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Aviram A, Barrett J, Mei-Dan E, Yoon EW, Melamed N. A prediction tool for mode of delivery in twin pregnancies-a secondary analysis of the Twin Birth Study. Am J Obstet Gynecol 2024; 231:124.e1-124.e11. [PMID: 37979823 DOI: 10.1016/j.ajog.2023.11.1230] [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: 08/07/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND One of the controversies regarding the management of twin gestations relates to the mode of delivery. Currently, counseling regarding the mode of delivery and the chance of successful vaginal twin delivery is based on the average risk for intrapartum cesarean delivery in the general population of twin pregnancies. Decision support tools that provide an individualized risk for intrapartum cesarean delivery based on the unique characteristics of each patient can improve counseling and decision-making regarding the choice of mode of delivery in twin pregnancies. OBJECTIVE This study aimed to develop and validate a prediction model to determine the risk for intrapartum cesarean delivery in twin pregnancies. STUDY DESIGN In this secondary analysis of the Twin Birth Study, a multicenter randomized controlled trial, we considered the subgroup of individuals who underwent a trial of vaginal delivery. Candidate predictors included maternal age, parity, previous cesarean delivery, conception method, chorionicity, diabetes and hypertension in pregnancy, gestational age at birth, the onset of labor, presentation of the second twin, sonographic fetal weight estimation, and fetal sex. The co-primary outcomes were overall intrapartum cesarean delivery and cesarean delivery of the second twin. Multivariable logistic regression models were used to estimate the probability of the study outcomes. Model performance was evaluated using measures of discrimination (the area under the receiver operating characteristic curve), calibration, and predictive accuracy. Internal validation was performed using the bootstrap resampling technique. RESULTS A total of 1221 individuals met the study criteria. The rate of overall intrapartum cesarean delivery and cesarean delivery for the second twin was 25.4% and 5.7%, respectively. The most contributory predictor variables were nulliparity, term birth (≥37 weeks), a noncephalic presentation of the second twin, previous cesarean delivery, and labor induction. The models for overall intrapartum cesarean delivery and cesarean delivery of the second twin had good overall discriminatory accuracy (area under the receiver operating characteristic curve, 0.720; 95% confidence interval, 0.688-0.752 and 0.736; 95% confidence interval, 0.669-0.803, respectively) and calibration (as illustrated by the calibration plot and Brier scores of 0.168; 95% confidence interval, 0.156-0.180 and 0.051; 95% confidence interval, 0.040-0.061, respectively). The models achieved good specificity (66.7% and 81.6%, respectively), high negative predictive value (86.0% and 96.9%, respectively), and moderate sensitivity (68.1% and 57.1%, respectively). CONCLUSION The prediction models developed in this study may assist care providers in counseling individuals regarding the optimal timing and mode of delivery in twin pregnancies by providing individualized estimates of the risk for intrapartum cesarean delivery.
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Affiliation(s)
- Amir Aviram
- Division of Maternal-Fetal Medicine, DAN Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada, (d)Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Canada
| | - Eugene W Yoon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada, (d)Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, DAN Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Etcheverry C, Betrán AP, de Loenzien M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries. Midwifery 2024; 132:103979. [PMID: 38520954 DOI: 10.1016/j.midw.2024.103979] [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: 03/23/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DESIGN A cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SETTING Thirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. PARTICIPANTS A total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FINDINGS The overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and "avoid pain in labour" was the most common perceived benefit of caesarean section. KEY CONCLUSIONS Our results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. CLINICAL TRIAL REGISTRY The QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.
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Affiliation(s)
- Camille Etcheverry
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France.
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
| | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina; Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
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Landrum M, Nocka HR, Ashebo L, Hilmara D, MacAlpine E, Flynn JM, Ho M, Newton PO, Sponseller PD, Lonner BS, Cahill PJ. Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2023; 43:620-625. [PMID: 37705419 DOI: 10.1097/bpo.0000000000002499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Little data exist on pregnancy and childbirth for adolescent idiopathic scoliosis (AIS) patients treated with a spinal fusion. The current literature relies on data from patients treated with spinal fusion techniques and instrumentation, such as Harrington rods, that are no longer in use. The objective of our study is to understand the effects of spinal fusion in adolescence on pregnancy and childbirth. METHODS Prospectively collected data of AIS patients undergoing posterior spinal fusion that were enrolled in a multicenter study who have had a pregnancy and childbirth were reviewed. Results were summarized using descriptive statistics and compared with national averages using χ 2 test of independence. RESULTS A total of 78 babies were born to 53 AIS patients. As part of their pre-natal care, 24% of patients surveyed reported meeting with an anesthesiologist before delivery. The most common types of delivery were spontaneous vaginal delivery (46%, n=36/78) and planned cesarean section (20%, n=16/78). Compared with the national average, study patients had a higher rate of cesarean delivery ( P =0.021). Of the women who had a spontaneous vaginal birth, 53% had no anesthesia (n=19/36), 19% received intravenous intermittent opioids (n=7/36), and 31% had regional spinal or epidural anesthesia (n=11/36). spontaneous vaginal delivery patients in our study cohort received epidural or spinal anesthesia less frequently than the national average ( P <0.001). Of those (n=26 pregnancies) who did not have regional anesthesia (patients who had no anesthesia or utilized IV intermittent opioids), 19% (n=5 pregnancies) were told by their perinatal providers that it was precluded by previous spine surgery. CONCLUSION The majority of AIS patients reported not meeting with an anesthesiologist before giving birth and those who had a planned C-section did so under obstetrician recommendation. The presence of instrumentation after spinal fusion should be avoided with attempted access to the spinal canal but should not dictate a delivery plan. A multidisciplinary team consisting of obstetrician, anesthesiologist, and orthopaedic surgeon can provide the most comprehensive information to empower a patient to make her decisions regarding birth experience anesthesia based on maternal rather than provider preference. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew Landrum
- The Children's Hospital of Philadelphia
- University of Texas Health San Antonio, San Antonio, TX
| | | | | | | | - Elle MacAlpine
- Washington University in St. Louis Department of Orthopaedic Surgery, St. Louis, MO
| | - John M Flynn
- The Children's Hospital of Philadelphia
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Patrick J Cahill
- The Children's Hospital of Philadelphia
- University of Pennsylvania, Philadelphia, PA
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Amuzie CI, Nwamoh UN, Ukegbu A, Umeokonkwo CD, Azuogu BN, Okedo-Alex IN, Kalu KU, Izuka M, Odini F. Urban-rural differences in health service-related factors associated with male involvement in family planning services in Abia State, Southeastern Nigeria. Ghana Med J 2022; 56:105-114. [PMID: 38322738 PMCID: PMC10630032 DOI: 10.4314/gmj.v56i3s.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objective To identify and compare the health service-related factors associated with male involvement in family planning services among the rural and urban areas in Abia State, Nigeria. Design A community-based cross-sectional study. Setting Twelve communities (six urban and six rural) in Abia State, Nigeria. Participants Five hundred and eighty-eight (588) men aged 15-59 years and resident in the study area 6 months before the study were recruited. Main outcome measure Male involvement in family planning services. Results The mean ages of the respondents were 41.8±8.0 years and 43.1±8.0 years in the urban and rural areas, respectively. Active male involvement in family planning services was significantly higher in urban areas (62.6%, 95%CI: 56.8%-68.1%) compared to the rural areas (47.6%, 95%CI: 41.5%-53.2%. p<0.001). The predictors of male involvement included gender preference of healthcare workers (aOR=1.75, 95%CI:1.01-3.03) and attitude of the healthcare workers (aOR=2.07, 95%CI:1.17-3.67) among the urban participants, compared to occupational status of the respondents (aOR=2.50, 95% CI: 1.16-5.56) and the availability of male-friendly clinics (aOR=2.27, 95%CI:1.25-4.15) among the rural participants. Conclusion Health service-related factors associated with male involvement varied between the urban and rural settings. Stakeholders should target addressing health service-related factors by types of settlement while designing family planning programs targeting men. Funding No funding was obtained for this study.
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Affiliation(s)
- Chidinma I Amuzie
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Uche N Nwamoh
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Andrew Ukegbu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Chukwuma D Umeokonkwo
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Benedict N Azuogu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ijeoma N Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - Kalu U Kalu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Michael Izuka
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Franklin Odini
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
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Zewude B, Siraw G, Adem Y. The Preferences of Modes of Child Delivery and Associated Factors Among Pregnant Women in Southern Ethiopia. Pragmat Obs Res 2022; 13:59-73. [PMID: 35873720 PMCID: PMC9296879 DOI: 10.2147/por.s370513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of the study was to identify the choice of mode of delivery and the factors associated with such preferences among pregnant women attending antenatal care services in Southern Ethiopia. Methods Using an institutional-based cross-sectional survey, quantitative data were collected from randomly selected pregnant women in Southern Ethiopia. A semi-structured questionnaire was distributed to pregnant women who had been attending antenatal healthcare services in purposively selected public and private healthcare facilities in Shashemene town. The completed cases were inserted into SPSS version 26 in which both descriptive and inferential statistical techniques were used to analyze the data. Results It was found that 75.4% of respondents replied that they prefer vaginal delivery while 24.6% had chosen cesarean section. Personal conviction motivated by the need to experience the labor process, the belief in it being a natural method, the perception that it is better for the wellbeing of both the mother and the child, previous experience of delivery by vaginal method, fear or the need to avoid episiotomy, and economic concerns have been mentioned as reasons for the choice of vaginal delivery. Moreover, respondents’ choice of the mode of delivery is significantly associated with religion, age, number of children, pregnancy experience, previous mode of delivery, self-rated social class status, autonomy to decide about mode of delivery, and type of healthcare organization of antenatal care attendance. Conclusion Although vaginal delivery has remained the most preferred mode of delivery among most pregnant women, about a quarter of pregnant women have reported that they prefer to deliver by cesarean section, a prevalence rate which is higher than the national average, indicating that the choice of cesarean section is still increasing among women.
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Affiliation(s)
- Bewunetu Zewude
- Department of Sociology, College of Social Sciences and Humanities, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getahun Siraw
- Department of Sociology, College of Social Sciences and Humanities, Dilla University, Dilla, Ethiopia
| | - Yesuf Adem
- Department of Business Management, Senabor College, Shashemene, Ethiopia
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Dumont A, de Loenzien M, Nhu HMQ, Dugas M, Kabore C, Lumbiganon P, Torloni MR, Gialdini C, Carroli G, Hanson C, Betrán AP. Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001264. [PMID: 36962691 PMCID: PMC10022020 DOI: 10.1371/journal.pgph.0001264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
Women's fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short- and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low- to moderate-certainty evidence-based information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes of birth. It is expected to build trust and foster more effective, satisfactory dialogue between pregnant women and providers. It can be easily adapted and updated as new evidence emerges. We encourage further studies in LMICs to assess the impact of DAT on quality decision-making for the appropriate use of caesarean section in these settings.
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Affiliation(s)
- Alexandre Dumont
- Research Institute for Sustainable Development, Paris University, Paris, France
| | - Myriam de Loenzien
- Research Institute for Sustainable Development, Paris University, Paris, France
| | | | - Marylène Dugas
- Interdisciplinary Chair in Health and Social Services for Rural Populations, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Charles Kabore
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Maria Regina Torloni
- Evidence Based Healthcare Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil
| | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Genève, Switzerland
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Colomar M, Opiyo N, Kingdon C, Long Q, Nion S, Bohren MA, Betran AP. Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences. PLoS One 2021; 16:e0251072. [PMID: 33951101 PMCID: PMC8099111 DOI: 10.1371/journal.pone.0251072] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women’s preferences for mode of birth and factors underlying preferences for CS. Methods Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. Results We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women’s partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). Conclusions A wide variety of factors underlie women’s preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay
- * E-mail:
| | - Newton Opiyo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Soledad Nion
- Faculty of Social Sciences, Sociology Department, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Amyx MM, Althabe F, Rivo J, Pingray V, Minckas N, Belizán M, Gibbons L, Murga GT, Fiorillo ÁE, Malamud JD, Casale RA, Cormick G, Belizán JM. Feasibility of Conducting a Trial Assessing Benefits and Risks of Planned Caesarean Section Versus Planned Vaginal Birth: A Cross-Sectional Study. Matern Child Health J 2021; 25:136-150. [PMID: 33392930 PMCID: PMC7922524 DOI: 10.1007/s10995-020-03073-4] [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] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. METHODS A cross-sectional survey of low-risk, nulliparous pregnant women (N = 416) and healthcare providers (N = 168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. RESULTS Few women (< 15%) or professionals (33.3%) would participate in an RCT, though more would participate in PCTs (88% women; 65.9% professionals) or PRPPTs (44.4% public, 63.4% private sector women; 44.0% professionals). However, most women would choose vaginal delivery in the PCT and PRPPT (> 85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women's reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women's right to choose (RCT). CONCLUSIONS FOR PRACTICE Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.
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Affiliation(s)
- Melissa M Amyx
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., #2400, New Orleans, LA, 70112, USA.
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
| | - Fernando Althabe
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Julie Rivo
- Duke University School of Medicine, Duke University, 8 Duke University Medical Center Greenspace, Durham, NC, 27703, USA
| | - Verónica Pingray
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Nicole Minckas
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - María Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Luz Gibbons
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Gerardo T Murga
- Instituto de Maternidad Y Ginecología Nuestra Señora de Las Mercedes, Av. Mate de Luna 1535, 4000, San Miguel de Tucumán, Tucumán Province, Argentina
| | - Ángel E Fiorillo
- Centro de Educación Médica E Investigaciones Clínicas "Norberto Quirno" (CEMIC), Av. E. Galván 4102, C1431FWO, Buenos Aires, Argentina
| | - Julio D Malamud
- Sanatorio de La Mujer, San Luis 2493, S2002, Rosario, Santa Fe, Argentina
| | - Roberto A Casale
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires, Argentina
| | - Gabriela Cormick
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - José M Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
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Xu Y, Ji C, Liu Y, Li M, Yao D, Wang X, Du J, Chen J. Vaccination recommendations, immunization status and safety of vaccination for premature infants in Zhejiang, China. Expert Rev Vaccines 2020; 19:973-981. [PMID: 33001703 DOI: 10.1080/14760584.2020.1831917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES More and more premature infants were born worldwide that are suffering from various complications, vaccination for whom is often delayed in China. We aim to describe current vaccination recommendations in practice, immunization status, and vaccination safety for premature infants in Zhejiang. METHODS The demographic information, medical records of treatments, and adverse events following immunization (AEFI) history were collected from infants' parents by questionnaire in the Vaccination Consultation Clinic(VCC). Vaccination data were retrieved from Zhejiang Provincial Immunization Information System. The information of AEFI was collected from the Chinese National Adverse Event Following Immunization Information System. RESULTS A total of 1515 premature infants visiting the VCC were included in the study. The majority (65.94%) of them were under 7 months. 47.59% of premature infants were advised to receive normal vaccinations, while 45.94% were advised to defer a specific vaccination and 6.47% were advised to defer all vaccinations. A total of 807 infants received 7187 vaccine doses were administered and only seven cases experienced mild and self-limiting adverse reactions (9.74/10,000). No uncommon or serious side effects were reported. CONCLUSION Most premature infants visiting the VCC did not receive vaccines on time. The majority of them can be safely vaccinated according to the national-recommended schedule.
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Affiliation(s)
- Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention , Hangzhou, Zhejiang, China
| | - Chai Ji
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine , Hangzhou, Zhejiang, China
| | - Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention , Hangzhou, Zhejiang, China
| | - Mingyan Li
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine , Hangzhou, Zhejiang, China
| | - Dan Yao
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine , Hangzhou, Zhejiang, China
| | - Xia Wang
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine , Hangzhou, Zhejiang, China
| | - Jian Du
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention , Hangzhou, Zhejiang, China
| | - Junfang Chen
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention , Hangzhou, Zhejiang, China
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Naudé N, Horak TA, Fawcus S, Stewart CJ, Lindow SW. Preference for mode of delivery in a low-risk population in Cape Town, South Africa. Eur J Obstet Gynecol Reprod Biol 2020; 254:259-265. [PMID: 33032102 DOI: 10.1016/j.ejogrb.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES There has been an increase in Caesarean section rates in many developed countries with maternal request frequently being cited as a reason. There are few studies examining African women's preference for mode of delivery. The objectives this study were to determine women's preference for mode of delivery in a low risk population to describe the major reasons for their preferences. STUDY DESIGN Women over the age of 18 with a singleton low risk pregnancy were recruited during the third trimester. Two trained interviewers conducted a questionnaire in the women's preferred language regarding her preference for mode of delivery. RESULTS Of the 195 women that participated, 160 (82.1 %) indicated a preference for vaginal delivery, 5 (2.6 %) preferred a Caesarean delivery, and 30 women (15.4 %) were unsure about their preferred mode of delivery. There was a significant association between delivery preference and age, ethnicity and HIV status. Level of education, employment, income, relationship status, and parity demonstrated no statistical association. In addition, 106 (54.4 %) did not believe that women should be given the right to request a Caesarean section. CONCLUSION The majority of women prefer to have a vaginal delivery. In this low risk population, 15.4 % of women were unsure about their preference.
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Affiliation(s)
- Nadia Naudé
- Department of Obstetrics and Gynaecology, Mowbray Maternity Hospital and UniverSity of Cape Town, 12 Hornsey Road, Mowbray, Cape Town, South Africa
| | - Tracey A Horak
- Department of Obstetrics and Gynaecology, Mowbray Maternity Hospital and UniverSity of Cape Town, 12 Hornsey Road, Mowbray, Cape Town, South Africa
| | - Susan Fawcus
- Department of Obstetrics and Gynaecology, Mowbray Maternity Hospital and UniverSity of Cape Town, 12 Hornsey Road, Mowbray, Cape Town, South Africa
| | - Chantal J Stewart
- Department of Obstetrics and Gynaecology, Mowbray Maternity Hospital and UniverSity of Cape Town, 12 Hornsey Road, Mowbray, Cape Town, South Africa
| | - Stephen W Lindow
- Director of Masters Projects, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland.
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ÖZCEYLAN G, TOPRAK D. Gebe Okullarının Doğum Şekilleri Üzerine Etkisi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.632582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Ansari AH, De Wel O, Pillay K, Dereymaeker A, Jansen K, Van Huffel S, Naulaers G, De Vos M. A convolutional neural network outperforming state-of-the-art sleep staging algorithms for both preterm and term infants. J Neural Eng 2020; 17:016028. [PMID: 31689694 DOI: 10.1088/1741-2552/ab5469] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To classify sleep states using electroencephalogram (EEG) that reliably works over a wide range of preterm ages, as well as term age. APPROACH A convolutional neural network is developed to perform 2- and 4-class sleep classification in neonates. The network takes as input an 8-channel 30 s EEG segment and outputs the sleep state probabilities. Apart from simple downsampling of the input and smoothing of the output, the suggested network is an end-to-end algorithm that avoids the need for hand-crafted feature selection or complex pre/post processing steps. To train and test this method, 113 EEG recordings from 42 infants are used. MAIN RESULTS For quiet sleep detection (the 2-class problem), mean kappa between the network estimate and the ground truth annotated by EEG human experts is 0.76. The sensitivity and specificity are 90% and 88%, respectively. For 4-class classification, mean kappa is 0.64. The averaged sensitivity and specificity (1 versus all) respectively equal 72% and 91%. The results outperform current state-of-the-art methods for which kappa ranges from 0.66 to 0.70 in preterm and from 0.51 to 0.61 in term infants, based on training and testing using the same database. SIGNIFICANCE The proposed method has the highest reported accuracy for EEG sleep state classification for both preterm and term age neonates.
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Affiliation(s)
- Amir H Ansari
- Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Belgium. imec, Leuven, Belgium
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Khatony A, Soroush A, Andayeshgar B, Saedpanah N, Abdi A. Attitude of primiparous women towards their preference for delivery method: a qualitative content analysis. ACTA ACUST UNITED AC 2019; 77:38. [PMID: 31452882 PMCID: PMC6700977 DOI: 10.1186/s13690-019-0364-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/06/2019] [Indexed: 11/15/2022]
Abstract
Background The delivery method is one of the primary concerns of primiparous women. Today, due to the fear of delivery, the number of cesarean sections has increased significantly. Considering the importance of choosing the type of delivery and the lack of study in this regard, the present study was conducted to explain the attitude of primiparous women towards their preference for delivery method. Method In this qualitative study, in-depth interview was conducted with 12 primiparous women. The transcripts of the interviews were read carefully by the researcher for several times. Finally, using the analytical method, the codes were extracted and subsequent subcategories and main categories were determined. To assess the credibility of the data, the Denzin & Lincoln’s criteria were used, which include Credibility, Transferability, Dependability, and Confirmability. Results Because of inexperience in delivery and ambiguity in process, most of the woman had a specific fear and they commonly affected by other advices and experiences. The majority of the participants had desire to vaginal delivery with announcing its advantages such as shortage of pain process, easy breast feeding, and mother ability to better carryout the newborn works. Other participants believed on adverse effects of normal vaginal delivery including bladder prolapse, uterus rupture, and probability of experience of both happenings (CS and NVD), frequent examination, pain and urine incontinence. Some stated cesarean section have benefits of less injury to neonate and preserving her/his beauty. Conclusion Results showed that, choosing a delivery method is difficult for primiparous women, and their attitude toward the type of delivery is influenced by subjective and internal factors. Giving awareness to primiparous women greatly enhances their tendency towards vaginal delivery.
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Affiliation(s)
- Alireza Khatony
- 1Health Institute, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Soroush
- 2Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahare Andayeshgar
- 2Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Neda Saedpanah
- 2Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- 3Students Research Committee, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Nursing Department, School of Nursing and Midwifery, Dowlat Abad, Kermanshah, Iran
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Loke AY, Davies L, Mak YW. Is it the decision of women to choose a cesarean section as the mode of birth? A review of literature on the views of stakeholders. BMC Pregnancy Childbirth 2019; 19:286. [PMID: 31399072 PMCID: PMC6688235 DOI: 10.1186/s12884-019-2440-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/29/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A debate on the decision of women to choose a cesarean section as the mode of birth in uncomplicated pregnancies from the views of relevant stakeholders. MAIN TEXT Using five electronic databases, a literature search was conducted for studies published from January 2003 to December 2016. Studies on a woman's right to request or to choose a cesarean section as the mode of birth in uncomplicated pregnancies were included. Fifty-five articles were identified (39 research studies and 16 opinion-based articles). Among health professionals, obstetricians were the most supportive of this right. It is argued that although women reported wanting to choose the mode of birth, with the safety of their babies as the priority, they also relied on the advice of their maternity care provider and considered it the responsibility of their obstetrician to make the decision. A higher proportion of the general public in countries with well-developed private healthcare accepted that a woman should have the freedom to choose the mode of birth. CONCLUSIONS This review provided a debate on the choice of pregnant women in uncomplicated pregnancies on the mode of birth from various stakeholders. Further research is required to explore what the meanings of autonomy of pregnant women to choose the mode of birth, and the process that they go through when making this decision.
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Affiliation(s)
- Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Louise Davies
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yim-Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Yaghobi Z, Mohaddes Hakkak H, Tavakoli Ghoochani H, Joveini H, Maheri M, Taherpour M, Hosseini SH. Factors Affecting the Intention to Choose the Natural vaginal delivery based on the Theory of Planned Behavior among Primigravidae. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2019. [DOI: 10.29252/jech.6.3.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Solanki G, Fawcus S, Daviaud E. A cross sectional analytic study of modes of delivery and caesarean section rates in a private health insured South African population. PLoS One 2019; 14:e0219020. [PMID: 31247013 PMCID: PMC6597103 DOI: 10.1371/journal.pone.0219020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Monitoring Caesarean Section (CS) rates is essential to ensure optimal use of the procedure. Information on CS rates in the South African private sector is limited and information from this study will assist in planning for the proposed NHI in South Africa. Objectives The objectives of this paper are to assess mode of delivery patterns and to determine CS rates amongst South African private health insurance scheme members; and to assess the extent to which CS rates are influenced by age and health status of the mother. Methods The 2015 claims for members of 10 health insurance schemes were analysed to assess delivery type patterns. Mode of delivery patterns were assessed by 6 delivery types: emergency, elective and “other” for caesarean deliveries; and non-assisted, assisted and “other” for vaginal deliveries; as well as by age and health condition of the mother. Results Of a total of 6,542 births analysed, 4,815 were CS giving a CS rate of 73·6% (95% CI 72·5%;74·7%). Emergency CS were the most common mode of delivery (39·7%), followed by elective CS (39·5%). CS rates increased with increasing maternal age and were higher for women with a medical condition. Conclusions CS rates for the South African private sector are considerably higher than the safe rates recommended by the WHO. The high CS rates is a cause for concern for the health system under the proposed NHI. To support initiatives encouraging evidence based practice, further research is required to understand the drivers for the high CS rates.
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Affiliation(s)
- Geetesh Solanki
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Honorary Research Associate: Health Economic Unit, University of Cape Town, Cape Town, South Africa
- NMG Consultants and Actuaries, Cape Town, South Africa
- * E-mail:
| | - Susan Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Emmanuelle Daviaud
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Rivo JC, Amyx M, Pingray V, Casale RA, Fiorillo AE, Krupitzki HB, Malamud JD, Mendilaharzu M, Medina ML, del Pino AB, Ribola L, Schvartzman JA, Tartalo GM, Trasmonte M, Varela S, Althabe F, Belizán JM. Obstetrical providers' preferred mode of delivery and attitude towards non-medically indicated caesarean sections: a cross-sectional study. BJOG 2018; 125:1294-1302. [PMID: 29325216 PMCID: PMC6041183 DOI: 10.1111/1471-0528.15122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. DESIGN Cross-sectional study. SETTING Two public and two private hospitals in Argentina. POPULATION Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. METHODS Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. MAIN OUTCOME MEASURES Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. RESULTS 168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19-18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. CONCLUSIONS Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. TWEETABLE ABSTRACT Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.
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Affiliation(s)
- JC Rivo
- Duke University School of Medicine, Duke University, Duke University Medical Center Greenspace, Durham, NC, USA
| | - M Amyx
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - V Pingray
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - RA Casale
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - AE Fiorillo
- Centro de Educación Médica e Investigaciones Clínicas, ‘Norberto Quirno’ (CEMIC), Autonomous City, Buenos Aires, Argentina
| | - HB Krupitzki
- Centro de Educación Médica e Investigaciones Clínicas, ‘Norberto Quirno’ (CEMIC), Autonomous City, Buenos Aires, Argentina
| | - JD Malamud
- Sanatorio de la Mujer, Rosario, Santa Fe Province, Argentina
| | - M Mendilaharzu
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán Province, Argentina
| | - ML Medina
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán Province, Argentina
| | - AB del Pino
- Sanatorio de la Mujer, Rosario, Santa Fe Province, Argentina
| | - L Ribola
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - JA Schvartzman
- Centro de Educación Médica e Investigaciones Clínicas, ‘Norberto Quirno’ (CEMIC), Autonomous City, Buenos Aires, Argentina
| | - GM Tartalo
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán Province, Argentina
| | - M Trasmonte
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - S Varela
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - F Althabe
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - JM Belizán
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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Nosratabadi M, Hekmat K, Dencker A, Abbaspoor Z. Individual and Group Psycho-Educational Counseling on Knowledge, Attitude and Preference for Birth Method in Nulliparous Women: A Randomized Controlled Trial. J Family Reprod Health 2018; 12:103-110. [PMID: 30820214 PMCID: PMC6391307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To study the effects of the Individual and Group Psycho-educational counseling in pregnant women on knowledge, attitude and mode of delivery. Materials and methods: This is a randomized controlled trial that carried out on 100 healthy nulliparous pregnant women with uncomplicated pregnancies, who had no contraindication for vaginal birth, but opted for a caesarean section in Medical centers of Dezful city, in the south west of Iran. Participants were randomly assigned into individual or group psycho-educational counseling from gestational week 20 and Knowledge, attitude and mode of delivery in the Individual and Group Psycho-educational counseling methods were measured. Results: All the participants (100%) in the individual and a majority (92%) in the group counseling changed their preference for birth method to vaginal birth after the counseling intervention. Baseline mean scores of knowledge and attitude into birth method selection were equal between groups. After the counseling intervention the mean scores increased significantly for knowledge in both the individual and group counseling groups: 12.96 and 12.88 before the intervention to 24.16 and 22.62, respectively (p < 0.001). Likewise attitude mean scores increased in both groups: 116.06 and 123.42, respectively, before the counseling sessions, that changed to 170.12 and 160.36 after the counseling sessions (p < 0.001). The differences in knowledge and attitude mean scores were statistically non-significant between groups after the intervention. Conclusion: The individual as well as the group psycho-educational counseling sessions increased the knowledge and attitude of pregnant women in relation to vaginal birth without significant differences between groups. Both methods can be recommended. A group counseling method is more effective for advising on the choice of delivery method when many women request a caesarean section without medical indications.
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Affiliation(s)
- Mahnaz Nosratabadi
- Department of Midwifery, Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
| | - Khadija Hekmat
- Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Anna Dencker
- Reproductive and Perinatal Health, Centre for Person-Centered Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zahra Abbaspoor
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Amyx M, Gibbons L, Xiong X, Mazzoni A, Althabe F, Buekens P, Belizán JM. Sources of influence on pregnant women's preferred mode of delivery in Buenos Aires, Argentina. Birth 2018; 45:71-78. [PMID: 28856723 PMCID: PMC5814339 DOI: 10.1111/birt.12307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Understanding influences on women's preferred delivery mode is vital for planning interventions to reduce cesarean rates and for ensuring that women receive correct information. Our objectives were to: determine if sources of information influencing a pregnant woman's preferred delivery mode and knowledge of cesarean indications differ by sociodemographic characteristics; to conduct a factor analysis of items related to information sources influencing this preference; and to determine if knowledge differs by information sources influencing this preference or their underlying latent constructs. METHODS Data from a prospective cohort study conducted in Buenos Aires was analyzed. Healthy nulliparous women aged 18-35, at >32 weeks of gestation and with live, singleton pregnancies participated. The primary research questions were evaluated using Chi-square tests, factor analysis, logistic regression, and generalized estimating equations. RESULTS A total of 382 women participated in the study. Women of lower socioeconomic status were more influenced by people, magazines and TV/movies in their mode of delivery preferences, and had poorer knowledge of cesarean indications. Sources of influence for preferred delivery mode and factors derived in factor analysis were not associated with knowledge level when considered individually or together, or when adjusted for sociodemographic characteristics, or when accounting for clustering by the hospital sector (public or private). CONCLUSIONS Higher socioeconomic status is associated with being less influenced by people and with better knowledge of indications for cesarean delivery. Knowledge of cesarean indications was not associated with the source of information about mode of delivery preferences.
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Affiliation(s)
- Melissa Amyx
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Luz Gibbons
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Xu Xiong
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Agustina Mazzoni
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Fernando Althabe
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - José M Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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Darsareh F, Aghamolaei T, Rajaei M, Madani A. Exploring First-time Pregnant Women's Motivations for Planning Vaginal Delivery: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:465-470. [PMID: 30386397 PMCID: PMC6178579 DOI: 10.4103/ijnmr.ijnmr_175_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In spite of medical indications, preferences for the mode of delivery are influenced by several factors. However, as the literature suggests, the underlying motivation of women choosing vaginal delivery is rarely attended to. The current study aimed to explore first-time pregnant women's motivation for planning vaginal delivery. Materials and Methods: An exploratory design with in-depth interviews was employed from September 2015 to March 2016. Participants were asked key questions about their beliefs about vaginal delivery, perceived outcomes of vaginal delivery, the impact of others perspectives on their decision, and factors that might inhibit or facilitate vaginal delivery. A community advertisement was placed in obstetricians' offices, public health departments, as well as beauty salons throughout the city of Bandar Abbas, Iran, to enroll target participants. All interviews were tape-recorded, transcribed, and subsequently analyzed. Results: Twelve pregnant women within the age range of 19–33 years volunteered to participate. Ninety four initial codes were obtained. These codes were then summed up into three themes as well as six subthemes. The three themes specified were personal beliefs, deliberation and risk assessment, and personal autonomy. Conclusions: A number of key motivating factors such as fast recovery after vaginal delivery, immediate breastfeeding, and powerful bonding were identified, which were influential in choosing vaginal delivery. Awareness of the fact that the provided information shapes women's beliefs and can lead to attitude changes, midwives played a key role in shaping positive and healthy attitudes toward natural birth giving as well as empower them to make autonomous decision.
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Affiliation(s)
- Fatemeh Darsareh
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Minoo Rajaei
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdoulhossain Madani
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Matinnia N, Haghighi M, Jahangard L, Ibrahim FB, Rahman HA, Ghaleiha A, Holsboer-Trachsler E, Brand S. Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae. ACTA ACUST UNITED AC 2017; 40:83-88. [PMID: 28614494 PMCID: PMC6899414 DOI: 10.1590/1516-4446-2017-2229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/06/2017] [Indexed: 12/01/2022]
Abstract
Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.
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Affiliation(s)
- Nasrin Matinnia
- Department of Nursing, College of Basic Science, Hamadan Branch, Islamic Azad University, Hamadan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, University of Medical Sciences, Hamadan, Iran
| | - Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, University of Medical Sciences, Hamadan, Iran
| | - Faisal B Ibrahim
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hejar A Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ali Ghaleiha
- Research Center for Behavioral Disorders and Substance Abuse, University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland.,University of Basel, Department of Sport, Exercise and Health Science, Division Sport and Psychosocial Health, Switzerland
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Zamani-Alavijeh F, Shahry P, Kalhori M, Araban M. Pregnant women's preferences for mode of delivery questionnaire: Psychometric properties. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2017; 6:20. [PMID: 28546985 PMCID: PMC5433639 DOI: 10.4103/2277-9531.204738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The rate of caesarean delivery is increasing worldwide. Maternal beliefs may be influential on the mode of delivery. This study aimed to validate pregnant women's preferences for mode of delivery questionnaire among pregnant women. MATERIALS AND METHODS This was a cross-sectional study which was done in Ahvaz Public and Private Health Care Centers. A total of 342 low-risk pregnant women were included in a study conducted in spring 2011 in Ahvaz, Iran. After careful consideration and performing content and face validity, a 62-item measure was developed and subjects completed the questionnaire. Reliability was estimated using internal consistency and validity was assessed by performing face, content and structure and discriminate validity. Data were analyzed using explanatory factor analysis, t-test, and correlations in SPSS 16. RESULTS The findings of content and face validity showed almost perfect results for both content validity ratio = 1 and content validity index = 1. The explanatory factor analysis indicated a 7-subscale measure (Eigenvalue >1, factor loading >0.4), and discriminate validity revealed satisfying results P < 0.05 for 6 out of 7 subscales. Internal consistency as measured by the Cronbach's alpha coefficient was acceptable for subscales. CONCLUSIONS In general, the findings suggest that this newly generated scale is a reliable and valid specific questionnaire for assessing pregnant women's preferences for mode of delivery. However, further studies are needed to establish stronger psychometric properties for the questionnaire.
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Affiliation(s)
- Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Shahry
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Kalhori
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Araban
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hassani L, Aghamolaei T, Ghanbarnejad A, Dadipoor S. The effect of an instructional program based on health belief model in decreasing cesarean rate among primiparous pregnant mothers. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2016; 5:1. [PMID: 27512693 PMCID: PMC4959261 DOI: 10.4103/2277-9531.184558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Although cesarean section has saved many mothers' and infants' lives, the problem is in its increasing prevalence. According to recent statistics, the current rate of cesarean in Iran is in fact 3-4 times as more than the standard rate defined by WHO. Therefore, the present study is aimed to estimate the effect of an instructional program based on health belief model on reducing cesarean rate among primiparous pregnant women. MATERIALS AND METHODS In this semi-experimental research, 60 primiparous women who had visited Bandar Abbas Healthcare Centers were selected as the subjects. They were in their 26-30(th) week of pregnancy. They were selected in a multi-stage cluster sampling method (a combination of clustering and simple randomization), and were divided into two groups, subjects and control group. The data were gathered using a valid and reliable questionnaire. The instructional intervention was done after the completion of the pretest questionnaire based on the sub-constructs of the health belief model in six instructional sessions. 1 month after the intervention, posttest questionnaires were completed by the subjects in both groups. The data were analyzed using descriptive statistics, standard deviation, independent t-test, and paired t-test. The significance level was set at <0.05. RESULTS Two groups had a significant difference between awareness score, perceived sensitivity, intensity, benefits, barriers, self-efficacy, and the performance (P < 0.001). In the experimental group, nine subjects (30%) had a natural delivery. CONCLUSION According to the findings of the current research, an instructional program illuminated (designed) by the health belief model can significantly influence pregnant women's awareness, intention, and choice of delivery type.
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Affiliation(s)
- Laleh Hassani
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sakineh Dadipoor
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Vacaflor CH. Obstetric violence: a new framework for identifying challenges to maternal healthcare in Argentina. REPRODUCTIVE HEALTH MATTERS 2016; 24:65-73. [PMID: 27578340 DOI: 10.1016/j.rhm.2016.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/30/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022] Open
Abstract
Argentina has recognized women's right to not be subjected to obstetric violence, the violence exercised by health personnel on the body and reproductive processes of pregnant women, as expressed through dehumanizing treatment, medicalization abuse, and the conversion of natural processes of reproduction into pathological ones. Argentina's legislative decision to frame this abuse and mistreatment of women under the rubric of gender-based violence permits the identification of failures in both the healthcare system and women's participation in society. This article examines how applying the Violence Against Women framework to address issues of abuse and mistreatment of women during maternal health care provides a beneficial approach for analyzing such embedded structural problems from public health, human rights, and ethics perspectives. The framework of Violence Against Women seeks to transform existing harmful cultural practices, not only through the protection of women's reproductive autonomy, but also through the empowerment of women's participation in society.
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Kisa S, Zeyneloğlu S. Opinions of women towards cesarean delivery and priority issues of care in the postpartum period. Appl Nurs Res 2016; 30:70-5. [PMID: 27091257 DOI: 10.1016/j.apnr.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
Abstract
This study was conducted, in order to determine the opinions of women who had a cesarean delivery and the problems that they faced in the postpartum period. This descriptive study was conducted with 337 women who delivered babies by cesarean section. The data were collected using a semi-structured questionnaire. The results of the study showed that 53.4% of women underwent cesarean delivery for the first time, and 83.1% said that it was the obstetrician's decision to have a cesarean delivery. More than half of the women (61.1%) had a negative experience with cesarean delivery due to postpartum pain (44.7%) and inability to care for their infant (35.9%). The most common problems associated with cesarean delivery were postpartum pain (96.1%), back pain (68.2%), problems passing gas (62.0%), bleeding (56.1%), breastfeeding problems (49.6%) and limitation of movement (43.6%) respectively. Understanding the the opinions and problems of women towards cesarean delivery assists healthcare professionals in identifying better ways to provide appropriate care and support.
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Affiliation(s)
- Sezer Kisa
- Gazi University, Faculty of Health Sciences, Department of Nursing, Besevler, Ankara, Turkey.
| | - Simge Zeyneloğlu
- Gaziantep University, Faculty of Health Sciences, Department of Nursing, Gaziantep, Turkey.
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Mazzoni A, Althabe F, Gutierrez L, Gibbons L, Liu NH, Bonotti AM, Izbizky GH, Ferrary M, Viergue N, Vigil SI, Zalazar Denett G, Belizán JM. Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study. BMC Pregnancy Childbirth 2016; 16:34. [PMID: 26857448 PMCID: PMC4746891 DOI: 10.1186/s12884-016-0824-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women's preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. METHODS A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women's preferences: a survey using a tailored questionnaire, and a discrete choice experiment. RESULTS Only 8 and 6% of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40% ended their pregnancies by caesarean section in public and private hospitals, respectively. CONCLUSIONS The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35% caesarean sections are unlikely related to their preferences for mode of delivery.
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Affiliation(s)
- Agustina Mazzoni
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
| | - Fernando Althabe
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Nancy H Liu
- UCSF General Internal Medicine, 3333 California Street, Box 0856, San Francisco, CA, 94118, USA
| | - Ana María Bonotti
- Maternal and Child Health Program, Ministry of Health, 483 1/2 7th Avenue, 1900, La Plata, Buenos Aires Province, Argentina
| | - Gustavo H Izbizky
- Department of Obstetrics, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Buenos Aires, Argentina
| | - Marta Ferrary
- Obstetrics Unit, Hospital Magdalena V. de Martínez, Avenida Constituyentes 395, General Pacheco, Tigre, 1617, Buenos Aires Province, Argentina
| | - Nora Viergue
- Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Hospital Universitario Saavedra, Av. Galván 4102, 1431FWO, Buenos Aires, Argentina
| | - Silvia I Vigil
- Obstetrics Unit, Hospital Británico de Buenos Aires, Perdriel 74, C1280AEB, Buenos Aires, Argentina
| | - Gabriela Zalazar Denett
- Obstetrics Unit, Hospital Materno Infantil Dr. Carlos Gianantonio, Diego Palma 505, San Isidro, Buenos Aires Province, Argentina
| | - José M Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
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Rahnama P, Mohammadi K, Montazeri A. Salient beliefs towards vaginal delivery in pregnant women: A qualitative study from Iran. Reprod Health 2016; 13:7. [PMID: 26801087 PMCID: PMC4724137 DOI: 10.1186/s12978-016-0120-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childbirth by cesarean section has increased at an alarming rate over the past few years in Iran. The present study was designed to explore pregnant women's beliefs about the mode of delivery in order to provide some suggestions for future interventions to increase vaginal delivery. METHODS This was a qualitative study framed by the Theory of Planned Behavior conducted in Tehran, Iran in 2013. Pregnant women attending public hospitals were recruited. The data were collected via in-depth interviews and focus group discussions. Interviews were conducted in a semi-structured manner. All interviews were tape recorded and transcribed verbatim. A content analysis approach was used to explore the data. RESULTS In all 36 pregnant women participated in the study. The mean age of women was 27.8 (SD = 4.5) years. In general, women preferred vaginal delivery. During interviews and focus group discussions several themes emerged related to the pain associated with vaginal delivery, fears of childbirth, related health concerns, and the role of decision makers. The findings were grouped into three main themes namely: behavioral beliefs (negative and positive beliefs towards outcomes of vaginal delivery), normative beliefs (injunctive norms and descriptive norms), and control beliefs (internal and external barriers). CONCLUSION Despite the fact that there were positive beliefs regarding vaginal delivery, participants indicated concerns related to loss of control and fear. It is essential that health care providers realize the psychological needs of women during pregnancy and the need for continuous support during childbirth. This type of support may improve their self-control during labor, and decrease fear of childbirth.
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Affiliation(s)
- Parvin Rahnama
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran
| | - Khadigheh Mohammadi
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. .,Faculty of Humanity Sciences, University of Science & Culture, ACECR, Tehran, Iran.
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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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Mode of delivery preferences in a diverse population of pregnant women. Am J Obstet Gynecol 2015; 212:377.e1-24. [PMID: 25446662 DOI: 10.1016/j.ajog.2014.10.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/13/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to assess women's preferences for vaginal vs cesarean delivery in 4 contexts: prior cesarean delivery, twins, breech presentation, and absent indication for cesarean. STUDY DESIGN This was a cross-sectional study of pregnant women at 24-40 weeks' gestation. After assessing stated preferences for vaginal or cesarean delivery, we used the standard gamble metric to measure the strength of these preferences and the time tradeoff metric to determine how women value the potential processes and outcomes associated with these 2 delivery approaches. RESULTS Among the 240 participants, 90.8% had a stated preference for vaginal delivery. Across the 4 contexts, these women indicated that, on average, they would accept a 59-75% chance of an attempted vaginal birth ending in a cesarean delivery before choosing a planned cesarean delivery, indicating strong preferences for spontaneous, uncomplicated vaginal delivery. Variations in preferences for labor processes emerged. Although uncomplicated labor ending in vaginal birth was assigned mean utilities of 0.993 or higher (on a 0-1 scale, with higher scores indicating more preferred outcomes), the need for oxytocin, antibiotics, or operative vaginal delivery resulted in lower mean scores, comparable with those assigned to uncomplicated cesarean delivery. Substantially lower scores (ranging from 0.432 to 0.598) were obtained for scenarios ending in severe maternal or neonatal morbidity. CONCLUSION Although most women expressed strong preferences for vaginal delivery, their preferences regarding interventions frequently used to achieve that goal varied. These data underscore the importance of educating patients about the process of labor and delivery to facilitate incorporation of informed patient preferences in shared decision making regarding delivery approach.
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Mulu W, Yimer M, Abera B. Sexual behaviours and associated factors among students at Bahir Dar University: a cross sectional study. Reprod Health 2014; 11:84. [PMID: 25481831 PMCID: PMC4271440 DOI: 10.1186/1742-4755-11-84] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Sexual behaviour is the core of sexuality matters in adolescents and youths. Their modest or dynamic behaviour vulnerable them to risky sexual behaviours. In Ethiopia, there is scarcity of multicentered representative data on sexual behaviours in students to have a national picture at higher education. This study therefore conducted to assess sexual behaviours and associated factors at Bahir Dar University, Ethiopia. Methods A cross sectional study was conducted among Bahir Dar University students from December to February 2013. Multistage sampling and self administered questionnaires were employed. Descriptive statistics such as frequency and mean were used to describe the study participants in relation to relevant variables. Multivariate analysis was carried for those variables that had a p-value of ≤ 0.2 in the bivariate analysis to identify the predictor variables. Results Of the 817 study participants, 297 (36.4%) students had ever had sex. The mean age at first sexual practice was 18.6 years. Unprotected sex, having multiple sex partners, sex with commercial sex workers and sex for the exchange of money was practiced by 184 (62%), 126 (42.7%), 22 (7.4%) and 12 (4%) of sexually active students, respectively. The proportion of attending night clubs and watching porn videos was 130 (15.8%) and 534 (65.4%), respectively. Male respondents had significant positive association with watching porn videos (AOR = 4.8, CI = 3.49 - 6.54) and attending night clubs (AOR = 3.9, CI = 2.3 – 6.7). Watching porn videos, attending night clubs, khat chewing and taking alcohol frequently were significantly associated for ever had sex and having multiple sexual partners. Khat chewing practice (AOR = 8.5, CI =1.31 - 55.5) and attending night clubs (AOR = 4.6, CI = 1.8 - 11.77) had statistical significant association with the purpose of sexual intercourse for the sake of money and for having sex with commercial sex workers, respectively. Conclusions Significant number of students had different risky sexual behaviours. Substance use, attending night clubs and watching porno video were predictor factors for practicing different sexual behaviours. Therefore, preventive intervention programmes should be strengthened, effectively implemented and monitored both in the earlier school and in the universities.
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Affiliation(s)
- Wondemagegn Mulu
- Bahir Dar University, College of Medicine and Health Sciences, Department of Medical Microbiology, Immunology and Parasitology, Bahir Dar, Ethiopia.
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Lotfi R, Tehrani FR, Dovom MR, Torkestani F, Abedini M, Sajedinejad S. Development of strategies to reduce cesarean delivery rates in iran 2012-2014: a mixed methods study. Int J Prev Med 2014; 5:1552-66. [PMID: 25709791 PMCID: PMC4336986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 10/18/2014] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND With the change in population policy from birth control toward encouraging birth and population growth in Iran, repeated cesarean deliveries as a main reason of cesarean section are associated with more potential adverse consequences. The aim of this research was to explore effective strategies to reduce cesarean delivery rates in Iran. METHODS A mixed methodological study was designed and implemented. First, using a qualitative approach, concepts and influencing factors of increased cesarean delivery were explored. Based on the findings of this phase of the study, a questionnaire including the proposed strategies to reduce cesarean delivery was developed. Then in a quantitative phase, the questionnaire was assessed by key informants from across the country and evaluated to obtain more effective strategies to reduce cesarean delivery. Ten participants in the qualitative study included policy makers from the Ministry of Health, obstetricians, midwives and anthropologists. In the next step, 141 participants from private and public hospitals, insurance experts, Academic Associations of Midwifery, and policy makers in Maternity Health Affairs of Ministry of Health were invited to assess and provide feedback on the strategies that work to reduce cesarean deliveries. RESULTS Qualitative data analysis showed four concept related to increased cesarean delivery rates including; "standardization", "education", "amending regulations", and "performance supervision". Effective strategies extracted from qualitative data were rated by participants then, using ACCEPT derived from A as attainability, C as costing, C as complication, E as effectiveness, P as popularity, and T as timing table 19 strategies were detected as priorities. CONCLUSIONS Although developing effective strategies to reduce cesarean delivery rates is complex process because of the multi-factorial nature of increased cesarean deliveries, in this study we have achieved strategies that in the context of Iran could work.
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Affiliation(s)
- Razieh Lotfi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Prof. Fahimeh Ramezani Tehrani, Parvaneh, Yaman Street, Velenjak, P.O. Box 19395-4763, Tehran, Iran. E-mail:
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Colomar M, Cafferata ML, Aleman A, Castellano G, Elorrio EG, Althabe F, Engelbrecht S. Mode of childbirth in low-risk pregnancies: Nicaraguan physicians' viewpoints. Matern Child Health J 2014; 18:2382-92. [PMID: 24740720 DOI: 10.1007/s10995-014-1478-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado ("humanization of childbirth") could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, UNICEM, Hosp Clinicas, Av Italia s/n, Montevideo, Uruguay,
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