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Calpbinici P, Uzunkaya Öztoprak P, Terzioğlu F, Üstün Y. The Fathers' Fear of Childbirth Scale: a Turkish validity and reliability study. J Reprod Infant Psychol 2024; 42:424-438. [PMID: 37309993 DOI: 10.1080/02646838.2023.2225084] [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: 12/06/2022] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Fathers' Fear of Childbirth Scale (FFCS) was developed specifically to measure fathers' fear of childbirth. The aim of this study was to investigate the Turkish validity and reliability of the FFCS. DESIGN This study used a cross-sectional and methodological design. METHODS The population of the study consists of 315 pregnant spouses who were registered at a hospital in Ankara, Turkey, between August 11 and 5 November 2021. The mean age of expectant fathers are 31.57 (5.88). After translating the FFCS to Turkish, a confirmatory factor analysis was conducted to examine its construct validity. Concurrent validity was established by examining the correlation between the FFCS-Turkish with the Fear of Birth Scale (FOBS) and the male version of the Childbirth Fear-Prior to Pregnancy scale (M-CFPP). Both internal consistency and test-retest reliability were examined for the FFCS-Turkish. Results: The scope validity index of the scale was found to be 0.96. Based on the results of confirmatory factor analysis, a two-factor structure with 17 items was verified. The fit indices were found to be χ2 = 309.610, χ2/df = 2.76, root mean square error = 0.075, goodness of fit index = 0.89, comparative fit index = 0.93, and adjusted goodness of fit index = 0.86. All fit indices were at good levels. A strong correlation was found between the FFCS and the FOBS and M-CFPP scales within the scope of concurrent validity. Cronbach's alpha reliability coefficient for the entire scale was 0.93. The test-retest reliability was also high. CONCLUSIONS The FFCS is a valid and reliable scale and measurement tool that can be used on Turkish expectant fathers.
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Affiliation(s)
- Pelin Calpbinici
- Department of Obstetrics and Gynecology Nursing, Nevşehir Hacı Bektaş Veli University, Semra and Vefa Küçük Faculty of Health Sciences, Nevsehir, Turkiye
| | - Pınar Uzunkaya Öztoprak
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkiye
| | | | - Yaprak Üstün
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkiye
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Lan Q, Fu ACL, McKay MJ, Simic M, Castrillon CM, Wei Y, Ferreira P. The association between musculoskeletal pain during pregnancy and pregnancy outcomes: A systematic review and meta-analyses. Eur J Obstet Gynecol Reprod Biol 2024; 294:180-190. [PMID: 38286038 DOI: 10.1016/j.ejogrb.2024.01.027] [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: 07/03/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To systematically investigate the association between musculoskeletal pain during pregnancy and birth outcomes including caesarean section, newborn birthweight, newborn birth length, and gestational age at birth. METHODS Medline, Embase, Web of Science, Cinahl and Scopus were systematically searched to identify eligible studies. Odds ratios, mean differences, and confidence intervals were used to describe results. Risk of Bias was assessed using the Newcastle-Ottawa Scale for observational studies. GRADE (The Grading of Recommendation Assessment, Development, and Evaluation) was used to assess the quality of each outcome. RESULTS Seven studies were included with a total population of 85,991 participants. There is low- quality evidence that pregnant women with musculoskeletal pain had 1.59 greater odds to experience delivery by caesarean section compared to those without musculoskeletal pain ([OR] 1.59, 95 % confidence interval [CI] 1.09 to 2.31). Both newborn birth weight (Mean Difference [MD] 77.79 g, 95 % [CI] -23.09 to 178.67) and newborn birth length ([MD] 0.55 cm, 95 % [CI] -0.47 to 1.56) were not affected by musculoskeletal pain, with very low-quality and low-quality evidence, respectively. There was moderate evidence that pregnant women with musculoskeletal pain had shorter gestational age (weeks), although the effect was small and possibly not clinically relevant ([MD] -0.41, 95 % [CI] -0.41 to -0.07). CONCLUSION Pregnant women experiencing musculoskeletal pain are at greater odds of delivering their babies via caesarean than those without musculoskeletal pain, however, musculoskeletal pain during pregnancy does not appear to affect newborn birth weight, length, or gestational age at birth.
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Affiliation(s)
- Qianwen Lan
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Allan Chak Lun Fu
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Marnee J McKay
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Carlos Mesa Castrillon
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
| | - Yuanye Wei
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, China.
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre Musculoskeletal Research Group, The University of Sydney, Australia.
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Vila Ortiz M, Gialdini C, Hanson C, Betrán AP, Carroli G, Mølsted Alvesson H. A bit of medical paternalism? A qualitative study on power relations between women and healthcare providers when deciding on mode of birth in five public maternity wards of Argentina. Reprod Health 2023; 20:122. [PMID: 37605278 PMCID: PMC10440876 DOI: 10.1186/s12978-023-01661-5] [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: 05/13/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Whether women should be able to decide on mode of birth in healthcare settings has been a topic of debate in the last few decades. In the context of a marked increase in global caesarean section rates, a central dilemma is whether pregnant women should be able to request this procedure without medical indication. Since 2015, Law 25,929 of Humanised Birth is in place in Argentina. This study aims at understanding the power relations between healthcare providers, pregnant women, and labour companions regarding decision-making on mode of birth in this new legal context. To do so, central concepts of power theory are used. METHODS This study uses a qualitative design. Twenty-six semi-structured interviews with healthcare providers were conducted in five maternity wards in different regions of Argentina. Participants were purposively selected using heterogeneity sampling and included obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. Reflexive thematic analysis was used to inductively develop themes and categories. RESULTS Three themes were developed: (1) Healthcare providers reconceptualize decision-making processes of mode of birth to make women's voices matter; (2) Healthcare providers feel powerless against women's request to choose mode of birth; (3) Healthcare providers struggle to redirect women's decision regarding mode of birth. An overarching theme was built to explain the power relations between healthcare providers, women and labour companions: Healthcare providers' loss of beneficial power in decision-making on mode of birth. CONCLUSIONS Our analysis highlights the complexity of the healthcare provider-woman interaction in a context in which women are, in practice, allowed to choose mode of birth. Even though healthcare providers claim to welcome women being an active part of the decision-making processes, they feel powerless when women make autonomous decisions regarding mode of birth. They perceive themselves to be losing beneficial power in the eyes of patients and consider fruitful communication on risks and benefits of each mode of birth to not always be possible. At the same time, providers perform an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place.
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Affiliation(s)
- M Vila Ortiz
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
| | - C Gialdini
- Facultad de Ciencias de la Salud Blanquerna, Universidad Ramón Llull, Barcelona, Spain
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - C Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - A P Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - G Carroli
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - H Mølsted Alvesson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Serçekuş P, Vardar O, Göral Türkçü S, Özkan S. Why are first time expectant fathers afraid of birth? : A qualitative study. Eur J Obstet Gynecol Reprod Biol 2020; 254:231-235. [PMID: 33011506 DOI: 10.1016/j.ejogrb.2020.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the fears associated with childbirth among first time expectant fathers and the reasons for these fears. STUDY DESIGN A descriptive, phenomenological approach was used. The sampling was composed of 16 men who were first time expectant fathers, who were at least primary school graduates, who were 18 years of age or older, whose partner was in her final trimester week of pregnancy, who did not have any psychiatric problems and who stated that they had a fear of childbirth. RESULTS The data were collected under the two main themes of fears about childbirth and the reasons for the fears. It was found that the expectant fathers had fears associated with the complications that could develop during childbirth and with the health personnel. CONCLUSIONS There were various fears associated with childbirth among expectant fathers. The reasons for the fears were mostly the negative stories heard. Health personnel have important duties in defining and decreasing the fears of expectant fathers associated with childbirth. It should not be forgotten that expectant fathers are also a part of childbirth in antenatal education.
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Affiliation(s)
- Pınar Serçekuş
- Pamukkale University, Faculty of Health Sciences, Denizli, Turkey.
| | - Okan Vardar
- Pamukkale University, Faculty of Health Sciences, Denizli, Turkey
| | | | - Sevgi Özkan
- Pamukkale University, Faculty of Health Sciences, Denizli, Turkey.
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Du SG, Tang F, Zhao Y, Sun GQ, Lin Y, Tan ZH, Wu XF. Effect of China's Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China. Curr Med Sci 2020; 40:348-353. [PMID: 32337696 DOI: 10.1007/s11596-020-2190-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 02/04/2020] [Indexed: 10/24/2022]
Abstract
China's universal two-child policy was released in October of 2015. How would this new policy influence the rate of overall cesarean delivery (CD) in China? The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China (a tertiary hospital) in 2016. In this study, 22 530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were enrolled as research objects. Electronic health records of these selected objects were retrieved. According to the history of childbirth, the selected cases were divided into primiparous group containing 16 340 cases and multiparous group containing 6190 cases. Chi-square test was carried out to compare the rate of CD, neuraxial labor analgesia, maternity insurance between the two groups; t-test was performed to compare the in-hospital days and gestational age at birth between the two groups. Pearson correlation coefficient was used to evaluate the relationship among observed monthly rate of multiparas, overall CD rate, and Elective Repeat Cesarean Delivery (ERCD) rate. The results showed that the CD rate in multiparous group was 55.46%, which was higher than that in primiparous group (34.66%, P<0.05). The rate of neuraxial labor analgesia in multiparas group was 9.29%, which was lower than that in primiparas group (35.94%, P<0.05). However, the rate of maternity insurance was higher in multiparas group (57.00%) than that in primiparas group (41.08%, P<0.05). The hospital cost and in-hospital days in multiparas group were higher, and the gestational age at birth in multiparas group was lower than in primiparas group (P<0.05). The overall CD rate slightly dropped in the first 4 months of the year (P<0.05), then increased from 36.27% (April) to 43.21% (December) (P<0.05). The rate of multiparas women and ERCD had the same trend (P<0.05). There were linear correlations among the rate of overall CD, the rate of multiparas women and the rate of ERCD rate (P<0.05). With the opening of China's two-child policy, the increasing rate of overall CD is directly related with the high rate of ERCD. Trials of Labor After Cesarean Section (TOLAC) in safe mode to reduce overall CD rate are warranted in the future.
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Affiliation(s)
- Shu-Guo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Fei Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Guo-Qiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ying Lin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Zhi-Hua Tan
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Xu-Feng Wu
- Department of Gynecology and Oncology, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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Solé E, Roca A, Torres A, Hernández AS, Fernández N, Díaz CN, Vieta E, Garcia-Esteve L. Obstetric complications in bipolar disorder: Psychiatric factors and the risk of caesarean section. Eur Neuropsychopharmacol 2020; 32:47-55. [PMID: 31911063 DOI: 10.1016/j.euroneuro.2019.12.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
Bipolar Disorder (BD) is a chronic psychiatric condition with somatic morbidity that requires continuous mood stabilizing treatment to prevent relapses. Pregnant women with BD have shown an increased rate of caesarean section (C-Section) in comparison with women without BD. Because specific differentiated profiles between mothers with BD that require C-Section and those that do not require C-Section have not been largely discussed, we aim to explore the risk factors associated with the type of delivery in pregnant women with BD. A prospective cohort study was conducted at the Perinatal Mental Health Unit. 100 pregnant women with BD were followed throughout their pregnancy by obstetric and psychiatric services at the same hospital. The cohort was developed in order to compare psychiatric and obstetric outcomes between women with BD that required C-Section (N = 40) versus women that did not require C-Section (N = 60). Final regression models showed an increased risk for obstetric complications during labour (OR 4,52, 95% CI 1,66-12,29), higher rates of hypothyroidism (OR 3,73, 95% CI 1,04-13,73) and treatment with lithium + antidepressant (OR 4,24, 95% CI 1,34-13,40) amongst the C-Section group when compared to the non-C-Section group. In our sample, women with BD treated with lithium plus antidepressant, with hypothyroidism and without obstetric complications have a 70,5% probability of C-Section. In conclusion, psychopharmacology and thyroid function might help understanding which women with BD will have more probability of C-Section. The implementation of more targeted interventions in selected patients might be useful to avoid complications during delivery.
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Affiliation(s)
- Eva Solé
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Bipolar and Depressives Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Alba Roca
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
| | - Anna Torres
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
| | - Ana Sandra Hernández
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Noemí Fernández
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Carmen Naranjo Díaz
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressives Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
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Solé E, Torres A, Roca A, Hernández AS, Roda E, Sureda B, Martin-Santos R, Vieta E, Garcia-Esteve L. Obstetric complications in bipolar disorder: The role of mental health disorders in the risk of caesarean section. J Affect Disord 2019; 252:458-463. [PMID: 31004826 DOI: 10.1016/j.jad.2019.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies' health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population. METHODS A case-control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section. RESULTS Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4-1,6). Case group had more somatic illness (SI) without treatment (P<, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P<, 001), obstetric complications during labour (P<,001), and SI with and without treatment (P<,001 and P=,007, respectively) were higher in women that required C- section. CONCLUSION Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.
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Affiliation(s)
- Eva Solé
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain; Bipolar Disorder Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Anna Torres
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Alba Roca
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Ana Sandra Hernández
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ester Roda
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Bàrbara Sureda
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Rocío Martin-Santos
- Vulnerability, Psychopathology and Gender research group, Generalitat de Catalunya, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender research group, Generalitat de Catalunya, Catalonia, Spain
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Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, Zhang J, Musana O, Wanyonyi SZ, Gülmezoglu AM, Downe S. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet 2018; 392:1358-1368. [PMID: 30322586 DOI: 10.1016/s0140-6736(18)31927-5] [Citation(s) in RCA: 303] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm. Worldwide, the frequency of CS continues to increase, and interventions to reduce unnecessary CSs have shown little success. Identifying the underlying factors for the continuing increase in CS use could improve the efficacy of interventions. In this Series paper, we describe the factors for CS use that are associated with women, families, health professionals, and health-care organisations and systems, and we examine behavioural, psychosocial, health system, and financial factors. We also outline the type and effects of interventions to reduce CS use that have been investigated. Clinical interventions, such as external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after CS, could reduce the frequency of CS use. Approaches such as labour companionship and midwife-led care have been associated with higher proportions of physiological births, safer outcomes, and lower health-care costs relative to control groups without these interventions, and with positive maternal experiences, in high-income countries. Such approaches need to be assessed in middle-income and low-income countries. Educational interventions for women should be complemented with meaningful dialogue with health professionals and effective emotional support for women and families. Investing in the training of health professionals, eliminating financial incentives for CS use, and reducing fear of litigation is fundamental. Safe, private, welcoming, and adequately resourced facilities are needed. At the country level, effective medical leadership is essential to ensure CS is used only when indicated. We conclude that interventions to reduce overuse must be multicomponent and locally tailored, addressing women's and health professionals' concerns, as well as health system and financial factors.
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Affiliation(s)
- Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carol Kingdon
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Abdu Mohiddin
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Newton Opiyo
- Review Production and Quality Unit, Cochrane, London, UK
| | - Maria Regina Torloni
- Postgraduate Program on Evidence-Based Healthcare, São Paulo Federal University, São Paulo, Brazil
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Othiniel Musana
- Uganda Martyrs University, St Francis Hospital Nsambya, Kampala, Uganda
| | - Sikolia Z Wanyonyi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Ahmet Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, Betran AP. Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in China: A mixed-methods systematic review. PLoS Med 2018; 15:e1002672. [PMID: 30325928 PMCID: PMC6191094 DOI: 10.1371/journal.pmed.1002672] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND China has witnessed a rapid increase of cesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and reasons for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs, which are those performed in the absence of medical indications. METHODS AND FINDINGS We conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, and one Chinese database (CNKI) using a combination of the key terms 'caesarean section', 'preference', 'choice', 'knowledge', 'attitude', 'culture', 'non-clinical factors', and 'health professionals-patient relations' between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%-17%) and 21% in late pregnancy (95% CI 15%-26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%-20%), 22% in late pregnancy (95% CI 18%-25%), and 30% postpartum (95% CI 19%-40%). Women's preferences for CS were found to rise as pregnancy progressed (preference change across longitudinal studies: mean difference 7%, 95% CI 1%-13%). One longitudinal study reported that the preference for CS among women's partners increased from 8% in late pregnancy to 17% in the immediate postpartum period. In addition, 18 quantitative studies revealed that some pregnant women, ranging from 4% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy. The qualitative meta-synthesis found that women's perceptions of CS as preferable were based on prioritising the baby's and woman's health and appeared to intensify through interactions with the health system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth, fostering the feeling that CS was the safest option. Health professionals' preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite subgroup and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women's preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS). CONCLUSIONS Despite a minority of women expressing a preference for CS, individual, health system, and socio-cultural factors converge, contributing to a high CS rate in mainland China, Hong Kong, and Taiwan. In order to reduce unnecessary CSs, interventions need to address all these non-clinical factors and concerns. SYSTEMATIC REVIEW REGISTRY Prospero CRD42016036596.
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Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Fan Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael Dominic Renecle
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa, United States of America
| | - Shayesteh Jahanfar
- School of Public Health, Central Michigan University, Mount Pleasant, Michigan, United States of America
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Zhang Z, Gu C, Zhu X, Ding Y, Simone S, Wang X, Tao H. Factors associated with Chinese nulliparous women's choices of mode of delivery: A longitudinal study. Midwifery 2018; 62:42-48. [PMID: 29653417 DOI: 10.1016/j.midw.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/15/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Caesarean section rates have risen beyond the WHO recommended level in many countries worldwide. An emerging epidemic in caesareans has appeared in China over the past two decades, mainly driven by non-medical factors. China's one-child policy was previously seen as a potential factor for contributing to women's high caesarean section rates. The Chinese government has officially announced a two-child policy in recent years, causing numerous families to reshape their fertility intentions and birth preferences. There have been few studies focusing on women's expected and actual delivery mode and the associated factors affecting their choices of mode of delivery. OBJECTIVE To investigate nulliparous women's expected and actual mode of delivery, and the related factors associated with delivery mode in the context of China's two-child policy. DESIGN, SETTINGS, AND PARTICIPANTS This longitudinal study approached 1368 pregnant women who attended the antenatal clinic regularly at a tertiary specialized women's hospital in Shanghai, China. Among the 1368 women, 1211 agreed to participate and were investigated at admission of this study. METHODS Data were collected via questionnaires using Birth Attitude Questionnaire (BAQ), Subjective Norm Questionnaire (SNQ), and Childbirth Self-Efficacy Scale (CSES). Descriptive statistics and logistic regression analyses were used. RESULTS Of 1211 participants, the number of women expecting a vaginal delivery at three pregnancy stages accounted for 74%, 78%, and 83%, respectively. Finally 48% (520/1084) ended up having a caesarean delivery. Caesarean section for lack of medical indications accounted for 57% (297/520). Among women who met the requirements of two-child policy, 39% planned to have a second child. In logistic regression analyses, participants with stronger expectations of caesarean deliveries during late pregnancy (aOR, 35.18; 95% CI, 12.66-97.74), having higher scores of birth attitude toward CS (aOR, 1.13; 95% CI, 1.06-1.20), and with lower scores of intrapartum childbirth self-efficacy (aOR, 0.85; 95% CI, 0.77-0.92) had significantly higher odds of having an actual caesarean delivery. CONCLUSIONS During the initial period of China's two-child policy, the majority of women value vaginal delivery whereas high caesarean section rate still becomes a great concern in current China. Individual preferences, birth attitude, and childbirth self-efficacy are altogether associated with women's different choices of mode of delivery.
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Affiliation(s)
- Zheng Zhang
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Obstetric Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunyi Gu
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| | - Xinli Zhu
- Obstetric Out-patient Clinics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Setterberg Simone
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Xiaojiao Wang
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Obstetric Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hua Tao
- Nursing Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Zhao J, Shan N, Yang X, Li Q, Xia Y, Zhang H, Qi H. Effect of second child intent on delivery mode after Chinese two child policy implementation: a cross sectional and prospective observational study of nulliparous women in Chongqing. BMJ Open 2017; 7:e018823. [PMID: 29282269 PMCID: PMC5770909 DOI: 10.1136/bmjopen-2017-018823] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess the influence of second child intent on the delivery preferences and final delivery modes of nulliparous women, particularly caesarean delivery on maternal request (CDMR), after implementation of China's two child policy. DESIGN Cross sectional and prospective observational study. SETTING A tertiary teaching hospital in Chongqing, China. PARTICIPANTS 1000 low risk nulliparous women were initially involved, and were divided into two groups based on their intent on having a second child. 814 women who completed all interviews were analysed. MAIN OUTCOME MEASURES Preferred mode of delivery in second trimester and at admission; final delivery mode, CDMR. RESULTS 814 women who completed all interviews were analysed, in whom 51.2% intended to have a second child. The preference for caesarean delivery (CD) at the second trimester between the intent and no intent group was 6.2% versus 17.9% (adjusted RR 0.35, 95% CI 0.20 to 0.63) and increased to 24.2% versus 37.3% (adjusted RR 0.65, 95% CI 0.45 to 0.94) at admission, respectively. The overall CD rates between the two groups were 41.0% versus 50.4% (adjusted RR 0.84, 95% CI 0.60 to 1.18), and the CDMR rates were 16.7% versus 29.0% (adjusted RR 0.56, 95% CI 0.37 to 0.86), respectively. CONCLUSIONS Women who intend to have a second child are less likely to request a CD, and high rates of CD and CDMR in nulliparous women may have decreased after implementation of China's two child policy.
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Affiliation(s)
- Jianlin Zhao
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nan Shan
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaochang Yang
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Li
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yinyin Xia
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hua Zhang
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Qi
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zhang H, Wu J, Norris J, Guo L, Hu Y. Predictors of preference for caesarean delivery among pregnant women in Beijing. J Int Med Res 2017; 45:798-807. [PMID: 28345422 PMCID: PMC5536660 DOI: 10.1177/0300060517696217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate factors associated with preference for caesarean or vaginal delivery among pregnant Chinese nulliparous and parous women. Methods In this cross-sectional study, a self-administered questionnaire was used to collect information on sociodemographic characteristics, preference/reasons for delivery mode, and knowledge of delivery complications. Results Of the 450 participants, 85 (18.9%) reported a preference for caesarean section (CS) pre-partum. Compared with women who would prefer a vaginal delivery, nulliparous women who preferred CS were more likely to be: ≥35 years; have no medical insurance; have had two or more pregnancies; have access to only one source of information about birthing options; knowledge of the complications of vaginal delivery and think doctors have no right to decide the type of delivery. For parous women who preferred CS, they were more likely to have had a previous caesarean delivery and live outside Beijing. Conclusions From this study conducted at a large, maternity centre in Beijing, the proportion of pregnant women with preference pre-partum for CS was moderate and their reasons were varied.
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Affiliation(s)
- Hongwei Zhang
- 1 Department of Obstetrics, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Jing Wu
- 2 School of Agroforestry & Medicine, Open University of China, Beijing, China
| | - Jessie Norris
- 3 National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Li Guo
- 1 Department of Obstetrics, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Yifei Hu
- 4 Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
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Serçekuş P, Egelioglu Cetisli N, İnci FH. Birth preferences by nulliparous women and their partners in Turkey. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:182-5. [PMID: 26842643 DOI: 10.1016/j.srhc.2015.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/13/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to examine the preferences of nulliparous women and their partners in giving birth and the reasons for these preferences. METHODS The sample in this cross-sectional study consisted of 162 pregnant women in the last trimester of pregnancy and their partners. Data collection was accomplished using a questionnaire. RESULTS It was found that most women (90.8%) and their partners (92%) preferred a vaginal birth. The couples' birth preferences were generally similar to one another. The main reasons for the choice of a vaginal birth were that it was natural and healthier for the mother and child and that recovery and discharge from the hospital were quicker. The main reasons for the choice of cesarean section were fear of childbirth and not putting the baby at risk. CONCLUSIONS Antenatal education may help to reduce the number of elective cesarean sections by changing the negative perceptions of vaginal birth and reducing the fear of childbirth.
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Affiliation(s)
- Pınar Serçekuş
- Denizli School of Health, Pamukkale University, Kınıklı Kampüs, Denizli, Turkey.
| | | | - Fadime Hatice İnci
- Denizli School of Health, Pamukkale University, Kınıklı Kampüs, Denizli, Turkey
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Sparks TN, Yeaton-Massey A, Granados JM, Handler SJ, Meyer MR, Caughey AB. Preference toward future mode of delivery: how do antepartum preferences and prior delivery experience contribute? J Matern Fetal Neonatal Med 2014; 28:1673-8. [DOI: 10.3109/14767058.2014.964674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Deng W, Klemetti R, Long Q, Wu Z, Duan C, Zhang WH, Ronsmans C, Zhang Y, Hemminki E. Cesarean section in Shanghai: women's or healthcare provider's preferences? BMC Pregnancy Childbirth 2014; 14:285. [PMID: 25148697 PMCID: PMC4148545 DOI: 10.1186/1471-2393-14-285] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences. METHODS An anonymous questionnaire survey, combined with data on CS indications taken from the patient record, was conducted among 272 first-time mothers having their first postnatal check-up in one university affiliated obstetrics and gynecology hospital in Shanghai, China, between September 2006 and January 2007. Logistic regression was used to study factors related to the recalled preference for CS and CS performed without medical indication, adjusting for maternal age, education and income. RESULTS The CS rate was 57% (151/263) among all women, 17% with medical indications and 40% without medical indications. For women without medical indications for CS (n = 215), there was no significant difference between women's preference for CS in early (25%) and late pregnancy (28%); 48% of women actually had CS. Women recalled preferring a vaginal delivery but who had CS were more likely to have had a CS suggested by a prenatal care doctor [OR (95% CI): 20 (3.88-107.1)] or by a delivery obstetrician [OR (95% CI): 26 (6.26-105.8)]. Among women recalled preferring and having CS, a suggestion from the prenatal care doctor to have CS was very common. CONCLUSIONS In the primiparous women without a medical indication for CS, women recall of a provider suggestion for CS was a strong predictor of CS both among women who recalled a preference for CS and among women who recalled a preference for vaginal delivery. Public health education needs strengthening, including discussion of the risks associated with CS and psychological and social support given to women to help them prepare for and cope with childbirth.
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Affiliation(s)
| | | | | | - Zhuochun Wu
- School of Public Health, Fudan University, 138 Yi Xue Yuan Road, P,O, Box 250, Shanghai 200032, China.
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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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Abstract
OBJECTIVE To estimate the association between delivery preferences during pregnancy and actual delivery mode. METHODS This was a prospective cohort study using data from the Norwegian Mother and Child Cohort Study (N=65,959). We analyzed predictors of birth outcome by means of women's preferences for mode or delivery and a range of medical and socioeconomic factors with multivariable logistic regression models. The term "elective" cesarean delivery includes cesarean deliveries planned 8 hours or more before delivery and performed as planned. RESULTS When asked about delivery preference at 30 weeks of gestation, 5% of the women reported a preference for a cesarean delivery, 84% had a preference for vaginal delivery, and 11% were neutral. Among those with a cesarean delivery preference, 48% subsequently had a cesarean delivery (12% acute and 36% elective), and of those with a vaginal preference 12% delivered by cesarean (8.7% acute and 3.1% elective). When adjusting for maternal characteristics and medical indications, the odds for an acute cesarean delivery among nulliparous women with a cesarean delivery preference was almost two times higher (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.49-2.62) and for elective cesarean delivery the preference was 12 times higher (OR 12.61, 95% CI 9.69-16.42) than for women with a vaginal preference. For multiparous women, the corresponding figures were OR 3.13 (95% CI 1.39-7.05) and OR 10.04 (95% CI 4.59-21.99). When multiparous women with previous cesarean deliveries were excluded, the OR for an elective cesarean delivery was 26 times higher given a cesarean delivery preference compared with a vaginal delivery preference (OR 25.78, 95% CI 7.89-84.28). Based on a small subset of women with planned cesarean delivery on maternal request (n=560), we estimated a predicted probability of 16% for nulliparous women (25% for multiparous women) for such cesarean delivery. CONCLUSION Pregnant women's expressed preferences for delivery mode were associated with both elective and acute cesarean deliveries. LEVEL OF EVIDENCE II.
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Li WY, Liabsuetrakul T, Stray-Pedersen B. Effect of mode of delivery on perceived risks of maternal health outcomes among expectant parents: a cohort study in Beijing, China. BMC Pregnancy Childbirth 2014; 14:12. [PMID: 24410828 PMCID: PMC3898524 DOI: 10.1186/1471-2393-14-12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/09/2014] [Indexed: 12/22/2022] Open
Abstract
Background Misperceptions regarding maternal health outcomes after vaginal delivery (VD) and cesarean delivery (CD) may contribute to the increasing trend towards CD. The effects of mode of delivery on parents’ perceived risks of health outcomes are unclear. This study aimed to compare the perceived risks of maternal health outcomes among pregnant women and their partners before and after delivery, and to evaluate factors related to inaccurate perceptions among women after delivery. Methods Consecutive eligible nulliparous women at 36-40 weeks gestation were approached during antenatal registration for electronic fetal monitoring, regardless of whether CD or VD was planned. Eligible women were aged 18-45 years, received antenatal care and planned delivery at the First Hospital of Tsinghua University, Beijing, and had partners who could be approached. Concerns about 12 maternal health outcomes were identified by literature search and validated using the content validity index. Women and their partners were questioned anonymously about the perceived risks of outcomes after CD and VD before delivery, and the perceived risks of the delivery experienced at 2-3 days after delivery. Perceived risks were compared with reported risks, and factors associated with inaccurate perceptions were evaluated. Results Among 272 couples approached, 264 women (97%) and 257 partners (94%) completed the questionnaire both before and after delivery. After CD, the perceived risk of seven health outcomes decreased in women and the perceived risk of two health outcomes increased in partners. After VD, the perceived risk of two outcomes decreased and of one outcome increased in women, and the perceived risk of three outcomes increased in partners. Women perceived higher risks of long-term perineal pain, pelvic organ prolapse, urinary/fecal incontinence, sexual dissatisfaction, and negative impact on the couple’s relationship after VD than after CD (all p < 0.05). CD was the most common factor associated with inaccurate perceptions among women after delivery. Conclusions The perceived risks of maternal health outcomes decreased after delivery in women and increased after delivery in their partners. Women continued to have inaccurate perceptions of the risks of health outcomes after delivery, indicating that further education is important.
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Affiliation(s)
- Wen-Ying Li
- Department of Obstetrics and Gynecology, First Hospital of Tsinghua University, Tsinghua University, No, 6 Jiuxianqiao 1st Street, Beijing 100016, Chaoyang District, China.
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Li WY, Liabsuetrakul T, Stray-Pedersen B. Change of childbirth preference after delivery among nulliparous Chinese women and their partners. J Obstet Gynaecol Res 2013; 40:184-91. [PMID: 24102777 DOI: 10.1111/jog.12153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to assess the effect of childbirth preference among nulliparous Chinese women and their partners on actual mode of delivery, and to assess women's change in preference from vaginal delivery to cesarean and the factors associated with this change. METHODS A cohort study was conducted from July to October 2011 in the First Hospital of Tsinghua University, Beijing. Nulliparous women at the gestational age of 36-40 weeks and their partners were included. Their childbirth preference was recorded twice: once in pregnancy and again 2 or 3 days post-partum. RESULTS Women preferring cesarean during pregnancy had a 3.9-fold higher chance of undergoing a cesarean than those preferring vaginal delivery (P = 0.004), while the partner's preference had no effect (P = 0.35). Preference for cesarean in the post-partum period increased significantly compared to that during pregnancy both among women, whose preference increased from 10.1% to 28.0%, and among their partners, whose preference increased from 7.8% to 16.7% (P < 0.001 for both). The rate of change in women's preference from vaginal delivery to cesarean was 26.0%. Women having high couple's monthly income, who were feeling depressed, whose partner preferred cesarean during pregnancy or who delivered by cesarean were more likely to experience this change due to fear of labor pain and perineal cutting and a greater perceived safety of cesarean. CONCLUSION Women's cesarean preference during pregnancy was associated with actual cesarean delivery. Inadequate quality of care in labor and delivery and overestimation of cesarean safety underlie post-partum women's increased preference for cesarean.
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Affiliation(s)
- Wen-Ying Li
- Department of Obstetrics and Gynecology, First Hospital of Tsinghua University and Tsinghua University, Beijing, China; Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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The Effect of PRECEDE PROCEED Model Combined with the Health Belief Model and the Theory of Self-Efficacy to Increase Normal Delivery Among Nulliparous Women. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.sbspro.2012.05.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fuglenes D, Aas E, Botten G, Øian P, Kristiansen IS. Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear. Am J Obstet Gynecol 2011; 205:45.e1-9. [PMID: 21620366 DOI: 10.1016/j.ajog.2011.03.043] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/24/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to identify predictors of preferences for cesarean among pregnant women, and estimate how different predictors influence preferences. STUDY DESIGN This was a cross-sectional study based on the Norwegian Mother and Child Cohort Study (n = 58,881). RESULTS Of the study population, 6% preferred cesarean over vaginal delivery. While 2.4% of nulliparous had a strong preference for cesarean, the proportion among multiparous was 5.1%. The probability that a woman, absent potential predictors, would have a cesarean preference was similar (<2%) for both nulliparous or multiparous. In the presence of concurrent predictors such as previous cesarean, negative delivery experience, and fear of birth, the predicted probability of a cesarean request ranged from 20-75%. CONCLUSION The proportion of women with a strong preference for cesarean was higher among multiparous than nulliparous women, but the difference was attributable to factors such as previous cesarean or fear of delivery and not to parity per se.
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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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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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Chu KH, Tai CJ, Hsu CS, Yeh MC, Chien LY. Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery. BMC Health Serv Res 2010; 10:138. [PMID: 20504354 PMCID: PMC2885388 DOI: 10.1186/1472-6963-10-138] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 05/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of cesarean delivery was 35% in 2007 in Taiwan. It is unclear how many of the cesarean deliveries were without medical indications. Women's preference for cesarean delivery during their course of pregnancy has rarely been studied and therefore our objectives were to examine rate of cesarean deliveries without medical indications, to explore women's preference for cesarean delivery as their gestation advances, and to compare background and perinatal factors among women who underwent different modes of delivery in Taiwan. METHODS This prospective study applied a longitudinal design. The study participants were 473 women who received prenatal care at four hospitals in Taipei and answered structured questionnaires at 20 to 24 weeks of pregnancy, 34 to 36 weeks of pregnancy, and 5 to 7 weeks after delivery. RESULTS Of the 151 women (31.9%) who had cesarean deliveries, 19.9% were without medical indication. Three indications: malpresentation, prior cesarean section, and dysfunctional labor together accounted for 82.6% of cesarean section with medical indications. The prevalence of maternal preference for cesarean delivery was found to be 12.5% and 17.5% during the second and third trimester, respectively. Of the women who preferred cesarean delivery during the second trimester, 93.2% eventually had a cesarean delivery. Women who were older, with older spouses, and who had health problems before or during pregnancy were more likely to have cesarean deliveries. CONCLUSIONS About 20% of cesarean deliveries were without medical indications. Women's preference for cesarean delivery during the second trimester predicts subsequent cesarean delivery. Counseling regarding mode of delivery should be offered early in pregnancy, especially for women who are older or with older spouses, have health problems, or had a prior cesarean section.
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Affiliation(s)
- Kuei-Hui Chu
- Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Chen-Jei Tai
- Department of Traditional Chinese Medicine, Taipei Medical University Hospital and Department of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Sen Hsu
- Department of Obstetrics and Gynecology, Taipei Medical University-Wanfang Hospital and Department of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mei-Chiang Yeh
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan
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Kingdon C, Neilson J, Singleton V, Gyte G, Hart A, Gabbay M, Lavender T. Choice and birth method: mixed-method study of caesarean delivery for maternal request. BJOG 2009; 116:886-95. [DOI: 10.1111/j.1471-0528.2009.02119.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pang MW, Law LW, Leung TY, Lai PY, La TK. Sociodemographic factors and pregnancy events associated with women who declined vaginal birth after cesarean section. Eur J Obstet Gynecol Reprod Biol 2009; 143:24-8. [DOI: 10.1016/j.ejogrb.2008.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 10/03/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
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Turner CE, Young JM, Solomon MJ, Ludlow J, Benness C, Phipps H. Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians. BJOG 2008; 115:1494-502. [DOI: 10.1111/j.1471-0528.2008.01892.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pang MW, Leung TN, Lau TK, Hang Chung TK. Impact of first childbirth on changes in women's preference for mode of delivery: follow-up of a longitudinal observational study. Birth 2008; 35:121-8. [PMID: 18507583 DOI: 10.1111/j.1523-536x.2008.00225.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A woman's childbirth experience has an influence on her future preferred mode of delivery. This study aimed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth. METHODS This prospective longitudinal observational study involved two units that provide obstetric care in Hong Kong. A mail survey was sent to 259 women 6 months after their first childbirth. These women had participated in a longitudinal cohort study that examined their preference for elective cesarean section in the antenatal period of their first pregnancies. Univariate and multivariate analyses were performed to identify determinants for women who changed from preferring vaginal birth to elective cesarean section. RESULTS Twenty-four percent (23.8%, 95% CI 18.4-29.3) of women changed from preferring vaginal birth to elective cesarean section after their first childbirth. Determinants found to be positively associated with this change included actual delivery by elective cesarean section (OR 106.3, 95% CI 14.7-767.4) intrauterine growth restriction (OR 19.5, 95% CI 1.1-353.6), actual delivery by emergency cesarean section (OR 8.4, 95% CI 3.4-20.6), higher family income (OR 3.2, 95% CI 1.1-8.8), use of epidural analgesia (OR 2.6, 95% CI 1.0-6.8), and higher trait anxiety score (OR 1.1, 95% CI 1.0-1.3). The most important reason for women who changed from preferring vaginal birth to elective cesarean section was fear of vaginal birth (24.4%). CONCLUSIONS A significant proportion of women changed their preferred mode of delivery after their first childbirth. Apart from reducing the number of cesarean sections in nulliparous women, prompt provision of education to women who had complications and investigations into fear factors during vaginal birth might help in reducing women's wish to change to elective cesarean section.
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Affiliation(s)
- Man Wah Pang
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, Shatin, Hong Kong SAR
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