Is generalized maternal optimism or pessimism during pregnancy associated with unplanned cesarean section deliveries in China?

Early pregnancy dispositional optimism and pregnancy outcomes among nulliparous people

BACKGROUND

Dispositional optimism, the expectation of positive outcomes after personal challenges, is a resilience factor associated with widespread health benefits. However, the data on pregnancy-related outcomes are more limited.

OBJECTIVE

This study aimed to assess the association of early pregnancy dispositional optimism with adverse perinatal outcomes.

STUDY DESIGN

This was a prospective cohort study completed between May 2019 and February 2022 at a single, large tertiary medical center. Nulliparous pregnant people were recruited from outpatient obstetrical care sites. Participants completed a validated assessment of dispositional optimism at <20 weeks of gestation and were followed up until delivery. The primary outcome was an adverse maternal outcome composite that included gestational diabetes mellitus, hypertensive disorders of pregnancy, and/or cesarean delivery. The secondary outcomes included individual composite components and a neonatal morbidity composite. Bivariate analyses compared characteristics and primary and secondary outcomes by dispositional optimism score quartile. Multivariable logistic regression compared outcomes by dispositional optimism score quartile with the highest quartile serving as the referent, controlling for confounders determined a priori.

RESULTS

Overall, 491 pregnant people were approached for participation, and 135 pregnant people (27.5%) declined participation. Among the 284 individuals who enrolled and had complete outcome data, the median dispositional optimism score was 16.0 (interquartile range, 14-18), and 47.9% of individuals experienced at least 1 adverse maternal outcome 135 (47.9%). After adjusting for confounders, the odds of adverse maternal outcomes were significantly higher in the lowest 2 optimism quartiles: quartile 1 (adjusted odds ratio, 3.33; 95% confidence interval, 1.57-7.36) and quartile 2 (adjusted odds ratio, 2.22; 95% confidence interval, 1.05-4.79) than the highest quartile. This was driven by significantly higher rates of hypertension (quartile 1: adjusted odds ratio, 2.62; 95% confidence interval, 1.12-6.29) and cesarean delivery (quartile 1: adjusted odds ratio, 2.75; 95% confidence interval, 1.20-6.55). There was no difference noted when quartile 3 was compared with quartile 4.

CONCLUSION

Lower early pregnancy dispositional optimism was associated with significantly higher odds of adverse maternal outcomes. Interventions targeting improvements in optimism may be a novel mechanism for reducing perinatal morbidity.

Dispositional Optimism, Mode of Delivery, and Perceived Labor Control among Recently Delivered Parturients

OBJECTIVE

Dispositional optimism (DO) is an understudied transdiagnostic resilience factor among peripartum individuals. Low DO is associated with increased fear and pain in labor and increased rates of emergent cesarean delivery, but it is unknown whether DO is associated with perceived control over the labor process.

STUDY DESIGN

This a planned secondary analysis of a prospective observational cohort of term parturients (n = 164) who were recruited in July and August 2021 during their delivery hospitalization at a single, tertiary medical center. Participants completed a baseline demographic survey prior to delivery and then completed evaluations of DO (Revised Life-Orientation Test [LOT-R]) and control over the labor process (Labor Agentry Scale [LAS]) during their postpartum hospitalization. DO was dichotomized into low and high by score of ≤14 or >14 on LOT-R, respectively, and labor agentry scores were compared between groups. Maternal demographics, pregnancy, and delivery characteristics were compared by DO status. Multivariable regression was performed, adjusting for known confounders (induction, labor analgesia, and mode of delivery).

RESULTS

Demographic, pregnancy, and neonatal characteristics were similar between those with low compared with high DO. People with low DO had significantly higher rates of cesarean section (44 vs. 24%, p = 0.02) and overall had lower LAS scores (139.4 vs. 159.4, p < 0.001), indicating that they felt less control over their labor process than those with high DO. In the multivariable regression, those with low DO had higher odds of a low LAS score after controlling for induction, labor analgesia, and mode of delivery (adjusted odds ratio = 1.29, 95% confidence interval: 1.20-1.39).

CONCLUSION

People with low DO had significantly lower perceived control over their labor, even after controlling for differences in mode of delivery. Interventions to alter DO may be an innovative way to improve birth experience and its associated perinatal mental health morbidities.

KEY POINTS

· It is unknown if there is an association between DO and perceived labor control.. · People with low DO had higher rates of cesarean delivery and lower perceived labor control.. · Altering DO may be a novel mechanism for improving birth experience..

Generalized Self-Efficacy, Dispositional Optimism, and Illness Acceptance in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common chronic endocrinopathies affecting between 5 and 10% of reproductive age women. A diagnosis of PCOS very often causes a deterioration in the woman’s self-esteem and self-image, and consequently her quality of life (QoL). The purpose of the study was to investigate generalized self-efficacy, dispositional optimism and acceptance of illness in women with PCOS and to explore factors that affect these variables. The study was performed between January and November 2016 among women with PCOS using health care services. The study used a diagnostic survey with questionnaires. The research instruments included the Generalized Self-Efficacy Scale (GSES), the Life Orientation Test-Revised (LOT-R), the Acceptance of Illness Scale (AIS), and a standardized interview questionnaire. Among the PCOS patients studied, the mean score for generalized self-efficacy was 28.74 (±5.16), dispositional optimism—13.56 (±4.28), and acceptance of illness—27.90 (±7.74). The respondents’ generalized self-efficacy was determined by their residence, education, socio-economic standing, BMI, and time from diagnosis (p < 0.05), while socio-economic standing was a determinant of dispositional optimism (p < 0.05). Determinants of illness acceptance in women with PCOS included their residence, socio-economic standing, and time from diagnosis (p < 0.05). Increased generalized self-efficacy and dispositional optimism contributed to more illness acceptance in PCOS patients. The present study, compared with others on the subject, will enable specialists providing care to women with PCOS to gain a deeper and more comprehensive understanding of the situation and condition of their patients. It will also allow for a better response to the needs of PCOS patients, and provide them with individualized, holistic specialist care, diagnostics, and treatment.

Comparative study of teaching natural delivery benefits and optimism training on mothers' attitude and intention to select a type of delivery: an educational experiment

Background

Despite advantages of normal vaginal delivery (NVD) and disadvantages of caesarean section (C-section) and the increasing C-section rate Iran, appropriate training is essential in reducing this trend. Optimism is one of the important psychological determinants which is a combination of positive desire and attitude in people.

Objective

The purpose of this study was to determine the effects of optimism training as well as training the benefits of natural childbirth on attitude and intentions to choose the type of delivery.

Methods

In this experimental study, 96 primiparous women referring to health centers in Mashhad (Iran) in 2014 with pregnancy duration of 30 to 34 weeks and without indication of C-section, were selected and randomly divided into two training groups and one control group. Optimism training was provided during six 60-minute sessions, whereas training the benefits of NVD was conducted in four 60-minute sessions. Pre-test and post-test were performed using valid and reliable questionnaires, researcher-made questionnaire, attitude-measuring questions on NVD and C-section, and optimism-measuring standard questionnaires (LOT-R). Data were analyzed by IBM-SPSS version 22, using Kruskal-Wallis, Chi square, paired-samples t-test, Independent-samples t-test, Man-Whitney U, and Wilcoxon signed-rank test.

Result

There was a significant difference between the mean scores of attitudes towards natural delivery in the group that received both optimism and natural delivery advantages trainings compared with the group receiving only the latter (p>0.001). Frequency of intentions to choose the type of delivery after optimism and natural delivery advantages trainings compared with training the benefits of natural childbirth only, did not show a significant difference (p=0.135).

Conclusion

Optimism training combined with training the benefits of natural childbirth is more effective in creating positive attitude towards natural delivery in comparison with only the NVD advantages education, but it has no effect on selecting the type of delivery. Probably one of the most important reasons of failure of achieving a proper result is the low sample size.

Trial registration

The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015063022995N1.

Funding

This trial is funded by Mashhad University of Medical Sciences in collaboration with the Evidence-Based Research Center (Ref: research/930321/1/172).

Cesarean section in the People's Republic of China: current perspectives

OBJECTIVE

To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People's Republic of China.

METHODS

Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed.

FINDINGS

Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People's Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People's Republic of China. There was a lively debate on whether women's preferences or providers' distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People's Republic of China's health development approach - focusing on specialized care and marginalizing primary care - that is playing a role. Although 30 articles were identified studying the consequences of cesareans, the methodologies are in general weak and the themes are out of focus.

CONCLUSION

The overuse of cesareans is rising alarmingly in the People's Republic of China and has become a real public health problem. No consensus has been made on the leverage factors that drive the cesarean epidemic, particularly for those nonclinical factors. The more macro level structural factors may have played a part, though further research is warranted to understand the mechanisms. Knowledge of the consequences of cesareans, particularly for women, is limited in the People's Republic of China, leaving a substantial literature gap.