrospective study including all live births ≥34-week gestation between 2008 and 2016 from Guangzhou Women and Children's Medical Center was divided into 5 stages: (1) no interventions; (2) patient-controlled epidural analgesia; (3) episiotomy restriction; (4) new labor management; (5) universal two-child policy. An interrupted time series design was used to measure the effect of interventions on overall cesarean rate, primary cesarean rate, maternal and neonatal outcomes.Results: There were 126,609 deliveries including 49,092 cesarean deliveries and 77,517 vaginal deliveries in this period. Overall cesarean delivery rate declined after implementing patient-controlled epidural analgesia, episiotomy restriction and universal two-child policy. Primary cesarean rate decreased after implementing episiotomy restriction. Cesarean rate with previous cesarean dramatically increased, and maternal request cesarean rate decreased gradually. Low Apgar rate (score ≤7 at 5 min) increased after episiotomy restriction and maternal postpartum hemorrhage rate increased after new labor management.Conclusions: Patient-controlled epidural analgesia, episiotomy restriction and the universal two-child policy showed the most significant effects to reducing the cesarean rate.
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Affiliation(s)
- Xiaoyan Sha
- Department of Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiping Hu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinying Yang
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dajun Fang
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weidong Li
- Department of Maternal and Child Health Information, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huizhu Zhang
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - V Coonrod
- Department of Obstetrics and Gynecology, Maricopa Integrated Health System/District Medical Group and University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Huishu Liu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Fan H, Gu H, You H, Xu X, Kou Y, Yang N. Social determinants of delivery mode in Jiangsu, China. BMC Pregnancy Childbirth 2019; 19:473. [PMID: 31805886 PMCID: PMC6894495 DOI: 10.1186/s12884-019-2639-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Less evidence exists regarding the association of social determinants and delivery mode in Jiangsu, and if the trend is influenced by the type of residence. This study aims to identify the significant social determinants of delivery mode, and also to compare the main differences in delivery mode between urban and rural areas. Methods We used data from the cross-sectional National Health Service Surveys conducted in Jiangsu Province in 2013. For the purposes of this study, information from women (15–64 years old) who had experienced childbirth the last 5 years were examined, and a total of 1365 participants were selected as research subjects. Results Participants using vaginal delivery mode and cesarean delivery mode were found in 616 (45.1%) and 751(54.9%) participants, respectively. The proportion of women using cesarean delivery was 53.5% in rural area and 58.2% in urban area. Meanwhile, our results showed that women in middle Jiangsu were more likely to use cesarean delivery, and cesarean delivery is more prevalent among richer women. We also find that the more use of prenatal care visit, the more use of cesarean delivery. Conclusions This study validated the relationship between social determinants and the mode of delivery in Jiangsu province. Social determinants are contextual factors, which may vary by region and additional work is needed to fully understand these relationships globally. Further studies are needed to elucidate mechanisms and pathways across various populations, and these social determinants should be incorporated into future multi-level interventions designed to decrease the cesarean delivery rate.
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Affiliation(s)
- Hong Fan
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China. .,Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, People's Republic of China.
| | - Hai Gu
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China.
| | - Hua You
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China.,Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, People's Republic of China
| | - Xinpeng Xu
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China
| | - Yun Kou
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China
| | - Nichao Yang
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China
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Zhu X, Wang Y, Zhou H, Qiu L, Pang R. Adaptation of the Childbirth Experience Questionnaire (CEQ) in China: A multisite cross-sectional study. PLoS One 2019; 14:e0215373. [PMID: 31017927 PMCID: PMC6481804 DOI: 10.1371/journal.pone.0215373] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/01/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The childbirth experience of women represents a significant aspect of quality care. Due to the lack of a reliable Chinese language tool for assessing childbirth experiences, examples must be adapted from other countries. The aim of this study was to translate an English version of the Childbirth Experience Questionnaire (CEQ) into Chinese and adapt this tool to the Chinese context. METHODS A questionnaire validation study was conducted. A forward-backward translation procedure involving the developer of the CEQ was conducted. The data were collected in postnatal wards at 50 birth facilities in 4 regions of Zhejiang Province, China. Women who gave birth vaginally at the investigated facilities during the study period completed an online questionnaire that included the Chinese version of the CEQ (CEQ-C), demographic information and clinical information. Psychometric analyses were performed to assess the internal and content consistency. After subdividing the sample into subsamples, an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to examine the structural validity. Known-group comparisons were performed to assess the discriminant validity. RESULTS Overall, 1747 women participated in this study. The content validity index (CVI) of the CEQ was 0.92. Based on the comments of the experts combined with the statistical results, we removed 3 items related to pain, sense of control and sense of security and changed 3 items to different dimensions. The CFA supported the four dimensions of the CEQ-C (standard root mean square residual (SRMR) = 0.037, root mean square error of approximation (RMSEA) = 0.036, comparative fit index (CFI) = 0.966, and Tucker-Lewis index (TLI) = 0.959). Cronbach's alpha of the CEQ-C was 0.88, and McDonald's omega value was 0.91. The duration of labor, delivery mode, parity, oxytocin augmentation, pain management, companionship, prenatal education and pain experienced exerted significant effects on the women's childbirth experiences. CONCLUSIONS Although some items performed differently in our analysis comparing the English and Chinese versions of the CEQ, the CEQ-C is reliable and valid. Additionally, the CEQ-C is an easy-to-use and promising tool for measuring childbirth experiences among Chinese women in facility settings that can be used to improve the quality of intrapartum care. Efforts are needed to provide women with respectful, evidence-based intrapartum care to facilitate positive childbirth experiences.
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Affiliation(s)
- Xiu Zhu
- Dept. of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Yan Wang
- Dept. of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hong Zhou
- Dept. of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Liqian Qiu
- Dept. of Women Health, Women Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruyan Pang
- Chinese Maternal and Child Health Association, Beijing, China
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Schantz C, de Loenzien M, Goyet S, Ravit M, Dancoisne A, Dumont A. How is women's demand for caesarean section measured? A systematic literature review. PLoS One 2019; 14:e0213352. [PMID: 30840678 PMCID: PMC6402700 DOI: 10.1371/journal.pone.0213352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background Caesarean section rates are increasing worldwide, and since the 2000s, several researchers have investigated women’s demand for caesarean sections. Question The aim of this article was to review and summarise published studies investigating caesarean section demand and to describe the methodologies, outcomes, country characteristics and country income levels in these studies. Methods This is a systematic review of studies published between 2000 and 2017 in French and English that quantitatively measured women’s demand for caesarean sections. We carried out a systematic search using the Medline database in PubMed. Findings The search strategy identified 390 studies, 41 of which met the final inclusion criteria, representing a total sample of 3 774 458 women. We identified two different study designs, i.e., cross-sectional studies and prospective cohort studies, that are commonly used to measure social demand for caesarean sections. Two different types of outcomes were reported, i.e., the preferences of pregnant or non-pregnant women regarding the method of childbirth in the future and caesarean delivery following maternal request. No study measured demand for caesarean section during the childbirth process. All included studies were conducted in middle- (n = 24) and high-income countries (n = 17), and no study performed in a low-income country was found. Discussion Measuring caesarean section demand is challenging, and the structural violence leading to demand for caesarean section during childbirth while in the labour ward remains invisible. In addition, the caesarean section demand in low-income countries remains unclear due to the lack of studies conducted in these countries. Conclusion We recommend conducting prospective cohort studies to describe the social construction of caesarean section demand. We also recommend conducting studies in low-income countries because demand for caesarean sections in these countries is rarely investigated.
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Affiliation(s)
- Clémence Schantz
- CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, Paris, France
- * E-mail:
| | - Myriam de Loenzien
- CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, Paris, France
| | | | - Marion Ravit
- CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, Paris, France
| | | | - Alexandre Dumont
- CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, Paris, France
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Abstract
PURPOSE To explore the reasons why some Chinese women travel to the United States on a tourist visa specifically to give birth, also known as birth tourism. STUDY DESIGN Qualitative, exploratory design. METHODS Using convenience and snowball sampling, Chinese women were recruited from the waiting rooms of obstetricians known to care for birth tourists. Participants completed demographic data and provided answers to questions about their reasons for traveling to give birth and their birth experience while in the United States. Qualitative content analysis methods were used to extract themes from participant narratives. RESULTS Twelve married, college-educated women, aged between 26 and 39 years, self-identifying as birth tourists from China participated in this study. Content analysis revealed two themes: (1) positive perceptions of childbirth in the United States; and (2) securing a future for their child. CLINICAL IMPLICATIONS Study findings suggest Chinese birth tourists come to the United States for a better childbirth experience, and to secure future opportunities for their children. Nurses should be aware of the current political climate on immigration and birth tourism in order to promote a safe and judgment-free environment when providing care to this unique population of women.
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Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, Betran AP. Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in China: A mixed-methods systematic review. PLoS Med 2018; 15:e1002672. [PMID: 30325928 PMCID: PMC6191094 DOI: 10.1371/journal.pmed.1002672] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND China has witnessed a rapid increase of cesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and reasons for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs, which are those performed in the absence of medical indications. METHODS AND FINDINGS We conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, and one Chinese database (CNKI) using a combination of the key terms 'caesarean section', 'preference', 'choice', 'knowledge', 'attitude', 'culture', 'non-clinical factors', and 'health professionals-patient relations' between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%-17%) and 21% in late pregnancy (95% CI 15%-26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%-20%), 22% in late pregnancy (95% CI 18%-25%), and 30% postpartum (95% CI 19%-40%). Women's preferences for CS were found to rise as pregnancy progressed (preference change across longitudinal studies: mean difference 7%, 95% CI 1%-13%). One longitudinal study reported that the preference for CS among women's partners increased from 8% in late pregnancy to 17% in the immediate postpartum period. In addition, 18 quantitative studies revealed that some pregnant women, ranging from 4% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy. The qualitative meta-synthesis found that women's perceptions of CS as preferable were based on prioritising the baby's and woman's health and appeared to intensify through interactions with the health system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth, fostering the feeling that CS was the safest option. Health professionals' preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite subgroup and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women's preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS). CONCLUSIONS Despite a minority of women expressing a preference for CS, individual, health system, and socio-cultural factors converge, contributing to a high CS rate in mainland China, Hong Kong, and Taiwan. In order to reduce unnecessary CSs, interventions need to address all these non-clinical factors and concerns. SYSTEMATIC REVIEW REGISTRY Prospero CRD42016036596.
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Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Fan Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael Dominic Renecle
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa, United States of America
| | - Shayesteh Jahanfar
- School of Public Health, Central Michigan University, Mount Pleasant, Michigan, United States of America
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Whitburn LY, Jones LE, Davey MA, McDonald S. The nature of labour pain: An updated review of the literature. Women Birth 2018; 32:28-38. [PMID: 29685345 DOI: 10.1016/j.wombi.2018.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/07/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions. AIM To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently - why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour. METHOD A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion. FINDINGS Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labour pain were identified and grouped into cognitive, social and environmental factors. CONCLUSION If a woman can sustain the belief that her pain is purposeful (i.e. her body working to birth her baby), if she interprets her pain as productive (i.e. taking her through a process to a desired goal) and the birthing environment is safe and supportive, it would be expected she would experience the pain as a non-threatening, transformative life event. Changing the conceptualisation of labour pain to a purposeful and productive pain may be one step to improving women's experiences of it, and reducing their need for pain interventions.
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Affiliation(s)
- Laura Y Whitburn
- School of Life Sciences, La Trobe University, Bundoora, Victoria 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Lester E Jones
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3186, Australia
| | - Susan McDonald
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia; Mercy Hospital for Women, Mercy Health, Heidelberg, Victoria 3084, Australia
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Zhang Z, Gu C, Zhu X, Ding Y, Simone S, Wang X, Tao H. Factors associated with Chinese nulliparous women's choices of mode of delivery: A longitudinal study. Midwifery 2018; 62:42-48. [PMID: 29653417 DOI: 10.1016/j.midw.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/15/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Caesarean section rates have risen beyond the WHO recommended level in many countries worldwide. An emerging epidemic in caesareans has appeared in China over the past two decades, mainly driven by non-medical factors. China's one-child policy was previously seen as a potential factor for contributing to women's high caesarean section rates. The Chinese government has officially announced a two-child policy in recent years, causing numerous families to reshape their fertility intentions and birth preferences. There have been few studies focusing on women's expected and actual delivery mode and the associated factors affecting their choices of mode of delivery. OBJECTIVE To investigate nulliparous women's expected and actual mode of delivery, and the related factors associated with delivery mode in the context of China's two-child policy. DESIGN, SETTINGS, AND PARTICIPANTS This longitudinal study approached 1368 pregnant women who attended the antenatal clinic regularly at a tertiary specialized women's hospital in Shanghai, China. Among the 1368 women, 1211 agreed to participate and were investigated at admission of this study. METHODS Data were collected via questionnaires using Birth Attitude Questionnaire (BAQ), Subjective Norm Questionnaire (SNQ), and Childbirth Self-Efficacy Scale (CSES). Descriptive statistics and logistic regression analyses were used. RESULTS Of 1211 participants, the number of women expecting a vaginal delivery at three pregnancy stages accounted for 74%, 78%, and 83%, respectively. Finally 48% (520/1084) ended up having a caesarean delivery. Caesarean section for lack of medical indications accounted for 57% (297/520). Among women who met the requirements of two-child policy, 39% planned to have a second child. In logistic regression analyses, participants with stronger expectations of caesarean deliveries during late pregnancy (aOR, 35.18; 95% CI, 12.66-97.74), having higher scores of birth attitude toward CS (aOR, 1.13; 95% CI, 1.06-1.20), and with lower scores of intrapartum childbirth self-efficacy (aOR, 0.85; 95% CI, 0.77-0.92) had significantly higher odds of having an actual caesarean delivery. CONCLUSIONS During the initial period of China's two-child policy, the majority of women value vaginal delivery whereas high caesarean section rate still becomes a great concern in current China. Individual preferences, birth attitude, and childbirth self-efficacy are altogether associated with women's different choices of mode of delivery.
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Affiliation(s)
- Zheng Zhang
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Obstetric Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunyi Gu
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| | - Xinli Zhu
- Obstetric Out-patient Clinics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Setterberg Simone
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Xiaojiao Wang
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Obstetric Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hua Tao
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy. Midwifery 2018; 62:6-13. [PMID: 29626722 DOI: 10.1016/j.midw.2018.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/14/2018] [Accepted: 03/11/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. DESIGN Qualitative descriptive design with in-depth semi-structured interviews. SETTING Postnatal wards at a tertiary specialized women's hospital in Shanghai, China. PARTICIPANTS 21 nulliparous women 2-3 days postpartum were purposively sampled until data saturation. METHODS In-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. RESULTS Two overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. CONCLUSION AND IMPLICATIONS FOR PRACTICE At the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them.
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Rosenberg KR, Trevathan WR. Evolutionary perspectives on cesarean section. EVOLUTION MEDICINE AND PUBLIC HEALTH 2018. [DOI: 10.1093/emph/eoy006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Karen R Rosenberg
- Department of Anthropology, University of Delaware, Newark, DE 19716, USA
| | - Wenda R Trevathan
- Department of Anthropology, New Mexico State University, Las Cruces, NM 80003, USA
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Liang H, Fan Y, Zhang N, Chongsuvivatwong V, Wang Q, Gong J, Sriplung H. Women's cesarean section preferences and influencing factors in relation to China's two-child policy: a cross-sectional study. Patient Prefer Adherence 2018; 12:2093-2101. [PMID: 30349203 PMCID: PMC6188957 DOI: 10.2147/ppa.s171533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study explored women's preference for cesarean section (CS) and the preference for cesarean sections' influencing factors, particularly nonmedical factors. METHODS A cross-sectional study was conducted in four tertiary hospitals in Hohhot. We recruited 1,169 pregnant women at ≥ 28 gestational weeks and classified subjects into three groups by delivery mode preference: vaginal birth (VB), CS, and "no clear preference". We identified the influencing factors of women's choices by multinomial logistic regression. The adjusted relative-risk ratios (aRRRs) for the factors affecting the preference for CS and "no clear preference" categories and their 95% CIs were computed, using the preference for VB as the reference group. RESULTS VB was preferred by 80.3% of the subjects, 8.8% preferred CS, and 10.9% had not decided yet. In the multinomial logistic regression, pregnant women intending to have more than one child were less likely to prefer CS (aRRR: 0.37; 95% CI: 0.22-0.61); choosing a lucky day for baby birth was the strongest factor for CS preference (aRRR: 12.36; 95% CI: 6.62-23.08), and other factors for CS preference were being aged 40 years and above (aRRR: 4.21; 95% CI: 1.43-12.40), being ethnic minority (aRRR: 2.00; 95% CI: 1.17, 3.41), feeling difficulty in getting pregnant (aRRR: 2.23; 95% CI: 1.20, 4.13), and having husband's preference for CS (aRRR: 7.62; 95% CI: 4.00-14.54). The top reasons for preferring CS were the belief that CS was safer (51.5%), associated with less pain (40.8%), and better for baby's and woman's health (24.3% and 22.3%, respectively). CONCLUSION Less than one-tenth of the study subjects preferred CS. The cultural beliefs had the strongest influence on the decision of delivery mode. Those intending to have two or more children following the two-child policy were less likely to choose CS.
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Affiliation(s)
- Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,
| | - Yancun Fan
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Nan Zhang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | | | - Qingchun Wang
- Department of Medical Education, Hohhot First Hospital, Hohhot, Inner Mongolia, China
| | - Jing Gong
- Department of Medical Education, Hohhot First Hospital, Hohhot, Inner Mongolia, China
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,
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Hu Y, Huang K, Sun Y, Wang J, Xu Y, Yan S, Zhu P, Tao F. Placenta response of inflammation and oxidative stress in low-risk term childbirth: the implication of delivery mode. BMC Pregnancy Childbirth 2017; 17:407. [PMID: 29207957 PMCID: PMC5718001 DOI: 10.1186/s12884-017-1589-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 11/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background Caesarean delivery rate is increasing gradually in China and there is no doubt that delivery mode is closely associated with the maternal health and infant development.This study examined the independent effect of delivery mode on placenta inflammation response and oxidative stress response. Methods A total of 3474 pregnant women recruited in Ma’anshan Birth Cohort Study were the initial study population. Data on maternal socio-demographic characteristics and pre-pregnancy BMI were collected at their 1st antenatal checkups. Pregnancy-specific anxiety was assessed during the three trimesters of pregnancy. Common pregnant complications were monitored in the whole pregnancy period. Delivery modes, as well as newborn characteristics were abstracted from medical records. Delivery modes included vaginal deliveries (VD), caesarean delivery with medical indications (CDMI), caesarean delivery on maternal request (CDMR) and urgent cesarean delivery (UCD). Placentas were collected during childbirth. The mRNA expression of IL-1β, TNF-a, IL-6, IFN-γ, IL-4, IL-10, IL-8, and HO-1 were assessed in the final sample of 1978 low-risk women with singleton term-births. Results The overall rate of caesarean delivery (CD) was 50.5% (1650/3265) in singleton term childbirths in this study. Among women who reported definite CD reasons, 56.8%of them chose the surgery without any medical indications.It shows a non-linear relationship between cytokines related with placenta inflammatory response, oxidative stress response and different delivery modes. At high percentiles of IL-1β, IFN-γ and IL-8, women with CDMR had higher expression levels compared to women with VD. Women with CDMI had higher levels at median percentiles of IL-1β, IFN-γ and IL-8. Women with CDMR had higher expression compared with VD at high percentiles of IL-6 and HO-1, and women with CDMI had higher levels of these two cytokines at their low percentiles. It is worth noting that at high percentiles, compared with normal delivery, the expression of IL-1β, IFN-γ, IL-8 and HO-1 have significantly altered in women with CDMR. Conclusion A high overall CD rate was found in this study, and caesarean delivery on maternal request was the major contributor to the high prevalence. Maternal placental oxidative stress and inflammatory response were closely associated with delivery mode. The effect is much amplified at high levels of expression in women who chose CD on maternal request.Such difference needs to be noticed and may have important implications for obstetricians, midwives and other perinatal health care workers.
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Affiliation(s)
- Yabin Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, People's Republic of China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China. .,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, People's Republic of China.
| | - Yuanfang Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, People's Republic of China
| | - Jianqing Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, People's Republic of China
| | - Yeqing Xu
- Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, Anhui, People's Republic of China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, Anhui, People's Republic of China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, People's Republic of China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, People's Republic of China
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Wang E, Hesketh T. Large reductions in cesarean delivery rates in China: a qualitative study on delivery decision-making in the era of the two-child policy. BMC Pregnancy Childbirth 2017; 17:405. [PMID: 29202726 PMCID: PMC5716234 DOI: 10.1186/s12884-017-1597-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/24/2017] [Indexed: 11/26/2022] Open
Abstract
Background In 2010, China’s cesarean delivery (CD) rates increased to one of the highest in the world, a significant proportion of which were without medical indication. However, recent studies have indicated some declines, coinciding with national and local efforts to promote vaginal birth, as well as the relaxation of the one-child policy. Considering these trends, we aimed to qualitatively explore attitudes towards childbirth and experiences of delivery decision-making among women and physicians. Methods Semi-structured interviews were conducted with 45 postpartum women and 7 healthcare providers at one county-level and one provincial-level maternity hospital in Zhejiang Province. We also collected routine data from 2007 to 2016 and observed doctor-patient interactions and hospital facilities as context for the interviews. Interviews were recorded, translated and transcribed into English, and then analyzed using a framework approach. Results From 2007 to 2016, cesarean delivery rates at the county-level and provincial-level hospital decreased from 46% to 32% and 68% to 44%, respectively. For low-risk women, vaginal birth was the primary choice of delivery method, encouraged by doctors and nurse-midwives. Elective CD was not as widely accepted, in contrast to previous years. Women were aware of and took into consideration the consequences of CD for future pregnancies. Among those who delivered vaginally, women viewed the existing pain relief methods, epidurals and transcutaneous electrical nerve stimulation, with caution or uncertainty. Even when requested, epidurals were only given under certain circumstances. For multiparas with previous CD, repeat CD remains the norm. Both women and professionals were cautious about vaginal birth after cesarean delivery (VBAC) given the associated risks. Conclusion In China, changes in family planning policy and efforts to promote vaginal birth have greatly changed the culture of delivery decision-making, leading to decreased CD rates. This demonstrates the powerful role social factors and public policy can play, and provides a model for other countries with high CD rates. Further research should explore changes in other reproductive decisions during this new multiparous era, particularly across provinces. Electronic supplementary material The online version of this article (10.1186/s12884-017-1597-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eileen Wang
- Institute for Global Health, School of Public Health, Zhejiang University, 866 Yuhangtang Lu, Hangzhou, 310058, China
| | - Therese Hesketh
- Institute for Global Health, School of Public Health, Zhejiang University, 866 Yuhangtang Lu, Hangzhou, 310058, China. .,Institute for Global Health, University College London, 30 Guilford St., London, UK.
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Magne F, Puchi Silva A, Carvajal B, Gotteland M. The Elevated Rate of Cesarean Section and Its Contribution to Non-Communicable Chronic Diseases in Latin America: The Growing Involvement of the Microbiota. Front Pediatr 2017; 5:192. [PMID: 28929093 PMCID: PMC5591430 DOI: 10.3389/fped.2017.00192] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022] Open
Abstract
The current recommendation of the World Health Organization (WHO) regarding cesarean section (C-section) is that this clinical practice should be carried out only under specific conditions, when the health or life of the mother/newborn dyad is threatened, and that its use should not exceed 10-15% of the total deliveries. However, over the last few decades, the frequency of C-section delivery in medium- and high-income countries has rapidly increased worldwide. This review describes the evolution of this procedure in Latin American countries, showing that today more than half of newborns in the region are delivered by C-section. Given that C-section delivery is more expensive than vaginal delivery, its use has increased more rapidly in the private than the public sector; nevertheless, the prevalence of C-section deliveries in the public sector is higher than the WHO's recommendations and continues to increase, representing a growing challenge for Latin America. Although the medium- and long-term consequences of C-section delivery, as opposed to vaginal delivery, on the infant health are unclear, epidemiological studies suggest that it is associated with higher risk of developing asthma, food allergy, type 1 diabetes, and obesity during infancy. These findings are important, as the incidence of these diseases in the Latin American pediatric population is also increasing, particularly obesity. Although the link between these diseases and delivery mode remains controversial, recent studies indicate that the establishment of the gut microbiota is delayed in infants born by C-section during the postnatal period, i.e., during a critical developmental window for the maturation of the newborn's immune system. This delay may favor the subsequent development of inflammatory and metabolic disorders during infancy. Accordingly, from a public health perspective, it is important to slow down and eventually reverse the pattern of increased C-section use in the affected populations.
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Affiliation(s)
- Fabien Magne
- Microbiology and Mycology Program, Institute of Biomedical Sciences (ICBM), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Alexa Puchi Silva
- Faculty of Medicine, Andres Bello University, Vina del Mar, Santiago, Chile
| | - Bielka Carvajal
- Department of Women and Newborn’s Health Promotion, University of Chile, Santiago, Chile
| | - Martin Gotteland
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
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