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Hernández-Vásquez A, Chacón-Torrico H, Bendezu-Quispe G. Geographic and socioeconomic inequalities in cesarean birth rates in Peru: A comparison between 2009 and 2018. Birth 2022; 49:52-60. [PMID: 34240458 DOI: 10.1111/birt.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a global concern about the high rates of cesarean birth (CB). This study aimed to investigate the geographic and socioeconomic inequalities in CB rates in the Peruvian population. METHODS We conducted a population-based study using the Peruvian Demographic and Family Health Surveys (ENDES, the Spanish acronym for Encuesta Demográfica y de Salud Familiar) between 2009 and 2018. ENDES reported data from births registered in the five years preceding survey execution. For the years 2009 (n = 10 289) and 2018 (n = 23 077), we calculated the weighted rates of CB among variables such as natural geographic domain (Coast, Andean, or Amazon), area of residence (rural or urban), wealth index quintile (quintile 1 is poorest, and quintile 5 is richest), and educational level. To assess inequalities, we calculated the concentration index (CIs), the slope index of inequality (SII), and the relative index of inequality (RII). RESULTS The CB rates by year were 21.4% (95% confidence interval [CI]: 20.0-22.9) in 2009 and 34.5% (95% CI: 33.4-35.5) in 2018. Women living in urban and coastal regions and with a higher education level had the highest CB rates. All the CIs were positive, reflecting a prowealthy inequality in CB rates, and both SII and RII were positive, indicating a gap between the use of cesarean in women in the higher wealth quintile compared with those in the lower quintile. CONCLUSIONS Cesarean birth rates have increased by 60% during the last decade in Peru. The richest wealth quintiles had the highest CB rates during the study years, which were well above global recommendations.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Guido Bendezu-Quispe
- Centro de Investigación Epidemiológica en Salud Global, Universidad Privada Norbert Wiener, Lima, Peru
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Montilla P, Merzagora F, Scolaro E, Requejo J, Ricciardi W, Meli E, Bazzi A, Vittori G, Bustreo F, Boldi R, Rizzoti M, Merialdi M, Betran AP. Lessons from a multidisciplinary partnership involving women parliamentarians to address the overuse of caesarean section in Italy. BMJ Glob Health 2020; 5:e002025. [PMID: 32133189 PMCID: PMC7042589 DOI: 10.1136/bmjgh-2019-002025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 11/05/2022] Open
Abstract
The increase of caesarean sections (CS) represents a global concern. Interventions tested to reduce unnecessary caesareans have shown limited success to date, partly because they have focused on medical perspectives or on single faceted interventions targeting only one group of stakeholders. Limited attention has been given to examining multidisciplinary and advocacy activities that could reduce unnecessary CS by raising awareness and engaging the media, advocacy groups, healthcare professionals and politicians. In 2009 in Italy, the national CS rate was the highest in Europe and momentum was building for action. This case study includes a description of the activities conducted in Italy during 2009–2012 by a partnership that included the non-governmental organisation Osservatorio Nazionale sulla Salute della Donna, a bipartisan group of Italian women parliamentarians and the WHO. The objectives were to generate awareness about the increase and overuse of CS in Italy, to foster political actions to reverse this trend, to engage with the media and journalists and to better understand women’s birth preferences and needs. A reduction of the CS rate has been observed in Italy following the activities of the initiative from 38.4% in 2009 to 34.2% in 2015 according to the Ministry of Health. Although we cannot infer a casual association between the Partnership and the CS decrease, it did contribute to political momentum and specific actions that should, in theory, have contributed to this reduction. These include the engagement of women parliamentarians for policy change, improved understanding of the local drivers of increases of CS including women’s needs and preferences, raising awareness and working with the media to convey appropriate information and an inclusive strategy giving the opportunity to local stakeholders to make their voices heard. This partnership initiative illustrates a model for generating dialogue, reflection and action in countries showing signs of readiness to address escalating CS.
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Affiliation(s)
| | | | - Elisa Scolaro
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | | - Ana Pilar Betran
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kosan Z, Kavuncuoglu D, Calıkoglu EO, Aras A. Delivery preferences of pregnant women: Do not underestimate the effect of friends and relatives. J Gynecol Obstet Hum Reprod 2019; 48:395-400. [PMID: 30904490 DOI: 10.1016/j.jogoh.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/02/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The mode of delivery is of vital importance to the health of both mother and child. We aimed to determine the preferences of pregnant women for the mode of delivery and the associated factors concerning their choices. METHODS In this descriptive study, a sample size of 418 individuals are needed to calculate an expected prevalence of 45% with an error of margin of 5%, a confidence interval of 95% and considering potential non-respondents of 10%. Sixteen subjects refused to take part in the study, 402 pregnant women presenting to hospitals in Erzurum city center during December 2016 and January 2017 consisted the study group. Distribution percentages were calculated based on the numbers of births in the hospitals. A questionnaire incluiding questions about sociodemographic characteristics, factors that may affect women's delivery preferences, delivery preferences, and the reasons for those preferences was used to collect the data. Data were analyzed on the SPSS 22.0 statistical software. The Chi-Square, Student t-tests and binary logistic regression analysis were used. p < 0.05 was regarded as statistically significant. RESULTS The proportion of cesarean delivery preferences was 69(17.2%). Women's preferences for normal vaginal delivery (NVD) or CS deliveries were significantly affected by the previous type of delivery (p < 0.001), type of pregnancy (natural vs. assisted) (p = 0.021) and problems in CS delivery among friends and relatives (p = 0.009). No statistically significant correlation was observed between delivery preferences and women's age, monthly family income, employment status, age at marriage, duration of the marriage, previous miscarriage, age at first delivery, and possession of information concerning types of delivery (p > 0.05). Multivariate analysis proved cesarean section experience, the presence of cesarean-related problems among relatives and educational status as independent affecting factors. CONCLUSION This investigation demonstrated women in Erzurum prefer substantially vaginal delivery. Family and relatives are essential for decision making, which suggests considering peer education as a method of information delivery.
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Affiliation(s)
- Zahide Kosan
- Department of Public Health, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Duygu Kavuncuoglu
- Department of Public Health, Ataturk University Medical Faculty, Erzurum, Turkey.
| | - Elif Oksan Calıkoglu
- Department of Public Health, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Aysun Aras
- Department of Public Health, Ataturk University Medical Faculty, Erzurum, Turkey
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farhadi Hassankiadeh R, Mehrabian F, Hasanparvar talab Z, Mehdizadeh H. The Choice of Delivery Type and Related Factors in Woman Working at Guilan University of Medical Sciences in 2017-2018. CASPIAN JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.29252/cjhr.4.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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ARDIÇ CÜNEYT. Role of mother education level in delivery method preference. FAMILY PRACTICE AND PALLIATIVE CARE 2018. [DOI: 10.22391/fppc.382429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Di Giacomo M, Piacenza M, Siciliani L, Turati G. Do public hospitals respond to changes in DRG price regulation? The case of birth deliveries in the Italian NHS. HEALTH ECONOMICS 2017; 26 Suppl 2:23-37. [PMID: 28940919 DOI: 10.1002/hec.3541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/17/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
We study how changes in Diagnosis-Related Group price regulation affect hospital behaviour in quasi-markets with exclusive provision by public hospitals. Exploiting a quasi-natural experiment, we use a difference-in-differences approach to test whether public hospitals respond to an exogenous change in Diagnosis-Related Group tariffs by increasing C-section rates and/or by upcoding. Controlling for a detailed set of mother characteristics, we find that price changes did not affect the probability of a C-section. We do however find evidence of upcoding: Conditional on the birth delivery method (either a C-section or a vaginal delivery), public hospitals experiencing the largest price change exhibit a higher probability of treating patients coded as complicated. This finding suggests that even public hospitals may be sensitive to market incentives.
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Affiliation(s)
| | | | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
| | - Gilberto Turati
- Department of Economics and Finance, Catholic University, Rome, Italy
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Cantone D, Pelullo CP, Cancellieri M, Attena F. Can antenatal classes reduce the rate of cesarean section in southern Italy? Women Birth 2016; 30:e83-e88. [PMID: 27686842 DOI: 10.1016/j.wombi.2016.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/07/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Among European Countries, Italy has the highest rate of cesarean section (36.8%), and in the Campania region this rate reaches 60.0%. QUESTION We conducted a retrospective cohort study to evaluate whether participation in antenatal classes during pregnancy reduces the rate of cesarean delivery in southern Italy. METHODS We selected three local health authorities, with the lowest, the highest, and an intermediate rate of cesarean delivery. The study included 1893 mothers who brought their children for vaccination and were interviewed about their participation in antenatal classes and their obstetric history. FINDINGS The main causes of cesarean section given in the interview were clinical indications (61.0%), previous cesarean section (31.0%) and woman's request (8.0%). When we excluded emergency cesarean delivery, we found a moderate association between participation in antenatal classes and cesarean section reduction (relative risk=1.27; 95% CI=1.08-1.49; in percentage values from 49.3% to 38.8%). Private hospitals and the two local health authorities with higher baseline rates of cesarean section showed an enhanced reduction of these rates. CONCLUSION Our paper shows moderate efficacy of antenatal classes, which reduced the occurrence of cesarean section by about 10%. However, the cesarean section rate remained high. As it is possible that different classes have a different level of efficacy, a further study on a standardized model of an antenatal classes is in progress, to assess its efficacy in term of cesarean section reduction, with the purpose of its widespread implementation to the whole region.
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Affiliation(s)
- Daniela Cantone
- Department of Psychology of the Second University of Naples, viale Ellittico 31, 81100 Caserta, Italy
| | - Concetta Paola Pelullo
- School of Hygiene and Preventive Medicine of the Second University of Naples, via Luciano Armanni 5, 80138, Napoli, Italy
| | - Mariagrazia Cancellieri
- School of Hygiene and Preventive Medicine of the Second University of Naples, via Luciano Armanni 5, 80138, Napoli, Italy
| | - Francesco Attena
- Department of Experimental Medicine of the Second University of Naples, via Luciano Armanni 5, 80138, Napoli, Italy.
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Clarke M, Savage G, Smith V, Daly D, Devane D, Gross MM, Grylka-Baeschlin S, Healy P, Morano S, Nicoletti J, Begley C. Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH trial): study protocol for a randomised controlled trial (ISRCTN10612254). Trials 2015; 16:542. [PMID: 26620402 PMCID: PMC4666170 DOI: 10.1186/s13063-015-1061-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The proportion of pregnant women who have a caesarean section shows a wide variation across Europe, and concern exists that these proportions are increasing. Much of the increase in caesarean sections in recent years is due to a cascade effect in which a woman who has had one caesarean section is much more likely to have one again if she has another baby. In some places, it has become common practice for a woman who has had a caesarean section to have this procedure again as a matter of routine. The alternative, vaginal birth after caesarean (VBAC), which has been widely recommended, results in fewer undesired results or complications and is the preferred option for most women. However, VBAC rates in some countries are much lower than in other countries. METHODS/DESIGN The OptiBIRTH trial uses a cluster randomised design to test a specially developed approach to try to improve the VBAC rate. It will attempt to increase VBAC rates from 25 % to 40 % through increased women-centred care and women's involvement in their care. Sixteen hospitals in Germany, Ireland and Italy agreed to join the study, and each hospital was randomly allocated to be either an intervention or a control site. DISCUSSION If the OptiBIRTH intervention succeeds in increasing VBAC rates, its application across Europe might avoid the 160,000 unnecessary caesarean sections that occur every year at an extra direct annual cost of more than €150 million. TRIAL REGISTRATION Current Controlled Trials ISRCTN10612254 , registered 3 April 2013.
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Affiliation(s)
- Mike Clarke
- Northern Ireland Network for Trials Methodology Research, Centre for Public Health, Institute of Clinical Sciences B, Queen's University Belfast, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BJ, UK.
| | - Gerard Savage
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Valerie Smith
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland.
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Declan Devane
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland.
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany.
| | | | - Patricia Healy
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland.
| | - Sandra Morano
- Medical School and Midwifery School, Genoa University, Genoa, Italy.
| | - Jane Nicoletti
- Medical School and Midwifery School, Genoa University, Genoa, Italy.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
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Macfarlane AJ, Blondel B, Mohangoo AD, Cuttini M, Nijhuis J, Novak Z, Ólafsdóttir HS, Zeitlin J. Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG 2015; 123:559-68. [DOI: 10.1111/1471-0528.13284] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Affiliation(s)
- AJ Macfarlane
- Centre for Maternal and Child Health Research; City University London; London UK
| | - B Blondel
- INSERM; Obstetrical Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - AD Mohangoo
- Department of Child Health; TNO; the Netherlands Organisation for Applied Scientific Research; Leiden the Netherlands
| | - M Cuttini
- Research Unit of Perinatal Epidemiology; Bambino Gesù Children's Hospital; Rome Italy
| | - J Nijhuis
- Department of Obstetrics and Gynaecology; GROW School of Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - Z Novak
- Perinatology Unit; University Medical Centre; Llubjana University; Llubjana Slovenia
| | - HS Ólafsdóttir
- Department of Obstetrics and Gynaecology; Landspitali University Hospital; Landspitali v/Hringbraut Iceland
| | - J Zeitlin
- INSERM; Obstetrical Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
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Abbaspoor Z, Moghaddam-Banaem L, Ahmadi F, Kazemnejad A. Iranian mothers' selection of a birth method in the context of perceived norms: A content analysis study. Midwifery 2014; 30:804-9. [DOI: 10.1016/j.midw.2013.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/04/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
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Atan SÜ, Duran ET, Kavlak O, Donmez S, Sevil U. Spontaneous vaginal delivery or caesarean section? What do Turkish women think? Int J Nurs Pract 2013; 19:1-7. [PMID: 23432882 DOI: 10.1111/ijn.12029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe women's feelings, attitudes and beliefs about different modes of childbirth. A descriptive cross-sectional study was conducted at the obstetrics clinics of Ege University and Dr Ekrem Hayri Ustundag Obstetrics and Gynaecology Hospital in Izmir, Turkey. Three-hundred forty-two women who had given birth via spontaneous vaginal delivery (SVD) or caesarean section (C/S) between June and December 2009 voluntarily agreed to participate. Fifty-seven per cent of participants were aged 20-24. Sixty per cent of the women (n = 205) had undergone C/S during their last delivery; among these women, the birth method of 90% (n = 185) was decided by their doctors, whereas the remaining 10% (n = 20) made the decision themselves or with their partners. Sixty-three per cent (n = 250) of women who underwent C/S said that if they gave birth again, they would prefer to deliver via SVD. Eighty-eight per cent (n = 300) of women wanted the legal right to choose their birth method. Although the rate of C/S was high, most women stated that if given the choice, they would prefer a SVD if they had another child.
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Affiliation(s)
- Senay Ünsal Atan
- Department of Gynaecological and Obstetric Nursing, Ege University Nursing Faculty, Izmir, Turkey.
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Torloni MR, Betrán AP, Montilla P, Scolaro E, Seuc A, Mazzoni A, Althabe F, Merzagora F, Donzelli GP, Merialdi M. Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences. BMC Pregnancy Childbirth 2013; 13:78. [PMID: 23530472 PMCID: PMC3621281 DOI: 10.1186/1471-2393-13-78] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 03/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About 20 million cesareans occur each year in the world and rates have steadily increased in almost all middle- and high-income countries over the last decades. Maternal request is often argued as one of the key forces driving this increase. Italy has the highest cesarean rate of Europe, yet there are no national surveys on the views of Italian women about their preferences on route of delivery. This study aimed to assess Italian women's preference for mode of delivery, as well as reasons and factors associated with this preference, in a nationally representative sample of women. METHODS This cross sectional survey was conducted between December 2010-March 2011. An anonymous structured questionnaire asked participants what was their preferred mode of delivery and explored the reasons for this preference by assessing their agreement to a series of statements. Participants were also asked to what extent their preference was influenced by a series of possible sources. The 1st phase of the study was carried out among readers of a popular Italian women's magazine (Io Donna). In a 2nd phase, the study was complemented by a structured telephone interview. RESULTS A total of 1000 Italian women participated in the survey and 80% declared they would prefer to deliver vaginally if they could opt. The preference for vaginal delivery was significantly higher among older (84.7%), more educated (87.6%), multiparous women (82.3%) and especially among those without any previous cesareans (94.2%). The main reasons for preferring a vaginal delivery were not wanting to be separated from the baby during the first hours of life, a shorter hospital stay and a faster postpartum recovery. The main reasons for preferring a cesarean were fear of pain, convenience to schedule the delivery and because it was perceived as being less traumatic for the baby. The source which most influenced the preference of these Italian women was their obstetrician, followed by friends or relatives. CONCLUSION Four in five Italian women would prefer to deliver vaginally if they could opt. Factors associated with a higher preference for cesarean delivery were youth, nulliparity, lower education and a previous cesarean.
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Affiliation(s)
- Maria Regina Torloni
- Obstetrics Department, São Paulo Federal University, São Paulo, Brazil, Rua Borges Lagoa 564, conj. 63, CEP 04038-000, São Paulo, SP, Brazil.
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Do caesarean section rates 'catch-up'? Evidence from 14 European countries. Health Care Manag Sci 2013; 16:328-40. [PMID: 23519946 DOI: 10.1007/s10729-013-9232-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/10/2013] [Indexed: 10/27/2022]
Abstract
This study investigated the catch up effect of Caesarean Section (CS) birth rates across 14 European countries during 1980-2009 for the first time. The panel stationary test incorporating multiple structural breaks and cross-sectional dependence was used to provide reliable evidence for the existence of the catch up effect of CS birth rates. Our results suggested that the CS birth rates in 14 European countries have mostly exhibited signs of convergence through a steady upward trend from 1980 to 2009. Policymakers in low CS birth rate countries should be cautioned concerning the negative impact of the increase of CS births.
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Ma KZM, Norton EC, Lee SYD. Mind the information gap: fertility rate and use of cesarean delivery and tocolytic hospitalizations in Taiwan. HEALTH ECONOMICS REVIEW 2011; 1:20. [PMID: 22828182 PMCID: PMC3403178 DOI: 10.1186/2191-1991-1-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 12/12/2011] [Indexed: 06/01/2023]
Abstract
BACKGROUND Physician-induced demand (PID) is an important theory to test given the longstanding controversy surrounding it. Empirical health economists have been challenged to find natural experiments to test the theory because PID is tantamount to strong income effects. The data requirements are both a strong exogenous change in income and two types of treatment that are substitutes but have different net revenues. The theory implies that an exogenous fall in income would lead physicians to recoup their income by substituting a more expensive treatment for a less expensive treatment. This study takes advantages of the dramatic decline in the Taiwanese fertility rate to examine whether an exogenous and negative income shock to obstetricians and gynecologists (ob/gyns) affected the use of c-sections, which has a higher reimbursement rate than vaginal delivery under Taiwan's National Health Insurance system during the study period, and tocolytic hospitalizations. METHODS The primary data were obtained from the 1996 to 2004 National Health Insurance Research Database in Taiwan. We hypothesized that a negative income shock to ob/gyns would cause them to provide more c-sections and tocolytic hospitalizations to less medically-informed pregnant women. Multinomial probit and probit models were estimated and the marginal effects of the interaction term were conducted to estimate the impacts of ob/gyn to birth ratio and the information gap. RESULTS Our results showed that a decline in fertility did not lead ob/gyns to supply more c-sections to less medically-informed pregnant women, and that during fertility decline ob/gyns may supply more tocolytic hospitalizations to compensate their income loss, regardless of pregnant women's access to health information. CONCLUSION The exogenous decline in the Taiwanese fertility rate and the use of detailed medical information and demographic attributes of pregnant women allowed us to avoid the endogeneity problem that threatened the validity of prior research. They also provide more accurate estimates of PID.JEL Classification: I10, I19, C23, C25.
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Affiliation(s)
- Ke-Zong M Ma
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Declercq E, Young R, Cabral H, Ecker J. Is a rising cesarean delivery rate inevitable? Trends in industrialized countries, 1987 to 2007. Birth 2011; 38:99-104. [PMID: 21599731 DOI: 10.1111/j.1523-536x.2010.00459.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cesarean delivery rates have been rising rapidly in many countries in the last decade. The objective of this research is to examine cesarean rates in industrialized countries and assess patterns in the trends toward increasing rates. METHODS We examined cesarean delivery rates per 1,000 live births from 1987 to 2007 in 22 industrialized countries. To enhance comparability, the inclusion criteria were at least 50,000 births annually and a per capita gross domestic product of at least U.S.$10,000 in 2007. Poisson regression was selected to model the cesarean delivery rates of countries across time. RESULTS We examined overall cesarean delivery rates, absolute changes in these rates, and changes in trend lines for cesarean rates for the period from 1987 to 2007. In 2007, 11 of the 21 countries reported overall cesarean rates of more than 25 percent, led by Italy (39%), Portugal (35%), the United States (32%), and Switzerland (32%). Five countries, the Slovak Republic, Czech Republic, Ireland, Austria, and Hungary more than doubled their cesarean delivery rate between 1992 and 2007. Comparing changes in rates across time periods, 14 countries experienced a greater increase in rates in the period between 1998 and 2002 compared with the period between 1993 and 1997. Comparing trends from 2003-2007 to 1998-2002, eighteen countries experienced a slowing down of rate increases across these two periods. CONCLUSION Although cesarean delivery rates continue to rise, the rate of increase appears to be slowing down in most industrialized countries.
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Affiliation(s)
- Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA
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Shahoei R, Riji HM, Saeedi ZA. 'Safe passage': pregnant Iranian Kurdish women's choice of childbirth method. J Adv Nurs 2011; 67:2130-8. [PMID: 21535090 DOI: 10.1111/j.1365-2648.2011.05656.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This article is a report of a grounded theory study of the influence of emotions on women's selection of a method of childbirth. BACKGROUND There is substantial evidence to indicate that a pregnant woman's emotions play an important role in the decision-making process of selecting a child delivery method. Despite this, however, there is a notable lack of research about the relationship between pregnant women's emotions and their choice of a childbirth method in developing countries. METHODS A qualitative study using the grounded theory approach was conducted. The data were collected from 22 Iranian Kurdish pregnant women in their third trimester using semi-structured interviews. Concurrent data collection and analysis took place between 2008 and 2009. A cumulative process of theoretical sampling and constant comparison was used to identify concepts and then expand, validate, and clarify them. FINDINGS The substantive grounded theory that was identified from data analysis was 'safe passage'. 'Safe passage' involved five phases that were not mutually exclusive in their occurrence. The five phases of the 'safe passage' theory that were identified from the data analysis were: 'safety of baby', 'fear', 'previous experience', 'social support' and 'faith'. The goal of 'safe passage' was to achieve a healthy delivery and to ensure the health of the newborn. CONCLUSION 'Safe passage' was a process used to determine how the emotions of pregnant Iranian Kurdish women influenced their choice of the mode of child delivery. More research is needed in this field to develop a body of knowledge beneficial to midwifery education and practice.
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Affiliation(s)
- Roonak Shahoei
- Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran.
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Mazzoni A, Althabe F, Liu NH, Bonotti AM, Gibbons L, Sánchez AJ, Belizán JM. Women's preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG 2010; 118:391-9. [PMID: 21134103 DOI: 10.1111/j.1471-0528.2010.02793.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The striking increase in caesarean section rates in middle- and high-income countries has been partly attributed to maternal request. We conducted a systematic review and meta-analysis of women's preferences for caesarean section. OBJECTIVES To review the published literature on women's preferences for caesarean section. SEARCH STRATEGY A systematic search of MEDLINE, EMBASE, LILACS and PsychINFO was performed. References of all included articles were examined. SELECTION CRITERIA We included studies that quantitatively evaluated women's preferences for caesarean section in any country. We excluded articles assessing health providers' preferences and qualitative studies. DATA COLLECTION AND ANALYSIS Two reviewers independently screened abstracts of all identified citations, selected potentially eligible studies, and assessed their full-text versions. We conducted a meta-analysis of proportions, and a meta-regression analysis to determine variables significantly associated with caesarean section preference. MAIN RESULTS Thirty-eight studies were included (n = 19,403). The overall pooled preference for caesarean section was 15.6% (95% CI 12.5-18.9). Higher preference for caesarean section was reported in women with a previous caesarean section versus women without a previous caesarean section (29.4%; 95% CI 24.4-34.8 versus 10.1%; 95% CI 7.5-13.1), and those living in a middle-income country versus a high-income country (22.1%; 95% CI 17.6-26.9 versus 11.8%; 95% CI 8.9-15.1). AUTHORS' CONCLUSIONS Only a minority of women in a wide variety of countries expressed a preference for caesarean delivery. Further research is needed to better estimate the contribution of women's demand to the rising caesarean section rates.
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Affiliation(s)
- A Mazzoni
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
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Ferrari J. Preferência pela via de parto nas parturientes atendidas em hospital público na cidade de Porto Velho, Rondônia. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2010. [DOI: 10.1590/s1519-38292010000600020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As parturientes que procuram o Centro Obstétrico do Hospital de Base de Porto Velho, Rondônia, para terem seus filhos são mulheres provenientes das camadas sociais desfavorecidas, ao contrário das mulheres com níveis de renda diferenciados que procuram os médicos em seus consultórios particulares e parem seus filhos por meio de cesarianas com dia e hora previamente marcados. O artigo aborda a questão do aumento da crescente incidência de cesarianas verificado em vários países latinos e também no mundo desenvolvido onde tem motivado necessárias e inadiáveis discussões no campo da Bioética e procura conhecer a opinião das parturientes quanto à via de parto que foram atendidas no Centro Obstétrico do Hospital de Base nos anos de 2006 e 2007.
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Kasai KE, Nomura RM, Benute GR, de Lucia MC, Zugaib M. Women's opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital. Midwifery 2010; 26:319-26. [DOI: 10.1016/j.midw.2008.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 05/17/2008] [Accepted: 08/13/2008] [Indexed: 11/26/2022]
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Buyukbayrak EE, Kaymaz O, Kars B, Karsidag AYK, Bektas E, Unal O, Turan C. Caesarean delivery or vaginal birth: Preference of Turkish pregnant women and influencing factors. J OBSTET GYNAECOL 2010; 30:155-8. [DOI: 10.3109/01443610903461436] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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De Nisi G, Berti M, Malossi R, Pederzini F, Pedrotti A, Valente A. Comparison of neonatal intensive care: Trento area versus Vermont Oxford Network. Ital J Pediatr 2009; 35:5. [PMID: 19490662 PMCID: PMC2687545 DOI: 10.1186/1824-7288-35-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 03/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND S. Chiara hospital is the only neonatal intensive care unit (NICU) in the Province of Trento (Italy). It serves a population of about 460000 people with about 5000 infants per year, admitting the totality of the inborn and outborn VLBWI of the province. The aim of this work is to compare mortality, morbidity and neonatal treatment of the very low birth weight infants (VLBWI) of Trento area with those recorded in the Vermont Oxford Network (VON) during 2004. METHODS In this retrospective analysis, the rates of complications and related treatments reported in VLBWI admitted in the S. Chiara NICU during the period 2000-2005 were compared with those recorded in the VON in 2004. The analysis included both the total populations and different weight groups. RESULTS The frequency of inborn infants was significantly higher in Trento than in VON: 91% vs 84% (MH 8.56; p-value 0.003). The administration of prenatal steroids (82% vs 74%; MH 7.47 and p-value 0.006) and caesarean section were significantly more frequent in the Trento area than in VON. In Trento significantly more VLBWI with BW = 1000 grams were given surfactant prophylaxis compared with VON and significantly fewer VLBWI in every Trento weight group developed RDS (MH 18.55; p-value 0.00001). Overall rates of complications (CLD, PDA, NEC, IVH) were significantly lower than in the Vermont Oxford Network. In CLD and PDA the differences were marked also in infants weighting less than 1000 grams. Overall rates of PNX, PVL, severe grade of ROP and mortality were similar in the two populations. In Trento, significantly more infants were discharged on human milk than in VON, in both the overall population and in BW sub-groups. CONCLUSION On the basis of this analysis, a less aggressive therapeutic strategy based on perinatal prevention in global management, such as that employed in Trento area, may be associated with an improvement in clinical outcomes in very low birth weight infants.
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Affiliation(s)
- Giuseppe De Nisi
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Mariarosaria Berti
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Riccardo Malossi
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Fabio Pederzini
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Anna Pedrotti
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
| | - Alberta Valente
- Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
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Abstract
BACKGROUND The cesarean section rate has increased worldwide over the past 20 years; in Italy, it is now more than 35 percent. Although clinical factors are important, the attitudes of health practitioners toward cesarean section need further investigation to correctly identify facilitators and barriers to changes. The objective of this study was to explore the attitudes toward cesarean section of midwives and obstetricians who worked in the same geographical area. METHODS Face-to-face structured interviews using an adaptation of the Survey of Clinicians' Views on Caesarean Section, an anonymous questionnaire with 35 open and closed answers on practitioners' views on cesarean section, were conducted. The questionnaire was given to the entire group of midwives and obstetricians working in Modena, a northern Italian district. RESULTS Of 262 eligible practitioners, 248 were interviewed (response rate 94.6%). The midwives' attitudes toward cesarean section differed from those of the obstetricians. Sixty-five percent of midwives considered the rates of cesarean section in their hospitals to be too high compared with 34 percent of obstetricians (p < 0.001). Midwives were also less inclined to believe that cesarean section provides benefits to the mother (p = 0.02) or that it is indicated by previous cesarean delivery (p < 0.001). No differences were observed between male and female obstetricians. CONCLUSIONS In this survey, the attitudes toward cesarean section were correlated more with professional role than with gender. This information can help policy makers to shape interventions aimed at providing better care for pregnant and childbearing women.
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Affiliation(s)
- Francesca Monari
- Department of Obstetrics and Gynecology, University Hospital, Modena, Italy
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Resectoscopic Correction of the “Isthmocele” in Women with Postmenstrual Abnormal Uterine Bleeding and Secondary Infertility. J Minim Invasive Gynecol 2008; 15:172-5. [DOI: 10.1016/j.jmig.2007.10.004] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 10/08/2007] [Accepted: 10/13/2007] [Indexed: 11/24/2022]
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Gamble J, Creedy DK, McCourt C, Weaver J, Beake S. A critique of the literature on women's request for cesarean section. Birth 2007; 34:331-40. [PMID: 18021149 DOI: 10.1111/j.1523-536x.2007.00193.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The influence of women's birth preferences on the rising cesarean section rates is uncertain and possibly changing. This review of publications relating to women's request for cesarean delivery explores assumptions related to the social, cultural, and political-economic contexts of maternity care and decision making. METHOD A search of major databases was undertaken using the following terms: "c(a)esarean section" with "maternal request,""decision-making,""patient participation,""decision-making-patient,""patient satisfaction,""patient preference,""maternal choice,""on demand," and "consumer demand." Seventeen papers examining women's preferred type of birth were retrieved. RESULTS No studies systematically examined information provided to women by health professionals to inform their decision. Some studies did not adequately acknowledge the influence of obstetric and psychological factors in relation to women's request for a cesarean section. Other potential influences were poorly addressed, including whether or not the doctor advised a vaginal birth, women's access to midwifery care in pregnancy, information provision, quality of care, and cultural issues. DISCUSSION The psychosocial context of obstetric care reveals a power imbalance in favor of physicians. Research into decision making about cesarean section that does not account for the way care is offered, observe interactions between women and practitioners, and analyze the context of care should be interpreted with caution.
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Affiliation(s)
- Jenny Gamble
- Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Australia
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Tamim H, El-Chemaly S, Nassar A, Mumtaz G, Kaddour A, Kabakian-Khasholian T, Fakhoury H, Yunis K. Incidence and correlates of cesarean section in a capital city of a middle-income country. J Perinat Med 2007; 35:282-8. [PMID: 17542661 DOI: 10.1515/jpm.2007.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence and correlates of cesarean deliveries (CS) in Beirut. METHODS A cross-sectional study conducted on 18,837 consecutive infants born at nine hospitals from the National Collaborative Perinatal Neonatal Network (NCPNN). Stepwise Logistic Regression was performed to determine CS correlates. RESULTS The rate of CS was 26.4% and correlated with socio-demographic, obstetrical and provider-related variables. Regression analysis identified age, paternal occupation, mode of payment, parity, birth weight, gestational age, multiple pregnancies, adequate prenatal care, complications during pregnancy, body mass index at delivery, hospital teaching status, day of the week and year of delivery to be significant correlates of CS. CONCLUSION This study shows an increased CS rate in a middle-income country, and identifies the correlates of women delivering by the abdominal route. These correlates may be used for effective reduction policies in the future.
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Affiliation(s)
- Hala Tamim
- Department of Kinesiology and Health Sciences, York University, Canada
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Fenwick J, Gamble J, Hauck Y. Believing in birth--choosing VBAC: the childbirth expectations of a self-selected cohort of Australian women. J Clin Nurs 2007; 16:1561-70. [PMID: 17655545 DOI: 10.1111/j.1365-2702.2006.01747.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study explored the childbirth expectations and knowledge of women who had experienced a caesarean and would prefer a vaginal birth in a subsequent pregnancy. BACKGROUND Vaginal birth after caesarean is considered best practice. However, in most western world countries, despite the inherent risks of caesarean for both mother and baby, the number of women labouring after a previous caesarean is declining. METHODS Newspaper advertisements were used to recruit Western Australian women who had experienced a caesarean. Thematic analysis was used to analyse the interview data collected from women who attempted a vaginal birth (n=24), or stated they would choose this option, in a subsequent pregnancy (n=11). FINDINGS For this cohort of women, their caesarean experience reinforced their previously held expectations about birthing naturally. The women held strong views about the importance of working with their bodies to achieve a vaginal birth, which was considered an integral part of being a woman and mother. Positive support from family and friends and a reluctance to undergo another caesarean was also influential. Women articulated the risks of caesarean and considered vaginal birth enhanced the health and well-being of the mother and baby, promoted maternal infant connection and the eased the transition to motherhood. CONCLUSION This study documents how the importance of birth, as a significant life event, remained the focus of these women's childbirth expectations influencing future decisions on birth mode and mediating against the 'pressure' of medical discourse promoting caesarean. RELEVANCE TO CLINICAL PRACTICE Knowledge and appreciation of the multiple dimensions that contribute to women's decisions after a caesarean provides valuable information on which service providers and researchers can draw as they investigate interventions that enhance the uptake and success of women birthing vaginally after a caesarean.
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Affiliation(s)
- Jennifer Fenwick
- School of Nursing and Midwifery, Curtin University & King Edward Memorial Hospital, Curtin University of Technology, Perth, WA, Australia.
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Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A. Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG 2007; 114:838-44. [PMID: 17506789 DOI: 10.1111/j.1471-0528.2007.01381.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to determine the feasibility of conducting a randomised controlled trial (RCT) on the use of aromatherapy during labour as a care option that could improve maternal and neonatal outcomes. DESIGN RCT comparing aromatherapy with standard care during labour. SETTING District general maternity unit in Italy. SAMPLE Two hundred and fifty-one women randomised to aromatherapy and 262 controls. METHODS Participants randomly assigned to administration of selected essential oils during labour by midwives specifically trained in their use and modes of application. MAIN OUTCOME MEASURES Intrapartum outcomes were the following: operative delivery, spontaneous delivery, first- and second-stage augmentation, pharmacological pain relief, artificial rupture of membranes, vaginal examinations, episiotomy, labour length, neonatal wellbeing (Apgar scores) and transfer to neonatal intensive care unit (NICU). RESULTS There were no significant differences for the following outcomes: caesarean section (relative risk [RR] 0.99, 95% CI: 0.70-1.41), ventouse (RR 1.5, 95% CI: 0.31-7.62), Kristeller manoeuvre (RR 0.97, 95% CI: 0.64-1.48), spontaneous vaginal delivery (RR 0.99, 95% CI: 0.75-1.3), first-stage augmentation (RR 1.01, 95% CI: 0.83-1.4) and second-stage augmentation (RR 1.18, 95% CI: 0.82-1.7). Significantly more babies born to control participants were transferred to NICU, 0 versus 6 (2%), P = 0.017. Pain perception was reduced in aromatherapy group for nulliparae. The study, however, was underpowered. CONCLUSION This study demonstrated that it is possible to undertake an RCT using aromatherapy as an intervention to examine a range of intrapartum outcomes, and it provides useful information for future sample size calculations.
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Affiliation(s)
- E Burns
- School of Health and Social Care, Oxford Brookes University, Oxford, UK.
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Bortolotti F, Iorio R, Jorio R, Resti M, Cammà C, Marcellini M, Giacchino R, Marazzi MG, Verucchi G, Zancan L, Barbera C, Maggiore G, Vajro P, Giannattasio A, Bartolacci S. Epidemiological profile of 806 Italian children with hepatitis C virus infection over a 15-year period. J Hepatol 2007; 46:783-90. [PMID: 17321633 DOI: 10.1016/j.jhep.2006.12.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 12/28/2006] [Accepted: 12/28/2006] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIMS To evaluate the epidemiological profile of Italian children with hepatitis C virus (HCV) infection over a 15-year period. METHODS Fifteen tertiary care centers, belonging to a national Observatory established in 1998, retrospectively/prospectively recruited 806 consecutive HCV-infected, otherwise healthy, children seen from 1990 to 2004. RESULTS Seven hundred and sixty four were Italian and 42 from foreign countries. Newly-diagnosed cases declined from 332 in 1995-1999 to 196 in 2000-2004, while the proportion of foreign children rose from 3% to 13%. Transfusion-transmitted infection disappeared after 1992. Maternal infection (with drug abuse in 63% of cases in the North) has become the most important mode of HCV diffusion throughout Italy and the exclusive source for all children infected in 2000-2004. The prevalence of HCV genotypes 3 and 4 increased and that of genotype 1b decreased significantly (p<0.02). Male/female ratio was significantly (p<0.001) lower among vertically infected (0.6) than in transfused children (1.3). CONCLUSIONS The number of children with newly-diagnosed HCV infection is declining in Italy and most post-transfusion cases are now young adults. Thus foreign children could significantly contribute to the reservoir of pediatric infection in years to come. New infections result from maternal transmission and seem to privilege females and genotypes 3 and 4.
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Affiliation(s)
- Flavia Bortolotti
- Clinica Medica 5, Medicina Clinica e Sperimentale - University Padua, via Giustiniani 2, 35100 Padua, Italy.
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McCourt C, Weaver J, Statham H, Beake S, Gamble J, Creedy DK. Elective cesarean section and decision making: a critical review of the literature. Birth 2007; 34:65-79. [PMID: 17324181 DOI: 10.1111/j.1523-536x.2006.00147.x] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The cesarean section rate continues to rise in many countries with routine access to medical services, yet this increase is not associated with improvement in perinatal mortality or morbidity. A large number of commentaries in the medical literature and media suggest that consumer demand contributes significantly to the continued rise of births by cesarean section internationally. The objective of this article was to critically review the research literature concerning women's preference or request for elective cesarean section published since that critiqued by Gamble and Creedy in 2000. METHODS A search of key databases using a range of search terms produced over 200 articles, of which 80 were potentially relevant. Of these, 38 were research-based articles and 40 were opinion-based articles. A total of 17 articles fitted the criteria for review. A range of methodologies was used, with varying quality, making meta-analysis of findings inappropriate, and simple summaries of results difficult to produce. RESULTS The range and quality of studies had increased since 2001, reflecting continuing concern. Women's preference for cesarean section varied from 0.3 to 14 percent; however, only 3 studies looked directly at this preference in the absence of clinical indications. Women's preference for a cesarean section related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors. CONCLUSIONS Research between 2000 and 2005 shows evidence of very small numbers of women requesting a cesarean section. A range of personal and societal reasons, including fear of birth and perceived inequality and inadequacy of care, underpinned these requests.
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Affiliation(s)
- Chris McCourt
- Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom
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Kingdon C, Baker L, Lavender T. Systematic review of nulliparous women's views of planned cesarean birth: the missing component in the debate about a term cephalic trial. Birth 2006; 33:229-37. [PMID: 16948723 DOI: 10.1111/j.1523-536x.2006.00108.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The suggestion that planned cesarean birth is gaining acceptance among women has led some physicians to advocate the need for a trial of primary planned cesarean section versus planned vaginal birth in healthy women with singleton cephalic pregnancies at term. This paper reviews published studies of nulliparous women's views of mode of birth collected in the antenatal period, examining why women may express a preference for cesarean birth and exploring implications for the debate about the need for a trial. METHODS A systematic literature review was undertaken of Cochrane, CINAHL, EMBASE, MEDLINE, and PsycINFO using the MeSH heading "cesarean section" and four free text spellings of "cesarean," or "birth" or "delivery," near truncated synonyms of 17 words meaning expressed preference. Studies of nulliparous women with a medical indication for cesarean birth, studies where a woman's preference for mode of birth was reported in the postpartum period, surveys of midwives or obstetricians, and opinion and non-English language papers were all excluded. RESULTS Nine papers were included in the review, which reported rates of women expressing a preference for cesarean birth that ranged from 0 to 100 percent at recruitment. However, the papers raised specific methodological, conceptual, and cultural issues that may have influenced women's preferences for mode of birth in the populations studied. These issues included the timing and frequency of data collection, complexity of factors determining individual women's decision making, and influence of societal norms. CONCLUSIONS Little evidence is available that an increasing cultural acceptance of cesarean delivery will bring about support for a trial among pregnant nulliparous women. Further qualitative research investigating the influence of both obstetric and psychosocial factors on women's views of vaginal and cesarean birth is required.
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Affiliation(s)
- Carol Kingdon
- Department of Midwifery Studies, University of Central Lancashire, Preston, Lancashire, UK
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Abstract
OBJECTIVE To study factors related to preference for cesarean delivery, among pregnant women without medical complications. METHODS A cross-sectional study was carried out among 156 pregnant women, in a private clinic in the city of Osasco, State of São Paulo, from October 2000 to December 2001. The pregnant women were at 28 weeks of pregnancy or more, with no formal contraindication for vaginal delivery at the time of the interview. Sociodemographic data and past and present obstetric history were assessed by applying a questionnaire. The pregnant women were specifically asked what their current preference for delivery was. Pearson's Chi-square test and logistic regression for multivariate analysis were performed with a 5% significance level. RESULTS Sixty-seven pregnant women (42.9%) said they had little motivation to undergo vaginal delivery. In the multivariate analysis, the following variables were statistically significant: previous vaginal birth (p=0.001; ORadj=0.04; 95% CI=0.01-0.12); husband's monthly income greater than 750 reais (p=0.006, ORadj=3.44; 95% CI=1.38-8.33). The women with a previous vaginal delivery presented 25-fold lower chance of choosing cesarean delivery. The opinion that the previous delivery experience was unsatisfactory was marginally associated with the main outcome (p=0.06; ORadj=0.42; 95% CI=0.16-1.05). CONCLUSIONS Motivation for cesarean delivery is associated with influences such as the type and degree of satisfaction with previous delivery and income.
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Affiliation(s)
- Alexandre Faisal-Cury
- Núcleo de Epidemiologia, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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Abstract
UNLABELLED Primary elective cesarean performed on a patient's request now comprises 4% to 18% of all cesareans and 14% to 22% of elective cesareans in reported series. Patients most commonly choose cesarean because of tocophobia, or fear of childbirth. Almost two thirds of obstetricians surveyed are willing to perform cesarean on request, citing decreased risk of pelvic floor or fetal injury, maintenance of sexual functioning, and physician and patient convenience. Contrasting these beliefs are the limited available data on short- and long-term maternal and perinatal morbidity and mortality that generally favor vaginal delivery. Moreover, comprehensive economic impact assessments of cesarean on request are lacking, and professional organizations do not agree on the ethics of offering patient choice cesarean. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to list the reasons that women and obstetricians choose elective cesarean delivery, to outline the ethical aspects of cesarean delivery, and to describe the material and fetal morbidity and mortality associated with cesarean delivery compared to vaginal delivery.
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Abstract
BACKGROUND In South Korea, cesarean section rates (i.e., the proportion of all live births delivered by cesarean section) approached 40 percent in 2000. The relative contribution of physicians and women to this high rate has been a source of debate. This study explored attitudes toward mode of delivery among South Korean women. METHODS A nationwide cross-sectional telephone survey of 505 Korean women aged 20 to 49 years was conducted using a proportionate quota and systematic random sampling method. The response rate was 57.3 percent. Data were collected using a structured questionnaire consisting of 7 questions about vaginal and cesarean delivery. RESULTS Over 95 percent of women preferred vaginal delivery during pregnancy and were willing to recommend this method to others. Of the women who delivered by cesarean section, 10.6 percent stated that they had requested a cesarean birth. Attitudes toward vaginal or cesarean delivery differed significantly according to a woman's education level. CONCLUSIONS Most study participants showed more favorable attitudes toward vaginal delivery than cesarean delivery. This result does not support the assumption that the upsurge of cesarean section rates in South Korea is associated with women's positive attitudes toward cesarean section. The main cause of the rapid rise of cesarean section rates in South Korea during the past two decades have its origins in health care practitioners and the health care system in which they work.
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Affiliation(s)
- Sang-Il Lee
- Departmrnt of Preventive Medicine, University of Ulsan College of Medicine, 388-1 Pungnap-2Dong, Songpa-Gu, Seoul 138-736, Korea
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