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Fredriksson M, Holmström IK, Höglund AT, Fleron E, Mattebo M. Caesarean section on maternal request: a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden. Reprod Health 2024; 21:97. [PMID: 38956635 PMCID: PMC11221017 DOI: 10.1186/s12978-024-01831-z] [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: 04/05/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making. METHODS A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription. RESULTS In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process). CONCLUSIONS The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Box 564, Uppsala, 751 22, Sweden.
| | - Inger K Holmström
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Box 564, Uppsala, 751 22, Sweden
- School of Health, Care and Social Work, Division of Caring Sciences and Health Care Pedagogics, Mälardalen University, Box 883, Västerås, 721 23, Sweden
| | - Anna T Höglund
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Box 564, Uppsala, 751 22, Sweden
| | - Emma Fleron
- Akutmottagningen för gynekologi vid Akademiska sjukhuset, Akademiska Sjukhuset, Uppsala, 751 85, Sweden
| | - Magdalena Mattebo
- School of Health, Care and Social Work, Division of Caring Sciences and Health Care Pedagogics, Mälardalen University, Box 883, Västerås, 721 23, Sweden
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Ramaiah R, Jothishanmugam A, Alshahrani SH, Innocent Rani V, Alshahrani BY, Rajagopal Sambasivan L, Xavier Dhas J. Kangaroo Mother Care Induced Serum Oxytocin Facilitates Prolactin and IL-10 Among Emergency Cesarean Mothers. J Multidiscip Healthc 2024; 17:2689-2699. [PMID: 38840703 PMCID: PMC11152167 DOI: 10.2147/jmdh.s444172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Background The rate of cesarean section is increasing from 15% to 40% in recent years. The type of delivery influences the hormonal, emotional and mental health of the mother, which correlates positively or negatively with the health benefits of the newborn. There have been many published studies on kangaroo mother care for mothers undergoing elective cesarean section, but there is still a lack of understanding about emergency cesarean section. Objective This study aimed to evaluate the benefits of KMC practice for mothers undergoing emergency cesarean section in terms of hormone levels such as oxytocin, cortisol, prolactin, interleukin-6 and interleukin-10. Methods This retrospective analysis used remnant serum (KMC group = 16; control group = 9), and clinical data such as KMC practice (15-30 minutes three or four times daily until discharge), breastfeeding initiation time, feeding time, crying time and hospital stay were extracted from the electronic database. All hormone and cytokine expressions were quantitatively determined by ELISA. Comparisons within and between groups were performed using appropriate statistical tests. Results In the KMC group, increased levels of the hormone oxytocin significantly reduced cortisol and IL-6 and negatively influenced prolactin and IL-10 levels. The elevated prolactin facilitates overall lactation behaviour, of which 64% reported breastfeeding directly at the breast. The cytokine analysis revealed a reduction in pro-inflammatory cytokines and thereby an improved wound healing was seen in the KMC group. Conclusion These quantitative results strongly encourage the use of KMC for mothers undergoing emergency cesarean section. These simple yet effective breastfeeding strategies promote maternal and infant health, which can reduce medication use.
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Affiliation(s)
- Ramasubbamma Ramaiah
- Medical and Surgical Department, College of Nursing, King Khalid University Abha, Khamis Mushait, Asir, Saudi Arabia
| | - Aruna Jothishanmugam
- Department of Nursing, University College at Aldair, Jazan University, Jazan, Saudi Arabia
| | - Shadia Hamoud Alshahrani
- Medical and Surgical Department, College of Nursing, King Khalid University Abha, Khamis Mushait, Asir, Saudi Arabia
| | - Vanitha Innocent Rani
- Psychiatric Nursing Department, Nursing College Mahayil, King Khalid University, Mahayil, Asir, Saudi Arabia
| | - Bader Yahya Alshahrani
- Supplies Warehouse Department, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Logapriya Rajagopal Sambasivan
- Biochemistry Department, Government Medical College, Thiruvallur, The TN Dr.MGR Medical University, Thiruvallur, TN, India
| | - Justin Xavier Dhas
- Artificial Intelligence and Data Science Department, Velammal Institute of Technology, Viraganur, Anna University, TN, India
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Connett GJ. Asthma, classical conditioning, and the autonomic nervous system - a hypothesis for why children wheeze. Arch Dis Child 2024; 109:462-467. [PMID: 37648401 PMCID: PMC11103287 DOI: 10.1136/archdischild-2023-325441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023]
Abstract
Paediatric asthma is an increasing global healthcare problem for which current treatments are not always effective. This review explores how abnormal triggering of the autonomic diving reflex might be important in explaining research findings and the real-world experience of asthma. It hypothesises that the way in which stress during pregnancy is associated with childhood asthma could be through effects on the developing nervous system. This results in increased parasympathetic responsiveness and specifically, excessive triggering of the diving reflex in response to wetting and cooling of the face and nose as occurs with upper airway infections and allergic rhinitis. In aquatic mammals the reflex importantly includes the contraction of airway smooth muscle to minimise lung volume and prevent nitrogen narcosis from diving at depth. Misfiring of this reflex in humans could result in the pathological airway narrowing that occurs in asthma. The diving reflex, and possibly also smooth muscle, is a vestigial remnant of our aquatic past. The hypothesis further suggests that classically conditioned reflex responses to neutral cues and contexts that were present at the same time as the stimuli that initially caused symptoms, become of themselves ongoing triggers of recurrent wheeze. Symptoms occurring in this way, irrespective of the presence of allergens and ongoing airway sensitisation, explain why allergen avoidance is poorly effective in alleviating wheeze and why asthma is made worse by stress. Interventions to suppress the diving reflex and to prevent reflex conditioned wheezing could result in more effective asthma management.
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Affiliation(s)
- Gary James Connett
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Chldren's Hospital, Southampton, UK
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Hu Q, Chen J, Ma J, Li Y, Xu Y, Yue C, Cong E. Causal effects of neuroticism on postpartum depression: a bidirectional mendelian randomization study. Arch Womens Ment Health 2024:10.1007/s00737-024-01466-w. [PMID: 38634868 DOI: 10.1007/s00737-024-01466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Postpartum depression (PPD) brings adverse and serious consequences to both new parents and newborns. Neuroticism affects PPD, which remains controversial for confounding factors and reverse causality in cross-sectional research. Therefore, mendelian randomization (MR) study has been adopted to investigate their causal relationship. METHODS This study utilized large-scale genome-wide association study genetic pooled data from three major databases: the United Kingdom Biobank, the European Bioinformatics Institute, and the FinnGen databases. The causal analysis methods used inverse variance weighting (IVW). The weighted median, MR-Egger method, MR-PRESSO test, and the leave-one-out sensitivity test have been used to examine the results' robustness, heterogeneity, and horizontal pleiotropy. The fixed effect model yielded the results of meta-analysis. RESULTS In the IVW model, a meta-analysis of the MR study showed that neuroticism increased the risk of PPD (OR, 1.17; 95% CI, 1.11-1.25, p < 0.01). Reverse analysis showed that PPD could not genetically predict neuroticism. There was no significant heterogeneity or horizontal pleiotropy bias in this result. CONCLUSION Our study suggests neuroticism is the risk factor for PPD from a gene perspective and PPD is not the risk factor for neuroticism. This finding may provide new insights into prevention and intervention strategies for PPD according to early detection of neuroticism.
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Affiliation(s)
- Qianying Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, China
- School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Jianhua Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, China
| | - Jingjing Ma
- School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yuting Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, China
| | - Yifeng Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, China.
| | - Chaoyan Yue
- Obstetrics and Gynecology Hospital of Fudan University, Fang Xie Road, No419, Shanghai, Shanghai, China.
| | - Enzhao Cong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, China.
- School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
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Geißler C, Knoerlein J, Bohlmann MK, Brandt A, Guluzade D, Gerber M, Watermann D, Weiz O, König G, Markfeld F, Klar M, Juhasz-Böss I, Kunze M. [Evaluation of Psychological Distress in Obstetric Patients during the Visit Ban in Hospitals in the SARS-CoV-2 Pandemic: A Prospective, Multicentre, Controlled Study]. Z Geburtshilfe Neonatol 2024; 228:80-87. [PMID: 37931900 DOI: 10.1055/a-2180-7507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Risk factors for postpartum depression include a lack of social support and perceived social isolation. We would like to determine whether the isolation of inpatients on the maternity wards during Covid-19 leads to increased psychological stress. METHODS This is a multicentre, controlled study of obstetric patients who gave birth during an inpatient stay. Patients were included during the visitation ban (study group) and after the visitation ban (control group). Psychological stress was evaluated with the Edinburgh Postnatal Depression Scale (EPDS) during the inpatient stay and six to eight weeks postpartum. RESULTS A total of 194 women were included, 107 in the study group and 87 in the control group. The overall result of the first EPDS shows a higher score in the study group compared to the control group (7.0 vs. 4.9 points). Primipara show a higher score in the first EPDS compared to multipara (7.28 vs. 4.82). Caesarean section, regardless of isolation, shows a higher score in the first EPDS than vaginal birth (8.42 vs. 5.11). Comparison of vaginal birth shows a higher score only in the study group (5.97 vs. 4.07). CONCLUSION In the context of Covid-19, women giving birth and new mothers, especially primipara, are exposed to increased psychological stress in the clinics. Caesarean section leads to increased psychological stress.
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Affiliation(s)
- Carmen Geißler
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Julian Knoerlein
- Anästhesiologische Klinik, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Michael K Bohlmann
- Frauenheilkunde und Geburtshilfe , St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Andreas Brandt
- Frauenheilkunde und Geburtshilfe, Ortenau Klinikum, Offenburg, Germany
| | - Durdana Guluzade
- Frauenheilkunde und Geburtshilfe , St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Monika Gerber
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Dirk Watermann
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Olga Weiz
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Gudrun König
- Geburtshilfe, Eichsfeld Klinikum, Eichsfeld, Germany
| | - Filiz Markfeld
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Maximilian Klar
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Ingolf Juhasz-Böss
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Mirjam Kunze
- Frauenklinik, Universitätsklinik Freiburg, Freiburg, Germany
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Al-abri K, Edge D, Armitage CJ. Prevalence and correlates of perinatal depression. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1581-1590. [PMID: 36646936 PMCID: PMC9842219 DOI: 10.1007/s00127-022-02386-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/14/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE This systematic review of systematic reviews aims to provide the first global picture of the prevalence and correlates of perinatal depression, and to explore the commonalities and discrepancies of the literature. METHODS Seven databases were searched from inception until April 2022. Full-text screening and data extraction were performed independently by two researchers and the AMSTAR tool was used to assess the methodological quality. RESULTS 128 systematic reviews were included in the analysis. Mean overall prevalence of perinatal depression, antenatal depression and postnatal depression was 26.3%, 28.5% and 27.6%, respectively. Mean prevalence was significantly higher (27.4%; SD = 12.6) in studies using self-reported measures compared with structured interviews (17.0%, SD = 4.5; d = 1.0) and among potentially vulnerable populations (32.5%; SD = 16.7, e.g. HIV-infected African women) compared to the general population (24.5%; SD = 8.1; d = 0.6). Personal history of mental illness, experiencing stressful life events, lack of social support, lifetime history of abuse, marital conflicts, maternity blues, child care stress, chronic physical health conditions, preeclampsia, gestational diabetes mellitus, being exposed to second-hand smoke and sleep disturbance were among the major correlates of perinatal depression. CONCLUSION Although the included systematic reviews were all of medium-high quality, improvements in the quality of primary research in this area should be encouraged. The standardisation of perinatal depression assessment, diagnosis and measurement, the implementation of longitudinal designs in studies, inclusions of samples that better represent the population and better control of potentially confounding variables are encouraged.
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Affiliation(s)
- Khalood Al-abri
- Division of Psychology and Mental Health, University of Manchester, G35 Coupland 1 Building, Manchester, UK
- Department of Community and Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Dawn Edge
- Division of Psychology and Mental Health, University of Manchester, G35 Coupland 1 Building, Manchester, UK
- Equality, Diversity and Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, University of Manchester, G35 Coupland 1 Building, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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Austin J, Wirtz A, Garrett M, Ferrell SC, Stephenson E, Gajjar S, Perloff S, Hartwell M. Associations of cesarean sections with comorbidities within the Pregnancy Risk Assessment Monitoring System. J Perinat Med 2023; 51:1025-1031. [PMID: 37203560 DOI: 10.1515/jpm-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Cesarean delivery (CD) is a common obstetrical procedure aimed at reducing maternal and infant morbidity and mortality in complicated pregnancies and medical emergencies yet carries potential complications. CD rates in the USA have increased over the years - likely associated with increased comorbidities. Thus, to expand the literature, our objective was to identify the likelihood of a woman having a CD when comorbidities - diabetes, high blood pressure (HBP), or depression - are present. METHODS We conducted a cross-sectional analysis of the 2019 Pregnancy Risk Assessment Monitoring System. Binary and multivariable logistic regression were used to calculate adjusted odds ratios (AORs) to determine associations between pre-existing and gestational comorbidities and CD among pregnant women. RESULTS Compared to those without a diagnosis, women with pre-existing diabetes (AOR: 1.69; CI: 1.54-1.86), pre-existing HBP (AOR: 1.58; CI: 1.46-1.69), and pre-existing depression (AOR: 1.14; CI 1.08-1.20; Table 2) were more likely to have a CD. Additionally, participants with gestational diabetes (AOR 1.43; CI 1.34-1.52), HBP (AOR 1.86; CI 1.76-1.95) and depression (AOR 1.13; CI 1.07-1.19) were also more likely to have a CD than those without comorbidities. CONCLUSIONS Higher rates of CD were found among individuals with a pre-existing or gestational diagnosis of diabetes, HBP, or depression than those without these diagnoses. With increasing rates of these conditions, it is likely that CD rates will continue their trajectory in the USA. Thus, professional organizations can have more impact by popularizing and making effective evidence-based guidelines for management.
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Affiliation(s)
- Jordyn Austin
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Alexis Wirtz
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA
| | - Morgan Garrett
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA
| | - Sydney C Ferrell
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA
| | - Elise Stephenson
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Swapnil Gajjar
- Department of Industrial Engineering & Management, Oklahoma State University, Stillwater, OK, USA
| | - Spenser Perloff
- Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Ramasauskaite D, Nassar A, Ubom AE, Nicholson W. FIGO good practice recommendations for cesarean delivery on maternal request: Challenges for medical staff and families. Int J Gynaecol Obstet 2023; 163 Suppl 2:10-20. [PMID: 37807587 DOI: 10.1002/ijgo.15118] [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] [Indexed: 10/10/2023]
Abstract
Elective cesarean delivery on maternal request is a challenging topic of discussion for patients, their families, and clinicians. Efforts to reduce the rate of cesarean deliveries should include the proportion of cesarean deliveries at term that occur solely due to maternal request rather than a maternal or fetal indication. Additionally, clinicians should follow good clinical practice, which includes family counseling, discussions on the benefits and potential risks of elective cesarean delivery, timing of delivery, and ethical and legal considerations. Furthermore, there is the need for a sustained workforce of perinatal clinicians and staff trained in the appropriate technique and management of operative complications. This article reviews global rates of elective cesarean on maternal request and outlines FIGO's good practice recommendations for counseling expectant mothers and the conduct of elective cesarean versus vaginal delivery.
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Affiliation(s)
- Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Wanda Nicholson
- George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Vaajala M, Kekki M, Mattila VM, Kuitunen I. Fear of childbirth and use of labor analgesia: A nationwide register-based analysis in Finland. Int J Gynaecol Obstet 2023; 162:945-949. [PMID: 37039963 DOI: 10.1002/ijgo.14781] [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: 02/26/2023] [Revised: 04/05/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To calculate the rates of labor analgesia among women with fear of childbirth (FOC) in multiparous and nulliparous women, because FOC might be associated with higher rates of labor analgesia. METHODS In this retrospective register-based cohort study, data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in pregnancies with FOC, when compared with those without. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. RESULTS A total of 19 285 pregnancies with diagnosed maternal FOC were found during our study period. The control group consisted of 757 997 pregnancies without diagnosed maternal FOC. Nulliparous women with diagnosed FOC had a higher rate of epidural analgesia (70.2% vs 67.1%), spinal analgesia (12.3% vs 7.6%), and pudendal block (17.6% vs 9.6%). Multiparous women with FOC had a notably higher rate for epidural analgesia (47.0% vs 29.0%). CONCLUSION The main finding in this study was that women with diagnosed FOC had a higher rate of labor analgesia. The results of this study can be used by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with FOC.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health, Center for Child, Adolescent and Maternal Health Research, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Wilson JM, He J, Flowers KM, Kovacheva V, Soens M, Schreiber KL. Pain Severity and Pain Interference in Late Pregnancy: An Analysis of Biopsychosocial Factors Among Women Scheduled for Cesarean Delivery. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:652-660. [PMID: 36331346 PMCID: PMC10233490 DOI: 10.1093/pm/pnac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Pain is a variably experienced symptom during pregnancy, and women scheduled for cesarean delivery, an increasingly common procedure, are a relatively understudied group who might be at higher pain risk. Although biopsychosocial factors are known to modulate many types of chronic pain, their contribution to late pregnancy pain has not been comprehensively studied. We aimed to identify biopsychosocial factors associated with greater pain severity and interference during the last week of pregnancy. METHODS In this prospective, observational study, 662 pregnant women scheduled for cesarean delivery provided demographic and clinical information and completed validated psychological and pain assessments. Multivariable hierarchical linear regressions assessed independent associations of demographic, clinical, and psychological characteristics with pain severity and pain interference during the last week of pregnancy. RESULTS Women in the study had a mean age of 34 years, and 73% identified as White, 11% as African American, 10% as Hispanic/Latina, and 6% as Asian. Most women (66%) were scheduled for repeat cesarean delivery. Significant independent predictors of worse pain outcomes included identifying as African American or Hispanic/Latina and having greater depression, sleep disturbance, and pain catastrophizing. Exploratory analyses showed that women scheduled for primary (versus repeat) cesarean delivery reported higher levels of anxiety and pain catastrophizing. CONCLUSIONS Independent of demographic or clinical factors, psychological factors, including depression, sleep disturbance, and pain catastrophizing, conferred a greater risk of late pregnancy pain. These findings suggest that women at higher risk of pain during late pregnancy could benefit from earlier nonpharmacological interventions that concurrently focus on psychological and pain symptoms.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jingui He
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vesela Kovacheva
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mieke Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Takahashi K, Samura O, Hasegawa A, Okubo H, Morimoto K, Horiya M, Okamoto A, Ochiai D, Tanaka M, Sekiguchi M, Miyasaka N, Suzuki Y, Tabata T, Hayata E, Nakata M, Suzuki T, Nishi H, Toda Y, Tanigaki S, Furuya N, Hasegawa J, Tamaru S, Kamei Y, Sayama S, Nagamatsu T, Takahashi YO, Kitagawa M, Arakaki T, Sekizawa A. COVID-19 mRNA vaccination status and concerns among pregnant women in Japan: a multicenter questionnaire survey. BMC Pregnancy Childbirth 2023; 23:332. [PMID: 37161480 PMCID: PMC10169175 DOI: 10.1186/s12884-023-05669-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND mRNA vaccination is an effective, safe, and widespread strategy for protecting pregnant women against infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, information on factors such as perinatal outcomes, safety, and coverage of mRNA vaccinations among pregnant women is limited in Japan. Therefore, this study aimed to investigate the perinatal outcomes, coverage, adverse effects, and short-term safety of mRNA vaccination as well as vaccine hesitancy among pregnant women. METHODS We conducted a multicenter online survey of postpartum women who delivered their offspring at 15 institutions around Tokyo from October 2021 to March 2022. Postpartum women were divided into vaccinated and unvaccinated groups. Perinatal outcomes, COVID-19 prevalence, and disease severity were compared between the two groups. Adverse reactions in the vaccinated group and the reasons for being unvaccinated were also investigated retrospectively. RESULTS A total of 1,051 eligible postpartum women were included. Of these, 834 (79.4%) had received an mRNA vaccine, while 217 (20.6%) had not, mainly due to concerns about the effect of vaccination on the fetus. Vaccination did not increase the incidence of adverse perinatal outcomes, including fetal morphological abnormalities. The vaccinated group demonstrated low COVID-19 morbidity and severity. In the vaccinated group, the preterm birth rate, cesarean section rate, and COVID-19 incidence were 7.2%, 33.2%, and 3.3%, respectively, compared with the 13.7%, 42.2%, and 7.8% in the unvaccinated group, respectively. Almost no serious adverse reactions were associated with vaccination. CONCLUSIONS mRNA vaccines did not demonstrate any adverse effects pertaining to short-term perinatal outcomes and might have prevented SARS-CoV-2 infection or reduced COVID-19 severity. Concerns regarding the safety of the vaccine in relation to the fetus and the mother were the main reasons that prevented pregnant women from being vaccinated. To resolve concerns, it is necessary to conduct further research to confirm not only the short-term safety but also the long-term safety of mRNA vaccines.
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Affiliation(s)
- Ken Takahashi
- Department of Obstetrics and Gynecology, The Jikei University Hospital, 3-19-18 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University Hospital, 3-19-18 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan.
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Akihiro Hasegawa
- Department of Obstetrics and Gynecology, The Jikei University Hospital, 3-19-18 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Haruna Okubo
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
- Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-Ku, Tokyo, 125-8506, Japan
| | - Keiji Morimoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
- Department of Obstetrics and Gynecology, The Jikei University Daisan Hospital, 4-11-1 Izumihonmachi, Komae, Tokyo, 201-8601, Japan
| | - Madoka Horiya
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa City, Chiba, 277-8567, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University Hospital, 3-19-18 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University Hospital, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University Hospital, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaki Sekiguchi
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Yuto Suzuki
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, 162-8666, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, 162-8666, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Tomoo Suzuki
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Hirotaka Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Yumi Toda
- Department of Obstetrics and Gynecology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Shinji Tanigaki
- Department of Obstetrics and Gynecology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Natsumi Furuya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine Hospital, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine Hospital, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Shunsuke Tamaru
- Department of Obstetrics and Gynecology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | | | | | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan
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Berg J, Källén K, Andolf E, Hellström-Westas L, Ekéus C, Alvan J, Vitols S. Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:639-648. [PMID: 36396536 DOI: 10.1016/j.jval.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/06/2022] [Accepted: 10/01/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES There is a lack of consensus around the definition of delivery by cesarean section (CS) on maternal request, and clinical practice varies across and within countries. Previous economic evaluations have focused on specific populations and selected complications. Our aim was to evaluate the cost-effectiveness of CS on maternal request compared with planned vaginal birth in a Swedish context, based on a systematic review of benefits and drawbacks and national registry data on costs. METHODS We used the results from a systematic literature review of somatic risks for long- and short-term complications for mother and child, in which certainty was rated low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation. Swedish national registry data were used for healthcare costs of delivery and complications. Utilities for long-term complications were based on a focused literature review. We constructed a decision tree and conducted separate analyses for primi- and multiparous women. Costs and effects were discounted by 3% and the time horizon was varied between 1 and 20 years. RESULTS Planned vaginal birth leads to lower healthcare costs and somatic health gains compared with elective CS without medical indication over up to 20 years. Although there is uncertainty around, for example, quality-of-life effects, results remain stable across sensitivity analyses. CONCLUSIONS CS on maternal request leads to increased hospitalization costs in a Swedish setting, taking into account short- and long-term consequences for both mother and child. Future research needs to study the psychological consequences related to different delivery methods, costs in outpatient care, and productivity losses.
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Affiliation(s)
- Jenny Berg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden.
| | - Karin Källén
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Unit of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| | - Ellika Andolf
- Department of Clinical Sciences, Division of Obstetrics, and Gynaecology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | | | - Cecilia Ekéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jonatan Alvan
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Sigurd Vitols
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden; Department of Medicine, Karolinska Institute, Stockholm, Sweden
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Fu T, Wang C, Yan J, Zeng Q, Ma C. Relationship between antenatal sleep quality and depression in perinatal women: A comprehensive meta-analysis of observational studies. J Affect Disord 2023; 327:38-45. [PMID: 36739002 DOI: 10.1016/j.jad.2023.01.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Perinatal depression is a global mental health problem. Studies have suggested that perinatal depression is related to poor sleep quality during pregnancy. However, evidence on the influence and mechanism of sleep quality on the risk of developing perinatal depression remains limited and inconclusive. METHODS A systematic review was conducted in PubMed, Web of Science, Embase, CINAHI and Cochrane Library for relevant original quantitative studies published in English. A hand search of the reference list of relevant studies was also performed. Meta-analysis was performed using RevMan software and a random-effects model. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using funnel plots and Begg's test. RESULTS A total of ten studies involving 39,574 participants were included in our meta-analysis. Overall, women who experienced poor sleep quality during pregnancy were at a significantly higher risk of developing depression, with antenatal depression 3.72 times higher, postpartum depression 2.71 times higher, and perinatal depression 3.46 times higher, compared to those did not experience poor sleep quality. LIMITATIONS Different measuring tools and unobserved confounding factors may make some bias in our result. What's more, not all included studies were initially designed to assess the association between antenatal sleep quality and the risk of developing perinatal depression. CONCLUSION Our meta-analysis found that antenatal sleep quality was negatively associated with the risk for perinatal depression. Our findings highlight the importance of improving sleep quality during pregnancy for mental health among perinatal women.
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Affiliation(s)
- Tingting Fu
- The Third Xiangya Hospital of Central South University, Department of Nursing, Changsha, Hunan, China
| | - Chunyu Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Xiangya Nursing School, Central South University, Changsha, Hunan, China; The Third Xiangya Hospital of Central South University, Department of Nursing, Changsha, Hunan, China.
| | - Qiya Zeng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York, USA
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AlDughaishi MYK, Seshan V, Matua GA. Antenatal Education Services in Oman: A Descriptive Qualitative Inquiry of Healthcare Provider's Perspective. SAGE Open Nurs 2023; 9:23779608231167820. [PMID: 37032959 PMCID: PMC10074616 DOI: 10.1177/23779608231167820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/22/2023] [Accepted: 03/19/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction To ensure positive pregnancy and birth outcomes, healthcare providers working in antenatal clinics are expected to provide regular antenatal education to enable early detection and timely treatment of pregnancy-related morbidities to prevent complications during labor, birth, and postnatal period. Although antenatal education and services are provided through standard programs in developed countries, presently there are no well-structured programs in many developing countries. The study compares the current service with the national and international guidelines. Objective To identify the current practices of healthcare providers in antenatal education service in Oman with the aim of identifying any major implementation gaps. Methods A qualitative inquiry was implemented through semi-structured in-depth interviews guided by open-ended questions. The study population were healthcare providers who routinely provide antenatal services at healthcare facilities. A purposive non-probability sampling technique was used to select the key informants. Data was analyzed manually using the thematic analysis framework. Results The antenatal education services provided fall under four themes: In relation to "Education for safe pregnancy," the findings revealed that healthcare providers did not adequately address the needs. In relation to "Education for Safe labor and Birth," the pregnant women are briefed with inadequate information about labor and birth during the antenatal period. In relation to "Education related to Postpartum," healthcare providers generally do not provide information regarding pregnant women's psychological wellbeing, breastfeeding, family planning, hygiene, and nutrition during antenatal visits. In relation to "Education related to Newborn Care," the study findings indicate that contrary to what was stipulated by the WHO (2016) to establish antenatal educational programs to help pregnant women gain the skills and knowledge regarding proper newborn care, our findings demonstrated a lack of education about newborn care by providers. Conclusion The findings have the capacity to contribute towards the development of remedial strategies to improve maternal and neonatal outcomes in Oman. This can be achieved by addressing the practice gaps identified when comparing the current practices with international standards.
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Affiliation(s)
| | - Vidya Seshan
- Maternal and Child Health Department, College
of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Gerald Amandu Matua
- Fundamentals and Administration Department,
College of Nursing, Sultan Qaboos University, Muscat, Oman
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15
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Effects of Benson Relaxation Technique and Music Therapy on the Anxiety of Primiparous Women Prior to Cesarean Section: A Randomized Controlled Trial. Anesthesiol Res Pract 2022; 2022:9986587. [PMID: 36589598 PMCID: PMC9803568 DOI: 10.1155/2022/9986587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
Background and Aims Primiparous women experience high levels of anxiety before cesarean section. Therefore, this research aimed to investigate the effects of the Benson Relaxation Technique (BRT) and Music Therapy (MT) on the anxiety of primiparous women prior to cesarean section. Methods A randomized controlled trial was carried out on 105 women scheduled for cesarean section. They were randomly assigned into three groups: BRT, MT, and control (n = 35 per group). The women in the BRT and MT groups performed exercises and listened to music, respectively, for 20 minutes prior to cesarean section. The State Anxiety Inventory was used to measure the women's anxiety in the groups before and after the intervention. Results Within-group comparisons showed that the women in the BRT (t = 5.61, p < 0.001, effect size (Cohen's d) = 0.94) and MT (t = 3.83, p = 0.001, d = 0.64) groups had significantly lower anxiety after the interventions compared to before the interventions. Also, between-group comparisons revealed that anxiety after the intervention was significantly lower in the BRT and MT groups compared to the control group (p = 0.007). Conclusions Although both of the BRT and MT helped with the reduction of anxiety among primiparous women before cesarean section, the BRT was shown more effective. These nonpharmacologic methods are safe and cost-effective and can improve well-being among women undergoing this invasive procedure. They can be used along with pharmacologic methods for reducing overreliance on medications.
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Ilska M, Kołodziej-Zaleska A, Banaś-Fiebrich E, Brandt-Salmeri A, Janowska-Tyc E, Łyszczarz A, Rzewiczok J, Piela B, Cnota W. Health-Related Quality-of-Life among Pregnant Women after First, Second, and Multiple Cesarean Sections in the Perinatal Period: A Short-Term Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16747. [PMID: 36554628 PMCID: PMC9779739 DOI: 10.3390/ijerph192416747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
The primary objective of this study was to compare assessments of health-related quality-of-life (HRQoL) in women who had a medical qualification for cesarean section (CS), depending on the number of CSs in their medical history. A short longitudinal study was conducted among 115 women on the day before a planned cesarean section (CS)-T1, and on the third day after CS-T2. They were divided into three groups. G1: no CS (n = 17); G2: one CS (n = 34); G3: two or more CSs (n = 64). Participants completed a set of questionnaires concerning sociodemographic aspects and psychological outcomes: the HRQoL questionnaire (EQ-5D-3L). A chi-square test, McNemar's test, and repeated measures ANOVA were used to compare the three groups in T1 and T2. Regardless of the number of CSs, before a CS, women mainly experience health problems with pain and anxiety/depression, and after a CS, mostly problems with pain, usual activity, and mobility. All participants experienced an increase in the amount of health problems with mobility and pain after a CS. Women who have had two or more CSs also had problems with self-care and usual activities. Women who have had one or two CSs experienced a decrease in the general assessment of the HRQoL, which is not observed in the group of women with multiple CSs. However, the HRQoL of women in the group with multiple CSs was lower before the CS than in the other groups. The results indicated the significance of the number of CSs, not only in postoperative, but also in preoperative HRQoL.
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Affiliation(s)
- Michalina Ilska
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland
| | - Anna Kołodziej-Zaleska
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland
| | - Ewa Banaś-Fiebrich
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Anna Brandt-Salmeri
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland
| | - Ewa Janowska-Tyc
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Anna Łyszczarz
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Justina Rzewiczok
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Bogusława Piela
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Wojciech Cnota
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
- Faculty of Health Sciences in Katowice, Medical University of Silesia, 41-703 Ruda Śląska, Poland
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A preliminary investigation into testing a transdiagnostic cognitive model of fear of childbirth (FOC): a multiple indicators multiple causes (MIMIC) model. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Caesarean Section on Maternal Request-Ethical and Juridic Issues: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091255. [PMID: 36143932 PMCID: PMC9506057 DOI: 10.3390/medicina58091255] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
In recent decades, the rate of caesarean deliveries has increased worldwide. The reasons for this trend are still largely misunderstood and controversial among researchers. The decision often depends on the obstetrician, his beliefs and experience, the characteristics of the patients, the hospital environment and its internal protocols, the increasing use of induction of labor, the medico-legal implications, and, finally, the mother’s ability to request delivery by caesarean section without medical indication. This review aims to describe the reasons behind the increasing demand for caesarean sections by patients (CDMR) and strategies aimed at reducing caesarean section rates and educating women about the risks and benefits of CS.
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Mode of Delivery Is Associated with Postpartum Depression: Do Women with and without Depression History Exhibit a Difference? Healthcare (Basel) 2022; 10:healthcare10071308. [PMID: 35885834 PMCID: PMC9317972 DOI: 10.3390/healthcare10071308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Whether the mode of birth delivery correlates with the incidence of postpartum depression (PPD) is still under debate. This study seeks to clarify such a correlation and to further investigate if there are any differences in the likelihood of PPD medical care use among women with and without a history of depression. A logistic regression at two assessment points (6-month and 12-month postpartum) on the National Health Insurance Database in Taiwan is performed. In total, 32,729 women were included who gave first birth from 2007 to 2011 via cesarean section (CS), elective CS, and vaginal delivery, of whom 3580 (10.9%) were diagnosed with a history of depression. Findings show that CS was associated with a higher likelihood of PPD doctor visits regardless of whether the women have a history of depression or not, but elective CS tended to have different impacts for these two groups of women. Mentally healthy women who experienced elective CS had 1.36- and 1.64-times higher risk of PDD medical care use than those who delivered vaginally, whereas previous depressive women undertaking an elective cesarean birth had no significant difference observed in incidences. A notably higher risk of elective CS delivery versus vaginal delivery for mentally healthy women suggests that elective CS is not clinically appropriate, yet it might be an alternative to vaginal delivery with careful counseling for pregnant women who experience a history of depression.
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Uphoff EP, Zamperoni V, Yap J, Simmonds R, Rodgers M, Dawson S, Seymour C, Kousoulis A, Churchill R. Mental health promotion and protection relating to key life events and transitions in adulthood: a rapid systematic review of systematic reviews. J Ment Health 2022:1-14. [PMID: 35658814 DOI: 10.1080/09638237.2022.2069724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND During the decades representing working-age adulthood, most people will experience one or several significant life events or transitions. These may present a challenge to mental health. AIM The primary aim of this rapid systematic review of systematic reviews was to summarise available evidence on the effectiveness of interventions to promote and protect mental health relating to four key life events and transitions: pregnancy and early parenthood, bereavement, unemployment, and housing problems. This review was conducted to inform UK national policy on mental health support. METHODS We searched key databases for systematic reviews of interventions for working-age adults (19 to 64 years old) who had experienced or were at risk of experiencing one of four key life events. Titles and abstracts were screened by two reviewers in duplicate, as were full-text manuscripts of relevant records. We assessed the quality of included reviews and extracted data on the characteristics of each literature review. We prioritised high quality, recent systematic reviews for more detailed data extraction and synthesis. RESULTS The search and screening of 3997 titles/abstracts and 239 full-text papers resulted in 134 relevant studies, 68 of which were included in a narrative synthesis. Evidence was strongest and of the highest quality for interventions to support women during pregnancy and after childbirth. For example, we found benefits of physical activity and psychological therapy for outcomes relating to mental health after birth. There was high quality evidence of positive effects of online bereavement interventions and psychological interventions on symptoms of grief, post-traumatic stress, and depression. Evidence was inconclusive and of lower quality for a range of other bereavement interventions, unemployment support interventions, and housing interventions. CONCLUSIONS Whilst evidence based mental health prevention and promotion is available during pregnancy and early parenthood and for bereavement, it is unclear how best to support adults experiencing job loss, unemployment, and housing problems.
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Affiliation(s)
| | | | - Jade Yap
- Mental Health Foundation, London, UK
| | | | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
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Wie JH, Lee SJ, Choi SK, Jo YS, Hwang HS, Park MH, Kim YH, Shin JE, Kil KC, Kim SM, Choi BS, Hong H, Seol HJ, Won HS, Ko HS, Na S. Prediction of Emergency Cesarean Section Using Machine Learning Methods: Development and External Validation of a Nationwide Multicenter Dataset in Republic of Korea. Life (Basel) 2022; 12:life12040604. [PMID: 35455095 PMCID: PMC9033083 DOI: 10.3390/life12040604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
This study was a multicenter retrospective cohort study of term nulliparous women who underwent labor, and was conducted to develop an automated machine learning model for prediction of emergent cesarean section (CS) before onset of labor. Nine machine learning methods of logistic regression, random forest, Support Vector Machine (SVM), gradient boosting, extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), k-nearest neighbors (KNN), Voting, and Stacking were applied and compared for prediction of emergent CS during active labor. External validation was performed using a nationwide multicenter dataset for Korean fetal growth. A total of 6549 term nulliparous women was included in the analysis, and the emergent CS rate was 16.1%. The C-statistics values for KNN, Voting, XGBoost, Stacking, gradient boosting, random forest, LGBM, logistic regression, and SVM were 0.6, 0.69, 0.64, 0.59, 0.66, 0.68, 0.68, 0.7, and 0.69, respectively. The logistic regression model showed the best predictive performance with an accuracy of 0.78. The machine learning model identified nine significant variables of maternal age, height, weight at pre-pregnancy, pregnancy-associated hypertension, gestational age, and fetal sonographic findings. The C-statistic value for the logistic regression machine learning model in the external validation set (1391 term nulliparous women) was 0.69, with an overall accuracy of 0.68, a specificity of 0.83, and a sensitivity of 0.41. Machine learning algorithms with clinical and sonographic parameters at near term could be useful tools to predict individual risk of emergent CS during active labor in nulliparous women.
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Affiliation(s)
- Jeong Ha Wie
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea;
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24289, Korea;
| | - Sae Kyung Choi
- Department of Obstetrics and Gynecology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea;
| | - Yun Sung Jo
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea;
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Mi Hye Park
- Department of Obstetrics and Gynecology, Ewha Medical Center, Ewha Medical Institute, Ewha Womans University College of Medicine, Seoul 07804, Korea;
| | - Yeon Hee Kim
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Korea;
| | - Jae Eun Shin
- Department of Obstetrics and Gynecology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Korea;
| | - Ki Cheol Kil
- Department of Obstetrics and Gynecology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea;
| | - Su Mi Kim
- Department of Obstetrics and Gynecology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Korea;
| | - Bong Suk Choi
- Innerwave Co., Ltd., Seoul 08510, Korea; (B.S.C.); (H.H.)
| | - Hanul Hong
- Innerwave Co., Ltd., Seoul 08510, Korea; (B.S.C.); (H.H.)
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul 05278, Korea;
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (H.S.K.); (S.N.)
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24289, Korea;
- Correspondence: (H.S.K.); (S.N.)
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22
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González-de la Torre H, Domínguez-Gil A, Padrón-Brito C, Rosillo-Otero C, Berenguer-Pérez M, Verdú-Soriano J. Validation and Psychometric Properties of the Spanish Version of the Fear of Childbirth Questionnaire (CFQ-e). J Clin Med 2022; 11:jcm11071843. [PMID: 35407450 PMCID: PMC8999905 DOI: 10.3390/jcm11071843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
The fear of childbirth is a topical concern, yet the issue has barely been studied in Spain, and only one fear of childbirth measurement instrument has been validated in the country. The aim of this study was to translate, adapt and validate the Fear of Childbirth Questionnaire (CFQ) for use in Spain, as well as to describe and evaluate the psychometric properties of the Spanish version of this instrument. In a first phase, a methodological study was carried out (translation–backtranslation and cross-cultural adaptation), and pilot study was carried out in the target population. In addition, content validation of the instrument was obtained (CFQ-e) from 10 experts. In the second phase, a cross-sectional study was carried out at several centres in Gran Canaria Island to obtain a validation sample. The evaluation of the psychometric properties of the CFQ-e, including construct validity through exploratory factor analysis and confirmatory factor analysis, the calculation of reliability via factor consistency using the ORION coefficients as well as alpha and omega coefficients were carried out. The CFQ-e showed evidence of content validity, adequate construct validity and reliability. The CFQ-e is composed of 37 items distributed in four subscales or dimensions: “fear of medical interventions”; “fear of harm and dying”; “fear of pain” and “fears relating to sexual aspects and embarrassment”. The CFQ-e constitutes a valid and reliable tool to measure the fear of childbirth in the Spanish pregnant population.
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Affiliation(s)
- Héctor González-de la Torre
- Research Unit, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain
- Department of Nursing, Nursing School La Palma, University of La Laguna, 38200 San Cristóbal de La Laguna, Spain
- Correspondence: (H.G.-d.l.T.); (J.V.-S.)
| | - Adela Domínguez-Gil
- Obstetrics and Gynaecology Department, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain; (A.D.-G.); (C.P.-B.); (C.R.-O.)
| | - Cintia Padrón-Brito
- Obstetrics and Gynaecology Department, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain; (A.D.-G.); (C.P.-B.); (C.R.-O.)
| | - Carla Rosillo-Otero
- Obstetrics and Gynaecology Department, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain; (A.D.-G.); (C.P.-B.); (C.R.-O.)
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
- Correspondence: (H.G.-d.l.T.); (J.V.-S.)
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23
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Veringa‐Skiba IK, de Bruin EI, van Steensel FJA, Bögels SM. Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness-based childbirth and parenting with enhanced care as usual. Birth 2022; 49:40-51. [PMID: 34250636 PMCID: PMC9292241 DOI: 10.1111/birt.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether mindfulness-based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes. DESIGN Randomized controlled trial. SETTING Midwifery settings, the Netherlands, April 2014-July 2017. POPULATION Pregnant women with high FOC (n = 141) and partners. METHODS Allocation to MBCP or ECAU. Hierarchical multilevel and intention-to-treat (ITT) and per-protocol (PP) analyses. MAIN OUTCOME MEASURES Primary: pre-/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self-requested cesarean birth (sCB), unmedicated childbirth, and 1- and 5-minute newborn's Apgar scores. RESULTS MBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43-0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36-0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23-3.20]). Newborn's 1-minute Apgar scores were higher in MBCP (DM -0.39, 95% CI [-0.74 to -0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1-minute Apgar. CONCLUSIONS MBCP for pregnant couples reduces mothers' fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care.
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Affiliation(s)
- Irena K. Veringa‐Skiba
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
| | - Esther I. de Bruin
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands,UvA‐mindsAcademic Center of the University of AmsterdamAmsterdamthe Netherlands
| | - Francisca J. A. van Steensel
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education (RICDE)Research Priority Area YieldUniversity of AmsterdamAmsterdamthe Netherlands
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Kanellopoulos D, Gourounti K. Tocophobia and Women's Desire for a Caesarean Section: a Systematic Review. MAEDICA 2022; 17:186-193. [PMID: 35733734 PMCID: PMC9168579 DOI: 10.26574/maedica.2022.17.1.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction:The rate of cesarean sections has been continuously increasing in most industrialized countries in recent years. It has been observed that the rate of cesarean sections has increased in the last thirty years and is now between 0.4 and 65%. A significant percentage of women, ranging from 1-20%, request a caesarean section without a medical indication. Aim:The aim of this study is to systematically review the available international literature concerning the phenomenon of tocophobia leading to woman`s desire for a caesarean section. Methods: The methodology followed, included an advanced search in various scientific databases and retrieval of the relevant quantitative studies. Results:We found a total of seven papers, all in English, which examined the correlation between tocophobia and women's desire for a caesarean section. Conclusions:One of the primary reasons behind women's desire to give birth through a caesarean delivery is the pathological fear associated with the labor process, known under the scientific term "tocophobia". According to the findings of this review, the prevalence of tocophobia ranged between 7-25% among primiparous women and 7.7-16.25% among multiparous ones. Approximately 7-18.6% of women with tocophobia asked for an elective cesarean section without any medical indication. Clinical treatment of tocophobia is required when the condition has a negative impact on the pregnant woman's quality of life and her bond with the embryo, as well as when it affects her decision regarding the method of childbirth.
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Heim MA, Makuch MY. Pregnant women’s knowledge of non-pharmacological techniques for pain relief during childbirth. Eur J Midwifery 2022; 6:5. [PMID: 35341133 PMCID: PMC8815084 DOI: 10.18332/ejm/145235] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/10/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The objective of the study was to assess knowledge of pregnant women in the third trimester of pregnancy on non-pharmacological techniques for pain relief during labor and childbirth. METHODS A cross-sectional study was conducted at a tertiary care facility of the University of Campinas, Brazil. The participants were 171 pregnant women, aged 18–35 years with 36 or more weeks of a singleton pregnancy. Participants responded to a questionnaire with data about sociodemographic and obstetric characteristics, knowledge on non-pharmacological techniques for pain relief during childbirth, the source of the information on these techniques, practice of physical activity and occurrence of pain during pregnancy. Parous women responded on the use of non-pharmacological techniques for pain relief during childbirth in previous deliveries. Multiple regression analysis with stepwise criteria of selection of variables was used to identify variables significantly associated with knowledge of non-pharmacological techniques for pain relief during childbirth. RESULTS A total of 165 (96.5%) participants reported knowledge on at least one non-pharmacological technique; 87.1% on the use of a warm shower during labor for pain relief, 80.7% on the use of the birthing ball, and 74.8% on breathing techniques. There were no significant differences between nulliparous and parous women. The main source of information reported was the Internet. Multivariate analysis showed that pregnant women who had pain during pregnancy reported more knowledge on the use of warm showers during labor (OR=2.64; 95% CI: 1.03–6.73). CONCLUSIONS Most women had knowledge of at least one non-pharmacological technique for pain relief during childbirth.
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Affiliation(s)
- Maria A. Heim
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria Y. Makuch
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
- Center for Research in Reproductive Health of Campinas (CEMICAMP), Campinas, Brazil
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26
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Depressive symptoms during pregnancy and after birth in women living in Sweden who received treatments for fear of birth. Arch Womens Ment Health 2022; 25:473-484. [PMID: 35190877 PMCID: PMC8921011 DOI: 10.1007/s00737-022-01213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/09/2022] [Indexed: 01/19/2023]
Abstract
The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based cognitive therapy, counseling with midwives, continuity with a known midwife or standard care. A secondary analysis was performed using data collected from four samples of women identified with fear of birth and receiving treatment with different methods. A questionnaire was used to collect data in mid-pregnancy and at follow-up 2 months after birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depressive Scale. In mid-pregnancy, 32% of the 422 women with fear of birth also reported a co-morbidity with depressive symptoms. At postpartum follow-up, 19% reported depressive symptoms 2 months after birth, and 12% showed continued or recurrent depressive symptoms identified both during pregnancy and postpartum. A history of mental health problems was the strongest risk factor for presenting with depressive symptoms. None of the treatment options in this study was superior in reducing depressive symptoms. This study showed a significant co-morbidity and overlap between fear of birth and depressive symptoms. Screening for depressive symptoms and fear of birth during pregnancy is important to identify women at risk and offer specific treatment.
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Korukcu O, Ozkaya M, Boran OF, Bakacak M. Factors associated with antenatal depression during the COVID-19 (SARS-CoV2) pandemic: A cross-sectional study in a cohort of Turkish pregnant women. Perspect Psychiatr Care 2022; 58:61-70. [PMID: 33772802 PMCID: PMC8251216 DOI: 10.1111/ppc.12778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine the effect of the COVID-19 pandemic on antenatal depression in Turkish pregnant women. DESIGN AND METHODS In this cross-sectional study, data were collected from 497 pregnant women between May and July 2020 using the Edinburgh Depression Scale (EDS) to determine the effect of obstetrics history, fear of hospitalization, concerns about the pandemic, birth, and the health of both mother and infant, on antenatal depression during the COVID-19 outbreak in Turkey. FINDINGS The general EDS mean score of the total group was determined as mean 13.70 ± 6.22, which was higher than the critical cutoff point of 13. According to the multiple linear regression model applied in the study, the best predictive variables for the mean EDS score were determined to be concerned about completing a healthy pregnancy (r = -0.45), social media and news programs related to COVID-19 increasing levels of concern (r = -0.31), fear of hospitalization as the birth approaches (r = -0.45), having bad dreams during the COVID-19 pandemic (r = -0.41), the request for an elective cesarean delivery because of fear of catching COVID-19 (r = -0.40), fear of breastfeeding the infant (r = -0.45), and concerns that their own health would be negatively affected because of the pandemic (r = - 0.39), and these variables affected the mean EDS score negatively (total variance 40.5%, R = 0.642). PRACTICAL IMPLICATIONS The COVID-19 pandemic has created an urgent need to implement specific antenatal programs to promote the psychological health of pregnant women and reduce antenatal depression during this or similar crises.
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Affiliation(s)
- Oznur Korukcu
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Meltem Ozkaya
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Omer Faruk Boran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Murat Bakacak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression. Arch Womens Ment Health 2022; 25:985-993. [PMID: 36030417 PMCID: PMC9420181 DOI: 10.1007/s00737-022-01263-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
Childbirth trauma is common and increases risk for postpartum depression (PPD). However, we lack brief measures to reliably identify individuals who experience childbirth trauma and who may be at greater prospective risk for PPD. To address this gap, we used data from a racially diverse prospective cohort (n=1082). We collected survey data during pregnancy and at 12 weeks postpartum, as well as clinician-reported data from medical records. A new three-item measure of patient-reported childbirth trauma was a robust and independent risk factor for PPD, above and beyond other known risk factors for PPD, including prenatal anxiety and depression. Cesarean birth, greater blood loss, and preterm birth were each associated with greater patient-reported childbirth trauma. Finally, there were prospective indirect pathways whereby cesarean birth and higher blood loss were related to higher patient-reported childbirth trauma, in turn predicting greater risk for PPD. Early universal postpartum screening for childbirth trauma, targeted attention to individuals with childbirth complications, and continued screening for depression and anxiety can identify individuals at risk for PPD. Such efforts can inform targeted interventions to improve maternal mental health, which plays a vital role in infant development.
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Mahfouz I, Asali F, Khalfieh T, Saleem H, Diab S, Samara B, Jaber H. >Early initiation of breastfeeding: Antenatal, peripartum, and neonatal correlates. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_25_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Personality impacts fear of childbirth and subjective birth experiences: A prospective-longitudinal study. PLoS One 2021; 16:e0258696. [PMID: 34731209 PMCID: PMC8565718 DOI: 10.1371/journal.pone.0258696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Previous research suggests that less emotionally stable, less conscientious, less extraverted, and less agreeable women tend to suffer from higher fear of childbirth and experience their delivery as worse. Moreover, there is evidence that birth characteristics and unexpected incidents during delivery may impact women’s birth experiences. However, it remains unknown whether the role of personality in subjective birth experiences varies between women with different birth characteristics. Methods We used data from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a regional-epidemiological study among pregnant women, who were prospectively followed up in multiple waves across the peripartum period. During pregnancy, personality was assessed with the short version of the Big Five Inventory. The Wijma Delivery Expectancy/ Experience Questionnaire was used to measure fear of childbirth (version A) during pregnancy and subjective birth experiences (version B) within the first 10 days after delivery. Results Linear regressions revealed that lower levels of emotional stability, agreeableness, and extraversion predicted higher fear of childbirth during pregnancy. Moreover, personality affected subjective birth experiences especially in women with specific birth characteristics: Lower emotional stability predicted worse subjective birth experiences in women with (vs. without) a preterm delivery, and higher conscientiousness predicted worse subjective birth experiences in women with an emergency cesarean section (vs. spontaneous delivery). Subjective birth experiences were also worse in less emotionally stable and less open women with (general) anesthesia (vs. no anesthesia) during delivery. Finally, higher emotional stability predicted a subjective birth experience that was worse than expected, particularly in multiparous women and women without anesthesia during delivery. Conclusions These findings suggest that less emotionally stable, less conscientious, and less open women tend to experience their delivery as worse particularly in case of unexpected incidents (i.e., preterm delivery, emergency cesarean section, and necessity of anesthetics) and might thus profit from early targeted interventions.
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Kuciel N, Sutkowska E, Biernat K, Hap K, Mazurek J, Demczyszak I. Assessment of the level of anxiety and pain in women who do and do not attend childbirth classes during the SARS-CoV-2 pandemic. Risk Manag Healthc Policy 2021; 14:4489-4497. [PMID: 34754255 PMCID: PMC8572113 DOI: 10.2147/rmhp.s311338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Participation in childbirth classes is aimed at learning to cope with the anxiety that accompanies a woman during her pregnancy and childbirth. The aim of the study was to answer the question whether the lack of access to childbirth classes affected anxiety and perinatal pain in pregnant women who gave birth during the pandemic period. MATERIALS AND METHODS This cross-sectional survey-based study involved women who were pregnant during the lockdown period. The respondents were asked to fill in the following questionnaires: a personal questionnaire, the Polish version of the Delivery Fear Scale and the Numeric Rating Scale for the assessment of average and maximum pain experienced during the labour. The survey was completed within 24-72 hours after the birth of the child. The obtained questionnaires were divided into 2 groups based on the information concerning attending or not attending childbirth classes (divided into subgroups): group A - patients participated in childbirth classes, and group B - patients did not participate in childbirth classes. RESULTS Groups were homogeneous in terms of age, weight, height, body mass index and week of gestation. Perception of anxiety did not differ between groups. There was a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there were no significant differences between groups in terms of mean and maximum pain during labour. CONCLUSION The level of anxiety and pain associated with childbirth is not modulated by childbirth classes during the pandemic period. There is s a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there are no significant differences between groups in terms of mean and maximum pain during labour.
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Affiliation(s)
- Natalia Kuciel
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Karolina Biernat
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Katarzyna Hap
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Justyna Mazurek
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Iwona Demczyszak
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
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Henderson I, Quenby S. The association between caesarean and postnatal psychological distress: Effect modification by mental health history. Paediatr Perinat Epidemiol 2021; 35:635-644. [PMID: 34255373 DOI: 10.1111/ppe.12791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between mode of delivery and postnatal depression is uncertain. Mental health history may modify the association. OBJECTIVES The objective of this study was to determine whether the association between caesarean and postnatal psychological distress (PPD) differs according to long-standing depression/anxiety. METHODS Analysis of the UK-based Millennium Cohort Study of women who gave birth 2000-2002 was carried out. The outcomes were PPD at 9 months by Rutter Malaise Inventory and actively treated physician-diagnosed depression/severe anxiety at 3 years. The exposure was mode of delivery. Adjusted relative risks were estimated using Poisson regression. Effect modification according to long-standing depression/anxiety was investigated multiplicatively and additively. RESULTS We included 15,936 women, of whom 2346 (13.4%, weighted) reported PPD. Women with long-standing depression/anxiety were at 34% lower risk of PPD following elective caesarean, compared with vaginal birth: relative risk (RR) 4.36 (95% confidence interval [CI] 3.76, 5.05), RR 3.25 (95% CI 2.23, 4.75) and RR 4.92 (95% CI 3.67, 6.59) for vaginal, elective and emergency caesarean births, respectively, with relative excess risk due to interaction (RERI) -1.28 (95% CI -2.73, 0.16), ratio of RRs 0.66 (95% CI 0.42, 1.05). Women with long-standing depression/anxiety were at greatest risk of later treatment following emergency caesarean, with RR 4.95 (95% CI 3.86, 6.34), RR 4.09 (95% CI 2.51, 6.65) and RR 6.74 (95% CI 4.87, 9.32), for vaginal, elective and emergency caesarean births, respectively; RERI 1.79 (95% CI -0.13, 3.71), ratio of RRs 1.36 (95% CI 0.94, 1.99); all RRs with reference to vaginal birth in the absence of long-standing depression/anxiety. There was no evidence of a similar association between emergency caesarean and PPD nor elective caesarean and later treatment. CONCLUSIONS Women with long-standing depression or anxiety who had elective caesarean had a lower risk of postnatal distress. When this group had emergency caesarean, there was greater risk of actively treated depression/anxiety at 3 years. These associations were not observed in women without long-standing depression/anxiety.
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Affiliation(s)
- Ian Henderson
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospital, Coventry, UK
| | - Siobhan Quenby
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospital, Coventry, UK
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Deng Y, Lin Y, Yang L, Liang Q, Fu B, Li H, Zhang H, Liu Y. A comparison of maternal fear of childbirth, labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: A cross-sectional study. Int J Nurs Sci 2021; 8:380-387. [PMID: 34631987 PMCID: PMC8488849 DOI: 10.1016/j.ijnss.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/13/2021] [Accepted: 09/09/2021] [Indexed: 10/26/2022] Open
Abstract
Objectives To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth. Methods A convenience sampling method was used. A total of 260 women undergoing spontaneous or induced labor, including 97 primiparas and 163 multiparas, were recruited in a large academic specialized hospital in Guangzhou, China, from February 2018 to August 2019. The clinical data of maternal and neonatal were extracted from a structured electronic medical record system. Other demographic information, such as employment and family monthly income, was collected by a questionnaire. The Numeric Rating Scale (NRS) and the Chinese version of the Childbirth Attitude Questionnaire (C-CAQ) were applied to assess maternal in-labor pain intensity and fear of childbirth. The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump. Results Eighty-two (84.5%) primiparas and ninety-nine (60.7%) multiparas received epidural analgesia (P < 0.001). In the epidural subgroup, the primiparous average fear of childbirth (36.46 ± 10.93) was higher than that of the multiparas (32.06 ± 10.23) (P = 0.007). However, multiparas reported more intense in-labor pain [8.0 (8.0, 9.0) vs. 8.0 (7.0, 8.0)], had more successful manual boluses per hour [2.68 (1.65, 3.85) vs. 1.77 (0.90, 2.47)], more hourly analgesic consumption [23.00 (16.00, 28.25) vs. 17.24 (11.52, 21.36) mL] and more average analgesic consumption [0.35 (0.24, 0.45) vs. 0.26 (0.19, 0.35) mL/(h·kg)] than the primiparas (P < 0.05). Spearman's correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth (r = 0.09) (P < 0.05), hourly analgesic consumption (r = 0.16) (P < 0.01) and average analgesic consumption (r = 0.17) (P < 0.05). No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth. Conclusions Fear of childbirth is a potential predictor of labor pain intensity. Further study is needed to explore its role and value in pain management during delivery. Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia, especially when analgesia resources are insufficient.
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Affiliation(s)
- Yongfang Deng
- Department of High-Risk Obstetric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing Administrative Office, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liyuan Yang
- Department of High-Risk Obstetric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiuxia Liang
- Department of Gynaecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bailing Fu
- Department of Gynaecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huizhu Zhang
- Delivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Liu
- Delivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Sys D, Kajdy A, Baranowska B, Tataj-Puzyna U, Gotlib J, Bączek G, Rabijewski M. Women's views of birth after cesarean section. J Obstet Gynaecol Res 2021; 47:4270-4279. [PMID: 34611958 DOI: 10.1111/jog.15056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vaginal birth is a safe mode of childbirth for the majority of women after cesarean section (CS). However, data show that women who have undergone a CS are more likely to have an elective CS (ECS) than a vaginal birth after CS (VBAC) in many areas of the world. AIM This study aimed to review the literature about women's mode of birth preferences and attitudes and the underlying reasons for, and factors associated with, their preferences. METHODS This is narrative literature review. PubMed/MEDLINE and Scopus databases were searched, limiting the results to non-interventional studies published between 1990 and 2020. Twenty-one articles were included in the analysis. RESULTS The review found 34 different factors that influence women's preferences. Five factors influenced both VBAC and ECS preference, depending on the study. The most common factors having a dualistic effect on preference were: medical staff recommendation, doctor's opinion, and fear of pain. The most common factors were: desire to experience natural childbirth, faster/easier recovery, support from doctor's, and midwife's opinion. Among the factors influencing the preference for ECS, two were particularly prominent: predictability, controllability and comfortability of CS and the belief that CS is safer for the baby and/or mother. CONCLUSIONS Our review showed that there are a variety of factors that influence women's preference for the mode of delivery after CS. Some of these have a dualistic effect according to the study. The key to making an informed decision regarding the mode of delivery is communication with medical professionals.
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Affiliation(s)
- Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Joanna Gotlib
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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Evaluación del impacto del parto mediante cesárea frente el parto vaginal en mujeres con depresión posparto: revisión sistemática cualitativa. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Qiu X, Yuan P, Li W, Jiang L. Post–cesarean section pemphigus vegetans in a young woman treated with methylprednisolone and thalidomide. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e62-e68. [DOI: 10.1016/j.oooo.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/06/2021] [Indexed: 02/06/2023]
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Relationship between delivery with anesthesia and postpartum depression: The Japan Environment and Children's Study (JECS). BMC Pregnancy Childbirth 2021; 21:522. [PMID: 34301185 PMCID: PMC8306350 DOI: 10.1186/s12884-021-03996-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with delivery with anesthesia, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without anesthesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, vaginal delivery with anesthesia was associated with a higher risk of postpartum depression (aOR: 1.233, 95% confidence interval: 1.079–1.409), compared with vaginal delivery without analgesia. Nevertheless, the risk dropped off one year after delivery. Among the pregnant women who requested delivery with anesthesia, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%). Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after vaginal delivery with anesthesia, compared with vaginal delivery without analgesia. Requests for delivery with anesthesia continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying maternal environmental statuses.
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Bíró A, Elek P. Caesarean delivery and the use of antidepressants. Eur J Public Health 2021; 30:727-733. [PMID: 32219394 DOI: 10.1093/eurpub/ckaa047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The high ratio of caesarean sections (C-sections) is a major public health issue in the developed world; but its implications on maternal mental health are not well understood. METHODS We use individual-level administrative panel data from Hungary between 2010 and 2016 to analyze the relationship between caesarean delivery and antidepressant consumption, an objective indicator of mental health. We focus on low-risk deliveries of mothers without subsequent birth in 3 years, and include around 135 000 observations. RESULTS After controlling for medical and socio-economic variables, antidepressant use before delivery is associated with an elevated risk of C-section (adjusted OR = 1.10, 95% CI 1.05-1.14) and C-section is associated with a higher probability of antidepressant use within 1-3 years after delivery (e.g. adjusted OR = 1.21, 95% CI 1.12-1.30, within 3 years after delivery, among mothers without pre-delivery antidepressant consumption). Our data restriction ensures that the results are not driven by a mechanical impact of decreasing fertility on the continuation of antidepressant use after a C-section. CONCLUSIONS The results suggest that C-section is associated with worse mental health over the 1- to 3-year horizon after birth. This relationship is particularly important if a caesarean delivery is not necessary due to medical reasons, and physicians as well as expectant mothers should be made aware of the potential mental health implications of the mode of delivery.
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Affiliation(s)
- Anikó Bíró
- "Lendület" Health and Population Research Group, Centre for Economic and Regional Studies, Budapest, Hungary
| | - Péter Elek
- "Lendület" Health and Population Research Group, Centre for Economic and Regional Studies, Budapest, Hungary.,Department of Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
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Nath S, Lewis LN, Bick D, Demilew J, Howard LM. Mental health problems and fear of childbirth: A cohort study of women in an inner-city maternity service. Birth 2021; 48:230-241. [PMID: 33733519 DOI: 10.1111/birt.12532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the population prevalence of severe fear of childbirth (FOC) during pregnancy and investigate its association with: (a) antenatal common mental disorders (depression and anxiety disorder) and (b) elective cesarean birth. METHODS 545 participants from an inner-city London maternity population were interviewed soon after their first antenatal appointment (mean gestation: 14 weeks). Current mental disorders were assessed using the Structured Clinical Interview DSM-IV. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) at approximately 28 weeks gestation (n = 377), with severe FOC defined using a cutoff of WDEQ-A ≥ 85. Birth mode information was collected at 3 months post-delivery using an adapted Adult Service Use Schedule. Linear regressions were used to model associations, adjusting for the effects of covariates (age, parity, relationship status, education, and planned pregnancy). Sampling weights were used to adjust for bias introduced by the stratified sampling. We also accounted for missing data within the analysis. RESULTS The estimated population prevalence of severe FOC was 3% (95% CI: 2%-6%) (n = 377). Depression and anxiety were significantly associated with severe FOC after adjustment for covariates (45% vs 11%; coefficient: 15.75, 95% CI: 8.08-23.42, P < .001). There was a weak association between severe FOC and elective cesarean birth. CONCLUSIONS Severe FOC occurs in around 3% of the population. Depression and anxiety are associated with FOC. Pregnant people with depression and anxiety may be at increased risk of experiencing severe FOC. Attitudes toward childbirth should be assessed as part of routine clinical assessment of pregnant people in contact with mental health services.
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Affiliation(s)
- Selina Nath
- Health Service and Population Research Department, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy N Lewis
- Health Service and Population Research Department, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jill Demilew
- Women's Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Louise M Howard
- Health Service and Population Research Department, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Roldán-Merino J, Ortega-Cejas CM, Lluch-Canut T, Farres-Tarafa M, Biurrun-Garrido A, Casas I, Castrillo-Pérez MI, Vicente-Hernández MM, Jimenez-Barragan M, Martínez-Mondejar R, Hurtado-Pardos B, Cabrera-Jaime S. Validity and reliability of the Spanish version of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-B). PLoS One 2021; 16:e0249942. [PMID: 33901208 PMCID: PMC8075224 DOI: 10.1371/journal.pone.0249942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-B) is an instrument that allows the experiences around fear of childbirth to be examined after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth and enables healthcare and additional assistance to women after birth to be adapted according to their needs. The objective of this study was to translate the W-DEQ-B into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) transcultural adaption of the questionnaire to Spanish and (2) a transversal study in a sample of 190 postpartum women from Sexual and Reproductive Health Clinics in the province of Barcelona (Spain). The psychometric properties were examined in terms of reliability (internal consistency and temporal stability) and construct validity (confirmatory factorial analysis [CFA] and exploratory factorial analysis [EFA]). The results of the CFA did not confirm unidimensionality of the W-DEQ-B questionnaire. The EFA suggested four very similar, but not identical, dimensions to those obtained in other studies in which the W-DEQ-B has been evaluated. Both the Cronbach's alpha and the omega coefficient were adequate for the total questionnaire and for each of the four dimensions. The results of this study confirm that the W-DEQ-B is multi-dimensional. In the Spanish version of the W-DEQ-B-Sp four dimensions have been identified that allow the experiences around fear of childbirth to be examined after the birth. The Spanish version of the WDEQ-B (WDEQ-B-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.
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Affiliation(s)
- Juan Roldán-Merino
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
- Research Group GEIMAC (Consolidated Group 2017–1681: Group of Studies of Invariance of the Instruments of Measurement and Analysis of Change in the Social and Health Areas), Barcelona, Spain
| | - Celia Maria Ortega-Cejas
- Midwife, Sexual and Reproductive Health Clinic (ASSIR), Mollet del Vallès Barcelona, Barcelona, Spain
| | - Teresa Lluch-Canut
- Research Group GEIMAC (Consolidated Group 2017–1681: Group of Studies of Invariance of the Instruments of Measurement and Analysis of Change in the Social and Health Areas), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mariona Farres-Tarafa
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
- Member Research Group GRISIMula (Grupo emergente 2017 SGR 531; Grupo en Recerca Enfermera en Simulación), Barcelona, Spain
- Secretary, GRISCA Research Group (Nursing Simulation in Catalonia and Andorra Research Group), Barcelona, Spain
| | - Ainoa Biurrun-Garrido
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
| | - Irma Casas
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Preventive Medicine Service, Hospital Germans Trias i Pujol, Barcelona, Spain
- Research Group Innovation in Respiratory Infections and Tuberculosis Diagnosis (Group Consolidat 2017 SGR 494), Barcelona, Spain
| | | | | | - Marta Jimenez-Barragan
- Midwifery Coordinator, Sexual and Reproductive Health Clinic (ASSIR) Fundació Assistencial Mútua Terrassa, (Terrassa) Midwife, Sexual and Reproductive Health Clinic (ASSIR) Rambla Terrassa, (Terrassa) Docente en Fundació Universitaria del Bages, Barcelona, Spain
| | | | - Barbara Hurtado-Pardos
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
| | - Sandra Cabrera-Jaime
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Corporate Care Management, Institut Català d’Oncologia (ICO), L’Hospitalet de LLobregat, Barcelona, Spain
- GRIN Group, IDIBELL, Institute of Biomedical Research, Barcelona, Spain
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Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study. J Pers Med 2021; 11:jpm11050338. [PMID: 33923164 PMCID: PMC8145360 DOI: 10.3390/jpm11050338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56–5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02–2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83–6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36–10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02–4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32–9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98–8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45–4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.
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Routine haemoglobin assay after uncomplicated caesarean sections. MENOPAUSE REVIEW 2021; 20:29-33. [PMID: 33935617 PMCID: PMC8077800 DOI: 10.5114/pm.2021.104474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/17/2021] [Indexed: 11/21/2022]
Abstract
Introduction This study designed to detect whether the routine haemoglobin (Hb) assay after uncomplicated caesarean section (CS) is necessary. Material and methods One hundred and twenty-two (122) women who delivered by uncomplicated elective CS were included in this observational study. Pre-operative investigations were performed according to the hospital protocol, including complete blood count, haemoglobin, prothrombin time, activated partial thromboplastin time, and liver and kidney function tests. After the uncomplicated elective CS, blood samples taken from participants immediately, 12, 24, 48 hours, and 1-week post-operative (PO) for haemoglobin assay. Student’s t-test was used to compare the pre-operative, and PO haemoglobins to detect whether or not the Hb assay after uncomplicated CSs is necessary. Results There was no significant difference between the pre-operative haemoglobin (11.6 ± 6.4 gms%), and the immediate PO haemoglobin (11.1 ± 5.9; p = 0.1 [95% CI: –1.05, 0.5, 2.05]) or 12-hour PO haemoglobin (10.9 ± 7.3; p = 0.9 [95% CI: –1.03, 0.7, 2.43]) or 24-hour PO haemoglobin (10.7 ± 8.2; p = 0.9 [95% CI: –0.95, 0.9, 2.75]). In addition, there was no significant difference between the pre-operative haemoglobin (11.6 ± 6.4 gms%), and 48-hour PO haemoglobin (11.2 ± 6.9; p = 0.7 [95% CI: –1.28, 0.4, 2.08]), or 1-week PO haemoglobin (11.4 ± 7.5; p = 0.9 [95% CI: –1.55, 0.2, 1.95]). Conclusions Routine PO haemoglobin assay after uncomplicated elective CSs is not necessary, especially when the pre-operative haemoglobin before the ECS ≥ 11 gms%, CS duration < 45 min, and estimated intra-operative blood loss ≤ 500 mL.
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Vogel TM. Unique Pain Management Needs for Pregnant Women with Pre-existing PTSD and Other Mental Health Disorders. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial. Ann Gen Psychiatry 2021; 20:2. [PMID: 33397393 PMCID: PMC7783989 DOI: 10.1186/s12991-020-00320-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anxiety and postpartum depression are the most common psychological problems in women after delivery. Cognitive behavior intervention has been reported to have an effect in the therapy of postpartum depression. This research aimed to investigate whether cognitive behavior intervention could prevent the pathogenesis of postpartum depression in primiparous women. METHODS In this randomized controlled trial, primiparous women who were prone to postpartum depression were recruited. Participates in the control group received routine postpartum care and those in the intervention group received both routine postpartum care and cognitive behavior intervention. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Edinburgh Postpartum Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were evaluated before and after the intervention. RESULTS In the intervention group, the post-intervention scores of HAMA, HAMD, EPDS and PSQI were all significantly lower than the baseline scores (p = 0.034, p = 0.038, p = 0.004, p = 0.014, respectively). The proportion of participants with postpartum depression in the intervention group (11.5%) was significantly lower than the control group (24.3%) after the 6-week intervention. Participants in the intervention group were significantly more satisfied with the care than those in the control group (p = 0.032). CONCLUSION This research provided evidence that cognitive behavioral intervention in postpartum period could alleviate anxiety and depression in primiparous women, and inhibit the pathogenesis of postpartum depression. Trial registry This clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000040076).
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Eide KT, Bærøe K. How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106071. [PMID: 33055135 PMCID: PMC8639926 DOI: 10.1136/medethics-2020-106071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 05/08/2023]
Abstract
Caesarean delivery is a common and life-saving intervention. However, it involves an overall increased risk for short-term and long-term complications for both mother and child compared with vaginal delivery. From a medical point of view, healthcare professionals should, therefore, not recommend caesarean sections without any anticipated medical benefit. Consequently, caesarean sections requested by women for maternal reasons can cause conflict between professional recommendations and maternal autonomy. How can we assure ethically justified decisions in the case of caesarean sections on maternal request in healthcare systems that also respect patients' autonomy and aspire for shared decisions? In the maternal-professional relationship, which can be characterised in terms of reciprocal obligations and rights, women may not be entitled to demand a C-section. Nevertheless, women have a right to respect for their deliberative capacity in the decision-making process. How should we deal with a situation of non-agreement between a woman and healthcare professional when the woman requests a caesarean section in the absence of obvious medical indications? In this paper, we illustrate how the maternal-professional relationship is embedded in a nexus of power, trust and risk that reinforces a structural inferiority for women. To accommodate for beneficial use of power, these decision processes need to be trustworthy. We propose a framework, inspired by Lukes' three-dimensional notion of power, which serves to facilitate trust and allows for beneficial power in shared processes of decision-making about the delivery mode for women requesting planned C-sections.
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Affiliation(s)
- Kristiane T Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Kristine Bærøe
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
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46
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Sandman L, Hansson E. An ethics analysis of the rationale for publicly funded plastic surgery. BMC Med Ethics 2020; 21:94. [PMID: 33008385 PMCID: PMC7531084 DOI: 10.1186/s12910-020-00539-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.
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Affiliation(s)
- Lars Sandman
- National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, S-581 83, Linköping, Sweden. .,, Västra Götaland Region, Sweden. .,Borås University, Borås, Sweden.
| | - Emma Hansson
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.,The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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47
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Wigert H, Nilsson C, Dencker A, Begley C, Jangsten E, Sparud-Lundin C, Mollberg M, Patel H. Women's experiences of fear of childbirth: a metasynthesis of qualitative studies. Int J Qual Stud Health Well-being 2020; 15:1704484. [PMID: 31858891 PMCID: PMC6968519 DOI: 10.1080/17482631.2019.1704484] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: Women’s experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women’s experiences of fear of childbirth. Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers. Results: The main results demonstrate a deepened understanding of women’s experiences of fear of childbirth interpreted through the metaphor “being at a point of no return”. Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear. Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth. Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other’s experiences will not happen to them.
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Affiliation(s)
- Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Chair of Nursing and Midwifery, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Elisabeth Jangsten
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carina Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Margareta Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Harshida Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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48
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Crane T, Buultjens M, Fenner P. Art-based interventions during pregnancy to support women's wellbeing: An integrative review. Women Birth 2020; 34:325-334. [PMID: 32912739 DOI: 10.1016/j.wombi.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The transition to motherhood is a dynamic experience. Antenatal care and education are designed to support women during pregnancy, however childbearing women often report a further need for emotional and social support beyond preparation for birth. Broadening routine antenatal care to included art-based interventions may offer women an opportunity to explore important aspects of the transition to motherhood. AIM The aim of this integrative review is to synthesise research regarding the use of art-based interventions with women during pregnancy. METHOD A systematic integrative review of the current evidence-base was conducted. A multi-database keyword search was implemented, and a total of six articles met inclusion criteria. Results were analysed using an inductive thematic analysis framework. FINDINGS Six studies met the inclusion criteria. Three major themes were generated: art-based engagements supported women to express complex emotion, fostered a sense of connection and strengthened personal resourcefulness. DISCUSSION Creative expression provided an opportunity to explore important aspects of the motherhood experience including, complex emotion, identity and bonding with the unborn child. Being in a group enhanced the health effects of art-making and the social connection felt supportive when role and identity was evolving. CONCLUSIONS Whilst research on the current topic is emergent, preliminary results suggest that facilitated art-based programs are valuable for pregnant women. Art-based experiences offer women a unique opportunity to explore the full dimensionality of the transition to motherhood which can contribute to improved health and wellbeing. These findings suggest that art-based programs may serve to complement existing antenatal care models.
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Affiliation(s)
- Tess Crane
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Melissa Buultjens
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Patricia Fenner
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
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Eide KT, Morken NH, Bærøe K. Tensions and interplay: A qualitative study of access to patient-centered birth counseling of maternal cesarean requests in Norway. Midwifery 2020; 88:102764. [PMID: 32534254 DOI: 10.1016/j.midw.2020.102764] [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: 12/06/2018] [Revised: 03/10/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to explore women's access to patient-centered counseling for concerns initiating cesarean requests in absence of obstetric indications in pregnancy, and to identify tensions, barriers and facilitators affecting such care. DESIGN, SETTING AND INFORMANTS This qualitative study (June 2016 to August 2017) obtained data through semi-structured in-depth interviews with 17 women requesting planned C-section during birth counseling at a university hospital in Norway and focus group discussions with 20 caregivers (9 midwives and 11 obstetricians) employed at the same hospital. Analysis was carried out by systematic text condensation, a method for thematic analysis in medical research, presented within the frames of Levesque and colleagues' conceptual framework of access to patient-centered care. FINDINGS The analysis revealed that there were considerable tensions in care seeking and provision of counseling for maternal requests for C-section. There was a prominent culture of vaginal delivery among caregivers and women. The appropriateness of CS on maternal request was debated and caregivers revealed diverging attitudes and practices when agreement with women was not reached. Women's views on their entitlement to choose were divided, but the majority of women did not support complete maternal choice. Midwife-led counseling were highly appreciated among woman as well as obstetricians. IMPLICATIONS FOR PRACTICE Tensions and barriers in care seeking and provision of counseling for women requesting C-section for non-obstetric reasons, call for standardized counseling in order for equal and adequate care to be provided across health care institutions and providers. Dialogue-based decision-making and midwife-led care may improve satisfaction of care, enhance spontaneous vaginal deliveries and avoid future conflicts.
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Affiliation(s)
- Kristiane Tislevoll Eide
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Jonas Lies veg 87, 5021 Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway.
| | - Kristine Bærøe
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.
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Du SG, Tang F, Zhao Y, Sun GQ, Lin Y, Tan ZH, Wu XF. Effect of China's Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China. Curr Med Sci 2020; 40:348-353. [PMID: 32337696 DOI: 10.1007/s11596-020-2190-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 02/04/2020] [Indexed: 10/24/2022]
Abstract
China's universal two-child policy was released in October of 2015. How would this new policy influence the rate of overall cesarean delivery (CD) in China? The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China (a tertiary hospital) in 2016. In this study, 22 530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were enrolled as research objects. Electronic health records of these selected objects were retrieved. According to the history of childbirth, the selected cases were divided into primiparous group containing 16 340 cases and multiparous group containing 6190 cases. Chi-square test was carried out to compare the rate of CD, neuraxial labor analgesia, maternity insurance between the two groups; t-test was performed to compare the in-hospital days and gestational age at birth between the two groups. Pearson correlation coefficient was used to evaluate the relationship among observed monthly rate of multiparas, overall CD rate, and Elective Repeat Cesarean Delivery (ERCD) rate. The results showed that the CD rate in multiparous group was 55.46%, which was higher than that in primiparous group (34.66%, P<0.05). The rate of neuraxial labor analgesia in multiparas group was 9.29%, which was lower than that in primiparas group (35.94%, P<0.05). However, the rate of maternity insurance was higher in multiparas group (57.00%) than that in primiparas group (41.08%, P<0.05). The hospital cost and in-hospital days in multiparas group were higher, and the gestational age at birth in multiparas group was lower than in primiparas group (P<0.05). The overall CD rate slightly dropped in the first 4 months of the year (P<0.05), then increased from 36.27% (April) to 43.21% (December) (P<0.05). The rate of multiparas women and ERCD had the same trend (P<0.05). There were linear correlations among the rate of overall CD, the rate of multiparas women and the rate of ERCD rate (P<0.05). With the opening of China's two-child policy, the increasing rate of overall CD is directly related with the high rate of ERCD. Trials of Labor After Cesarean Section (TOLAC) in safe mode to reduce overall CD rate are warranted in the future.
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Affiliation(s)
- Shu-Guo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Fei Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Guo-Qiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ying Lin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Zhi-Hua Tan
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Xu-Feng Wu
- Department of Gynecology and Oncology, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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