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Striebich S, Ayerle GM. Fear of childbirth (FOC): pregnant women's perceptions towards the impending hospital birth and coping resources - a reconstructive study. J Psychosom Obstet Gynaecol 2020; 41:231-239. [PMID: 32838630 DOI: 10.1080/0167482x.2019.1657822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: To provide obstetric care which meets the needs of pregnant women with fear of childbirth (FOC), a deeper understanding is required of the beliefs of these women regarding their impending birth and the coping resources they possess to cope with their fear.Methods: Problem-centred interviews were carried out with 12 pregnant women who self-reported high FOC. Data analysis was performed using Bohnsack's Documentary Method to reconstruct collective frames of orientation and implicit and explicit orientations in daily practice and interaction.Results: The interviewees see birth as a field of tension between the poles of naturalness and medicalization. Their need for information displays a need to be in control and fear of losing control. Medical and technological monitoring and one-to-one care promote security. Pregnant women with FOC want to know how they can contribute to a physiological birth.Conclusions: Structural, organizational and conceptual changes in obstetric care are needed to cater to the needs of pregnant women with FOC. Alongside the need for evidence-based information about non-medical and medical pain-relief as well as decision-making aids, the provision of a continuity model of midwifery care is important.
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Affiliation(s)
- Sabine Striebich
- Medical Faculty, Institute for Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Gertrud M Ayerle
- Medical Faculty, Institute for Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
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Eide KT, Morken NH, Bærøe K. Maternal reasons for requesting planned cesarean section in Norway: a qualitative study. BMC Pregnancy Childbirth 2019; 19:102. [PMID: 30922267 PMCID: PMC6440101 DOI: 10.1186/s12884-019-2250-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature. In order to find adequate, targeted treatment and preventive strategies, we need a better understanding of this phenomenon. The aim of this study is to provide a qualitative exploration of maternal requests for a planned cesarean section in Norway, in the absence of obstetric indications. Methods A descriptive qualitative study was conducted consisting of 17 semi-structured, in-depth interviews with women requesting cesarean section and six focus group discussions with 20 caregivers (nine midwives, 11 obstetricians) working at a university hospital in Norway. Data were analyzed with Systematic Text Condensation, a method for thematic cross-case analysis. Results Fear of birth emerged most commonly as a result of a previous traumatic birth experience that prompted a preference for a planned cesarean to avoid a repetition of the trauma. For some women in our study, postnatal care and the puerperal period were their crucial past experiences, and giving birth by planned cesarean was seen as a way to ensure mental rather than physical capability to care for the expected child after birth. Others were under the impression of being at high risk for an emergency C-section, and requesting a planned one was based on their perceived risk. Such perceptions included having a narrow pelvis, hereditary factors or previous birth outcomes. Some primiparas requested a planned cesarean based on a deep-seated fear since their early teens, accompanied by alienation towards the idea of giving birth. Some obstetricians participating in our study also experienced requests that lacked what they regarded as any well-grounded reason or significant fear. Conclusions Behind a maternal request for a planned cesarean section are various rationales and life experiences needing carefully targeted attention and health care. Previous births are an important driver; thus, maternally requested cesareans should be regarded partly as an iatrogenic problem. Electronic supplementary material The online version of this article (10.1186/s12884-019-2250-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristiane Tislevoll Eide
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway.
| | - Nils-Halvdan Morken
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Jonas Lies veg 87, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway
| | - Kristine Bærøe
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway
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Arnon Z, Dor A, Bazak H, Attias S, Sagi S, Balachsan S, Schiff E. Complementary medicine for laboring women: a qualitative study of the effects of reflexology. ACTA ACUST UNITED AC 2018; 16:jcim-2018-0022. [DOI: 10.1515/jcim-2018-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/28/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Despite pharmacological interventions, labor pain and anxiety still remain a challenge, and can carry long-term psychological complications. The goal of this study was to assess the effect of reflexology on these symptoms and to explore the physical and psychological components of women’s experience associated with this treatment.
Methods
This qualitative study was conducted in an Israeli university hospital that offers integrative medicine services. Reflexology was offered to laboring women in the hospital, by the medical staff. In-depth, open interviews were conducted with 36 women, still in hospital, who consented to be interviewed, within 48 h after delivery. Questions referred to their labor experience with reflexology treatment.
Results
Of the 36 participants, 34 (94%) described a positive and empowering experience. They reported reduced pain and anxiety, and an increased sense of self-efficacy brought about by the ability to become active and manage labor.
Conclusions
Using reflexology as one of the complementary medicine treatment available can contribute greatly to the entire labor experience as it empowers women and increases self-confidence and ability to self-manage labor and delivery.
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Affiliation(s)
- Zahi Arnon
- Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
| | - Asnat Dor
- Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
- Department of Education , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
| | - Hadar Bazak
- Outstanding Students’ Program – Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
| | - Samuel Attias
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
- School of public Health , University of Haifa , Haifa , Israel
| | - Shlomi Sagi
- Department of Obstetrics and Gynecology , Bnai Zion Medical Center , Haifa , Israel
| | | | - Elad Schiff
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
- Faculty of Medicine , Technion – Israel Institute of Technology , Haifa , Israel
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Striebich S, Mattern E, Ayerle GM. Support for pregnant women identified with fear of childbirth (FOC)/tokophobia - A systematic review of approaches and interventions. Midwifery 2018; 61:97-115. [PMID: 29579696 DOI: 10.1016/j.midw.2018.02.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/20/2018] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND providing appropriate care for pregnant women with high or severe fear of childbirth (FOC) is a challenge in midwifery care today. FOC is associated with predisposing anamnestic factors, various sociodemographic and psychosocial characteristics, and may result in serious healthrelated consequences. It is therefore important to establish which interventions may increase a woman's faith in her own ability to cope with labour and birth. AIM to systematically identify and review studies examining interventions for relief of severe fear of childbirth in pregnancy and their underlying conceptual foundation. METHODS a systematic literature search was performed following Cochrane Collaboration and PRISMA Statement recommendations. Inclusion criteria were: studies including pregnant women diagnosed with high or severe FOC or who requested a caesarean section due to severe FOC, studies (regardless of design) observing the effect of an intervention addressing FOC, and studies published in English. Publications addressing anxiety or stress were excluded. 377 references were screened by title and abstract. The risk of bias was assessed. FINDINGS 19 articles referring to 15 research projects were included in the analysis. The studies show heterogeneity regarding assessment methods, type, conceptualisation and application of interventions. There is evidence that both cognitive therapy sessions and a theory-based group psychoeducation with relaxation are effective interventions. KEY CONCLUSIONS despite methodological limitations, single or group psychoeducation sessions for nulliparous women or therapeutic conversation during pregnancy (in group or individual sessions) have the potential to strengthen women's self-efficacy and decrease the number of caesarean sections due to FOC. The theoretical validation of an intervention deepens the understanding of psychological processes in women coping with severe FOC. IMPLICATIONS FOR PRACTICE theory-based concepts of care for both antenatal and intrapartum support of pregnant women with high or severe FOC should be developed, piloted, tested, evaluated and implemented within the given healthcare system. Midwives need to be competent to address pregnant women's fears regarding labour and birth in antenatal care. The use of a valid assessment tool to identify the level of FOC in women, even if they do not raise the issue, is recommended in routine antenatal care so that appropriate expert support can be offered. A one-on-one conversation may be feasible for those women unwilling to fill in a questionnaire. Cooperative local networks between midwives, psychologists and obstetricians qualified in psychotherapy should be established to ensure timely and effective care for women with high or severe FOC.
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Affiliation(s)
- Sabine Striebich
- Institute for Health and Nursing Sciences, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Elke Mattern
- Department of Applied Health Sciences, University of Applied Sciences, Gesundheitscampus 6-8, 44801 Bochum Germany.
| | - Gertrud M Ayerle
- Institute for Health and Nursing Sciences, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
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Câmara R, Burlá M, Ferrari J, Lima L, Amim J, Braga A, Rezende J. Cesarean section by maternal request. Rev Col Bras Cir 2017; 43:301-10. [PMID: 27679953 DOI: 10.1590/0100-69912016004002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/09/2016] [Indexed: 11/22/2022] Open
Abstract
Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks. RESUMO A cesariana a pedido materno é aquela realizada em uma gestante sem indicações médicas e sem contraindicação para tentativa do parto vaginal. Existe grande controvérsia sobre a realização da cesariana a pedido. Riscos potenciais da cesariana a pedido incluem complicações em gravidezes subsequentes, tais como: rotura uterina, placenta prévia e acretismo. Potenciais benefícios da cesariana a pedido englobam um menor risco de hemorragia pós-parto na primeira cesariana e menos complicações cirúrgicas quando comparada ao parto vaginal. A cesariana a pedido jamais deve ser realizada antes de 39 semanas.
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Affiliation(s)
- Raphael Câmara
- - Institute of Gynecology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcelo Burlá
- - Department of Maternal and Child Care, Faculty of Medicine, Federal Fluminense University, Niteroi, RJ, Brazil.,- Society of Gynecology and Obstetrics of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Ferrari
- - Federal University of Rondônia, Porto Velho, RO, Brazil
| | - Lana Lima
- - Department of Obstetrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Joffre Amim
- - Department of Obstetrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Antonio Braga
- - Department of Maternal and Child Care, Faculty of Medicine, Federal Fluminense University, Niteroi, RJ, Brazil.,- Department of Obstetrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jorge Rezende
- - Department of Obstetrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Huser M, Janku P, Hudecek R, Zbozinkova Z, Bursa M, Unzeitig V, Ventruba P. Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas. Int J Gynaecol Obstet 2017; 137:170-173. [PMID: 28171703 DOI: 10.1002/ijgo.12116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/09/2016] [Accepted: 02/03/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery. METHODS In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated. RESULTS Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 ± 3.6 in the vaginal group and 1.0 ± 2.7 in the cesarean group (P=0.005). The mean POP scores (POPDI-6) were 2.2 ± 2.3 and 2.1 ± 2.0, respectively (P=0.944). The mean Wexner scores to evaluate FI were 1.3 ± 1.7 and 1.0 ± 1.5, respectively (P=0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42). CONCLUSION Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery. ClinicalTrials.gov: NCT02661867.
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Affiliation(s)
- Martin Huser
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Petr Janku
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Robert Hudecek
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Masaryk University Medical School, Brno, Czech Republic
| | - Miroslav Bursa
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, Prague, Czech Republic
| | - Vit Unzeitig
- Department of Obstetrics and Gynecology, University Hospital Ostrava and University of Ostrava Medical School, Ostrava, Czech Republic
| | - Pavel Ventruba
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
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