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Zewudu L, Keshaun F, Silesh M, Tefera M, Ketema Bogale E, Demis A, Tekle ZY. Preference of cesarean delivery and its associated factors among pregnant women attending ante natal care at public health facilities of Debrebrehan City, Ethiopia: Cross-sectional study. PLoS One 2024; 19:e0296990. [PMID: 38295110 PMCID: PMC10829985 DOI: 10.1371/journal.pone.0296990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/24/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND A Caesarean section is a surgical procedure used to prevent or treat life-threatening maternal or fetal complications. Women's delivery preferences have become a global issue of interest to many researchers and clinicians, especially given the ever-increasing rate of cesarean sections. There is limited data on the preference for cesarean delivery and its associated factors for Ethiopian women, particularly in the study area. The aim of the study is to assess the preference for cesarean delivery and its associated factors among pregnant women attending antenatal care at public health facilities in Debre Berhan, Ethiopia, in 2023. METHODS An institution-based cross-sectional study design was done from May 5-20, 2023, among 512 participants, and a multi-stage sampling technique was used. The data were collected by using interviewer-administered semi-structured questionnaires. The data were entered by Epi Data version 4.6 and then transferred to SPSS version 25 for analysis. With logistic regression, those variables with a p-value <0.25 in the bivariate analysis were candidates for multivariate logistic regression, and variables with a p-value <0.05 were considered statistically significant. RESULT The preference for a cesarean section was 26%, with a CI of 22.3% to 29.9%. Pregnant mothers who were not satisfied with their previous intrapartum care (AOR; 6.3 CI = (3.5-11), P = 0.01), had no knowledge about cesarean delivery (AOR; 2.9; 95% CI = 1.6-5.3), P = 0.01), had a previous history of spontaneous abortion (AOR; 3.1; 95% CI = (1.5-6.3), P = 0.001), lived in an urban area (AOR; 1.9; 95% CI = (1.0-3.5), P = 0.038), and had a current pregnancy-related problem (AOR; 4.8; 95% CI = 1.9-10), P = 0.001) were significantly associated with the preference for cesarean delivery. CONCLUSION In this study, the preference for cesarean delivery was high as compared to the World Health Organization recommendation. Pregnant mothers who were not satisfied with their previous intrapartum care, had no knowledge about cesarean delivery, had a previous history of spontaneous abortion, had an urban residence, and had a current pregnancy-related problem were significantly associated with a preference for caesarean delivery. Clinicians who are working in the delivery room should improve their service provision by using patient-centered care to increase patient satisfaction.
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Affiliation(s)
- Lemlem Zewudu
- Debre Berhan compressive specialized Hospital Amhara Region, Debre Berhan, Ethiopia
| | - Fetene Keshaun
- Department of Midwifery School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mulualem Silesh
- Department of Midwifery School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mitiku Tefera
- Department of Midwifery School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral Sciences Department, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aberham Demis
- Department of Midwifery, Deber-Berehan Health Science College, Debre Berhan, Amhara, Ethiopia
| | - Zewedie Yeshaw Tekle
- Department of Midwifery, Deber-Berehan Health Center, Debre Berhan, Amhara, Ethiopia
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Nguyen TT, Nguyen LH, Nguyen HTT, Dam VAT, Vu TMT, Latkin CA, Zhang MWB, Ho RCM, Ho CSH. Preferences for childbirth delivery and pain relief methods among pregnant women in Vietnam. Front Med (Lausanne) 2024; 11:1290232. [PMID: 38352144 PMCID: PMC10861798 DOI: 10.3389/fmed.2024.1290232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background Understanding childbirth delivery and pain relief method preferences is important as a part of the shared decision-making process between pregnant women and health professionals. This study aimed to examine the preferences for childbirth delivery modes and pain relief methods and factors related to these preferences among pregnant women in Vietnam. Methods A cross-sectional survey on pregnant women was conducted in two obstetrics hospitals in Vietnam. Face-to-face interviews using a structured questionnaire were performed to collect information about sociodemographic characteristics, pregnancy characteristics, preferences for different childbirth delivery modes, and pain relief methods. Multivariate logistic regression was employed for determining associated factors with the preferences. Results Of 576 pregnant women, 34% of participants preferred cesarean section. Most of the sample did not have any preferences for specific pharmacological pain relief methods (70.1%), while support from partner/relatives was the most preferable non-pharmacological method (61.3%), following by water birth (11.1%) and acupuncture (9.9%). Desire to have another baby, relatives' experience, selection date of birth, and instrumental social support were major drivers of the cesarean section selection. This preference was an important factor in the preference for pharmacological pain relief. Meanwhile, high levels of informational and emotional support were associated with non-pharmacological method preference. Conclusion This study highlighted a high preference rate for cesarean section in urban pregnant women in Vietnam. Holistic approaches from family, health facility, and policy should be performed to diminish the cesarean rate preference and promote the use of non-pharmacological pain relief methods during birth.
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Affiliation(s)
- Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Vu Anh Trong Dam
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Thuc Minh Thi Vu
- Institute of Health Economics and Technology (iHEAT), Hanoi, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Melvyn W. B. Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Pidd D, Newton M, Wilson I, East C. Optimising maternity care for a subsequent pregnancy after a psychologically traumatic birth: A scoping review. Women Birth 2023; 36:e471-e480. [PMID: 37024378 DOI: 10.1016/j.wombi.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Psychological birth trauma is recognised as a significant and ubiquitous sequelae from childbirth, with the incidence reported as up to 44%. In a subsequent pregnancy, women have reported a range of psychological distress symptoms from anxiety, panic attacks, depression, sleep difficulties and suicidal thoughts. AIM To summarise evidence on optimising a positive pregnancy and birth experience for a subsequent pregnancy following a psychologically traumatic pregnancy and identify research gaps. METHODS This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR check list. Six databases were searched using key words relating to psychological birth trauma and subsequent pregnancy. Utilising agreed criteria, relevant papers were identified, and data were extracted and synthesised. RESULTS A total of 22 papers met the inclusion criteria for this review. All papers addressed different aspects of what was important to women in this cohort, summarised as women wanting to be at the centre of their care. Pathways of care were diverse ranging from free birth to elective caesarean. There was no systematic process for identifying a previously traumatic birth experience and no education to enable clinicians to understand the importance of this. CONCLUSION For women who have experienced a previous psychologically traumatic birth, being at the centre of their care, in their subsequent pregnancy, is a priority. Embedding woman-centred pathways of care for women with this experience, as well as multidisciplinary education on the recognition and prevention of birth trauma, should be a research priority.
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Affiliation(s)
- Deborah Pidd
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg, VIC 3084, Australia.
| | - Michelle Newton
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia
| | - Ingrid Wilson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Singapore Institute of Technology, Singapore
| | - Christine East
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
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Landry I, René C, Demontigny F. Family centered nursing practices towards women and their families in the birthing context: A qualitative systematic review. Nurs Open 2023; 10:5937-5949. [PMID: 37306178 PMCID: PMC10416028 DOI: 10.1002/nop2.1880] [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: 08/01/2022] [Revised: 02/13/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
AIM Synthesize qualitative evidence examining how nurses' attitudes, beliefs, and sense of efficacy and the context surrounding birth facilitate or hinder family-centered nursing practice. DESIGN Thematic synthesis of qualitative studies. METHODS A literature search was conducted in CINAHL, MEDLINE, PsycINFO, SCOPUS, SCIENCE DIRECT, REPÈRES, CAIRN, and ÉRUDIT from October 2020 to June 2021. The PRISMA guidelines were followed, and studies were critically appraised using the Critical Appraisal Skills Programme checklist. Data were extracted by two independent reviewers, and Thomas and Harden's qualitative thematic synthesis method was performed for data analysis. RESULTS Thirteen studies were included. Three analytical themes were generated: (1) sharing power: opposing beliefs, (2) feeling a sense of efficacy in fulfilling one's role, and (3) managing a challenging work environment. PATIENT OR PUBLIC CONTRIBUTION Synthesizing nurses' experience is essential to promote implementation of favourable changes for care that is more focused on the needs of families.
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Affiliation(s)
- Isabelle Landry
- Centre for Studies and Research on Family Intervention (CERIF), Department of Nursing ScienceUniversité du Québec en OutaouaisGatineauQuebecCanada
| | - Caroline René
- Centre for Studies and Research on Family Intervention (CERIF), Department of Nursing ScienceUniversité du Québec en OutaouaisGatineauQuebecCanada
| | - Francine Demontigny
- Centre for Studies and Research on Family Intervention (CERIF), Research Group on Fatherhood, Family and Society, Department of Nursing ScienceUniversité du Québec en OutaouaisGatineauQuebecCanada
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Walędziak M, Różańska-Walędziak A. Does Obesity Influence Women's Decision Making about the Mode of Delivery? J Clin Med 2022; 11:jcm11237234. [PMID: 36498808 PMCID: PMC9740825 DOI: 10.3390/jcm11237234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction: The ratio of cesarean deliveries (CDs) has been increasing worldwide, with a growing problem of cesarean delivery on maternal request (CDMR) and an alarmingly increasing rate of CD in the private sector. There are numerous factors influencing women’s preferences for the mode of delivery and their opinion about shared decision making (SDM). Material and method: The study was designed as an online survey, filled in by 1040 women. The questionnaire included questions about women’s preferences for the mode of delivery, their opinions about CDMR and the process of decision making regarding the mode of delivery. Results: There were no statistically significant differences found between women with a BMI ≤ 25 kg/m2 and >25 kg/m2, nor with a BMI ≤ 30 kg/m2 and >30 kg/m2, on the subject of the preferred method of delivery, and the opinion regarding SDM and CDMR without medical indications. More than 85% of women in all groups, who preferred CD as the mode of delivery, wanted to have CDMR. Conclusion: We have not found obesity and overweight to be a factor influencing women’s preferred mode of delivery, their opinion about SDM and their preference for CDMR without medical indications. However, the sample size of women with morbid obesity with a BMI ≥ 35 kg/m2 was too small for the results to be considered significant in this group, and it will therefore be subject to further studies.
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Affiliation(s)
- Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
- Correspondence:
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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Factors Influencing Polish Women's Preference for the Mode of Delivery and Shared-Decision Making: Has Anything Changed over the Last Decade? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121782. [PMID: 36556984 PMCID: PMC9781590 DOI: 10.3390/medicina58121782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022]
Abstract
Background and Objectives: Shared-decision making has become an important trend in the problem of women’s preference for the way of delivery. There are different factors influencing women, including obstetric history, culture, religion, family and social influences. Materials and Methods: The study was designed as an online survey with the aim of acquiring information about women’s knowledge, opinions and preferences about the mode of delivery and the decision-making process. Data were collected from 1175 women in 2010 and 1033 in 2020. Results: A significant increase in the proportion of women who prefer vaginal delivery (VD) was found to be present with an increasing level of education, with the lowest rate in the group with primary education (66.0% in 2010 and 33.3% in 2020) and highest with medical education—86.3% in 2010 and 69.3% in 2020 (p < 0.05). This trend existed both in 2010 and 2020; however, the proportion of women who preferred VD has decreased over the last decade in all groups, and even two-fold in the primary education group. No significant correlation was found between a history of previous delivery and the preference of the way of delivery, decision-making or paid cesarean delivery on maternal request (CDMR). A history of VD significantly reduced the preference for having a cesarean delivery, with only 6.9% of women in 2010 with a history of VD, and 8.9% in 2020 having preferred a cesarean delivery. In 2010, 34.9% of women with a history of cesarean section (CS) only, compared to 6.9% of women with a history VD only, had preference for CS with, respectively, 36.4% vs. 5.8% in 2020. Conclusions: As the proportion of women who prefer cesarean delivery has significantly increased over the last decade, we should emphasize the importance of educating women about the advantages and disadvantages of vaginal and cesarean delivery. The patient’s preference should always be discussed with the obstetrician and the medical indications explained.
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Lukasse M, Bratsberg AB, Thomassen K, Nøhr EA. Use of pudendal nerve block among midwives in Norway: A national cross-sectional study. Eur J Midwifery 2022; 6:34. [PMID: 35794878 PMCID: PMC9172938 DOI: 10.18332/ejm/146690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pudendal nerve block (PNB) is an effective analgesic during the second stage of labor and for suturing. With the introduction of epidural and spinal analgesia, PNB use decreased considerably. Most midwives receive some teaching on PNB during their midwifery education. The aim of this study was to examine the use of PNB by midwives in Norway. METHODS This was a cross-sectional study, in January 2020, using an electronic questionnaire which was distributed to approximately 1500 midwives. RESULTS A total of 527 midwives responded to the questionnaire (35%). Less than half (44.6%) of the midwives used PNB, of whom only half (123/235) used it frequently (at least once a month). The use of PNB was most common at specialized obstetric units with ≥1500 births per year. Midwives who reported good theoretical knowledge and practical skills of PNB used it significantly more often than midwives not reporting these (p<0.001). Reasons for not using PNB were: the lack of practice and experience (72.6%), and never having been taught (42.8%). Midwives reported needing training (83%) and clinical support to start using PNB (43%). CONCLUSIONS Few midwives use PNB regularly. To increase the use of PNB, midwifery education needs to include both theoretical and practical skills teaching. Midwives with insufficient knowledge and skills require the same teaching and training. In the clinical area, midwives require clinical support and supervision to practice and gain experience. Women are not offered PNB as long as midwives are not confident in providing this method of pain relief.
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Affiliation(s)
- Mirjam Lukasse
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Alette B. Bratsberg
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Department of Obstetrics, Telemark Hospital Trust, Skien, Norway
| | - Katrine Thomassen
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Department of Obstetrics, Vestfold Hospital Trust, Tonsberg, Norway
| | - Ellen A. Nøhr
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Wu J, Feng L, Zhang H, Guo L, Pérez-Escamilla R, Hu Y. The Inconsistency Between Women's Preference and Actual Mode of Delivery in China: Findings From a Prospective Cohort Study. Front Public Health 2022; 10:782784. [PMID: 35433620 PMCID: PMC9005775 DOI: 10.3389/fpubh.2022.782784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have found that the rates of cesarean preference were much lower than the actual rates of cesarean births in China. We aimed to observe this inconsistency between preferred and actual modes of delivery and the factors associated with the inconsistency. Methods We conducted a prospective cohort study at the maternity hospital with the largest number of deliveries in Beijing. We collected data through a questionnaire applied in the outpatient department, and medical records from the hospital's information system. Unconditional logistic regression was used to identify factors influencing the inconsistency between preferred and actual delivery mode. Results The rates of actual cesarean section and of cesarean preference were 41 and 17%, respectively (χ2 = 82.9, P < 0.0001). The overall inconsistency rate was 31%, with 119 women preferred vaginal delivery but experienced cesarean section, accounting for 67% women undergoing cesarean section. Risk factors for this inconsistency between preferred vaginal delivery and actual cesarean section included: maternal obesity, receiving assisted reproduction, having an abnormal amniotic fluid volume, and fetal distress. Pre-labor rupture of membranes was a unique factor associated with such inconsistency between cesarean section preference and vaginal delivery at delivery. Conclusions The inconsistent rate between preferred delivery at late pregnancy and actual delivery is high in China. Further research is needed to understand how to lower cesarean rates in China, taking maternal preferences for vaginal deliveries into account.
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Affiliation(s)
- Jing Wu
- School of Agroforestry & Medicine, the Open University of China, Beijing, China
| | - Li Feng
- School of Agroforestry & Medicine, the Open University of China, Beijing, China
| | - Hongwei Zhang
- Obstetrics Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Li Guo
- Obstetrics Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | | | - Yifei Hu
- Department of Child, Adolescent health and Maternal health, School of Public Health, Capital Medical University, Beijing, China
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Cesarean delivery on maternal request: How do French obstetricians feel about it? Eur J Obstet Gynecol Reprod Biol 2021; 269:84-89. [PMID: 34974210 DOI: 10.1016/j.ejogrb.2021.12.006] [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: 08/16/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The number of cesarean deliveries on maternal request (CDMR) is unknown in France. We aimed to evaluate the rate of obstetricians willing to perform a CDMR in 2020 in Paris and to compare OB/GYN seniors' and residents' points of view about CDMR using six hypothetical clinical scenarios. STUDY DESIGN A survey was conducted between January to March 2020 with an anonymous self-administrated questionnaire sent by email to OB/GYN seniors working in 16 public and private maternity units and residents of Paris. Questionnaire was based on previous peer-reviewed literature. Socio professional characteristics were collected. OB/GYN seniors were asked if they agree to perform a CDMR and have already done one. OB/GYN seniors' and residents' points of view on six hypothetical clinical scenarios (CDMR, scarred uterus, breech presentation, multiple pregnancy, history of perineal tears or stillbirth) were compared. RESULTS Eighty-three OB/GYN seniors and one hundred and fifteen residents answered to our questionnaire. Twenty-three (27,7%) OB/GYN seniors were ready to perform a CDMR, mostly because they think that mode of delivery is a woman's choice. Physicians working in a private maternity unit or having an exclusive private practice were significantly more willing to perform a cesarean delivery on maternal request. No differences were found between the OB/GYN seniors' and residents' point of view on the six hypothetical clinical scenarios. A third of OB/GYN seniors and residents reported having done at least one CDMR during their career or during their residency. CONCLUSION One out of four OB/GYN senior interviewed is ready to perform a CDMR in Paris in 2020. OB/GYN seniors and residents share the same point of view concerning CDMR.
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Ďuríčeková B, Škodová Z, Bašková M. Mode of delivery preferences among multiparous women based on previous birth experience. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Smith V, Hannon K, Begley C. Clinician's attitudes towards caesarean section: A cross-sectional survey in two tertiary level maternity units in Ireland. Women Birth 2021; 35:423-428. [PMID: 34420910 DOI: 10.1016/j.wombi.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although caesarean section (CS) is a life-saving intervention when medically indicated, the growth in CS rates is causing concern. In reducing unnecessary CS, it is important to understand clinicians' attitudes towards CS so that these might be understood contextually. OBJECTIVE To explore clinicians' attitudes towards CS in Ireland. METHODS A cross sectional survey involving maternity care professionals in two urban maternity hospitals in Ireland. Descriptive statistics were used to analyse the data. Ethical approval was granted by the Research Ethics Committees of the University and the two study sites. FINDINGS One hundred and fifty-two maternity care professionals responded to the survey. Most (97%) indicated that the CS rate in their unit was 'high', although 81% believed there was a shift in culture towards a lower threshold for performing CS. Most participants (85%) considered birth a natural process that should not be interfered with unless necessary and that elective CS is not the safest option for the mother (74%) or baby (71%), yet 45% believed that a woman should be able to have a CS if she wants a CS. Just over half the participants considered a previous 3rd or 4th degree tear an indication for an elective CS. Offering vaginal birth after a previous CS for fetal distress and failure to progress increased with clinical experience. CONCLUSION The findings of this survey can be considered contextually in addressing high CS rates and will be of wider relevance in understanding maternity care providers' beliefs about CS in general.
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Affiliation(s)
- Valerie Smith
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland.
| | - Kathleen Hannon
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland
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Donate-Manzanares M, Rodríguez-Cano T, Rodríguez-Almagro J, Hernández-Martínez A, Santos-Hernández G, Beato-Fernández L. Mixed-method study of women's assessment and experience of childbirth care. J Adv Nurs 2021; 77:4195-4210. [PMID: 34297861 DOI: 10.1111/jan.14984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/24/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine women's evaluations of quality of care from their perspectives. BACKGROUND Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce. DESIGN Mixed-methods explanatory sequential design. METHODS A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis. RESULTS The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care. CONCLUSION Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified. IMPACT This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services.
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Affiliation(s)
| | - Teresa Rodríguez-Cano
- Servicio de Psiquiatría del Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real, Spain
| | - Julián Rodríguez-Almagro
- Facultad de Enfermería de Ciudad Real, Campus de Ciudad Real, Calle de Camilo José Cela, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Facultad de Enfermería de Ciudad Real, Campus de Ciudad Real, Calle de Camilo José Cela, Ciudad Real, Spain
| | - Gloria Santos-Hernández
- Servicio de Obstetricia y Ginecología del Hospital Virgen de la Salud de Toledo, Toledo, Spain
| | - Luis Beato-Fernández
- Servicio de Psiquiatría del Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real, Spain
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Jatta F, Sundby J, Vangen S, Lindskog BV, Sørbye IK, Owe KM. Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115938. [PMID: 34205921 PMCID: PMC8197892 DOI: 10.3390/ijerph18115938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.
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Affiliation(s)
- Fatou Jatta
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Johanne Sundby
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Siri Vangen
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Ingvil Krarup Sørbye
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
| | - Katrine Mari Owe
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Department of Child health and development, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Correspondence: ; Tel.: +47-91683023
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Buyuk GN, Kansu-Celik H, Kaplan ZAO, Kisa B, Ozel S, Engin-Ustun Y. Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4). REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:436-441. [PMID: 34318468 PMCID: PMC10411140 DOI: 10.1055/s-0041-1731378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/19/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. METHODS The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. RESULTS The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. CONCLUSION This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.
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Affiliation(s)
- Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Hatice Kansu-Celik
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Zeynep Asli Oskovi Kaplan
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Burcu Kisa
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Sule Ozel
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
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15
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Naghibi SA, Khazaee-Pool M, Moosazadeh M. The Iranian version of theory-based intention for cesarean section (IR-TBICS) scale: development and first evaluation. BMC Pregnancy Childbirth 2021; 21:5. [PMID: 33402125 PMCID: PMC7784005 DOI: 10.1186/s12884-020-03498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate at which mothers experience a cesarean section in the absence of medical signs is growing worldwide. Women's beliefs and intentions play an essential role in the request or choice of a delivery method. At present, there is no comprehensive, validated scale for assessing pregnant women's beliefs about cesarean section in the Iranian population. This study was performed to develop and assess the validity and reliability of the intention-based cesarean section scale using the theory of reasoned action (TRA) constructs as a theoretical framework for measuring intention toward the selection of a delivery method. METHODS In this cross-sectional validation study, 480 pregnant women were recruited from Sari, in northern Iran, through a multistage random sampling approach. Content validity was examined using the content validity index (CVI) and content validity ratio (CVR). Furthermore, both exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to assess the construct validity of the developed scale. Reliability was measured by internal consistency and the intraclass correlation coefficient (ICC). Quality criteria for floor and ceiling effects were derived from existing guidelines and consensus within our research group. RESULTS The results obtained from the factor analysis showed that the data were fit to the model (χ2 = 2298.389, P < 0.001). The TRA comprised 24 items assessing five domains, which described 62.46% of the common variance. The CFA showed a model with suitable fitness for the data. Cronbach's alpha coefficient for the domains of the scale ranged from 0.609 to 0.843, and the ICC value ranged from 0.71 to 0.84, which is within the satisfactory range. The IR-TBICS scale had no floor or ceiling effect on the total score or any of the dimensions. CONCLUSIONS The belief-based cesarean section scale appears to be a reliable instrument. It is considered suitable and can be applied in other research in Iran.
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Affiliation(s)
- Seyed Abolhassan Naghibi
- Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
- Health Sciences Research Center, Addiction Research Institutes, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Khazaee-Pool
- Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran.
- Health Sciences Research Center, Addiction Research Institutes, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Research Institutes, Mazandaran University of Medical Sciences, Sari, Iran
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Gaudernack LC, Michelsen TM, Egeland T, Voldner N, Lukasse M. Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway. BMC Pregnancy Childbirth 2020; 20:605. [PMID: 33032529 PMCID: PMC7542692 DOI: 10.1186/s12884-020-03196-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background Prolonged labor might contribute to a negative birth experience and influence first-time mothers’ attitudes towards future pregnancies. Previous studies have not adjusted for possible confounding factors, such as operative delivery, induction and postpartum hemorrhage. We aimed to determine the impact of prolonged labor on birth experience and a wish for cesarean section in subsequent pregnancies. Methods A survey including the validated “Childbirth Experience Questionnaire”. First-time mothers giving birth between 2012 and 2014 at a Norwegian university hospital participated. Data from deliveries were collected. Regression analysis and thematic content analysis were performed. Results 459 (71%) women responded. Women with labor duration > 12 h had significantly lower scores on two out of four sub-items of the questionnaire: own capacity (p = 0.040) and perceived safety (p = 0.023). Other factors contributing to a negative experience were: Cesarean section vs vaginal birth: own capacity (p = 0.001) and perceived safety (p = 0.007). Operative vaginal vs spontaneous birth: own capacity (p = 0.001), perceived safety (p < 0.001) and participation (p = 0.047). Induced vs spontaneous start: own capacity (p = 0.039) and participation (p = 0.050). Postpartum hemorrhage ≥500 ml vs < 500 ml: perceived safety (p = 0.002) and participation (p = 0.031). In the unadjusted analysis, prolonged labor more than doubled the risk (odds ratio (OR) 2.66, 95%CI 1.42–4.99) of a subsequent wish for cesarean delivery. However, when adjustments were made for mode of delivery and induction, emergency cesarean section (OR 8.86,95%CI 3.85–20.41) and operative vaginal delivery (OR 3.05, 95%CI 1.46–6.38) remained the only factors significantly increasing the probability of wanting a cesarean section in subsequent pregnancies. The written comments on prolonged labor (n = 46) indicated four main themes:
Difficulties gaining access to the labor ward. Being left alone during the unexpectedly long, painful early stage of labor. Stressful operative deliveries and worse pain than imagined. Lack of support and too little or contradictory information from the staff.
Conclusions Women with prolonged labors are at risk of a negative birth experience. Prolonged labor per se did not predict a wish for a cesarean section in a subsequent pregnancy. However, women with long labors more often experience operative delivery, which is a risk factor of a later wish for a cesarean section.
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Affiliation(s)
- L C Gaudernack
- Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital / Oslo Metropolitan University, College of Applied Sciences, Oslo, Norway.
| | - T M Michelsen
- Department of Obstetrics Rikshospitalet, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Egeland
- Biostatistics (BIAS), Norwegian University of Life Sciences, Aas, Norway
| | - N Voldner
- Faculty of Health Studies, VID Scientific International Diaconal Specialized University Oslo, Oslo, Norway
| | - M Lukasse
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway. .,Faculty of Health and Social sciences, University of South-Eastern Norway, Notodden, Norway.
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