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Ibici Akça E, Aksoy Derya Y. Effects of tele-education given based on the health belief model on mode of delivery tendencies in pregnant women. J Reprod Infant Psychol 2024; 42:681-699. [PMID: 36127862 DOI: 10.1080/02646838.2022.2125939] [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: 04/28/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cesarean sections, which have a high risk of maternal and neonatal complications and increase health expenditures, have become a global problem. Hence, it is extremely important to encourage women to have normal deliveries. OBJECTIVE This study was conducted to determine the effects of tele-education given to nulliparous pregnant women based on the health belief model (HBM) on their normal delivery beliefs and tendencies. METHODS This randomized-controlled study was conducted with 149 nulliparous pregnant women. Participants in the experimental group received a tele-education programme in 8 sessions prepared in line with the health belief model regarding normal delivery for 15 days. The data was collected by using the "Pregnancy Information Form" and "Belief Scale for Normal Delivery (BSND)". RESULTS After the tele-education programme, the post-test BSND mean score was 89.90±14.10 in the experimental group and 78.80±12.65 in the control group, where the difference between them was significant (p < 0.01). Additionally, the post-test mean scores of participants in the experimental group in all BSND's subdimensions were significantly higher than those of the women in the control group (p < 0.05). CONCLUSION The tele-education given in line with the HBM increased the belief and tendency levels of the nulliparous pregnant women towards normal delivery.
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Affiliation(s)
- Emine Ibici Akça
- Department of Midwifery, Faculty of Health Sciences, Amasya University, Amasya, Turkey
| | - Yeşim Aksoy Derya
- Department of Midwifery, Faculty of Health Sciences, Inonu University, Malatya, Turkey
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Domingues RMSM, Dias MAB, do Carmo Leal M. Women's preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project. Reprod Health 2024; 20:188. [PMID: 38549093 PMCID: PMC10976663 DOI: 10.1186/s12978-024-01771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND In 2015, a quality improvement project called "Adequate Childbirth Project" (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women's preference for vaginal birth (VB) at the end of pregnancy. METHODS Evaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women's preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women's preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram. RESULTS Four thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99-3.24) and multiparous women (OR 1.44 95% CI 0.97-2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22-24.50) and in multiparous women (OR 53.11 95% CI 37.31-75.60). CONCLUSIONS The PPA had a positive effect on women's preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.
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Affiliation(s)
- Rosa Maria Soares Madeira Domingues
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Laboratório de Pesquisa Clínica em DST/Aids, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, CEP 21040-360, Brazil.
| | - Marcos Augusto Bastos Dias
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca/ Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Nuampa S, Ratinthorn A, Lumbiganon P, Rungreangkulkij S, Rujiraprasert N, Buaboon N, Jampathong N, Dumont A, Hanson C, de Loenzien M, Bohren MA, Betrán AP. "Because it eases my Childbirth Plan": a qualitative study on factors contributing to preferences for caesarean section in Thailand. BMC Pregnancy Childbirth 2023; 23:280. [PMID: 37095449 PMCID: PMC10124050 DOI: 10.1186/s12884-023-05576-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Although caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women's and health professionals' preferences for CS delivery in Thailand. METHODS We conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes. RESULTS There were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers' perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby's safety, a protective shield for doctors); and (3) CS facilitates time management (baby's destiny at an auspicious time, family's management, manage my work/time). CONCLUSIONS Women mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women's lives. From health professionals' perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.
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Affiliation(s)
- Sasitara Nuampa
- Department of Obstetrics and Gynaecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Ameporn Ratinthorn
- Department of Obstetrics and Gynaecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Somporn Rungreangkulkij
- Centre for Research and Training on Gender and Women's Health, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Nilubon Rujiraprasert
- Centre for Research and Training on Gender and Women's Health, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Natthapat Buaboon
- Department of Family of Nursing and Midwifery, Faculty of Nursing, Thammasat University, Prathumthani, Thailand
| | | | - Alexandre Dumont
- Université Paris Cité, IRD, Inserm, F-75006, Paris, Ceped, France
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Stoll K, Titoria R, Turner M, Jones A, Butska L. Perinatal outcomes of midwife-led care, stratified by medical risk: a retrospective cohort study from British Columbia (2008-2018). CMAJ 2023; 195:E292-E299. [PMID: 36849178 PMCID: PMC9970624 DOI: 10.1503/cmaj.220453] [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] [Accepted: 11/29/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Anecdotal evidence suggests that the profile of midwifery clients in British Columbia has changed over the past 20 years and that midwives are increasingly caring for clients with moderate to high medical risk. We sought to compare perinatal outcomes with a registered midwife as the most responsible provider (MRP) versus outcomes among clients with physicians as their MRP across medical risk strata. METHODS This retrospective cohort study (2008-2018) used data from the BC Perinatal Data Registry. We included all births that had a family physician, obstetrician or midwife listed as the MRP (n = 425 056) and stratified the analysis by pregnancy risk status (low, moderate or high) according to an adapted perinatal risk scoring system. We estimated differences in outcomes between MRP groups by calculating adjusted absolute and relative risks. RESULTS The adjusted absolute and relative risks of adverse neonatal outcomes were consistently lower among those who chose midwifery care across medical risk strata, compared with clients who had a physician as MRP. Midwifery clients experienced higher rates of spontaneous vaginal births, vaginal births after cesarean delivery and breastfeeding initiation, and lower rates of cesarean deliveries and instrumental births, with no increase in adverse neonatal outcomes. We observed an increased risk of oxytocin induction among high-risk birthers with a midwife versus an obstetrician as MRP. INTERPRETATION Our findings suggest that compared with other providers in BC, midwives provide safe primary care for clients with varied levels of medical risk. Future research might examine how different practice and remuneration models affect clinical outcomes, client and provider experiences, and costs to the health care system.
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Affiliation(s)
- Kathrin Stoll
- Department of Family Practice (Stoll), University of British Columbia; Provincial Health Services Authority (Titoria); Midwifery Program (Turner, Butska), Department of Family Practice, University of British Columbia; Women's Health Research Institute (Jones), BC Women's Hospital, Vancouver, BC
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Xu J, Li L, Ma XQ, Zhang M, Qiao J, Redding SR, Wang R, Ouyang YQ. Fertility Intentions, Parenting Attitudes, and Fear of Childbirth among College Students in China: A Cross-Sectional Study. J Pediatr Adolesc Gynecol 2023; 36:65-71. [PMID: 35933080 DOI: 10.1016/j.jpag.2022.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/09/2022] [Accepted: 07/28/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE This study aimed to investigate the current situation regarding fertility intentions, parenting attitudes, and fear of childbirth among college students in mainland China and the factors related to these variables. DESIGN A cross-sectional study SETTING: Colleges across China PARTICIPANTS: Five hundred and eighty-three college students attending regular institutions of higher education MAIN OUTCOME MEASURES: Fertility intentions and fear of childbirth were measured using the Swedish Fertility Awareness Questionnaire and the Childbirth Fear Prior to Pregnancy scale. RESULTS Only 38.8% of participants expressed their willingness to have children, and there was a significant difference between male and female students (P < .02). Males regarded having children as more important (P < .01), and females were more concerned about the negative effects of becoming parents, including difficulties in the labor market, having less freedom, and having less money. When deciding whether to have children, factors such as work, economics, and childcare were more important to females. Students who did not want children had higher levels of fear of childbirth than those who wanted children or were unsure (P < .02). CONCLUSIONS The fertility intentions of college students were not optimistic. In addition to the 2-child Chinese fertility policy, interventions aimed at reducing the cost of raising children, eliminating gender inequality in the workplace, and normalizing childcare institutions might help alleviate conflict between work and childrearing.
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Affiliation(s)
- Jing Xu
- School of Nursing, Wuhan University, Wuhan, China
| | - Lu Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Xiao-Qian Ma
- School of Public Health, Wuhan University, Wuhan, China
| | - Miao Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Jia Qiao
- School of Nursing, Wuhan University, Wuhan, China
| | | | - Rong Wang
- Renmin Hospital of Wuhan University, Wuhan, China.
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Costa DDDO, Ribeiro VS, Ribeiro MRC, Esteves-Pereira AP, Leal MDC, Silva AAMD. Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil. CAD SAUDE PUBLICA 2023; 39:e00138922. [PMID: 36995799 DOI: 10.1590/0102-311xen138922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/26/2022] [Indexed: 03/29/2023] Open
Abstract
Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.
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Zhang N, Chang X, Liu R, Zheng C, Wang X, Birch S. General population preferences for cancer care in health systems of China: A discrete choice experiment. Cancer Med 2022; 12:7485-7497. [PMID: 36479927 PMCID: PMC10067129 DOI: 10.1002/cam4.5473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/13/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer in China has posed considerable challenges for cancer care delivery systems. This study aimed to determine the general population's preferences for cancer care, to provide evidence for building a people-centered integrated cancer care system. METHODS We conducted a discrete choice experiment that involved 1,200 participants in Shandong Province. Individuals were asked to choose between cancer care scenarios based on the type and level of hospitals, with various out-of-pocket costs, waiting time, and contact working in the hospitals. Individual preferences, willingness to pay, and uptake rate were estimated using a mixed-logit model. RESULTS This study included 848 respondents (70.67%). Respondents preferred county hospitals with shorter hospitalization waiting times and contact working in hospitals. Compared to the reference levels, the three highest willingness to pay values were related to waiting time for hospitalization (¥97,857.69-¥145411.70-¥212,992.10/$14512.70-$21565.16-$31587.61), followed by the county-level hospital (¥32,545.13/$4826.58). The preferences of the different groups of respondents were diverse. Based on a county-level general hospital with contact in the hospital, 50% out-of-pocket costs and a waiting time of 15 days, the probability of seeking baseline care was 0.37. Reducing the waiting time from 15 to 7, 3, and 0 days, increases the probability of choosing a county-level hospital from 0.37 to 0.58, 0.64, and 0.70, respectively. CONCLUSIONS This study suggests that there is a substantial interest in attending county-level hospitals and that reducing hospitalization waiting time is the most effective measure to increase the probability of seeking cancer care in county-level hospitals.
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Affiliation(s)
- Nan Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University Jinan China
- NHC Key Lab of Health Economics and Policy Research (Shandong University) Jinan China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences Jinan China
| | - Xuan Chang
- Department of Publicity Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Ruyue Liu
- School of Public Health Weifang Medical University Weifang China
| | - Caiyun Zheng
- School of Public Health Sun Yat‐Sen University Guangzhou China
| | - Xin Wang
- School of Public Health Sun Yat‐Sen University Guangzhou China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland Brisbane Australia
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Gaining insight from future mothers: A survey of attitudes and perspectives of childbirth. Midwifery 2022; 115:103499. [DOI: 10.1016/j.midw.2022.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/02/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022]
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Park Y, Kim JH, Lee KS. Changes in cesarean section rate before and after the end of the Korean Value Incentive Program. Medicine (Baltimore) 2022; 101:e29952. [PMID: 35984147 PMCID: PMC9388010 DOI: 10.1097/md.0000000000029952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Korean government implemented a value incentive program providing incentives to providers based on C-section rates, with the rates being publicized. The program ended in 2014 after the administration decided that the effects of the incentive program were limited. In this report, we analyzed changes in C-section rates with the value incentive program. METHODS The analysis used claim data from Korea's National Health Insurance. The study period (2011-2016) was divided into two phases: before and after the program. This study included 95 providers that were tertiary or general hospitals having more than 200 deliveries per year during the study period. The dependent variable was the risk-adjusted C-section rate. Independent variables included time and hospital characteristics such as hospital type, district, and ownership. Interrupted time series analysis was performed to analyze the data. RESULTS Our results showed that risk-adjusted C-section rates increased immediately after the end of the incentive program for C-sections. The immediate effect of intervention, a change of 1.73% (P < .05), was statistically significant, as was the trend after intervention, at 0.21% (P < .0001). The slope showed an increase after the intervention to 0.25% per medical institution, which was contrary to the trend of the preintervention decline (negative slope). CONCLUSION Risk-adjusted C-section rates increased immediately after the discontinuation of a value incentive program. Tertiary hospitals showed greater increases in C-section rates than general hospitals after the intervention.
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Affiliation(s)
- YouHyun Park
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Jae-hyun Kim
- Department of Healthcare Administration, Dankook University, Cheonan, Republic of Korea
| | - Kwang-soo Lee
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
- *Correspondence: Kwang-soo Lee, Department of Health Administration, Yonsei University, 1, Yeonsedae-gil, Heungeop-myeon, Wonju-si 26493, Gangwon-do, Republic of Korea (e-mail: )
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Ataman H, Dişsiz M. Premenstrual Syndrome and Childbirth Fear Prior to Pregnancy in Young Women: An Association and Cross-Sectional Study. Rev Assoc Med Bras (1992) 2022; 68:898-903. [PMID: 35946765 DOI: 10.1590/1806-9282.20211211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine the association between premenstrual syndrome and the childbirth fear prior to pregnancy. METHODS This was an association and cross-sectional study conducted on 327 university students. Data were collected using "Participant Information Form," "Premenstrual Syndrome Scale," and "Childbirth Fear-Prior to Pregnancy Scale." RESULTS It was found that the childbirth fear had increased in students with premenstrual syndrome. The Women Childbirth Fear-Prior to Pregnancy Scale score was statistically significantly higher among students who preferred caesarean section than those who preferred vaginal delivery. There was a weak, positive, and statistically significant correlation between the students' depressive sensation, anxiety, fatigue, nervousness, depressive thoughts, pain, appetite changes, sleep pattern changes, and bloating subscales of Premenstrual Syndrome Scale and Women Childbirth Fear-Prior to Pregnancy Scale. CONCLUSION The score of the Women Childbirth Fear-Prior to Pregnancy Scale increases with an increase in the score of the Premenstrual Syndrome subscale. It should be evaluated whether or not women experiencing premenstrual syndrome have the childbirth fear prior to pregnancy.
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Affiliation(s)
- Hacer Ataman
- Istanbul Medeniyet University, Faculty of Health Sciences - Istanbul, Turkey
| | - Melike Dişsiz
- University of Health Sciences, Hamidiye Faculty of Nursing - Istanbul, Turkey
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Sima YT, Skjærven R, Kvalvik LG, Morken NH, Klungsøyr K, Sørbye LM. Cesarean delivery in Norwegian nulliparous women with singleton cephalic term births, 1967-2020: a population-based study. BMC Pregnancy Childbirth 2022; 22:419. [PMID: 35585522 PMCID: PMC9118652 DOI: 10.1186/s12884-022-04755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Nulliparous women contribute to increasing cesarean delivery in the Nordic countries and advanced maternal age has been suggested as responsible for rise in cesarean delivery rates in many developed countries. The aim was to describe changes in cesarean delivery rates among nulliparous women with singleton, cephalic, term births by change in sociodemographic factors across 50 years in Norway. Methods We used data from the Medical Birth Registry of Norway and included 1 067 356 women delivering their first, singleton, cephalic, term birth between 1967 and 2020. Cesarean delivery was described by maternal age (5-year groups), onset of labor (spontaneous, induced and pre-labor CD), and time periods: 1967–1982, 1983–1998 and 1999–2020. We combined women’s age, onset of labor and time period into a compound variable, using women of 20–24 years, with spontaneous labor onset during 1967–1982 as reference. Multivariable regression models were used to estimate adjusted relative risk (ARR) of cesarean delivery with 95% confidence interval (CI). Results Overall cesarean delivery increased both in women with and without spontaneous onset of labor, with a slight decline in recent years. The increase was mainly found among women < 35 years while it was stable or decreased in women > = 35 years. In women with spontaneous onset of labor, the ARR of CD in women > = 40 years decreased from 14.2 (95% CI 12.4–16.3) in 1967–82 to 6.7 (95% CI 6.2–7.4) in 1999–2020 and from 7.0 (95% CI 6.4–7.8) to 5.0 (95% CI 4.7–5.2) in women aged 35–39 years, compared to the reference population. Despite the rise in induced onset of labor over time, the ARR of CD declined in induced women > = 40 years from 17.6 (95% CI 14.4–21.4) to 13.4 (95% CI 12.5–14.3) while it was stable in women 35–39 years. Conclusion Despite growing number of Norwegian women having their first birth at a higher age, the increase in cesarean delivery was found among women < 35 years, while it was stable or decreased in older women. The increase in cesarean delivery cannot be solely explained by the shift to an older population of first-time mothers. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04755-3.
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Affiliation(s)
- Yeneabeba Tilahun Sima
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Grimstvedt Kvalvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Linn Marie Sørbye
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Critiquing the evolution of maternity care preferences research: A systematic mixed studies review. Midwifery 2022; 111:103386. [DOI: 10.1016/j.midw.2022.103386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
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Childbirth fear, birth-related mindset and knowledge in non-pregnant women without birth experience. BMC Pregnancy Childbirth 2022; 22:249. [PMID: 35331176 PMCID: PMC8951686 DOI: 10.1186/s12884-022-04582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Childbirth fear and interventions during childbirth might be related to the mindset and knowledge non-pregnant women have regarding childbirth. Non-pregnant women before their first birth experience may be particularly at risk for childbirth fear. Methods The present study examined the expressions and associations of birth-related mindset, knowledge, and fear among 316 young, non-pregnant women without birth experience. They participated in a cross-sectional online study and completed the Childbirth Fear Prior to Pregnancy, the Mindset and Birth Questionnaire, and a birth knowledge test. Results Most women (44%) had a natural mindset and low fear, 29% had a medical mindset and low fear, 8% natural mindset and higher fear, and 19% medical mindset and higher fear. There were no differences in knowledge between the four groups. Some gaps in knowledge appeared concerning signs of beginning birth, and non-medical approaches to pain relief. From women with natural mindset and low childbirth fear, a higher percentage (13%) has already watched a birth, as compared to the other groups. Natural mindset was associated with lower childbirth fear, whereas knowledge was independent from childbirth fear. Higher knowledge was low associated with natural mindset. Mindset and childbirth fear were independent from age and education degree. Conclusions Gynecologists, midwifes and other health professionals may develop an awareness for birth as a natural event in their non-pregnant patients, and take birth-related fear into account in their counseling, with focus on women’s self-efficacy and non-medical approaches to pain relief.
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Varnakioti D, Gourounti K, Sarantaki A, Tzavara C, Lykeridou A. The Development and the Psychometric evaluation of the Adolescents Intensions towards the Birth Options Scale in Greek. Eur J Midwifery 2022; 6:11. [PMID: 35341132 PMCID: PMC8899851 DOI: 10.18332/ejm/145968] [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: 12/15/2021] [Revised: 12/17/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Worldwide, the rising of caesarean section rates is a major public health issue. Little is known regarding birth attitudes held by students who are the next generation of parents. The aim of this study was to develop and assess the psychometric properties of the Adolescents Intentions towards Birth Options Scale (AIBOS), a self-report and short instrument assessing intentions towards birth options in young adolescents. METHODS The AIBOS was framed by Ajzen’s theory of planned behavior and developed in a three-phase process using an integrated mixed-methods approach that included literature reviews, professional focus groups, and a psychometric survey evaluation. The psychometric evaluation was conducted by recruiting a sample of 480 high school students. Content validity, exploratory factor analysis, discriminant and construct validity, test-retest reliability and internal consistency were explored. RESULTS The expert panel determined that the content validity was satisfactory. The final 17-item scale consisted of five factors explaining 48.9% of the total variance in the data. Discriminant validity was satisfactory. Cronbach’s α coefficient was over 0.7 for each factor, indicating acceptable internal consistency of the questionnaire. There was significant agreement in all subscales as emerged from test-retest. CONCLUSIONS The AIBOS demonstrated good content validity, an easily interpretable five-factor structure, acceptable internal consistency, high test-retest reliability, and satisfactory discriminant and construct validity with sample characteristics. It is an easily comprehensible, easily completed tool, which matches the culture of young adolescents.
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Affiliation(s)
- Dimitra Varnakioti
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Kleanthi Gourounti
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Antigoni Sarantaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Chara Tzavara
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Lykeridou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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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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Morris JM, Bertotti AM. Protocol versus practice: Deviations from guidelines in low-risk twin deliveries in the United States. Birth 2022; 49:147-158. [PMID: 34549453 DOI: 10.1111/birt.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medical guidelines recommend vaginal delivery for low-risk twin pregnancies because cesareans increase the probability of maternal morbidity and mortality. Yet, vaginal delivery rates for twins are considerably lower than for comparable singletons. One explanation for this disparity argues that greater risk associated with twins warrants increased surgical intervention. An alternative explanation is that twin deliveries are more likely to deviate from protocols that advise vaginal birth. METHODS Using the 2017 Natality Detail File (N = 3,197,401), we measured alignment of vaginal birth and trial of labor (TOL) with the American College of Obstetricians and Gynecologists' guidelines for twin and singleton no-indicated-risk births. We calculated predicted probabilities for the population and by maternal race/ethnicity to assess whether low rates of vaginal births among twins are explained by associated risk factors, or by deviations from recommended delivery methods. RESULTS Overall, 31.2% of twins were born vaginally compared with 79.4% of singletons. Controlling for indicated risks, the predicted probability of vaginal birth for twins was 0.49 and 0.85 for singletons. The predicted probability of TOL for twins was 0.18 and 0.47 for singletons. Maternal race/ethnicity was only weakly associated with mode of delivery. These findings indicate that no-indicated-risk twin pregnancies, across maternal racial/ethnic categories, have lower probabilities of vaginal birth and TOL than would be expected with widespread adherence to current guidelines. CONCLUSIONS Given the life-threatening consequences that may result from unnecessary surgical procedures, our findings highlight the need for further research to illuminate medical and nonmedical mechanisms driving nonadherence to clinical guidelines for twin births.
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Perrotta C, Romero M, Sguassero Y, Straw C, Gialdini C, Righetti N, Betran AP, Ramos S. Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees. BMJ Open 2022; 12:e053419. [PMID: 35078842 PMCID: PMC8796244 DOI: 10.1136/bmjopen-2021-053419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore obstetricians', midwives' and trainees' perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. SETTING We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants. RESULTS Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. CONCLUSIONS Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
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Affiliation(s)
- Carla Perrotta
- School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | | | - Cecilia Straw
- School of Social Sciences, University of Buenos Aires, CEDES, Buenos Aires, Argentina
| | | | - Natalia Righetti
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Silvina Ramos
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
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Baljon K, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial. Int J Womens Health 2022; 14:279-295. [PMID: 35241937 PMCID: PMC8887672 DOI: 10.2147/ijwh.s347971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores. PARTICIPANTS AND METHODS This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time. RESULTS A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the labor duration (165 vs 333 minutes, p < 0.001), improved vital signs, which resulted in higher APGAR scores, and increased maternal satisfaction. CONCLUSION The labor unit management could consider adopting BRM as one of the non-pharmacological analgesia for healthy women in labor. TRIAL REGISTRATION ISRCTN87414969, registered 3 May 2019.
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Affiliation(s)
- Kamilya Baljon
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
- Department of Nursing, Nursing College, Umm, Al-Qura University, Makkah, Saudi Arabia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
| | - Adibah Hanim Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
| | - Lee Khuan
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, 43400, Malaysia
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
- Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia (HPUPM Teaching Hospital), Serdang, 43400, Selangor, Malaysia
- Correspondence: Boon-How Chew, Department of Family Medicine, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, 43400, Selangor, Malaysia, Tel +60 3-89472520, Fax +60 3-89472328, Email ;
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Haque M, Umar B. Growing concern over rising caesarean section rates: Is it a problem for low- and middle-income countries only? ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_148_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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20
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Appraisals of Childbirth Experience in Hungary. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10080302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The main focus of our research is to identify the factors that impact childbirth experience positively and negatively, with special attention to the case of caesarean sections. Drawing on a telephone survey conducted over four years between 2021 and 2018, we use data on 2000 Hungarian mothers and assessed a total of 4266 births. According to the regression analysis, there is a significant association between childbirth experience and settlement type, marital status, financial situation and factors measuring social support, as well as between high-risk pregnancy and informal patient payments. Significant results relating to caesarean sections indicate that the proportion of this mode of birth is higher among women who are older, completed a higher level of education and who live in settlements of a larger type. Based on regression analysis, we can conclude that the likelihood of opting for a caesarean section increases with the mother having a degree or diploma, giving birth with support from an obstetrician of her own choice, experiencing high-risk pregnancy or being older.
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21
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Miller YD, Danoy-Monet M. Reproducing fear: the effect of birth stories on nulligravid women's birth preferences. BMC Pregnancy Childbirth 2021; 21:451. [PMID: 34182948 PMCID: PMC8240297 DOI: 10.1186/s12884-021-03944-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Preference for caesarean birth is associated with higher fear and lower self-efficacy for vaginal birth. Vicarious experience is a strong factor influencing self-efficacy in nulligravid women, and is increasingly accessible via digital and general media. This study assessed the effect of exposure to different birth stories on nulligravid women's childbirth preferences and the factors mediating these effects. METHODS Nulligravid women (N = 426) were randomly allocated to one of four conditions exposing them to written birth stories. Stories varied by type of birth (vaginal/caesarean) and storyteller evaluation (positive/negative) in a 2 × 2 design. Childbirth preference, fear of labour and vaginal birth, and self-efficacy for vaginal birth were measured before and after exposure via a two-way between groups analysis of covariance. Hierarchical regression models were used to determine the mediating effects of change in childbirth fear and childbirth self-efficacy. RESULTS Variations in type of birth and storyteller evaluation significantly influenced childbirth preferences (F (1, 421) = 44.78, p < 0.001). The effect of vaginal birth stories on preference was significantly mediated by fear of labour and vaginal birth and self-efficacy. Effects of exposure to caesarean birth stories were not explained by changes in fear or self-efficacy. CONCLUSIONS Childbirth preferences in nulligravid women can be significantly influenced by vicarious experiences. For stories about vaginal birth, the influence of birth stories on women's fear and self-efficacy expectancy are partly responsible for this influence. The findings highlight the importance of monitoring bias in vicarious experiences, and may inform novel strategies to promote healthy childbirth.
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Affiliation(s)
- Yvette D Miller
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Marion Danoy-Monet
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Queensland, Australia
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22
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Mayne L, Liu C, Tanaka K, Amoako A. Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital. J OBSTET GYNAECOL 2021; 42:61-66. [PMID: 33938362 DOI: 10.1080/01443615.2021.1873923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to determine the main contributors to caesarean section (CS) rates at an Australian tertiary hospital. We conducted a retrospective review of women who delivered in an Australian tertiary hospital between 2014 and 2017. Women were allocated according to a modified Robson Ten-Group Classification System and CS indications were collected in nulliparous women and women with previous CS. The largest contributor to the 35.7% overall CS rate was women with a term cephalic infant and a previous CS (31.5% relative CS rate) and the most common indication was repeat CS. The group CS rate in nulliparous women with a cephalic term infant was higher when labour was induced compared to occurring spontaneously (36.6% and 18.1% respectively). The primary CS indication for these women was labour dystocia and maternal request was the most common CS indication for nulliparous women with a pre-labour CS.IMPACT STATEMENTWhat is already known on this subject? Significantly increasing caesarean section (CS) rates continue to prompt concern due to the associated neonatal and maternal risks. The World Health Organisation have endorsed the Robson Ten-Group Classification System to identify and analyse CS rate contributors.What do the results of this study add? We have used the modified Robson Ten-Group Classification System to identify that women with cephalic term infants who are nulliparous or who have had a previous CS are the largest contributors to overall CS rates. CS rates were higher in these nulliparous women if labour was induced compared to occurring spontaneously and the primary CS indication was labour dystocia. In nulliparous women with a CS prior to labour the most common CS indication was maternal request. Majority of women with a previous CS elected for a repeat CS.What are the implications of these findings for clinical practice? Future efforts should focus on minimising repeat CS in multiparous women and primary CS in nulliparous women. This may be achieved by redefining the definition of labour dystocia, exploring maternal request CS reasoning and critically evaluating induction timing and indication. Appropriately promoting a trial of labour in women with a previous CS in suitable candidates may reduce repeat CS incidence.
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Affiliation(s)
- Leah Mayne
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Cathy Liu
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Keisuke Tanaka
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Akwasi Amoako
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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Varnakioti D, Gourounti K, Sarantaki A. Students' Attitudes Towards Birth Decisions. MAEDICA 2021; 16:107-111. [PMID: 34221164 PMCID: PMC8224716 DOI: 10.26574/maedica.2020.16.1.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Numerous approaches have been examined to reduce unnecessary cesarean sections. Recently, concerns regarding both the psychosocial and behavioral factors that affect birth decisions have been raised. Adolescents perceive conception, pregnancy, and birth as important aspects of sexual health education; however, they exhibit poor knowledge regarding the aforementioned concepts. Aim:To identify data that examine attitudes toward birth choices among adolescents and young adults. To indicate the necessity of educational interventions, among young populations, in order to provide positive attitudes towards birth choices. Materials and methods:We reviewed PubMed, MEDLINE, and Google Scholar for research - and respective reference lists - published between 1997 and 2020. Results:We found a total of 13 papers, all in English, that examined attitudes and beliefs toward birth options in young populations. Conclusion:Regardless of a recorded rise in the rates of cesarean sections, young students who are introduced into a medicalized birth culture report vaginal birth preference in a healthy future pregnancy. Future research must examine all circumstances and factors that influence the discrepant correlation of the aforementioned vaginal birth preference and the high rates of cesarean sections.
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Affiliation(s)
- Dimitra Varnakioti
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
| | - Kleanthi Gourounti
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
| | - Antigoni Sarantaki
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
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Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews. Int Urogynecol J 2020; 32:1663-1673. [PMID: 33068134 DOI: 10.1007/s00192-020-04550-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In recent years the number of caesarean sections has increased worldwide for different reasons. to review the scientific evidence relating to the impact of the type of delivery on pelvic floor disorders (PFDs) such as urinary and faecal incontinence and pelvic organ prolapse. METHODS A review of systematic reviews and meta-analysis, drawn from the following databases: MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud/Latin American and Caribbean Health Sciences Literature) prior to January 2019. The directives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in assessing article quality. RESULTS Eleven systematic reviews were evaluated, 6 of which found a significantly decreased risk of urinary incontinence associated with caesarean section and 3 meta-analyses showed a significant reduction in POP for caesarean section, compared with vaginal delivery. Of 5 reviews that examined delivery type and faecal incontinence, only one indicated a lower incidence of faecal incontinence associated with caesarean delivery. However, most of the studies included in these reviews were not adjusted for important confounding factors and the risk of PFDs was not analysed by category of caesarean delivery (elective or urgent). CONCLUSION When compared with vaginal delivery, caesarean is associated with a reduced risk of urinary incontinence and pelvic organ prolapse. These results should be interpreted with caution and do not help to address the question of whether elective caesareans are protective of the maternal pelvic floor.
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Murata C, Gutiérrez-Castrellón P, Pérez-Villatoro F, García-Torres I, Enríquez-Flores S, de la Mora-de la Mora I, Fernández-Lainez C, Werner J, López-Velázquez G. Delivery mode-associated gut microbiota in the first 3 months of life in a country with high obesity rates: A descriptive study. Medicine (Baltimore) 2020; 99:e22442. [PMID: 33019428 PMCID: PMC7535699 DOI: 10.1097/md.0000000000022442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Delivery methods during childbirth and their related gut microbiota profiles have important impacts on health later in life, they can contribute to the development of diseases such as obesity, whose highest prevalence rate is found among the Mexican child population. Coincidentally, Mexico has one of the highest global average annual rate increase in cesarean births (C-section). Since Mexico leads the world in childhood obesity, studying the relationship between childbirth delivery methods and gut microbiota profiles in this vulnerable population may be used to identify early risk factors for obesity in other developed and developing countries. The objective of this study is to determine the association between child delivery method and gut microbiota profiles in healthy Mexican newborns.Fecal samples of 57 term infants who participated in a randomized clinical trial in 2013 to study the safety of Agave fructans in newborns, were used in this study. DNA samples were extracted and used to characterize the microbiota composition using high-throughput 16S rRNA gene sequencing. The samples were further divided based on childbirth delivery method, as well as early diet. Gut microbiota profiles were determined and analyzed using cluster analysis followed by multiple correspondence analysis.An unusual high abundance of Proteobacteria was found in the gut microbiota of all Mexican infants studied, regardless of delivery method. Feces from infants born by C-section had low levels of Bacteroidetes, high levels of Firmicutes, especially Clostridium and Enterococcus, and a strikingly high ratio of Firmicutes/Bacteroidetes (F:B). Profiles enriched in Bacteroidetes and low F:B ratios, were strongly associated with vaginal delivery.The profile of gut microbiota associated with feces from Mexican infants born by C-section, may be added to the list of boosting factors for the worrying obesity epidemic in Mexico.
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Affiliation(s)
- Chiharu Murata
- Research Methodology Department. National Institute of Pediatrics, Mexico
| | | | | | | | | | | | - Cynthia Fernández-Lainez
- Laboratory of Inborn Errors of Metabolism and Screening, INP, and Postgraduate in Biological Sciences, UNAM, México. Actual Address: Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Julieta Werner
- Indigenous Services Canada, Thunder Bay, Ontario, Canada
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Moore MF. Birth Observation Among African American Women Prior to Pregnancy. J Perinat Educ 2020; 29:181-187. [PMID: 33223791 PMCID: PMC7662164 DOI: 10.1891/j-pe-d-19-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A focused ethnography among African American college students who had observed a live birth prior to their own pregnancy was pursued. Women described two reasons to attend births: curiosity about birth, or a desire to support the birth mother. Women attended the births of friends, family members, or saw their mother give birth to a younger sibling. Themes included pain, operative or traumatic birth, and surprise at the length and/or stages of labor. Some language suggested lingering trauma. Future expectations included painful labor, operative birth or damage, or traumatic labor and birth. Other women felt closer to the infant, or felt more prepared for their own births after observing birth. Prior personal experiences at birth should be explored prenatally.
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ÇITAK BİLGİN N. Hemşirelik Öğrencilerinin Doğuma İlişkin Algıları: Nitel Bir Çalışma. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.718115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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28
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Striebich S, Ayerle GM. Fear of childbirth (FOC): pregnant women's perceptions towards the impending hospital birth and coping resources - a reconstructive study. J Psychosom Obstet Gynaecol 2020; 41:231-239. [PMID: 32838630 DOI: 10.1080/0167482x.2019.1657822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: To provide obstetric care which meets the needs of pregnant women with fear of childbirth (FOC), a deeper understanding is required of the beliefs of these women regarding their impending birth and the coping resources they possess to cope with their fear.Methods: Problem-centred interviews were carried out with 12 pregnant women who self-reported high FOC. Data analysis was performed using Bohnsack's Documentary Method to reconstruct collective frames of orientation and implicit and explicit orientations in daily practice and interaction.Results: The interviewees see birth as a field of tension between the poles of naturalness and medicalization. Their need for information displays a need to be in control and fear of losing control. Medical and technological monitoring and one-to-one care promote security. Pregnant women with FOC want to know how they can contribute to a physiological birth.Conclusions: Structural, organizational and conceptual changes in obstetric care are needed to cater to the needs of pregnant women with FOC. Alongside the need for evidence-based information about non-medical and medical pain-relief as well as decision-making aids, the provision of a continuity model of midwifery care is important.
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Affiliation(s)
- Sabine Striebich
- Medical Faculty, Institute for Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Gertrud M Ayerle
- Medical Faculty, Institute for Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
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Dominiek C, Natasha D, Foureur M, Spear V, Amanda H. Exploring unwarranted clinical variation: The attitudes of midwives and obstetric medical staff regarding induction of labour and planned caesarean section. Women Birth 2020; 34:352-361. [PMID: 32674990 DOI: 10.1016/j.wombi.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. AIM To map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation. METHODS A custom-created survey of medical and midwifery staff at eight Sydney hospitals. Staff were asked to rate their level of agreement with 45 "evidence-based" statements regarding caesareans and inductions on a five-point Likert scale. Responses were grouped by profession, and comparisons made of inter- and intra-professional responses. FINDINGS Total 275 respondents, 78% midwifery and 21% medical. Considerable inter- and intra-professional variation was noted, with midwives generally less likely to consider any of the planned birth indications "valid" compared to medical staff. Indications for induction with most variation in midwifery responses included maternal characteristics (age≥40, obesity, ethnicity) and fetal macrosomia; and for medical personnel in-vitro fertilisation, maternal request, and routine induction at 39 weeks gestation. Indications for caesarean with most variation in midwifery responses included previous lower segment caesarean section, previous shoulder dystocia, and uncomplicated breech; and for medical personnel uncomplicated dichorionic twins. Indications with most inter-professional variation were induction at 41+ weeks versus 42+ weeks and cesarean for previous lower segment caesarean section. DISCUSSION Both inter- and intra-professional variation in what were considered valid indications reflected inconsistency in underlying evidence and/or guidelines. CONCLUSION Greater focus on interdisciplinary education and consensus, as well as on shared decision-making with women, may be helpful in resolving these tensions.
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Affiliation(s)
- Coates Dominiek
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia.
| | - Donnolley Natasha
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia.
| | - Maralyn Foureur
- Hunter New England Nursing and Midwifery Research Centre, Australia; University of Newcastle, Faculty of Health and Medicine, Australia.
| | - Virginia Spear
- Royal Hospital for Women, South Easters Sydney Local Health District, Australia
| | - Henry Amanda
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia.
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Coates D, Thirukumar P, Spear V, Brown G, Henry A. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth 2020; 33:323-333. [DOI: 10.1016/j.wombi.2019.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
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Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033844. [PMID: 32540887 PMCID: PMC7299053 DOI: 10.1136/bmjopen-2019-033844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae. METHODS AND ANALYSIS This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals. TRIAL REGISTRATION NUMBER ISRCTN87414969, registered 3 May 2019.
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Affiliation(s)
- Kamilya Jamel Baljon
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Muhammad Hibatullah Romli
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Adibah Hanim Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lee Khuan
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Coates D, Thirukumar P, Henry A. Making shared decisions in relation to planned caesarean sections: What are we up to? PATIENT EDUCATION AND COUNSELING 2020; 103:1176-1190. [PMID: 31836248 DOI: 10.1016/j.pec.2019.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To map the literature in relation to shared decision making (SDM) for planned caesarean section (CS), particularly women's experiences in receiving the information they need to make informed decisions, their knowledge of the risks and benefits of CS, the experiences and attitudes of clinicians in relation to SDM, and interventions that support women to make informed decisions. METHODS Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018. RESULTS 34 studies were included, with 9750 women and 3313 clinicians. Overall women reported limited SDM, and many did not have the information required to make informed decisions. Clinicians generally agreed with SDM, while recognising it often does not occur. Decision aids and educational interventions were viewed positively by women. CONCLUSION Many women were not actively involved in decision-making. Decision aids show promise as a SDM-enhancing tool. Studies that included clinicians suggest uncertainty regarding SDM, although willingness to engage. PRACTICE IMPLICATIONS Moving from clinician-led decision-making to SDM for CS has potential to improve patient experiences, however this will require considerable clinician training, and implementation of SDM interventions.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Sydney, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia.
| | | | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Negrini R, Ferreira RDDS, Albino RS, Daltro CAT. Reducing caesarean rates in a public maternity hospital by implementing a plan of action: a quality improvement report. BMJ Open Qual 2020; 9:e000791. [PMID: 32381595 PMCID: PMC7223294 DOI: 10.1136/bmjoq-2019-000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Caesarean rates increased in different parts of the world, rising from 20% to 33% in the USA and from 40% to 55% in Brazil between 1996 and 2011; however, there was no reduction in morbimortality rates. Several factors have been suggested as responsible for this increase, such as health judicialisation, fear of the painful process on the patients' part and reduction of medical training in vaginal delivery and labour complications. It is urgent to reverse this process and, therefore, a model of actions was created with the intention of engaging the team in order to reduce caesarean rates in a Brazilian hospital. METHODOLOGY The model was based on the following actions: encouragement of labour analgesia; execution of written reports of any cardiotocographic examination; plan-do-study-act cycles for nursing orientations about the positions that favour pregnant women during labour; creation of a birth induction form; monthly feedback with physicians and nurses on caesarean rates achieved; verification of the caesarean rate by medical staff with individual feedback; daily round of medical coordination for case discussions; disclosure of caesarean rates on hospital posters; and constant dissemination of literature with strategies to reduce caesarean delivery. This plan of action started in January 2016. The mean caesarean section rate in the 31 months preceding the interventions (period A) was then compared with the 31 subsequent months (period B). RESULTS Both periods presented caesarean rates with normal distribution. The mean caesarean rate was 29.24% (range: 38.69%-23.89%, SD 3.24%) vs 25.84% (range: 17.96%-34.97%, SD 3.92%, p<0.05), respectively, for periods A and B. CONCLUSION After the implementation of the plan of action, there was a reduction in caesarean rates in this hospital.
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Affiliation(s)
- Romulo Negrini
- Maternal Fetal Department, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
- Hospital Geral de Itapecerica da Serra, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, São Paulo, Brazil
| | - Raquel Domingues da Silva Ferreira
- Maternal Fetal Department, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
- Hospital Geral de Itapecerica da Serra, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, São Paulo, Brazil
| | - Renata Silva Albino
- Hospital Geral de Itapecerica da Serra, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, São Paulo, Brazil
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Stoll KH, Downe S, Edmonds J, Gross MM, Malott A, McAra-Couper J, Sadler M, Thomson G. A Survey of University Students' Preferences for Midwifery Care and Community Birth Options in 8 High-Income Countries. J Midwifery Womens Health 2020; 65:131-141. [PMID: 31957228 DOI: 10.1111/jmwh.13069] [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: 03/23/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available. METHODS A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options. RESULTS Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences. DISCUSSION It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users.
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Affiliation(s)
- Kathrin H Stoll
- Division of Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Joyce Edmonds
- Connell School of Nursing, Boston College, Boston, Massachusetts
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Anne Malott
- Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Judith McAra-Couper
- Centre for Midwifery & Women's Health Research, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Michelle Sadler
- Department of History and Social Sciences, Faculty of Liberal Arts, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, United Kingdom
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- International Childbirth Attitudes-Prior to Pregnancy (ICAPP) Study Team (see list of names in Acknowledgments)
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Chua SC, Gidaszewski B, Khajehei M. Efficacy of surgical excision and sub-dermal injection of triamcinolone acetonide for treatment of keloid scars after caesarean section: a single blind randomised controlled trial protocol. Trials 2019; 20:363. [PMID: 31215471 PMCID: PMC6582563 DOI: 10.1186/s13063-019-3465-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 05/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background One of the first-line options to treat keloid scars is corticosteroid injection after excision of the existing scar. A thorough literature search has shown a lack of research on the injection of corticosteroid injection immediately after the excision of the existing caesarean section keloid scars. Therefore, in the proposed study, we aim to investigate the effect of surgical excision and corticosteroid (triamcinolone acetonide) injection immediately after surgical removal of old caesarean section keloid scars on the recurrence of the scars. This is a protocol for a randomised controlled trial. Methods/design Pregnant women (n = 150), who attend antenatal clinics at Westmead Hospital in New South Wales, Australia, have a keloid scar from a previous caesarean section, meet the inclusion criteria and sign the consent form, will be randomised to either the control or the intervention group. The control group will receive surgical excision of the keloid scar at the beginning of the procedure during skin incision. The baby will be delivered according to normal procedures, and routine wound closure will be performed in accordance with National Institute for Health and Care Excellence guidelines. The intervention group will receive surgical excision of the keloid scar after the delivery of the baby, and closure of the uterus layers, rectus sheath and the fat layer will be completed as explained above. Then, triamcinolone acetone will be injected sub-dermally at the time of wound closure. Two ampules of triamcinolone acetonide will be administered at a single dose; each ampule contains 10 mg/1 ml active medication. The surgeon will inject one ampule along the entire length of the upper edge of the skin incision and one ampule along the entire length of the lower edge of the skin incision, using a 25 G needle. After the procedure is completed, the surgeon will fill in the post-operation survey. The participants will be followed up post-operation, daily on the ward and then at 6 weeks, 6 months and 12 months post-partum. Main outcomes are (1) keloid formation after caesarean section and (2) changes in the appearance and specification of the keloid scar after the intervention. Discussion We anticipate that surgical excision and steroid injection will be a safe, lasting and cost-effective treatment in the management of caesarean keloid scars which will be useful for patients unable to undergo cosmetic surgery due to clinical or financial reasons. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618000984291. Registered on 12 June 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3465-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seng Chai Chua
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, Australia
| | - Beata Gidaszewski
- Department of Women's and Newborn Health, Westmead Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Marjan Khajehei
- Department of Women's and Newborn Health, Westmead Hospital, Sydney, Australia. .,The University of Sydney, Sydney, Australia. .,University of New South Wales, Room 3046, Research and Education Network (REN) Building, Westmead Public Hospital, Hawkesbury Rd, Westmead, Sydney, NSW, 2145, Australia.
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Weeks FH, Sadler M, Stoll K. Preference for caesarean attitudes toward birth in a Chilean sample of young adults. Women Birth 2019; 33:e159-e165. [PMID: 30992177 DOI: 10.1016/j.wombi.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/18/2019] [Accepted: 03/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide. AIM To identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures. METHODS An online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference. FINDINGS Among eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9-14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1-2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0-3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0-6.8) were associated with caesarean preference. DISCUSSION Preference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth. CONCLUSIONS Patient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth.
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Affiliation(s)
- Fiona H Weeks
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health. 1 W. Wilson St., Madison, WI, 53704, United States.
| | - Michelle Sadler
- Department of History and Social Sciences, Faculty of Liberal Arts, Universidad Adolfo Ibáñez, Diagonal Las Torres, Peñalolén, Santiago, 2640, Chile.
| | - Kathrin Stoll
- Birth Place Lab., University of British Columbia, BC Women's Hospital Shaughnessy Building E418 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
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Rutherford JN, Asiodu IV, Liese KL. Reintegrating modern birth practice within ancient birth process: What high cesarean rates ignore about physiologic birth. Am J Hum Biol 2019. [DOI: 10.1002/ajhb.23229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Julienne N. Rutherford
- Department of Women, Children, and Family Health Science; College of Nursing, University of Illinois at Chicago; Chicago Illinois
| | | | - Kylea L. Liese
- Department of Women, Children, and Family Health Science; College of Nursing, University of Illinois at Chicago; Chicago Illinois
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Physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers: A modest role of ethnicity. Dev Psychopathol 2018; 30:1959-1976. [DOI: 10.1017/s0954579418001281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractMapuche represents the largest indigenous group in Chile amounting to nearly 10% of the total population. In a longitudinal cohort of 12,398 children, we analyzed the role of ethnicity in physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers (age 2.5 years), taking into account sociodemographic and caregiver characteristics. As indicated by our univariate analysis, the Mapuche developmental niche was characterized by lower income, lower maternal education, poorer quality of the home environment, longer breastfeeding, and higher parental stress. Physical development showed higher body mass index. Mapuche children showed less externalizing problems. We then analyzed the incremental contribution of ethnicity in a series of hierarchical regressions with the second wave of developmental measurements (age 4.5 years) as outcome variables, showing a significant but modest incremental contribution of ethnicity to the prediction of children's development between 2.5 and 4.5 years of age. Controlling for environmental variables, Mapuche showed less externalizing and internalizing, behavior problems. Socioeconomic status, quality of the home environment, and parenting stress were stronger predictors of socioemotional development than ethnicity per se.
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Stoll K, Edmonds J, Sadler M, Thomson G, McAra-Couper J, Swift EM, Malott A, Streffing J, Gross MM, Downe S. A cross-country survey of attitudes toward childbirth technologies and interventions among university students. Women Birth 2018; 32:231-239. [PMID: 30150150 DOI: 10.1016/j.wombi.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PROBLEM & AIM Cultural beliefs that equate birth technology with progress, safety and convenience contribute to widespread acceptance of childbirth technology and interventions. Little is known about attitudes towards childbirth technology and interventions among the next generation of maternity care users and whether attitudes vary by country, age, gender, childbirth fear, and other factors. METHODS Data were collected via online survey in eight countries. Students who had never had children, and who planned to have at least one child were eligible to participate. FINDINGS The majority of participants (n=4569) were women (79.3%), and the median age was 22 years. More than half of students agreed that birth technology makes birth easier (55.8%), protects babies from harm (49.1%) and that women have a right to choose a medically non-indicated cesarean (50.8%). Respondents who had greater acceptance of childbirth technology and interventions were from countries with higher national caesarean birth rates, reported higher levels of childbirth fear, and were more likely to report that visual media or school-based education shaped their attitudes toward birth. Positive attitudes toward childbirth technology and interventions were also associated with less confidence in knowledge of birth, and more common among younger and male respondents. DISCUSSION/CONCLUSION Educational strategies to teach university students about pregnancy and birth in ways that does not frighten them and promotes critical reflection about childbirth technology are needed. This is especially true in countries with high rates of interventions that reciprocally shape culture norms, attitudes, and expectations.
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Affiliation(s)
- Kathrin Stoll
- Birth Place Lab, University of British Columbia, BC Women's Hospital Shaughnessy Building E418 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Joyce Edmonds
- Connell School of Nursing, Boston College, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Michelle Sadler
- Department of History and Social Sciences, Faculty of Liberal Arts, Adolfo Ibáñez University, Diagonal Las Torres 2640, Peñalolén, Santiago, Chile.
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Judith McAra-Couper
- Centre for Midwifery & Women's Health Research, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Emma M Swift
- Department of Midwifery, Faculty of Nursing-University of Iceland, Iceland.
| | - Anne Malott
- Midwifery Education Program, McMaster University, 1280 Main St. West, MDCL 2nd Floor, Hamilton, Ontario, Canada.
| | - Joana Streffing
- Midwifery Research and Education Unit, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
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Kingdon C, Downe S, Betran AP. Women's and communities' views of targeted educational interventions to reduce unnecessary caesarean section: a qualitative evidence synthesis. Reprod Health 2018; 15:130. [PMID: 30041661 PMCID: PMC6057083 DOI: 10.1186/s12978-018-0570-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is continued debate about the role of women and communities in influencing rising rates of caesarean section (CS). In settings where CS rates exceed recommended levels, mothers and babies are exposed to potential harms that may outweigh the potential benefits. There is therefore a need to understand how educational interventions targeted at women and communities to reduce unnecessary CS are perceived and used. This qualitative evidence synthesis aimed to explore what women and communities say about the barriers and facilitators to intervention effectiveness for these important groups. METHOD Seven electronic databases were searched using predefined search terms. Studies reporting qualitative data pertaining to interventions, published between 1985 and March 2017, with no language restriction were sought. Study quality was independently assessed by two authors before qualitative evidence synthesis was undertaken using an interpretive, meta-ethnography approach. Resulting Statements of Findings were assessed using GRADE-CERQual, and summarised thematically. RESULTS Twelve studies were included. They were published between 2001 and 2016. Eleven were from high-income countries. Twelve Summaries of Findings encompassed the data, and were graded (moderate or high) on CerQual. The Statements of Findings are reported under three final themes: 1) Mutability of women's and communities' beliefs about birth; 2) Multiplicity of individual information needs about birth; 3) Interactions with health professionals and influence of healthcare system on actual birth method. Women and communities value educational interventions that include opportunities for dialogue, are individualised (including acknowledgement of previous birth experiences), and are consistent with available clinical care and the advice of the health professional they come into contact with. CONCLUSION Women's values and preferences for birth, and for information format and content, vary across populations, and evolves in individual women over time. Interactions with health professionals and health system factors can partly be responsible for changes in views. Educational interventions should take into account these dynamic interactions, as well as the women's need for emotional support and dialogue with professionals alongside information about birth. Further research is required to test these findings and the utility of their practical application, particularly in medium and low income settings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2017 CRD42017059453 .
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Affiliation(s)
- Carol Kingdon
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Ana Pilar Betran
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
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