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Hoxha I, Grezda K, Udutha A, Taganoviq B, Agahi R, Brajshori N, Rising SS. Systematic review and meta-analysis examining the effects of midwife care on cesarean birth. Birth 2024; 51:264-274. [PMID: 38037256 DOI: 10.1111/birt.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births. METHODS We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse-variance random-effects meta-analysis was used to generate overall odds ratios (ORs). RESULTS We observed a significantly lower likelihood of cesarean birth in midwife-led care, midwife-attended births, among those who received instruction pre-birth from midwives, and within institutions with a midwifery presence. CONCLUSIONS Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.
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Affiliation(s)
- Ilir Hoxha
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Kolegji Heimerer, Prishtina, Kosovo
- Evidence Synthesis Group, Prishtina, Kosovo
| | | | - Anirudh Udutha
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Etcheverry C, Betrán AP, de Loenzien M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries. Midwifery 2024; 132:103979. [PMID: 38520954 DOI: 10.1016/j.midw.2024.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DESIGN A cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SETTING Thirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. PARTICIPANTS A total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FINDINGS The overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and "avoid pain in labour" was the most common perceived benefit of caesarean section. KEY CONCLUSIONS Our results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. CLINICAL TRIAL REGISTRY The QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.
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Affiliation(s)
- Camille Etcheverry
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France.
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
| | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina; Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
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Wyss C, Inauen J, Cignacco E, Raio L, Aubry EM. Mediating processes underlying the associations between maternal obesity and the likelihood of cesarean birth. Birth 2024; 51:52-62. [PMID: 37621158 DOI: 10.1111/birt.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2022] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pregnant women with obesity are more likely to experience cesarean birth compared to women without obesity. Yet, little is known about the underlying mechanisms. The objective of this study was therefore to evaluate how mediators contribute to the association between obesity and prelabor/intrapartum cesarean birth. METHODS We retrospectively analyzed Swiss cohort data from 394,812 singleton, cephalic deliveries between 2005 and 2020. Obesity (BMI ≥ 30 kg/m2 ) was defined as the exposure and prelabor or intrapartum cesarean birth as the outcomes. Hypothesized mediators included gestational comorbidities, large-for-gestational-age infant, pregnancy duration >410/7 weeks, slower labor progress, labor induction, and history of cesarean birth. We performed path analyses using generalized structural equation modeling and assessed mediation by a counterfactual approach. RESULTS Women with obesity had a cesarean birth rate of 39.36% vs. 24.12% in women without obesity. The path models mainly showed positive direct and indirect associations between obesity and cesarean birth. In the total sample, the mediation models explained up to 39.47% (95% CI 36.92-42.02) of the association between obesity and cesarean birth, and up to 57.13% (95% CI 54.10-60.16) when including history of cesarean birth as mediator in multiparous women. Slower labor progress and history of cesarean birth were found to be the most clinically significant mediators. CONCLUSIONS This study provides empirical insights into how obesity may increase cesarean birth rates through mediating processes. Particularly allowing for a slower labor progress in women with obesity might reduce cesarean birth rates and prevent subsequent repeat cesarean births in multiparous women.
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Affiliation(s)
- Carmen Wyss
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Eva Cignacco
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Evelyne M Aubry
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Peterwerth NH, Halek M, Schäfers R. Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:155. [PMID: 38389073 PMCID: PMC10882933 DOI: 10.1186/s12884-024-06338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION German Clinical Trials Register DRKS00017172 (18.06.2019).
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Germany.
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rainhild Schäfers
- Institute of Midwifery Science, Faculty of Medicine, University of Münster, Malmedyweg 17-19, 48149, Münster, Germany
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Etcheverry C, Betrán AP, de Loenzien M, Robson M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project. BMC Pregnancy Childbirth 2024; 24:67. [PMID: 38233792 PMCID: PMC10792793 DOI: 10.1186/s12884-024-06257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Improving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso. METHODS A cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women's characteristics. RESULTS A total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%. CONCLUSION Our results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women's preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care. TRIAL REGISTRATION The QUALI-DEC trial is registered on the Current Controlled Trials website ( https://www.isrctn.com/ ) under the number ISRCTN67214403.
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Affiliation(s)
- Camille Etcheverry
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/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
| | - Myriam de Loenzien
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
| | | | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
- Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
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Silva RPD, Pazin-Filho A. Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021. CIENCIA & SAUDE COLETIVA 2024; 29:e00512023. [PMID: 38198318 DOI: 10.1590/1413-81232024291.00512023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 01/12/2024] Open
Abstract
Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.
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Affiliation(s)
- Rildo Pinto da Silva
- Programa de Mestrado Profissional em Gestão de Organizações de Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. R. Pedreira de Freitas, Casa 2, Campus Universitário. 14049-900 Ribeirão Preto SP Brasil.
| | - Antonio Pazin-Filho
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto SP Brasil
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Trinh LTT, Achat HM, Pesce A. Caesarean sections before and during the COVID-19 pandemic in western Sydney, Australia. J OBSTET GYNAECOL 2023; 43:2265668. [PMID: 37883209 DOI: 10.1080/01443615.2023.2265668] [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: 04/21/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND To determine the changes in emergency and elective caesarean section (CS) rates since the COVID-19 pandemic, identify the groups most affected, and examine changes in the factors associated with CS rates, and reasons for CS. METHODS We conducted a retrospective cohort study using routinely collected data of 22,346 births from before the pandemic (January 2018-February 2020) and 18,597 births during the pandemic (March 2020-December 2021). Data were analysed using multinominal logistic regression. RESULTS The CS rate increased by 4.1% (from 30.1% to 34.2%), reflecting increases of 2.3% in emergency CS (from 11.5% to 13.8%) and 1.7% in elective CS (from 18.7% to 20.4%). Large groups with notable increases were women who were nulliparous (7.2% increase), from South Asia (6.0%), obese (5.2%) and giving birth at a small hospital (6.1%). Compared to pre-pandemic, the relative risk of an emergency CS versus a vaginal delivery increased 1.36 times (adjusted relative risk ratio (aRRR) = 1.36; 95% CI = 1.27, 1.45) and the risk of having an elective CS increased 1.11 times (aRRR = 1.11; 95% CI = 1.04, 1.20). Factors associated with both emergency and elective CS were age, region of birth, reproductive history, body mass index, hypertension, diabetes, mode of antenatal care and hospital. Socio-Economic Indexes for Areas and antenatal care were only associated with elective CS. Baby gender was only associated with emergency CS. Preterm gestation at delivery was associated with reduced emergency but increased elective CS. Foetal compromise was the most common indication for emergency CS (43.2%) and increased the most (8.0%). Previous CS was the most common indication for elective CS (61.5%) and reduced the most (1.9%). CONCLUSIONS Both emergency and elective CS rates increased significantly during the pandemic, with the former increasing at a higher rate. The persistent upward trend of CS rates, exacerbated by increasing proportions of nulliparous women undergoing CSs, is concerning.
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Affiliation(s)
- Lieu Thi Thuy Trinh
- Epidemiology and Health Analytics, Western Sydney Local Health District, Parramatta, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, Parramatta, Australia
| | - Andrew Pesce
- Women's Health, Westmead Hospital, Westmead, Australia
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8
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Warrener A. The multifactor pelvis: An alternative to the adaptationist approach of the obstetrical dilemma. Evol Anthropol 2023; 32:260-274. [PMID: 37527355 DOI: 10.1002/evan.21997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/23/2023] [Accepted: 07/08/2023] [Indexed: 08/03/2023]
Abstract
The obstetrical dilemma describes the competing demands that a bipedally adapted pelvis and a large-brained neonate place on human childbirth and is the predominant model within which hypotheses about the evolution of the pelvis are framed. I argue the obstetrical dilemma follows the adaptationist program outlined by Gould and Lewontin in 1979 and should be replaced with a new model, the multifactor pelvis. This change will allow thorough consideration of nonadaptive explanations for the evolution of the human pelvis and avoid negative social impacts from considering human childbirth inherently dangerous. First, the atomization of the pelvis into discrete traits is discussed, after which current evidence for both adaptive and nonadaptive hypotheses is evaluated, including childbirth, locomotion, shared genetics with other traits under selection, evolutionary history, genetic drift, and environmental and epigenetic influences on the pelvis.
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Affiliation(s)
- Anna Warrener
- Department of Anthropology, University of Colorado Denver, Denver, Colorado, USA
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9
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Zahroh RI, Sutcliffe K, Kneale D, Vazquez Corona M, Betrán AP, Opiyo N, Homer CSE, Bohren MA. Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis. BMC Public Health 2023; 23:1851. [PMID: 37741979 PMCID: PMC10517530 DOI: 10.1186/s12889-023-16718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use. METHODS We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success. RESULTS We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components. CONCLUSION We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Katy Sutcliffe
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Newton Opiyo
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Swift B, Taneri B, Cagnan I, Becker CM, Zondervan KT, Quigley MA, Rahmioglu N. Predictors and trends of Caesarean section and breastfeeding in the Eastern Mediterranean region: Data from the cross-sectional Cyprus Women's Health Research (COHERE) Initiative. PLoS One 2023; 18:e0287469. [PMID: 37418433 PMCID: PMC10328327 DOI: 10.1371/journal.pone.0287469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/22/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Caesarean section (C-section) is a life-saving procedure when medically indicated but unmet need and overuse can add to avoidable morbidity and mortality. It is not clear whether C-section has a negative impact on breastfeeding and there is limited data available on rates of C-section or breastfeeding from Northern Cyprus, an emerging region in Europe. This study aimed to investigate prevalence, trends and associations of C-section and breastfeeding in this population. METHODS Using self-reported data from the representative Cyprus Women's Health Research (COHERE) Initiative, we used 2,836 first pregnancies to describe trends in C-section and breastfeeding between 1981 and 2017. Using modified Poisson regression, we examined the relationship between year of pregnancy and C-section and breastfeeding, as well as the association between C-section and breastfeeding prevalence and duration. RESULTS C-section prevalence in first pregnancies increased from 11.1% in 1981 to 72.5% in 2017 with a relative risk of 2.60 (95%CI; 2.14-2.15) of babies being delivered by C-section after 2005 compared to before 1995, after full adjustment for demographic and maternal medical and pregnancy related factors. Prevalence of ever breastfeeding remained steady throughout the years at 88.7% and there was no significant association between breastfeeding initiation and the year of pregnancy, or demographic and maternal medical and pregnancy related variables. After full adjustment, women who gave birth after 2005 were 1.24 (95%CI; 1.06-1.45) times more likely to breastfeed for >12 weeks compared to women who gave birth before 1995. There was no association between C-section and breastfeeding prevalence or length. CONCLUSION Prevalence of C-section in this population is much higher than WHO recommendations. Public awareness campaigns surrounding choice during pregnancy and change in legal framework to allow for midwife-led continuity models of birthing care should be implemented. Further research is required to understand the reasons and drivers behind this high rate.
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Affiliation(s)
- Bethan Swift
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Bahar Taneri
- Faculty of Arts and Sciences, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Ilgin Cagnan
- Faculty of Arts and Sciences, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
| | - Christian M. Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nilufer Rahmioglu
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
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11
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Ahamed F, Rehman T, Kaur A. Why do Mothers from Remote Rural Areas opt for Cesarean Delivery: An Observational Analytical Study from West Bengal, India. Indian J Community Med 2023; 48:573-578. [PMID: 37662136 PMCID: PMC10470558 DOI: 10.4103/ijcm.ijcm_911_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background The percentage of cesarean section (C-section) deliveries has doubled in the last two decades in India. Although C-section delivery is a life-saving intervention, multiple maternal and neonatal morbidities are often associated with this procedure, adversely affecting the quality of life of both the mother and child. Material and Methods This community-based cross-sectional study was conducted to assess the point of view of mothers who delivered from January 2020 to June 2021. Results The mean (standard deviation (SD)) age of the 866 study participants at delivery was 24.5 (4.8) years, and 60.2% were primigravidas. A total of 613 (70.8%; 95% CI: 67.8-73.8) C-sections were conducted, of which 65.9% (n = 404) were planned and 21.9% were done on maternal request. C-sections were significantly associated with private institutes (adjusted prevalence ratio (aPR) 1.90; 95% CI: 1.70-2.11), at-risk pregnancy (aPR 1.37; 95% CI: 1.26-1.49), and primigravida (aPR 1.16; 95% CI: 1.05-1.29). About 55.3%, 29.8%, and 14.9% of women considered vaginal delivery to be risky, painful, and inconvenient, respectively. Conclusion It is imperative to generate awareness regarding modes of delivery during antenatal care (ANC) so that mothers can make better-informed choices.
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Affiliation(s)
- Farhad Ahamed
- Department of Community Medicine and Family Medicine, AIIMS Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, West Bengal, India
| | - Tanveer Rehman
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Amandeep Kaur
- Department of Community Medicine and Family Medicine, AIIMS Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, West Bengal, India
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12
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Piva VMR, Voget V, Nucci LB. Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil. BMC Pregnancy Childbirth 2023; 23:455. [PMID: 37340447 DOI: 10.1186/s12884-023-05768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates. METHODS We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data. RESULTS CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries. CONCLUSION Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
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Affiliation(s)
- Veridiana Monteiro Ramos Piva
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
| | - Verena Voget
- Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
| | - Luciana Bertoldi Nucci
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
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13
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Alruwaili TA, Crawford K, Jahanfar S, Hampton K, Fooladi E. Pregnant persons and birth partners' experiences of shared decision-making during pregnancy and childbirth: An umbrella review. PATIENT EDUCATION AND COUNSELING 2023; 114:107832. [PMID: 37295043 DOI: 10.1016/j.pec.2023.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This umbrella review aimed to summarize evidence on pregnant persons and/or their birth partners' experiences and expectations of SDM during pregnancy and childbirth. METHODS We searched eight databases from 2011 to 2023. Quantitative, qualitative and mixed methods systematic reviews were included in this review. RESULTS We have identified 26 reviews that report on 622 primary studies involving over 213,000 pregnant persons and 22,000 birth partners, examining a broad range of decision-making scenarios in maternity care. The three-talk model was used to categorise the themes which include communication, weighing options, and making a decision. Multiple reviews have reported that pregnant persons and birth partners have mixed experiences in several decision-making scenarios, with insufficient information and inadequate consideration or answers to their questions being common issues. Pregnant persons and birth partners prefer clear explanations, simple communication, and involvement in decision-making. Exclusion from the decision-making during pregnancy and childbirth may lead to negative experiences, whilst involvement improves satisfaction, reduces distress and fosters empowerment. CONCLUSIONS The review highlights the importance of promoting SDM in maternity care, as it is fundamental to promoting maternal, newborn, and family well-being. PRACTICE IMPLICATIONS Health systems should redesign antenatal classes and train healthcare providers to enhance communication skills and encourage informed decision-making by pregnant persons and birth partners.
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Affiliation(s)
- Tahani Ali Alruwaili
- Monash Nursing and Midwifery school, Monash University, Melbourne, VIC, Australia; Nursing College, Aljouf University, Sakaka, Saudi Arabia.
| | - Kimberley Crawford
- Monash Nursing and Midwifery school, Monash University, Melbourne, VIC, Australia
| | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Kerry Hampton
- Monash Nursing and Midwifery school, Monash University, Melbourne, VIC, Australia
| | - Ensieh Fooladi
- Monash Nursing and Midwifery school, Monash University, Melbourne, VIC, Australia
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14
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Safrin S. The Impact of Malpractice Damage Caps on C-section Rates and Alternative Approaches. Clin Obstet Gynecol 2023; 66:278-292. [PMID: 37036792 DOI: 10.1097/grf.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
About half of the states in the United States have had noneconomic damage caps in place for at least 8 years. National aggregate data shows that women are just as likely to give birth by cesarean section (C-section) in states with damage caps as in ones without. For the most recent year studied, the national C-section rate for births in states with damage caps was 33.04% compared with a 32.10% ratefor births in states without caps. Other initiatives (malpractice insurance reform, accessible public disclosure of hospital C-section rates, and improved compensation for vaginal delivery) should be considered to reduce C-section rates.
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15
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Gartner DR, Debbink MP, Brooks JL, Margerison CE. Inequalities in cesarean births between American Indian & Alaska Native people and White people. Health Serv Res 2023; 58:291-302. [PMID: 36573019 PMCID: PMC10012218 DOI: 10.1111/1475-6773.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors. DATA SOURCES AND STUDY SETTING We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017. STUDY DESIGN We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native-White inequality. DATA COLLECTION/EXTRACTION METHODS Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate. PRINCIPAL FINDINGS After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0-34.8), 3.2 percentage points (95% CI: 1.8-4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie). CONCLUSIONS The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low-risk Robson group 1 and those with non-cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Michelle P. Debbink
- Department of Obstetrics and GynecologyUniversity of Utah Health and Intermountain HealthcareSalt Lake CityUtahUSA
| | - Jada L. Brooks
- School of NursingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Claire E. Margerison
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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16
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Duffy A, Maculey C, Lindow SW, O'Connell MP. Midwives' personal and professional attitudes towards women's delivery choices, interventions and neonatal care. J Perinat Med 2023; 51:392-395. [PMID: 36096499 DOI: 10.1515/jpm-2022-0165] [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: 03/26/2022] [Accepted: 08/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Caesarean section (CS) rates in middle- and high-income countries are rising partly due to maternal request. This study aimed to explore the personal and professional attitudes of midwives and nurses towards women's delivery choices, interventions and neonatal care. METHODS Midwifery and nursing staff at the Coombe hospital were asked to complete a questionnaire concerning decisions for elective CS and neonatal care. The midwives' responses were divided into multiparous and nulliparous according to their own parity. RESULTS Multiparae and nulliparae did not differ on their personal preferences for their own baby. Only 3% wanted an elective CS in a normal, healthy pregnancy but this increased to 80.2% when there was a breech presentation and 42% if the estimated fetal weight was >4.5 kg. These numbers and trends were very close to the midwives' professional recommendations under the same circumstances. The lower threshold for full resuscitation and ICU care was at 23 and 24 weeks gestation for both personal and professional recommendations. In the case of severely premature babies or babies with a poor prognosis, 54% stated that the approach to neonatal care was correct. CONCLUSIONS Overall, midwives' professional views reflected what they would want for themselves and their babies. Only 3% recommended an elective CS in a normal, healthy pregnancy making it unlikely that midwives' attitudes are driving the rise in CS rates in Ireland.
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Affiliation(s)
- Ailbhe Duffy
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Chloe Maculey
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Stephen W Lindow
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael P O'Connell
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
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17
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Johansson M, Alvan J, Pettersson A, Hildingsson I. Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis. BMC Pregnancy Childbirth 2023; 23:210. [PMID: 36978038 PMCID: PMC10044365 DOI: 10.1186/s12884-023-05471-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women's and clinicians' attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS. METHODS The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual. RESULTS The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000-2022), involving 242 women and 141 clinicians. From the women's perspectives, two themes arose: women regarded CS as the safest mode of birth; and women's rights to receive support and acceptance for a CS request. From the clinicians' perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women's rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options. CONCLUSION Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman's birth preferences, they also felt the need to resist a woman's request for CS and encourage her to give birth vaginally due to the associated increases in health risks.
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Affiliation(s)
- Margareta Johansson
- Department of Women’s and Children’s Health, Uppsala University, Akademiska University Hospital, SE- 751 85 Uppsala, Sweden
| | - Jonatan Alvan
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Ingegerd Hildingsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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18
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Akinlusi FM, Olayiwola AA, Rabiu KA, Oshodi YA, Ottun TA, Shittu KA. Prior childbirth experience and attitude towards subsequent vaginal birth after one caesarean delivery in Lagos, Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:82. [PMID: 36717780 PMCID: PMC9885646 DOI: 10.1186/s12884-023-05348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Prior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women's prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change. OBJECTIVE To describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD. METHOD This cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis. RESULTS The modal maternal and gestational age groups were 30-39 years (68.1%) and 29-34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery. CONCLUSIONS Antenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate.
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Affiliation(s)
- Fatimat M. Akinlusi
- grid.411276.70000 0001 0725 8811Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria ,grid.411278.90000 0004 0481 2583Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, No 1 – 5, Oba Akinjobi Way, Ikeja, Nigeria
| | - Abideen A. Olayiwola
- grid.411278.90000 0004 0481 2583Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, No 1 – 5, Oba Akinjobi Way, Ikeja, Nigeria
| | - Kabiru A. Rabiu
- grid.411276.70000 0001 0725 8811Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria ,grid.411278.90000 0004 0481 2583Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, No 1 – 5, Oba Akinjobi Way, Ikeja, Nigeria
| | - Yusuf A. Oshodi
- grid.411276.70000 0001 0725 8811Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria ,grid.411278.90000 0004 0481 2583Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, No 1 – 5, Oba Akinjobi Way, Ikeja, Nigeria
| | - Tawaqualit A. Ottun
- grid.411276.70000 0001 0725 8811Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria ,grid.411278.90000 0004 0481 2583Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, No 1 – 5, Oba Akinjobi Way, Ikeja, Nigeria
| | - Khadijah A. Shittu
- grid.416091.b0000 0004 0417 0728Department of Obstetrics and Gynaecology, Royal United Hospital, NHS Foundation Trust, Combe Park, Bath, BA1 3NG England
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Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study. PLoS One 2022; 17:e0279403. [PMID: 36576912 PMCID: PMC9797090 DOI: 10.1371/journal.pone.0279403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Clinicians' perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives' and obstetricians' views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians' views and experiences emerged following data analysis. These were: 'A fear factor' describing clinicians' fear of adverse outcomes and subsequent litigation, 'Personal preferences versus a threshold-clinician driven factors emphasising the influence of clinicians' personal beliefs, and 'Standardised versus individualised care-a system perspective' explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians' personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the 'next step action' and assist in devising future intervention studies to reduce any unnecessary CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Zahroh RI, Kneale D, Sutcliffe K, Vazquez Corona M, Opiyo N, Homer CSE, Betrán AP, Bohren MA. Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features. BMC Health Serv Res 2022; 22:1526. [PMID: 36517885 PMCID: PMC9753390 DOI: 10.1186/s12913-022-08783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population-level have limited benefits for women and babies. Many interventions targeting healthcare providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting healthcare providers. METHODS: We used Qualitative Comparative Analysis (QCA) to identify if certain combination of important intervention features (e.g. type of intervention, contextual characteristics, and how the intervention was delivered) are associated with a successful intervention as reflected in a reduction of CS. We included 21 intervention studies targeting healthcare providers to reduce CS, comprising of 34 papers reporting on these interventions. To develop potential theories driving intervention success, we used existing published qualitative evidence syntheses on healthcare providers' perspectives and experiences of interventions targeted at them to reduce CS. RESULTS We identified five important components that trigger successful interventions targeting healthcare providers: 1) training to improve providers' knowledge and skills, 2) active dissemination of CS indications, 3) actionable recommendations, 4) multidisciplinary collaboration, and 5) providers' willingness to change. Importantly, when one or more of these components are absent, dictated nature of intervention, where providers are enforced to adhere to the intervention, is needed to prompt successful interventions. Unsuccessful interventions were characterised by the absence of these components. CONCLUSION We identified five important intervention components and combinations of intervention components which can lead to successful interventions targeting healthcare providers to optimise CS use. Health facility managers, researchers, and policy-makers aiming to improve providers' clinical decision making and reduce CS may consider including the identified components to optimise benefits.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Dylan Kneale
- grid.83440.3b0000000121901201EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Katy Sutcliffe
- grid.83440.3b0000000121901201EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Martha Vazquez Corona
- grid.1008.90000 0001 2179 088XGender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Newton Opiyo
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caroline S. E. Homer
- grid.1056.20000 0001 2224 8486Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Ana Pilar Betrán
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- grid.1008.90000 0001 2179 088XGender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
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21
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Panda S, Begley C, Corcoran P, Daly D. Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study. Birth 2022; 49:812-822. [PMID: 35695041 PMCID: PMC9796356 DOI: 10.1111/birt.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/28/2021] [Accepted: 05/09/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is widespread concern around the rising rates of cesarean births (CBs), especially among first-time mothers, despite evidence suggesting increased morbidities after birth by cesarean. There are uncertainties around factors associated with rising rates of CBs among first-time mothers in Ireland, and insight into these is essential for understanding the rising trend in CBs. Therefore, this study aimed to identify the factors associated with CBs in nulliparous women. METHODS A prospective cohort study was conducted in three maternity hospitals in the Republic of Ireland between 2012 and 2017. Data were collected from 3047 nulliparous women using self-administered surveys antenatally and at 3 months postpartum and from consenting women's hospital records (n = 2755) and analyzed using the Poisson regression to assess associations between demographic and clinical factors and the main outcome measures, planned and unplanned CBs. RESULTS Common risk factors for planned and unplanned CBs were being aged ≥40 years, being in private care, multiple pregnancy, and fetus in breech or other malpresentations. An unplanned CB occurred for 22.43% (n = 377/1681) of women who did not have induction of labor (IOL) or who had IOL with no epidural, but the risk was about twice as high for women who had IOL and epidural. CONCLUSIONS Findings confirm multifactorial reasons for CB and the challenge of reversing the increasing CB rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy, and preexisting hypertension in Ireland continue to increase. There is a need to address prelabor interventions, especially IOL combined with epidural analgesia with respect to unplanned CB.
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Affiliation(s)
- Sunita Panda
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Cecily Begley
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Paul Corcoran
- National Perinatal Epidemiology CentreUniversity College CorkCorkIreland
| | - Deirdre Daly
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
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22
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Does a Healthy Lifestyle Lower the Elevated Risk of Obesity Caused by Caesarian Section Delivery in Children and Adolescents? Nutrients 2022; 14:nu14173528. [PMID: 36079786 PMCID: PMC9460904 DOI: 10.3390/nu14173528] [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: 07/25/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Both caesarean section (CS) and lifestyle were linked with child adiposity. This study aimed to investigate whether CS delivery is linked with elevated risk of child adiposity regardless of a healthy lifestyle. Methods: All the subjects in this study came from a baseline survey of a national school-based program on healthy lifestyle interventions against adiposity among Chinese children and adolescents. A questionnaire was used to collect the information on delivery mode and lifestyle. According to the weighted lifestyle score, subjects were categorized into healthy, intermediate, and unhealthy lifestyle. Results: A total of 44,961 children aged 6−18 years were enrolled in the current study. Overall, 41.9% (18,855/44,961) of children were delivered by CS. Compared with children delivered by vaginal delivery, children delivered by CS had a higher adiposity risk (OR = 1.56; 95%CI: 1.46−1.66; p < 0.001) after adjustment for age, sex, region, mother adiposity, ethnicity, and weighted lifestyle factors. Compared with children with a healthy lifestyle, children with an unhealthy lifestyle had a higher risk of child adiposity (OR = 1.31; 95%CI: 1.19−1.44). Children delivered by CS who had an unhealthy lifestyle had a 106% higher (OR = 2.06; 95%CI: 1.79−2.37) risk of child adiposity compared with children delivered by vaginal delivery who had a healthy lifestyle. However, keeping a healthy lifestyle in later life seems not to offset the increased risk of child adiposity caused by CS (OR = 1.59; 95%CI: 1.39−1.82). Conclusions: Both CS and unhealthy lifestyle were linked with child adiposity risk. Keeping a healthy lifestyle did not counteract the elevated risk of child adiposity caused by CS.
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Colomar M, Colistro V, Sosa C, de Francisco LA, Betrán AP, Serruya S, De Mucio B. Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study. BMC Pregnancy Childbirth 2022; 22:471. [PMID: 35672663 PMCID: PMC9175367 DOI: 10.1186/s12884-022-04792-y] [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: 08/16/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database. Methods We included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models. Results Of the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital. Conclusion Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04792-y.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay. .,Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay.
| | - Valentina Colistro
- Department of Quantitative Methods, School of Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Claudio Sosa
- Department of Obstetrics and Gynecology, Pereira Rossell Hospital, School of Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Luis Andres de Francisco
- Family, Health Promotion and Life Course, Pan American Health Organization, World Health Organization, Washington, United States
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Suzanne Serruya
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay
| | - Bremen De Mucio
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay
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What would reduce caesarean section rates?—Views from pregnant women and clinicians in Ireland. PLoS One 2022; 17:e0267465. [PMID: 35482745 PMCID: PMC9049329 DOI: 10.1371/journal.pone.0267465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 04/10/2022] [Indexed: 01/10/2023] Open
Abstract
Background Caesarean section rates continue to rise in most parts of the world. While CS is a lifesaving procedure there is evidence that, beyond a certain threshold, CS rates may contribute to increased maternal and perinatal morbidity. This study aimed to elicit the views of pregnant women’s and clinicians’ on how CS rates might be reduced. Methods Pregnant women and their partners, and clinicians working with pregnant women in a maternity hospital in the Republic of Ireland of Ireland, were invited to participate in focus groups. Eligibility criteria included all women attending antenatal classes and clinicians working with pregnant women. A convenience sample was used and interviews were audio recorded, transcribed, and analysed using thematic analysis. Results Four focus group interviews were conducted with 30 clinicians and 15 pregnant women and two partners participated in three focus groups. A further two women were interviewed individually. Participants expressed a view that rising CS rates were impacted by a societal perception that CS had become a ‘normal mode of birth’. Suggestions for reducing CS rates were offered by clinicians and pregnant women and their partners. Conclusions Clinicians and pregnant women consider that CS rates can be reduced if a shared philosophy supporting normal birth is prioritised alongside adequate resourcing. Women and their partners also believe that enhanced communication with clinicians is central to reducing CS rates.
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25
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion. A protocol for a qualitative evidence synthesis. HRB Open Res 2022; 4:127. [PMID: 35187397 PMCID: PMC8822135 DOI: 10.12688/hrbopenres.13467.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions. Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)
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Affiliation(s)
- Silvia Alòs-Pereñíguez
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
| | - Deirdre O'Malley
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
- Nursing, Midwifery & Health Studies, Dundalk Institute of Technology, Dundalk, A91 K584, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
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26
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Corrigan S, Howard V, Gallagher L, Smith V, Hannon K, Carroll M, Begley C. Midwives’ views of an evidence-based intervention to reduce caesarean section rates in Ireland. Women Birth 2022; 35:536-546. [DOI: 10.1016/j.wombi.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
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27
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Culleton-Quinn E, Bø K, Fleming N, Mockler D, Cusack C, Daly D. Elite female athletes' experiences of symptoms of pelvic floor dysfunction: A systematic review. Int Urogynecol J 2022; 33:2681-2711. [PMID: 36040507 PMCID: PMC9477953 DOI: 10.1007/s00192-022-05302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/10/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes' experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes' experiences of symptoms of PFD. METHODS The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes' experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity. RESULTS Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions. CONCLUSIONS The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.
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Affiliation(s)
- Elizabeth Culleton-Quinn
- School of Medicine, Trinity College, Dublin, Ireland ,Discipline of Physiotherapy and Discipline of Occupational Therapy, Trinity College, Dublin, Trinity Centre for Health Sciences, James’s St., Dublin, D08W9RT Ireland
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway ,Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | - Neil Fleming
- School of Medicine, Trinity College, Dublin, Ireland
| | | | - Cinny Cusack
- Physiotherapy Department, Rotunda Hospital, Dublin, Ireland
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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28
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Hirsh-Yechezkel G, Glasser S, Farhi A, Levitan G, Shachar Y, Zaslavsky-Paltiel I, Boyko V, Ezra Y, Lerner-Geva L. Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives. WOMEN'S HEALTH 2022; 18:17455057221125366. [DOI: 10.1177/17455057221125366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: This study aimed to describe Israeli maternity departments’ policies regarding cesarean delivery on maternal request, and factors associated with obstetricians’ support for cesarean delivery on maternal request in specific scenarios. Methods: This multicenter cross-sectional study included 22 maternity department directors and 222 obstetricians from the majority of Israeli hospitals. Directors were interviewed and completed a questionnaire about their department’s cesarean delivery on maternal request policy, and obstetricians responded to a survey presenting case scenarios in which women requested cesarean delivery on maternal request. The scenarios represented profiles referring to the following factors: maternal age, poor obstetric history, pregnancy complications, and psychological problems. The survey also included the obstetricians’ socio-demographic information and questions about other issues associated with cesarean delivery on maternal request. The main outcome measures were department policies regarding cesarean delivery on maternal request and obstetricians’ support for cesarean delivery on maternal request in specific cases. Results: Policies were divided between allowing and prohibiting cesarean delivery on maternal request (n = 10 and 12, respectively), and varied regarding issues such as informed consent and pre-surgery consultation. Most of the obstetricians (96.5%) did not support cesarean delivery on maternal request in the “reference scenario” describing a young woman with no obstetric complications. Additional factors increased the rate of support. Support was greater among obstetricians aged > 45 (odds ratio = 2.11; 95% confidence intervals 1.33–3.36) and lower among females (odds ratio = 0.58; 95% confidence intervals 0.39–0.86). Obstetricians whose department policy was less likely to allow cesarean delivery on maternal request reported lower rates of support for cesarean delivery on maternal request in most cases. Conclusion: Policies and obstetricians’ support for cesarean delivery on maternal request vary broadly depending on clinical profiles and physician characteristics. Department policy has an impact on obstetricians’ support for cesarean delivery on maternal request. Health policy will benefit from a framework in which the organizations, physicians, and patients are consulted.
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Affiliation(s)
- Galit Hirsh-Yechezkel
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Saralee Glasser
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Adel Farhi
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Gila Levitan
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Yael Shachar
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Inna Zaslavsky-Paltiel
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Valentina Boyko
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynaecology, Hadassah University Hospital, Jerusalem, Israel
| | - Liat Lerner-Geva
- Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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29
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion: a protocol for a qualitative evidence synthesis. HRB Open Res 2021; 4:127. [DOI: 10.12688/hrbopenres.13467.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions. Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)
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30
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Sys D, Kajdy A, Baranowska B, Tataj-Puzyna U, Gotlib J, Bączek G, Rabijewski M. Women's views of birth after cesarean section. J Obstet Gynaecol Res 2021; 47:4270-4279. [PMID: 34611958 DOI: 10.1111/jog.15056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vaginal birth is a safe mode of childbirth for the majority of women after cesarean section (CS). However, data show that women who have undergone a CS are more likely to have an elective CS (ECS) than a vaginal birth after CS (VBAC) in many areas of the world. AIM This study aimed to review the literature about women's mode of birth preferences and attitudes and the underlying reasons for, and factors associated with, their preferences. METHODS This is narrative literature review. PubMed/MEDLINE and Scopus databases were searched, limiting the results to non-interventional studies published between 1990 and 2020. Twenty-one articles were included in the analysis. RESULTS The review found 34 different factors that influence women's preferences. Five factors influenced both VBAC and ECS preference, depending on the study. The most common factors having a dualistic effect on preference were: medical staff recommendation, doctor's opinion, and fear of pain. The most common factors were: desire to experience natural childbirth, faster/easier recovery, support from doctor's, and midwife's opinion. Among the factors influencing the preference for ECS, two were particularly prominent: predictability, controllability and comfortability of CS and the belief that CS is safer for the baby and/or mother. CONCLUSIONS Our review showed that there are a variety of factors that influence women's preference for the mode of delivery after CS. Some of these have a dualistic effect according to the study. The key to making an informed decision regarding the mode of delivery is communication with medical professionals.
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Affiliation(s)
- Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Joanna Gotlib
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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D'Agostini Marin DF, da Rosa Wernke A, Dannehl D, de Araujo D, Koch GF, Marçal Zanoni K, Baschirotto Dorigon Coral K, Valeriano Guimarães N, Feuerschuette O, Pinto Moehlecke Iser B. The Project Appropriate Birth and a reduction in caesarean section rates: an analysis using the Robson classification system. BJOG 2021; 129:72-80. [PMID: 34529333 DOI: 10.1111/1471-0528.16919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess caesarean section (CS) rates before and after the implementation of the Project Appropriate Birth (PPA), based on the Robson ten group classification system. DESIGN A before-and-after study. SETTING Maternity hospital in South Brazil. POPULATION All pregnant women attending from April 2016 to April 2017 (period 1, pre-implementation of PPA) and from June 2017 to June 2018 (period 2, post-implementation of PPA). METHODS Maternal and obstetric characteristics were evaluated, including Robson's classification, based on the characteristics of pregnancy and childbirth. A chi-square test and crude and adjusted relative rates were used to analyse the study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES The CS rate for each group, their contribution to the overall CS rate and the differences in these contributions before and after PPA implementation. RESULTS The CS rates decreased from 62.4 to 55.6%, which represented a 10.9% reduction after the implementation of the PPA. Pregnant women in Robson classification groups 1-4 had a 21.4% reduction in CS rates, ranging from 49.1 to 38.6%. The greatest contributors to the overall CS rates were group 5 and group 2, accounting for more than 60% of the CS deliveries. CONCLUSION The study results suggest that Project Appropriate Birth had an impact on the reduction of CS rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labour and childbirth assistance contributed to reduce CS rates. TWEETABLE ABSTRACT The Project Appropriate Birth is an innovative project that has demonstrated promising results, suggesting that interventions based on scientific evidence can lead to real changes in childbirth care, contributing to reduce CS rates. The aim of the PPA is to promote activities to improve childbirth care and encourage vaginal delivery. In this study, 6238 pregnant women admitted to the hospital for delivery were included and classified into one of the Robson 10-group classification. Findings revealed a 10.9% reduction in the overall CS rate and a 21.4% reduction for pregnant women in Robson classification groups 1 through 4, after the implementation of the PPA.
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Affiliation(s)
- D F D'Agostini Marin
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - A da Rosa Wernke
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - D Dannehl
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - D de Araujo
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - G F Koch
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - K Marçal Zanoni
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - K Baschirotto Dorigon Coral
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - N Valeriano Guimarães
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - O Feuerschuette
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - B Pinto Moehlecke Iser
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
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Bam V, Lomotey AY, Kusi-Amponsah Diji A, Budu HI, Bamfo-Ennin D, Mireku G. Factors influencing decision-making to accept elective caesarean section: A descriptive cross-sectional study. Heliyon 2021; 7:e07755. [PMID: 34430742 PMCID: PMC8365447 DOI: 10.1016/j.heliyon.2021.e07755] [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: 01/28/2021] [Revised: 05/09/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
Elective caesarean sections (CS) that have medical indications contribute to better pregnancy outcomes but women have to consent for the procedure to be performed within reasonable time limits for the desired outcomes. This study aimed to determine the factors that influence women's decision-making and the duration of the decision-making process to accept primary or repeat elective CS in a district hospital in Ghana. A descriptive cross-sectional study was conducted among 163 purposively-sampled postnatal women in a hospital, who had experienced a CS. A questionnaire was used to collect data after the women gave their consent to participate. Data was analyzed using SPSS version 25.0 and presented using appropriate descriptive statistics. Chi-square test of independence was done to determine the association between any two categorical variables. Major factors that influenced women's decision-making to accept elective CS were support from their husband/partner/relatives (39.3 %), their baby's life being at risk (24.5 %), history of previous CS and knowledge about the procedure (19.6 %). Age and parity had significant relationship with the influencing factors. However, age was only significant for the influence of husband/partner/relative in the decision-making to accept CS (p < 0.01). Age (R2 = 0.19, p < 0.001); previous CS (R2 = 0.14, p < 0.001) are the major predictors of the duration of the decision-making process. Women's decision-making in consultation with relatives is the main influencer to accept elective caesarean section. There is the need to involve relatives during the antenatal care period in order for younger women in particular to be readily supported to make timely decisions to avoid preventable complications and allay client's fears.
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Affiliation(s)
- Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | - Hayford Isaac Budu
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Dorothy Bamfo-Ennin
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Georgina Mireku
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
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Guan X, Lo TW. Restrictive Deterrence in Drug Offenses: A Systematic Review and Meta-Synthesis of Mixed Studies. Front Psychol 2021; 12:727142. [PMID: 34512482 PMCID: PMC8423896 DOI: 10.3389/fpsyg.2021.727142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
Deterrence by punishment aims to prevent a crime; however, it is not always successful. Restrictive deterrence explains the continuous criminal activities that occur despite deterrence; offenders enact various strategies to avoid detection, which is more typical among drug offenders given that they have a high frequency of offending and exposure to punishment. This systematic review provides an in-depth understanding of restrictive deterrence of drug offenders. Two prominent themes, "restrictive deterrence strategy" and "deterrability and restrictive deterrence," depict drug offenders' restrictive deterrence and effectively fit within the certainty-severity framework of punishment. Future studies should investigate restrictive deterrence strategies in the after-arrest context, the facilitative effect of perception of risk on strategy development, and facilitators or inhibitors affecting the diffusion of restrictive deterrence strategies.
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Affiliation(s)
| | - T. Wing Lo
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
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A Cross-Sectional Study to Assess the Frequency and Risk Factors Associated with Cesarean Section in Southern Punjab, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168812. [PMID: 34444565 PMCID: PMC8391541 DOI: 10.3390/ijerph18168812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023]
Abstract
The increasing frequency of cesarean section (CS) is a major public health issue, and it is on the rise in Pakistan. A cross-sectional study approach was used to assess the frequency of CS and its contributing factors, along with the assessment of knowledge in mothers who had undergone CS in one of the under-developed regions of Pakistan. Data collection was done by using a self-developed study questionnaire. The statistical package for social sciences (SPSS) was utilized for the statistical analysis. During the study period, a total of 173 (69.7%) women have given births by CS; among those, 104 (60.1%) were elective/planned CSs while 69 (39.8%) were emergency CSs. The higher CS frequency was significantly associated with younger age (p = 0.03) and pre-term gestational age (p < 0.001). Pregnancy complications, such as gestational diabetes, hypertension, preeclampsia/eclampsia, and vaginal bleeding, were the significant risk factors for CS (p < 0.001). The highlighted contributing factors to CS in the current study were preterm of gestational age, mothers of a younger age (20–24 years), and mothers that belong to urban populations. These risk factors can be addressed by implementing community-focused educational interventions during the gestational period. The sample size in this study was small; therefore, the results cannot be generalized to the whole population.
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Smith V, Hannon K, Begley C. Clinician's attitudes towards caesarean section: A cross-sectional survey in two tertiary level maternity units in Ireland. Women Birth 2021; 35:423-428. [PMID: 34420910 DOI: 10.1016/j.wombi.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although caesarean section (CS) is a life-saving intervention when medically indicated, the growth in CS rates is causing concern. In reducing unnecessary CS, it is important to understand clinicians' attitudes towards CS so that these might be understood contextually. OBJECTIVE To explore clinicians' attitudes towards CS in Ireland. METHODS A cross sectional survey involving maternity care professionals in two urban maternity hospitals in Ireland. Descriptive statistics were used to analyse the data. Ethical approval was granted by the Research Ethics Committees of the University and the two study sites. FINDINGS One hundred and fifty-two maternity care professionals responded to the survey. Most (97%) indicated that the CS rate in their unit was 'high', although 81% believed there was a shift in culture towards a lower threshold for performing CS. Most participants (85%) considered birth a natural process that should not be interfered with unless necessary and that elective CS is not the safest option for the mother (74%) or baby (71%), yet 45% believed that a woman should be able to have a CS if she wants a CS. Just over half the participants considered a previous 3rd or 4th degree tear an indication for an elective CS. Offering vaginal birth after a previous CS for fetal distress and failure to progress increased with clinical experience. CONCLUSION The findings of this survey can be considered contextually in addressing high CS rates and will be of wider relevance in understanding maternity care providers' beliefs about CS in general.
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Affiliation(s)
- Valerie Smith
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland.
| | - Kathleen Hannon
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland
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Zahroh RI, Disney G, Betrán AP, Bohren MA. Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017. BMJ Glob Health 2021; 5:bmjgh-2020-003844. [PMID: 33380412 PMCID: PMC7780721 DOI: 10.1136/bmjgh-2020-003844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period. METHODS Seven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference. RESULTS The proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales. CONCLUSION This study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - George Disney
- Disability and Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Munro S, Wilcox ES, Lambert LK, Norena M, Kaufman S, Encinger J, Kendall T, Thompson R. A survey of health care practitioners' attitudes toward shared decision-making for choice of next birth after cesarean. Birth 2021; 48:194-208. [PMID: 33538001 DOI: 10.1111/birt.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with a history of cesarean may benefit from shared decision-making (SDM) interventions, such as patient decision aids, that provide individualized clinical information and help to clarify personal preferences. We sought to understand the factors that influence how care practitioners support choices for mode of birth and what individual and health system factors influence uptake of SDM in routine care. METHODS We conducted a cross-sectional survey of health care practitioners in British Columbia, Canada (2016-2017). Participants included family physicians, midwives, obstetricians, and registered nurses. We conducted descriptive and inferential analyses of quantitative data and subjected the open-ended survey responses to thematic analysis. RESULTS Analysis of survey responses (n = 307) suggested there was no significant association between the size of the participant hospital and their medico-legal concerns about mode of birth. Environmental factors that may influence the use of SDM included the length of time it takes to initiate an emergency cesarean and the timing of when the SDM intervention is introduced to the patient. No participants reported protocols prohibiting VBAC at their hospital. Participants preferred an SDM approach where the pregnant person is involved in making the final decision for mode of birth. CONCLUSIONS Although maternity care practitioners express attitudes and behaviors that may support SDM for mode of birth after cesarean, implementing SDM using a patient decision aid alone may be challenging because of environmental factors. Our study demonstrates how survey data can aid in identifying how, when, where, for whom, and why an SDM intervention could be implemented.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth S Wilcox
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Leah K Lambert
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Sarah Kaufman
- Clinical Nurse Specialist, Fraser Health Authority, Surrey, BC, Canada
| | - Jana Encinger
- Clinical Quality and Systems Improvement, Perinatal Services BC, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Tamil Kendall
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rachel Thompson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Begley K, Begley C, Smith V. Shared decision-making and maternity care in the deep learning age: Acknowledging and overcoming inherited defeaters. J Eval Clin Pract 2021; 27:497-503. [PMID: 33188540 PMCID: PMC9292822 DOI: 10.1111/jep.13515] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making.
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Affiliation(s)
- Keith Begley
- Department of Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Coates D, Donnolley N, Foureur M, Henry A. Inter-hospital and inter-disciplinary variation in planned birth practices and readiness for change: a survey study. BMC Pregnancy Childbirth 2021; 21:391. [PMID: 34016068 PMCID: PMC8135152 DOI: 10.1186/s12884-021-03844-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND How the application of evidence to planned birth practices, induction of labour (IOL) and prelabour caesarean (CS), differs between Australian maternity units remains poorly understood. Perceptions of readiness for practice change and resources to implement change in individual units are also unclear. AIM To identify inter-hospital and inter-professional variations in relation to current planned birth practices and readiness for change, reported by clinicians in 7 maternity units. METHOD Custom-created survey of maternity staff at 7 Sydney hospitals, with questions about women's engagement with decision making, indications for planned birth, timing of birth and readiness for change. Responses from midwives and medical staff, and from each hospital, were compared. FINDINGS Of 245 completed surveys (27% response rate), 78% were midwives and 22% medical staff. Substantial inter-hospital variation was noted for stated planned birth indication, timing, women's involvement in decision-making practices, as well as in staff perceptions of their unit's readiness for change. Overall, 48% (range 31-64%) and 64% (range 39-89%) agreed on a need to change their unit's caesarean and induction practices respectively. The three units where greatest need for change was perceived also had least readiness for change in terms of leadership, culture, and resources. Regarding inter-disciplinary variation, medical staff were more likely than midwifery staff to believe women were appropriately informed and less likely to believe unit practice change was required. CONCLUSION Planned birth practices and change readiness varied between participating hospitals and professional groups. Hospitals with greatest perceived need for change perceived least resources to implement such change.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology Sydney, Sydney, Australia.
- Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia.
| | - Natasha Donnolley
- 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, Newcastle, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Amanda Henry
- 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, Sydney, Australia
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Bakker W, Zethof S, Nansongole F, Kilowe K, van Roosmalen J, van den Akker T. Health workers' perspectives on informed consent for caesarean section in Southern Malawi. BMC Med Ethics 2021; 22:33. [PMID: 33781273 PMCID: PMC8008515 DOI: 10.1186/s12910-021-00584-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Informed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers’ beliefs and experiences related to principles and practice of informed consent. Methods Qualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus group discussion were used to collect data. Participants were 22 clincal officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework. Results Definition and purpose of informed consent revolved around providing information, respecting women’s autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman’s refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women’s lack of education and their dependency on others to make decisions. Conclusions Health workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00584-9.
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Affiliation(s)
- Wouter Bakker
- St. Luke's Hospital, Malosa, Malawi. .,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. .,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Siem Zethof
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
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Cesarean Delivery and Gender of Delivering Physicians: A Systematic Review and Meta-analysis. Obstet Gynecol 2021; 136:1170-1178. [PMID: 33156182 DOI: 10.1097/aog.0000000000004172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the association of the gender of the delivering physician and the odds of performing cesarean delivery. DATA SOURCES CINAHL, ClinicalTrials.gov, Cochrane Library, PubMed, Scopus and Web of Science from the first year of records through May 2020. METHODS OF STUDY SELECTION We included studies that reported odds ratios (OR), or data allowing the calculation of ORs, for cesarean delivery performed by female and male delivering physicians. We also included studies that reported the preference of physicians for performing cesarean deliveries. TABULATION, INTEGRATION, AND RESULTS Independent data extraction was carried out by at least two researchers. Standard inverse-variance random effects meta-analysis was used to generate overall ORs. Finally, in two separate meta-analyses, we analyzed 15 studies containing clinical data for 1,269,625 births, and 11 studies containing data for the preference for delivery mode of 4,911 obstetricians. Both the crude and adjusted odds of a cesarean delivery were lower for those performed by female physicians (crude OR 0.75, 95% CI 0.68-0.84, τ=0.029, adjusted OR 0.74, 95% CI 0.65-0.85, τ=0.031). We also found that female physicians had a lower preference for cesarean delivery in both crude and adjusted analysis (crude OR 0.59, 95% CI 0.36-0.96, I=77%, adjusted OR 0.58, 95% CI 0.40-0.84, I=67%). CONCLUSION Female physicians are less likely to perform cesarean delivery and less likely to prefer it. This was observed across different health systems and populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020158442.
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Acceptance of trial of labor after cesarean (Tolac) among obstetricians in the Western Region of Saudi Arabia: A cross-sectional study. Saudi J Biol Sci 2021; 28:2795-2801. [PMID: 34012321 PMCID: PMC8116973 DOI: 10.1016/j.sjbs.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Babies to women eligible for trial of labor after a cesarean (TOLAC) are sometimes delivered by cesarean section (CS). To obtain clinicians' attitudes and beliefs about TOLAC, this study was designed to investigate the views of clinicians when advising TOLAC-eligible pregnant women about TOLAC, and to explore their reasons in favor of or against TOLAC. Methods Interviews were carried out individually (face-to-face) with clinicians using a specially designed questionnaire to collect data from obstetricians in the Western Region of Saudi. Regression analysis was used as appropriate. Results Among the 183 obstetricians included in the current study, approximately 79.2% were against offering TOLAC. However, most of the physicians (89.1%) were in favor of offering TOLAC to patients who had had a successful vaginal birth after CS. significant associations were found between physicians' opposition to TOLAC and medical and most non-medical factors. Conclusion Clinicians should recognize that the critical role they play in the delivery decision-making process and in boosting women's confidence in TOLAC may be key to increasing the rate of TOLAC.
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Factors associated with women's birth beliefs and experiences of decision-making in the context of planned birth: A survey study. Midwifery 2021; 96:102944. [PMID: 33610064 DOI: 10.1016/j.midw.2021.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 11/22/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In many high-income countries, approximately half of all births are now planned regarding timing, either by elective Caesarean Section (CS) or induction of labour (IOL). To what degree this is explained by women's birth beliefs and preferences, and in turn, factors such as parity and ethnicity that may influence them, is contentious. Within a broader study on Timing of Birth by planned CS or IOL, we aimed to explore the association between demographic and pregnancy factors, with women's birth beliefs and experiences of planned birth decision-making in late pregnancy. DESIGN Survey study of women's birth beliefs and experiences of planned birth decision-making. Both univariate analysis and ordinal regression modelling was performed to examine the influence of; parity; cultural background; continuity of pregnancy care; CS or IOL; and whether CS was "recommended" or "requested", on women's stated birth beliefs and decision-making experience. SETTING 8 Sydney hospitals PARTICIPANTS: Women planned to have an IOL or CS between November 2018-July 2019. MEASUREMENT The survey included four statements regarding birth beliefs and ten statements about experiences of decision-making on a 5-item Likert scale, as well as questions about demographic and pregnancy factors that might influence these beliefs. FINDINGS Of 340 included surveys, 56% regarded IOL and 44% CS. Women indicated strong belief both that they should be supported to make decisions about their birth and that their doctor/midwife knows what is best for them (over 90% agreement for both). Regarding decision-making, over 90% also agreed they had trust in the person providing information, understood it, and had sufficient time for both questions and decision-making. However only 58% were provided written information, 19% felt they "didn't really have a choice", and 9% felt pressure to make a decision. On both univariate and multivariate analysis, women having CS (versus IOL) expressed more positive views of their experience and involvement in decision-making, as did women experiencing a pregnancy continuity-of-care model. Women identifying as from a specific cultural or ethnic background expressed more negative experiences. On modelling, the studied factors accounted for only a small proportion of the variation in responses (3-19%). CONCLUSIONS Continuity of pregnancy care was associated with positive decision-making experiences and cultural background with more negative experiences. Women whose planned birth was IOL versus CS also reported more negative decision-making experiences. IMPLICATIONS FOR PRACTICE Attention to improving quality of information provision, including written information, to women having IOL and women of diverse background, is recommended to improve women's experiences of planned birth decision-making.
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Dimassi K, Halouani A, Kammoun A, Ami O, Simon B, Velemir L, Fauck D, Triki A. The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial. PLoS One 2021; 16:e0245645. [PMID: 33481875 PMCID: PMC7822305 DOI: 10.1371/journal.pone.0245645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. Conclusions Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.
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Affiliation(s)
- Kaouther Dimassi
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
- * E-mail:
| | - Ahmed Halouani
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Amine Kammoun
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Olivier Ami
- Ramsay Healthcare France, La Muette, Paris, France
| | - Benedicte Simon
- Ramsay Healthcare France, Les Franciscaines, Versailles, France
| | - Luka Velemir
- Lenval Foundation Polyclinique Santa Maria, Nice, France
| | - Denis Fauck
- Ramsay Healthcare France, Saint Lambert, La Garenne-Colombes, France
| | - Amel Triki
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
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Coates D, Donnolley N, Henry A. The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions. J Midwifery Womens Health 2020; 66:161-173. [PMID: 33368913 DOI: 10.1111/jmwh.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The global rise in the rate of induction of labor and cesarean birth shows considerable unexplained variation both within and between countries. Prior research suggests that the extent to which women are engaged in the decision-making process about birth options, such as elective cesarean, induction of labor, or use of fetal monitoring, is heavily influenced by clinician beliefs and preferences. The aim of this study was to investigate the beliefs about labor interventions and birth options held by midwives and obstetric medical staff from 8 Sydney hospitals and assess how the health care providers' beliefs were associated with discipline or years of experience. METHODS This is a survey study of midwives and obstetric staff that was distributed between November 2018 and July 2019. Modified from the previously validated birth attitudes survey for the Australian context, survey domains include (1) maternal choice and woman's role in birth, (2) safety by mode or place of birth, (3) attitudes toward cesarean birth for preventing urinary incontinence, (4) approaches to decrease cesarean birth rates, and (5) fears of birth mode. Responses were compared between professions and within professions by years of experience using Mann-Whitney U testing. RESULTS A total of 217 midwives and 58 medical staff completed the survey (response rate, 30.5%). Midwifery staff responses generally favored a physiologic approach to birth, versus beliefs more in favor of intervention (particularly cesarean birth) among medical staff. There was interprofessional discrepancy on most items, particularly regarding safety of mode or place of birth and approaches to decrease cesarean birth rates. Within disciplines, there was more variation in medical staff attitudes than within the midwifery staff. No clinically important differences in beliefs by years of experience were noted. DISCUSSION Clinicians need to be aware of their own beliefs and preferences about birth as a potential source of bias when counselling women, particularly when there are a range of treatment options and the evidence may not strongly favor one option over another. As both groups had similar perceptions about the importance of women's autonomy, shared decision-making training could help bridge belief gaps and improve care around birth decisions.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology Sydney, Ultimo, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Natasha Donnolley
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, Australia.,The George Institute for Global Health, UNSW Medicine, University of New South Wales, Australia
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Peterwerth NH, Halek M, Tulka S, Schäfers R. Risk Perception of Health Professionals in Intrapartum Care Decisions: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e21443. [PMID: 33226353 PMCID: PMC7721551 DOI: 10.2196/21443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Risk perception plays an important role in decision-making processes. Differences in obstetric intervention rates suggest that, in addition to medical indications, the risk perception of obstetric health professionals might have a major influence on their decision-making process during childbirth. Although studies have investigated whether risk perception affects the role of midwifery or influences decision making during childbirth, little is known about what obstetric health professionals actually perceive as risk or risky situations and whether different risk perceptions lead to more interventions during intrapartum care. Objective The objective of this study is to understand the association of risk perception and the decision-making processes of obstetric health professionals (midwives and obstetricians) in Germany during intrapartum care. The study has 3 specific aims: (1) gain insight into what obstetric health professionals perceive as risk in the German clinical setting, (2) assess the extent to which personal and systemic factors have an impact on obstetric health professionals’ risk perception, and (3) investigate whether different perceptions of risk are associated with different decisions being made by obstetric health professionals. Methods This is an exploratory sequential mixed methods study with 2 phases, a qualitative followed by a quantitative phase. In the first phase, qualitative data are collected and analyzed by conducting focus group discussions and applying qualitative content analysis to address aim 1. In the second phase, for aims 2 and 3 and to help explain the qualitative results, quantitative data are collected and analyzed by conducting an observational study using case vignettes within a survey constructed on the basis of the qualitative results. Results Enrollment in the first (qualitative) phase began in July 2019, and data collection and analysis have been completed. The second (quantitative) phase is currently planned, and data collection is expected to start in December 2020. First results of the qualitative phase are expected to be submitted for publication in 2020, with completion of the second phase scheduled for 2021. Conclusions This mixed methods study will examine the perception of risk and its association with the decision-making processes of obstetric health professionals during their care of women in childbirth. The rationale for this approach is that the qualitative data and their analysis explore participants' views in more depth, while the quantitative data will help to provide and explore a general understanding of the research problem. The results are expected to be relevant to health care professionals, policymakers, and educational institutions in order to minimize underuse, overuse, and misuse of interventions during intrapartum care. Trial Registration German Clinical Trials Register DRKS00017172; https://tinyurl.com/y2zoowkx International Registered Report Identifier (IRRID) DERR1-10.2196/21443
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Bochum, Germany.,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sabrina Tulka
- Institute for Medical Biometry and Epidemiology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Rainhild Schäfers
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Bochum, Germany
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Martín-Arribas A, Vila-Candel R, O’Connell R, Dillon M, Vila-Bellido I, Beneyto MÁ, De Molina-Fernández I, Rodríguez-Conesa N, González-Blázquez C, Escuriet R. Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8394. [PMID: 33202745 PMCID: PMC7696735 DOI: 10.3390/ijerph17228394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. METHODS A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016-2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.
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Affiliation(s)
- Anna Martín-Arribas
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Faculty of Medicine, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
- Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain
| | - Rhona O’Connell
- School of Nursing and Midwifery, University College Cork, T12 YN60 Cork, Ireland;
| | - Martina Dillon
- Cork University Maternity Hospital, Wilton, T12 YE02 Cork, Ireland;
| | - Inmaculada Vila-Bellido
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | - M. Ángeles Beneyto
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | | | | | | | - Ramón Escuriet
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Catalan Health Service, Government of Barcelona, 08028 Catalonia, Spain
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Chan MH, Hauck Y, Kuliukas L, Lewis L. Women's experiences of their involvement around care decisions during a subsequent pregnancy after a previous caesarean birth in Western Australia. Women Birth 2020; 34:e442-e450. [PMID: 33004288 DOI: 10.1016/j.wombi.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women who have a caesarean birth can have an experience that may impact decision-making for subsequent births. For some women this decision-making can be associated with anxiety. AIM To provide rich, surface level descriptions by exploring women's experiences of their involvement in decision-making during a subsequent pregnancy after a previous caesarean birth. METHODS A descriptive qualitative study was performed between May 2018 and February 2019 using Braun and Clarke's six steps guided analysis. Pregnant women with a previous caesarean birth, receiving antenatal care at a tertiary maternity hospital in Western Australia, and self-reported low to moderate levels of anxiety were invited to participate in a telephone interview. FINDINGS Women's (n = 17) experiences revealed four themes: 1) Learning from past experiences (two sub-themes loss of control and coming to terms), 2) Claiming ownership in decisions (two sub-themes challenging professional judgement and prioritising her needs, wishes and preferences), 3) Being empowered (three sub-themes getting a full picture, speaking out, and not just the baby or a number), 4) Moving forward (two sub-themes building trust in health professionals and establishing guardrails to minimise loss of control). DISCUSSION Women's experiences around decision-making in a subsequent pregnancy can vary according to whether their fears and anxieties are acknowledged and addressed. Women who are informed, and receive support and respect are empowered to move forward. CONCLUSION Continuity of care may provide women with more opportunities to build trusting relationships with clinicians and be truly known as an individual with unique preferences and desires.
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Affiliation(s)
- Maria Hakyung Chan
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
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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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50
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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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