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Takeshita M, Toyomoto R, Marui K, Ito M, Eto H, Takehara K, Matsui M. Cardiotocography use for fetal assessment during labor in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 166:580-595. [PMID: 38287690 DOI: 10.1002/ijgo.15390] [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: 09/16/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The use of cardiotocography (CTG) to improve neonatal outcomes is controversial. The medical settings, subjects, utilizations, and interpretation guidelines of CTG are unclear for low- and middle-income countries (LMICs). OBJECTIVES To assess and review CTG use for studies identified in LMICs and provide insights on the potential for effective use of CTG to improve maternal and neonatal outcomes. SEARCH STRATEGY The databases Medline, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published and unpublished literature through September 2023. SELECTION CRITERIA Publications were identified which were conducted in LMICs, based on the World Bank list of economies for 2019; targeting pregnant women in childbirth; and focusing on the utilization of CTG and neonatal outcomes. DATA COLLECTION AND ANALYSIS Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA-ScR guidelines. RESULTS The searches generated 1157 hits, of which 67 studies were included in the review. In the studies there was considerable variation and ambiguity regarding the study settings, target populations, utilizations, timing, frequency, and duration of CTG. While cesarean section rates were extensively investigated as an outcome of studies of CTG itself and the effect of additional techniques on CTG, other clinically significant outcomes, including neonatal mortality, were not well reported. CONCLUSIONS Variations and ambiguities were found in the use of CTG in LMICs. Due to the limited amount of evidence, studies are needed to examine CTG availability in the context of LMICs.
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Affiliation(s)
- Mai Takeshita
- Department of Health Informatics, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Kanae Marui
- Department of Health Informatics, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Masami Ito
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Hiromi Eto
- Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kenji Takehara
- Department of Health Policy, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
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Zahroh RI, Hazfiarini A, Martiningtyas MA, Ekawati FM, Emilia O, Cheong M, Betran AP, Homer CS, Bohren MA. Rising caesarean section rates and factors affecting women's decision-making about mode of birth in Indonesia: a longitudinal qualitative study. BMJ Glob Health 2024; 9:e014602. [PMID: 38897616 PMCID: PMC11191729 DOI: 10.1136/bmjgh-2023-014602] [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: 11/20/2023] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women's preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women's preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth. METHODS We conducted a longitudinal qualitative study using in-depth interviews with 28 women accessing private and public health facilities in Jakarta, the region with the highest CS rates. Interviews were conducted two times: during the woman's third trimester of pregnancy and in the postpartum period, between October 2022 and March 2023. We used a reflexive thematic approach for analysis. RESULTS We generated three themes: (1) preferences about the mode of birth, (2) decision-making about the mode of birth and (3) regrets about the actual mode of birth. Most women preferred vaginal birth. However, they were influenced by advertisements promoting enhanced recovery after CS (ERACS) as an 'advanced technique' of CS, promising a comfortable, painless and faster recovery birth. This messaging influenced women to perceive CS as equivalent or even superior to vaginal birth. Where women's preferences for mode of birth shifted around the time of birth, this was primarily due to the obstetricians' discretion. Women felt they did not receive adequate information from obstetricians on the benefits and risks of CS and vaginal birth and felt disappointed when their actual mode of birth was not aligned with their preferences. CONCLUSION Our study shows that despite rising CS rates, Indonesian women prefer vaginal birth. This highlights the need for better communication strategies and evidence-based information from healthcare providers. Given the rising popularity of ERACS, more work is urgently needed to standardise and regulate its use.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Moya Ad Martiningtyas
- Technology, Health, Education, Social, and Environment (THESE) Initiatives, Mataram, Indonesia
| | - Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ova Emilia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Marc Cheong
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, Victoria, Australia
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caroline Se Homer
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Węgrzynowska M, Baranowska B, Sys D, Kajdy A, Karzel K, Bączek G, Szlendak B, Tataj-Puzyna U. Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland. Birth 2024; 51:384-394. [PMID: 37915248 DOI: 10.1111/birt.12794] [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: 07/06/2022] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. METHODS We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. RESULTS The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. CONCLUSIONS The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.
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Affiliation(s)
- Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Dorota Sys
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Szlendak
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Güneş HY, Keskin ME. Impact of COVID-19 pandemic on the circadian rhythm of cesarean section deliveries. Medicine (Baltimore) 2024; 103:e38358. [PMID: 38787977 PMCID: PMC11124710 DOI: 10.1097/md.0000000000038358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Circadian rhythms synchronize all biological functions, enabling humans to foresee and respond better to periodic environmental changes. The coronavirus disease (COVID-19) lockdown regulations significantly changed the lighting conditions in pregnant women, leading to chronological disruption. This study aimed to investigate the impact of the COVID-19 on the circadian rhythm of cesarean deliveries. We investigated whether the circadian rhythm of cesarean section deliveries changed during the first year of the COVID-19 pandemic at a tertiary hospital in Van Province, eastern Turkey. We analyzed the distribution of birth times for 1476 cesarean deliveries performed between March 01, 2020 and January 20, 2021 (1st year of the COVID-19 pandemic) and compared this information with data from 1194 cesarean deliveries performed during a similar period in the previous year. The primary outcome was the change in the circadian rhythm of cesarean deliveries. Secondary outcomes included cesarean section (CS) delivery rates, indications for CS, 1st and 5th minutes Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration scores, and anesthesia technique use rates. Regarding the time distribution of CS deliveries in the first year of the COVID-19 pandemic, the maximum number of cesarean deliveries (n = 234, 16%) occurred between 14:00 and 16:00 (P = .112). Cesarean deliveries in pre-COVID-19 group were most frequently performed between 10:00 and 12:00, at a rate of 18% (n = 216) (P = .001). In both groups, the time point at which CS deliveries were the least performed was 04:00 to 06:00, and the rates were different (n = 35, 2% and n = 14, 1%, respectively) (P = .022). A 4-hour phase shift was detected at the peak of the birth time in the first year of the COVID-19 pandemic compared to the previous year. These results suggest that the circadian rhythm of cesarean deliveries is affected by the pandemic.
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Affiliation(s)
- Haci Yusuf Güneş
- Department of Anesthesiology, Faculty of Medicine, Van Yuzuncu Yil University, Tuşba, Van, Turkey
| | - Mehmet Emin Keskin
- Department of Anesthesiology, Faculty of Medicine, Van Yuzuncu Yil University, Tuşba, Van, Turkey
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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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Berdzuli N, Llop-Gironés A, Farcasanu D, Butu C, Grbic M, Betran AP. From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania. BMJ Open 2024; 14:e065004. [PMID: 38417956 PMCID: PMC10900340 DOI: 10.1136/bmjopen-2022-065004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE To improve understanding of the drivers of the increased caesarean section (CS) rate in Romania and to identify interventions to reverse this trend, as well as barriers and facilitators. DESIGN A formative research study was conducted in Romania between November 2019 and February 2020 by means of in-depth interviews and focus-group discussions. Romanian decision-makers and high-level obstetricians preselected seven non-clinical interventions for consideration. Thematic content analysis was carried out. PARTICIPANTS 88 women and 26 healthcare providers and administrators. SETTINGS Counties with higher and lower CS rates were selected for this research-namely Argeș, Bistrița-Năsăud, Brașov, Ialomița, Iași, Ilfov, Dolj and the capital city of București (Bucharest). RESULTS Women wanted information, education and support. Obstetricians feared malpractice lawsuits; this was identified as a key reason for performing CSs. Most obstetrics and gynaecology physicians would oppose policies of mandatory second opinions, financial measures to equalise payments for vaginal and CS births and goal setting for CS rates. In-service training was identified as a need by obstetricians, midwives and nurses. In addition, relevant structural constraints were identified: perceived lower quality of care for vaginal birth, a lack of obstetricians with expertise in managing complicated vaginal births, a lack of anaesthesiologists and midwives, and family doctors not providing antenatal care. Finally, women expressed the need to ensure their rights to dignified and respectful healthcare through pregnancy and childbirth. CONCLUSION Consideration of the views, values and preferences of all stakeholders in a multifaceted action tailored to Romanian determinants is critical to address relevant determinants to reduce unnecessary CSs. Further studies should assess the effect of multifaceted interventions.
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Affiliation(s)
- Nino Berdzuli
- Country Health Programs, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Alba Llop-Gironés
- Country Health Programs, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Dana Farcasanu
- Centre for Health Policies and Services, Bucharest, Romania
| | - Cassandra Butu
- World Health Organization Country Office for Romania, Copenhagen, Denmark
| | - Miljana Grbic
- World Health Organization Country Office for Romania, Bucharest, Romania
| | - Ana Pilar Betran
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Cleeve A, Annerstedt KS, Betrán AP, Mölsted Alvesson H, Kaboré Wendyam C, Carroli G, Lumbiganon P, Nhu Hung MQ, Zamboni K, Opiyo N, Bohren MA, El Halabi S, Gialdini C, Vila Ortiz M, Escuriet R, Robson M, Dumont A, Hanson C. Implementing the QUALI-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam: a process delineation and theory-driven process evaluation protocol. Glob Health Action 2023; 16:2290636. [PMID: 38133667 PMCID: PMC10763892 DOI: 10.1080/16549716.2023.2290636] [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: 08/25/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The project 'Quality Decision-making by women and providers' (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women's birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the planned process evaluation, which aims to assess how and for whom QUALI-DEC worked, the mechanisms of change and their interactions with context and setting; adaptations to intervention and implementation strategies, feasibility of scaling-up, and cost-effectiveness of the intervention. We developed a project theory of change illustrating how QUALI-DEC might lead to impact. The theory of change, together with on the ground observations of implementation processes, guided the process evaluation strategy including what research questions and perspectives to prioritise. Main data sources will include: 1) regular monitoring visits in healthcare facilities, 2) quantitative process and output indicators, 3) a before and after cross-sectional survey among post-partum women, 4) qualitative interviews with all opinion leaders, and 5) qualitative interviews with postpartum women and health workers in two healthcare facilities per country, as part of a case study approach. We foresee that the QUALI-DEC process evaluation will generate valuable information that will improve interpretation of the effectiveness evaluation. At the policy level, we anticipate that important lessons and methodological insights will be drawn, with application to other settings and stakeholders looking to implement complex interventions aiming to improve maternal and newborn health and wellbeing.Trial registration: ISRCTN67214403.
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Affiliation(s)
- Amanda Cleeve
- Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Healthcare facility, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - 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
| | | | | | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Karen Zamboni
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Global Fund, Geneva, Switzerland
| | - Newton Opiyo
- 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
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Soha El Halabi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
- Faculty of Health Sciences, Fundacio Blanquerna, Barcelona, Spain
| | - Mercedes Vila Ortiz
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - Ramón Escuriet
- Faculty of Health Sciences, Fundacio Blanquerna, Barcelona, Spain
- Department of Health, Government of Catalonia, Spain
| | - Michael Robson
- The National Maternity Hospital and University College Dublin, National University of Ireland, Dublin, Ireland
| | - Alexandre Dumont
- Université Paris Cité, Research Institute for Sustainable Development (IRD), Inserm, Paris, France
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Kashiha M, Hosseini J, Samadaee Gelehkolaee K. Mothers' Perceptions About Childbirth Preparation Classes: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:278-286. [PMID: 37901189 PMCID: PMC10611932 DOI: 10.30476/ijcbnm.2023.98607.2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023]
Abstract
Background Childbirth preparation classes are designed for better adaptation of couples to physiological and psychological changes related to pregnancy and childbirth. Therefore, we aimed to explore the mothers' perceptions about childbirth preparation classes. Methods A qualitative study was conducted using the conventional qualitative content analysis method from May to August 2022. Eighteen women who had given birth in the last six months in one of the hospitals in Tehran and at least 20 days had passed since their delivery were included in the study; also, five husbands, two midwives, and two obstetricians were interviewed. The participants were purposefully selected according to the inclusion criteria. Sampling continued until data saturation. Data were collected through individual, in-depth, and semi-structured interviews and analyzed by the MAXQDA version 10 software. Results Mothers' age ranged from 17 to 37 years. 128 primary codes, 7 sub-sub themes, 3 sub-themes, and one theme were extracted. The sub-themes included satisfaction from the choice (perception forming for better choices, common consent), making the wait pleasant (dignity-oriented professional care, adaptation to change, feeling of empowerment), and good termination (free and conscious choice for birth mode, self-control during delivery process). Finally, a theme called "making motherhood pleasant" was extracted. Conclusion Making motherhood pleasant can be a meaningful achievement of childbirth preparation classes. Paying more attention to improving the quality of these classes can help improve family health. Therefore, policymakers should implement strategies to facilitate women's access to these classes.
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Affiliation(s)
- Mina Kashiha
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalil Hosseini
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keshvar Samadaee Gelehkolaee
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Birinci Ş, Parpucu ÜM. When a caesarean section is necessary: Analysis of cesarean sections performed in the Republic of Turkey in 2022 in accordance with the World Health Organization Multi-Country Research Guidelines. Turk J Obstet Gynecol 2023; 20:184-190. [PMID: 37667478 PMCID: PMC10478727 DOI: 10.4274/tjod.galenos.2023.35919] [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: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 09/06/2023] Open
Abstract
Objective The aim of our study, in light of the World Health Organization Multi-Country Survey (WHO-MCS) data examining the data of the Ministry of Health for the year 2022, comparing the cesarean sections (C/S) performed in the Republic of Turkey (TR) with the WHO-MCS data, and comparing the number of cesarean sections applied more than the reference values. Materials and Methods According to the database of the Turkish Ministry of Health, in 2022, 1166175 deliveries took place in the Republic of Turkey, and 706370 (60.5%) cesarean section deliveries were recorded as 365764 (51%) primary C/S. Using the Ministry of Health registration system based on the Robson classification. Results The number and rate of C/S operations performed per birth in 2022 in TR (n=706370; 60.50%) were found to be significantly higher when compared to the number and rate of C/S on a global scale (n=246062; 21.10%), (p<0.001). When cesarean section operations performed in the Ministry of Health hospitals, private institutions, foundation universities, public universities and other public unit hospitals were compared with WHO MCS reference values and C/S ratios, 44.2% versus 24.7% (p=0.05), versus 77.4%, versus 34.2% (p<0.001), 74.3% versus 29.5% (p<0.001), 75% versus 35.8% (p<0.001), 69.3% versus 35.9% (p<0.001). Conclusion The amount of cesarean sections performed according to the total number of births in the Turkish Republic is relatively high and its cost nearly 1 billion 750 million TL.
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Affiliation(s)
| | - Ümit Murat Parpucu
- University of Health Sciences Turkey, Vocational School of Health, İstanbul, Turkey
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Bizuayehu HM, Harris ML, Chojenta C, Cavenagh D, Forder PM, Loxton D. Patterns of Labour Interventions and Associated Maternal Biopsychosocial Factors in Australia: a Path Analysis. Reprod Sci 2023; 30:2767-2779. [PMID: 36973581 PMCID: PMC10480095 DOI: 10.1007/s43032-023-01219-7] [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: 12/15/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
In Australia, nearly half of births involve labour interventions. Prior research in this area has relied on cross-sectional and administrative health data and has not considered biopsychosocial factors. The current study examined direct and indirect associations between biopsychosocial factors and labour interventions using 19 years of population-based prospective data. The study included singleton babies among primiparous women of the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. Data from 5459 women who started labour were analysed using path analysis. 42.2% of babies were born without intervention (episiotomy, instrumental, or caesarean delivery): Thirty-seven percent reported vaginal birth with episiotomy and instrumental birth interventions, 18% reported an unplanned caesarean section without episiotomy and/or instrumental interventions, and 3% reported unplanned caesarean section after episiotomy and/or instrumental interventions. Vaginal births with episiotomy and/or instrumental interventions were more likely among women with chronic hypertension (RRR(95%-CI):1.50(1.12-2.01)), a perceived length of labour of more than 36 h (RRR(95%-CI):1.86(1.45-2.39)), private health insurance (RRR(95%-CI):1.61(1.41-1.85)) and induced labour (RRR(95%-CI):1.69(1.46-1.94)). Risk factors of unplanned caesarean section without episiotomy and/or instrumental birth intervention included being overweight (RRR(95%-CI):1.30(1.07-1.58)) or obese prepregnancy (RRR(95%-CI):1.63(1.28-2.08)), aged ≥ 35 years (RRR(95%-CI):1.87(1.46-2.41)), having short stature (< 154 cm) (RRR(95%-CI):1.68(1.16-2.42)), a perceived length of labour of more than 36 h (RRR(95%-CI):3.26(2.50-4.24)), private health insurance (RRR(95%-CI):1.38(1.17-1.64)), and induced labour (RRR(95%-CI):2.56(2.16-3.05)). Prevention and management of hypertension, diabetes, and obesity during preconception and/or antenatal care are keys for reducing labour interventions and strengthening the evidence-base around delivery of best practice obstetric care.
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia.
- Descriptive Epidemiology, Cancer Council Queensland, Brisbane, Australia.
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
- The First Nations Cancer & Wellbeing Research (FNCWR) Program, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Melissa L Harris
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Dominic Cavenagh
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Peta M Forder
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
| | - Deborah Loxton
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Centre for Women's Health Research, The University of Newcastle, Newcastle, Australia
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Silva B, Viana Pinto P, Costa MA. Cesarean Scar Pregnancy: A systematic review on expectant management. Eur J Obstet Gynecol Reprod Biol 2023; 288:36-43. [PMID: 37421745 DOI: 10.1016/j.ejogrb.2023.06.030] [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: 04/26/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
A Cesarean Scar Pregnancy (CSP) is a variant of uterine ectopic pregnancy defined by full or partial implantation of the gestational sac in the scar of a previous cesarean section. The continuous increase of Cesarean Deliveries is causing a parallel increase in CSP and its complications. Considering its high morbidity, the most usual recommendation has been termination of pregnancy in the first trimester; however, several cases progress to viable births. The aim of this systematic review is to evaluate the outcome of CSP managed expectantly and understand whether sonographic signs could correlate to the outcomes. An online-based search of PubMed and Cochrane Library Databases was used to gather studies including women diagnosed with a CSP who were managed expectantly. The description of all cases was analysed by the authors in order to obtain information for each outcome. 47 studies of different types were retrieved, and the gestational outcome was available in 194 patients. Out of these, 39 patients (20,1%) had a miscarriage and 16 (8,3%) suffered foetal death. 50 patients (25,8%) had a term delivery and 81 (41,8%) patients had a preterm birth, out of which 27 (13,9%) delivered before 34 weeks of gestation. In 102 (52,6%) patients, a hysterectomy was performed. Placenta Accreta Spectrum (PAS) was a common disorder among CSP and was linked to a higher rate of complications such as foetal death, preterm birth, hysterectomy, haemorrhagic morbidity and surgical complications. Some of the analysed articles showed that sonographic signs with specific characteristics, such as type II and III CSP classification, Crossover Sign - 1, "In the niche" implantation and lower myometrial thickness could be related to worse outcomes of CSP. This article provides a good understanding of CSP as an entity that, although rare, presents with a high rate of relevant morbidity. It is also understood that pregnancies with confirmed PAS had an even higher rate of morbidity. Some sonographic signs were shown to predict the prognosis of these pregnancies and further investigation is necessary to validate one or more signs so they can be used for a more reliable counselling of women with CSP.
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Affiliation(s)
- Beatriz Silva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Viana Pinto
- Department of Biomedicine, Service of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal; Gynecology and Obstetrics Service, University Hospital Center São João, Porto, Portugal.
| | - Maria Antónia Costa
- Gynecology and Obstetrics Service, University Hospital Center São João, Porto, Portugal; Department of Gynecology-Obstetrics and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
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12
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Tappis H, Lak R, Alhilfi R, Zangana AH, Wadi F, Hipgrave D, Ibrahim S. Quality of maternal and newborn health care at private hospitals in Iraq: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:331. [PMID: 37161362 PMCID: PMC10170688 DOI: 10.1186/s12884-023-05678-3] [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: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Approximately 25% of facility births take place in private health facilities. Recent national studies of maternal and newborn health (MNH) service availability and quality have focused solely on the status of public sector facilities, leaving a striking gap in information on the quality of maternal and newborn care services. METHODS A rapid cross-sectional assessment was conducted in November 2022 to assess the quality of MNH services at private hospitals in Iraq. Multi-stage sampling was used to select 15% of the country's 164 private hospitals. Assessment tools included a facility assessment checklist, a structured health worker interview tool, and a structured client exit interview tool. Data collection was conducted using KoboToolbox software on Android tablets, and analysis conducted using SPSS v28. RESULTS All hospitals visited provided MNH services and had skilled personnel present or on-call 24 h/day, 7 days/week. Most births (88%) documented between January and June 2022 were cesarean births. Findings indicate that nearly all hospitals have the human resources, equipment, medicines and supplies necessary for quality antenatal, intrapartum and early essential newborn care, and many are also equipped with special units and resources needed to care for small and sick babies. However, while resources are in place for basic and advanced care, there are gaps in knowledge and practice of high-impact interventions that require few or no resources to perform, including skin-to-skin thermal care and support for early initiation of breastfeeding. Person-centered maternity care scores suggest that private hospitals offer a positive experience of care for all clients, however there is room for improvement in provider-client communication. CONCLUSIONS This assessment highlights the need for deeper dives into factors that underly decisions about how and where to give birth, and both understanding and practice of early essential newborn care and pre-discharge examinations and counseling at private healthcare facilities in Iraq. Engaging private health facility staff in efforts to monitor and improve the quality of maternal and newborn care, with a focus on early essential newborn care and provider-client communication for all clients, will ensure that women and newborns benefit from the best care possible with available resources.
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Affiliation(s)
- Hannah Tappis
- Department of International Health, Johns Hopkins Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Rebaz Lak
- Kurdistan Higher Council of Medical Specialties, Erbil, Iraq
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Sarbaz M, Mousavi Baigi SF, Manouchehri Monazah F, Dayani N, Kimiafar K. The trend of normal vaginal delivery and cesarean sections before and after implementing the health system transformation plan based on ICD-10 in the northeast of Iran: A cross-sectional study. Health Sci Rep 2023; 6:e1131. [PMID: 36923373 PMCID: PMC10009419 DOI: 10.1002/hsr2.1131] [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: 10/31/2022] [Revised: 01/22/2023] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Aims Concerning the growing rate of cesarean sections (CSs) worldwide, encouraging normal vaginal deliveries (NVDs) and mitigating CS rates is a necessity. This study investigated the status of delivery in hospitals affiliated with the Mashhad University of Medical Sciences (MUMS) before and after implementing health system transformation plan (HSTP). Methods A cross-sectional study was conducted in 2017 in the obstetrics and gynecology ward in four MUMS teaching hospitals. Data were extracted from hospital information systems (HISs) based on the International Classification of Diseases (ICD-10) and analyzed in SPSS VE10 software. Results The results revealed a significant difference between the rate of NVDs and CSs before and after HSTP, such that implementing this plan in MUMS hospitals has raised the rate of NVDs by 4%. Except for the age groups of less than 15 and 36-40 years, the difference between NVD and CS was significant in different age groups before and after HSTP. The rate of NVD significantly increased within 2 months after implementing HSTP. Furthermore, the difference in the rate of previous CS before and after implementing HSTP was significant (p < 0.001). Conclusion The results of this study show the positive impact of the implementation of the HSTP on CS reduction and NVD increase in the studied hospitals. Since the studied hospitals were teaching and concerning the different costs of NVD and CS between the public and private hospitals, it is recommended to study all hospitals with the obstetrics and gynecology ward to precisely assess the success of HSTP in encouraging NVD.
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Affiliation(s)
- Masoumeh Sarbaz
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences Mashhad University of Medical Sciences Mashhad Iran
| | - Seyyedeh Fatemeh Mousavi Baigi
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences Mashhad University of Medical Sciences Mashhad Iran.,Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
| | - Fereshte Manouchehri Monazah
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences Mashhad University of Medical Sciences Mashhad Iran
| | - Nooshin Dayani
- Department of Medical Informatics, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Khalil Kimiafar
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences Mashhad University of Medical Sciences Mashhad Iran
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Braga A, Sun SY, Zaconeta ACM, Junior AT, Luz AG, Osanan G, Duarte G, Ramos JGL, Wender MCO, Nomura RMY, Francisco RPV, Borges VTM, Mattar R. Increase in cesarean sections in Brazil - a call to reflection. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:109-112. [PMID: 37105193 PMCID: PMC10166644 DOI: 10.1055/s-0043-1768454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
- Department of Maternal Child, Fluminense Federal University, Niterói, RJ, Brazil
- Vassouras University, Vassouras, RJ, Brazil
| | - Sue Yazaki Sun
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Alberto Trapani Junior
- Departamento de Ginecologia e Obstetrícia, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Gabriel Osanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - José Geraldo Lopes Ramos
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Celeste Osório Wender
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roseli Mieko Yamamoto Nomura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Rosiane Mattar
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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15
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Sugai S, Nishijima K, Haino K, Yoshihara K. Pregnancy outcomes at maternal age over 45 years: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100885. [PMID: 36739911 DOI: 10.1016/j.ajogmf.2023.100885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to identify trends in pregnancy outcomes, especially delivery mode, among pregnant patients older than 45 years. DATA SOURCES A literature search was performed using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between January 1, 2010, and June 30, 2022. STUDY ELIGIBILITY CRITERIA The primary outcomes were cesarean delivery and assisted delivery. The secondary outcomes were preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth. The inclusion criteria were studies examining the relationship between older age pregnancy and pregnancy outcomes, studies that compared pregnancy outcomes at maternal age ≥45 years and <45 years, and at least one of the primary and secondary pregnancy outcomes were included. METHODS Study screening was performed after duplicates were identified and removed. The quality of each study and publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. The inverse variance method was used to integrate the results if studies had an adjusted analysis. RESULTS Among 4209 studies initially retrieved, 24 were included in this review. All studies were retrospective, observational studies. Pregnant patients aged ≥45 years had a significantly higher cesarean delivery rate (odds ratio, 2.87; 95% confidence interval, 2.50-3.30; I2=97%) than those aged <45 years. However, the emergency cesarean delivery rate was lower in older pregnant patients (odds ratio, 0.61; 95% confidence interval, 0.47-0.79; I2=79%). Pregnancy in older individuals was associated with a lower assisted delivery rate than pregnancy in younger individuals (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; I2=48%). Preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth were more likely to occur in pregnant patients aged ≥45 years than in those aged <45 years. Adjusted pooled analyses showed trends similar to those in the unadjusted pooled analyses. CONCLUSION Adverse pregnancy outcomes, typically cesarean delivery, were more likely to occur in older (≥45 years) pregnant patients than in younger pregnant patients. However, the assisted delivery rate was lower in older pregnant patients.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
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Laine K, Pay AD, Yli BM. Time trends in caesarean section rates and associations with perinatal and neonatal health: a population-based cohort study of 1 153 789 births in Norway. BMJ Open 2023; 13:e069562. [PMID: 36725101 PMCID: PMC9896176 DOI: 10.1136/bmjopen-2022-069562] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To study caesarean section (CS) rates and associations with perinatal and neonatal health in Norway during 1999-2018. DESIGN Population-based cohort study. SETTING Medical Birth Registry of Norway. PARTICIPANTS 1 153 789 births and 1 174 066 newborns. METHODS CS, intrapartum, perinatal and neonatal mortality rates expressed as percentages (%) or per mille (‰) with 95% CIs. PRIMARY AND SECONDARY OUTCOME MEASURES CS rates in the Robson Ten-Group Classification System; intrapartum, perinatal and neonatal mortality rates. RESULTS The overall CS rate increased from 12.9% in 1999 to 16.7% in 2008 (p<0.001), and then reduced to 15.8% in 2018 (p<0.001). The largest reductions were observed in Robson groups 2 and 4. In Robson group 2, the planned CS rate decreased from 9.6% in 2007-2008 to 4.6% in 2017-2018, the intrapartum CS rate decreased from 26.6% in 2007-2008 to 22.3% in 2017-2018. In Robson group 4, the planned CS rate decreased from 16.1% in 2007-2008 to 7.6% in 2017-2018, and the intrapartum CS rate decreased from 7.8% in 2007-2008 to 5.2% in 2017-2018.The intrapartum fetal mortality rate decreased from 0.51 per 1000 (‰) in 1999-2000 to 0.14‰ in 2017-2018. Neonatal mortality decreased from 2.52‰ to 1.58‰. CONCLUSIONS CS rates in Norway increased between 1999 and 2008, followed by a significant reduction between 2008 and 2018. At the same time, fetal and neonatal mortality rates decreased. Norwegian obstetricians and midwives have contributed to maintaining a low CS rate under 17%. These findings indicate that restricting the use of CS is a safe option for perinatal health.
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Affiliation(s)
- Katariina Laine
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aase Devold Pay
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Department of Gynecology and Obstetrics, Bærum Hospital, Vestre Viken HF, Oslo, Norway
| | - Branka M Yli
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
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Lupu VV, Miron IC, Raileanu AA, Starcea IM, Lupu A, Tarca E, Mocanu A, Buga AML, Lupu V, Fotea S. Difficulties in Adaptation of the Mother and Newborn via Cesarean Section versus Natural Birth-A Narrative Review. Life (Basel) 2023; 13:life13020300. [PMID: 36836657 PMCID: PMC9965845 DOI: 10.3390/life13020300] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Birth is a physiological act that is part of the morpho-functional economy of the maternal body. Each stage in the act of birth has a predetermined pathway that is neurohormonally induced and morpho-functionally established through specific and characteristic adaptations. Like maternity, childbirth also has an important impact on the maternal body as a biological structure and psycho-emotional behavior. Cesarean section performed at the request of the mother with no medical underlying conditions besides the prolonged hospitalization risk can also cause breathing problems in children, delayed breastfeeding, and possible complications in a future pregnancy. Vaginal birth remains the path of choice for a physiological evolution pregnancy. Although erroneously considered safe and easy today, cesarean section delivery must remain an emergency procedure or a procedure recommended for pregnancies where birth is a risk to the mother and to the child, as cesarean section itself is a risk factor for negative outcomes for both mother and baby. This review summarizes the impact that both cesarean section and natural birth have on mother and newborn in their attempt to adapt to postpartum events and extrauterine life.
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Affiliation(s)
- Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Anca Adam Raileanu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (A.L.); (E.T.)
| | - Iuliana Magdalena Starcea
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (A.L.); (E.T.)
| | - Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (A.L.); (E.T.)
| | - Elena Tarca
- Department of Surgery II—Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (A.L.); (E.T.)
| | - Adriana Mocanu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ana Maria Laura Buga
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Valeriu Lupu
- Pediatrics, Vaslui Emergency County Hospital, 730006 Vaslui, Romania
| | - Silvia Fotea
- Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
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Quinzaños-Fresnedo C, Ríos-Castillo B, Hernández-Gordillo HC, Duque-Molina C. [The need for paradigm change in maternal care: AMIIMSS model, scopes and challenges]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2022; 60:119-126. [PMID: 36796030 PMCID: PMC10651308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 06/18/2023]
Abstract
Undoubtedly, great advances have been made in terms of maternal and infant morbidity and mortality. However, in Mexican Social Security System, the quality of maternal care is questionable, as reflected in proportions of cesarean births three times higher than those recommended by WHO, abandonment of exclusive breastfeeding and the fact that up to one in three women is a victim of abuse during delivery. Given this, the IMSS decides to implement the model called Integral Maternal Care AMIIMSS, focused on users experience and based on friendly obstetric care, along different stages of the reproductive process. Four pillars underpin the model, women's empowerment, infrastructure adaptation, training and adaptation of processes and standards. Although there are advances, with 73 pre-labor rooms enabled and 14,103 friendly attentions granted, there are pending tasks and challenges. In terms of empowerment, the birth plan needs to be included as an institutional practice. In terms of infrastructure adequacy, a budget is required to build and adapt friendly spaces. In addition, it is necessary to update the staffing tables and include new categories, for an adequate operation of the program. On training, the adaptation of academic plans for doctors and nurses is pending. In terms of processes and regulations, there is a lack of qualitative evaluation of the impact of the program on people's experience and satisfaction and elimination of obstetric violence.
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Affiliation(s)
- Claudio Quinzaños-Fresnedo
- Instituto Mexicano del Seguro Social, Coordinación de Unidades Médicas de Alta Especialidad, División de Atención Médica en UMAE. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Brendha Ríos-Castillo
- Instituto Mexicano del Seguro Social, Coordinación de Innovación en Salud, División de Excelencia Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Hugo César Hernández-Gordillo
- Instituto Mexicano del Seguro Social, Coordinación de Unidades de Segundo Nivel, División de Atención Gineco-Obstétrica y Perinatal. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Célida Duque-Molina
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Jamaluddine Z, Paolucci G, Ballout G, Al-Fudoli H, Day LT, Seita A, Campbell OMR. Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings. BMC Pregnancy Childbirth 2022; 22:935. [PMID: 36514024 PMCID: PMC9746094 DOI: 10.1186/s12884-022-05264-z] [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: 05/18/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of caesarean-section rates from conflict-affected settings is scarce. This study examines caesareans-section rates among Palestinian refugees by seven-group classification, compares to WHO guidelines, and to rates in the host settings, and estimates the costs of high rates. METHODS Electronic medical records of 290,047 Palestinian refugee women using UNRWA's (United Nations Relief and Works Agency for Palestine Refugees in the Near East) antenatal service from 2017-2020 in five settings (Jordan, Lebanon, Syria, West Bank, Gaza) were used. We modified Robson criteria to compare rates within each group with WHO guidelines. The host setting data were extracted from publicly available reports. Data on costs came from UNRWA's accounts. FINDINGS Palestinian refugees in Gaza had the lowest caesarean-section rates (22%), followed by those residing in Jordan (28%), West Bank (30%), Lebanon (50%) and Syria (64%). The seven groups caesarean section classification showed women with previous caesarean-sections contributed the most to overall rates. Caesarean-section rates were substantially higher than the WHO guidelines, and excess caesarean-sections (2017-2020) were modelled to cost up to 6.8 million USD. We documented a steady increase in caesarean-section rates in all five settings for refugee and host communities; refugee rates paralleled or were below those in their host country. INTERPRETATION Caesarean-section rates exceed recommended guidance within most groups. The high rates in the nulliparous groups will drive future increases as they become multiparous women with a previous caesarean-section and in turn, face high caesarean rates. Our analysis helps suggest targeted and tailored strategies to reduce caesarean-section rates in priority groups (among low-risk women) organized by those aimed at national governments, and UNRWA, and those aimed at health-care providers.
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Affiliation(s)
- Zeina Jamaluddine
- grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK ,grid.174567.60000 0000 8902 2273School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Gloria Paolucci
- grid.501184.90000 0001 2173 1062United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA Headquarters, Amman, Jordan
| | - Ghada Ballout
- grid.501184.90000 0001 2173 1062United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA Headquarters, Amman, Jordan
| | - Hussam Al-Fudoli
- grid.501184.90000 0001 2173 1062United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA Headquarters, Amman, Jordan
| | - Louise T. Day
- grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Akihiro Seita
- grid.501184.90000 0001 2173 1062United Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA Headquarters, Amman, Jordan
| | - Oona M. R. Campbell
- grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Varallo JE, Ruto D, Patted A. Surgical Burden of Disease in Women. Obstet Gynecol Clin North Am 2022; 49:795-808. [DOI: 10.1016/j.ogc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Tegegne TK, Chojenta C, Getachew T, Smith R, Loxton D. Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: Evidence from national population and health facility data. PLoS One 2022; 17:e0277885. [PMID: 36395274 PMCID: PMC9671448 DOI: 10.1371/journal.pone.0277885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/06/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caesarean section has a significant role in reducing maternal and neonatal mortality. A linked analysis of population and health facility data is valuable to map and identify caesarean section use and associated factors. This study aimed to identify geographic variation and associated factors of caesarean delivery in Ethiopia. METHOD Linked data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) and the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) survey was performed. Spatial analysis was conducted to identify geographic variations and factors associated with caesarean delivery. Hierarchical Bayesian analysis was also performed to identify factors associated with caesarean delivery using the SAS MCMC procedure. RESULTS Women's age and education, household wealth, parity, antenatal care (ANC) visits, and distance to caesarean section facility were associated with caesarean delivery use. Women who had ≥4 ANC visits were 4.67 (95% Credible Interval (CrI): 2.17, 9.43) times more likely to have caesarean delivery compared to those who had no ANC visits. Women who had education and were from rich households were also 2.80 (95% CrI: 1.83, 4.19) and 1.80 (95% CrI: 1.08, 2.84) times more likely to have caesarean deliveries relative to women who had no education and were from poor households, respectively. A one-kilometer increase in distance to a caesarean section facility was associated with an 88% reduction in the odds of caesarean delivery (Adjusted Odds Ratio (AOR) = 0.12, 95% CrI: 0.01, 0.78). Hotspots of high caesarean section rates were observed in Addis Ababa, Dire Dawa, and the Harari region. In addition, women's age at first childbirth and ≥4 ANC visits showed significant spatially varying relations between caesarean delivery use across Ethiopia. CONCLUSION Caesarean section is a lifesaving procedure, and it is essential to narrow disparities to reduce maternal and neonatal mortality and avoid unnecessary procedures.
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Affiliation(s)
- Teketo Kassaw Tegegne
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia
- * E-mail:
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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22
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Okten SB, Gunduz A, Sencelikel T, Desteli G, Usta Gunduz EB, Bildaci TB. The role of personality traits on mode of delivery. J Psychosom Obstet Gynaecol 2022; 43:292-297. [PMID: 33541178 DOI: 10.1080/0167482x.2021.1879045] [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] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim of this study is to understand the motives behind CS requests in nulliparous women in their late pregnancy better and to investigate if specific personality traits affect the maternal decision on mode of delivery. MATERIAL AND METHOD This prospective study was conducted with 70 healthy, nulliparous parturient with singleton pregnancies. Women at their 28-32. weeks of gestation were asked to fill a socio-demographic data form and the questionnaires; Personality Belief Questionnaire - Short Form (PBQ-SF) and The Childbirth Attitudes Questionnaire (CAQ). After delivery, all the results of pre-filled questionnaires and women's mode of delivery were analyzed and compared. RESULTS There were significant differences in personality types; dependent (p = 0.033), passive-aggressive (p = 0.031), obsessive-compulsive (p = 0.001), antisocial (p = 0.014), narcissistic (p = 0.014) and borderline (p = 0.014) between vaginal delivery and CS groups. The CAQ scores of the mothers who requested CS were significantly higher (p:0.007). Weak but significant positive relation was found between total CAQ scores and avoidant (p = 0.022), dependent (p = 0.034), passive-aggressive (p = 0.040), narcissistic (p = 0,006), schizoid (p = 0.007), paranoid (p = 0.007) and borderline (p = 0.007) personality types. CONCLUSION This is the first study that investigates the relationship between mode of delivery and personality traits according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and cognitive behavioral perspective in the literature. These personality traits can be carried at a level that is not clinically significant to create an obvious pathology, yet they might play a role as the motives behind the apparent reasons for women who request CS. Understanding women's motives and attitudes for childbirth during their pregnancy may help healthcare providers to tailor women's approach to childbirth to avoid unnecessary CS.
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Affiliation(s)
- Sabri Berkem Okten
- Department of Obstetrics and Gynecology, Baskent University Istanbul Health Practice and Research Center, Istanbul, Turkey
| | - Anil Gunduz
- Department of Psychology, Istanbul Kent University, Istanbul, Turkey
| | - Tugce Sencelikel
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Guldeniz Desteli
- Department of Obstetrics and Gynecology, Baskent University Istanbul Health Practice and Research Center, Istanbul, Turkey
| | - Elvan Basak Usta Gunduz
- Department of Child Psychiatry, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Tevfik Berk Bildaci
- Department of Obstetrics and Gynecology, Baskent University Istanbul Health Practice and Research Center, Istanbul, Turkey
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Quezada-Pinedo HG, Cajachagua-Torres KN, Guzman-Vilca WC, Tarazona-Meza C, Carrillo-Larco RM, Huicho L. Flat trend of high caesarean section rates in Peru: A pooled analysis of 3,376,062 births from the national birth registry, 2012 to 2020. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 12:None. [PMID: 35992298 PMCID: PMC9378316 DOI: 10.1016/j.lana.2022.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Methods Findings Interpretation Funding
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Affiliation(s)
- Hugo G. Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- Corresponding author at: Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands, Na-2907; PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Kim N. Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Wilmer Cristobal Guzman-Vilca
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carla Tarazona-Meza
- Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Centre for Non-Communicable Diseases Research and Training, Johns Hopkins University, Baltimore MD, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
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Fait T, Šťastná A, Kocourková J, Waldaufová E, Šídlo L, Kníže M. Has the cesarean epidemic in Czechia been reversed despite fertility postponement? BMC Pregnancy Childbirth 2022; 22:469. [PMID: 35668353 PMCID: PMC9172003 DOI: 10.1186/s12884-022-04781-1] [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: 07/27/2021] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia. Methods Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. Results Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95–35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14–34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76–2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16–1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86–2.21, p<0.001). Conclusions The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.
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Affiliation(s)
- Tomáš Fait
- Department of Gynecology and Obstetrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia.,Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Anna Šťastná
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Jiřina Kocourková
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia.
| | - Eva Waldaufová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Luděk Šídlo
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Michal Kníže
- Department of Gynecology and Obstetrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
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Women's views and preferences regarding the mode of birth after cesarean section: Polish cross-sectional web-based survey. Eur J Obstet Gynecol Reprod Biol 2022; 273:26-32. [PMID: 35453069 DOI: 10.1016/j.ejogrb.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Currently, the most common indication for cesarean section is a previous cesarean section. Some of them are performed for no medical reasons. Therefore, it is crucial to recognize the preferences and expectations of women concerning birth after cesarean section. This study's main aim was to understand the women's points of view on the mode of birth after cesarean. STUDY DESIGN A cross-sectional study was conducted, and data was collected using an original structured online questionnaire. The study group consisted of 733 pregnant Polish women who had previously undergone a cesarean birth. RESULTS Women more often preferred vaginal birth after cesarean section (73.26%) and less frequently (23.33%) chose elective cesarean section. Women preferring VBAC when making decisions were guided by the benefits, opportunities, and risks associated with each mode of birth. For women preferring elective cesarean section the only highly significant factor was the experience of previous deliveries. Women mainly use Internet sources and the support of other women giving birth after cesarean section. More than half of the women did not talk about the mode of birth with their midwife, and every fifth did not talk about it with the obstetrician. CONCLUSION Obstetric history and personal beliefs about birth after cesarean section, motivations, and concerns about childbirth affect women's preferences regarding the mode of birth. It is necessary to educate women, in particular, talks about the opportunities and risks associated with cesarean birth carried out by the medical staff at an early stage of pregnancy.
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Edmonds JK, Woodbury SR, Lipsitz SR, Weiseth A, Farrell ME, Shah NT, Greene N, Gregory KD. Comparing Methods of Identifying Outlying Nurses in Audits of Low-Risk Cesarean Delivery Rates. J Nurs Care Qual 2022; 37:149-154. [PMID: 34446663 DOI: 10.1097/ncq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The low-risk cesarean delivery (CD) rate is an established performance indicator for providers in maternity care for quality improvement purposes. PURPOSE Our objectives were to assess nurse performance using adjusted nurse-level CD rates and to compare methods of identifying nurse outliers. METHODS We conducted a retrospective, cohort study of 6970 births attended by 181 registered nurses in one hospital's maternity unit. Adjusted and unadjusted nurse-level CD rates were compared and agreement between 3 definitions (statistical, top decile, over a benchmark) of outliers calculated. RESULTS Adjusted nurse-level CD rates varied from 5.5% to 53.2%, and the unadjusted rates varied from 5% to 50%. Risk adjustment had little impact on the ranking of nurses, and outliers were consistently identified by 3 definitions. CONCLUSIONS Trade-offs between statistical certainty and feasibility need to be considered when classifying nurse outliers. Findings can help target interventions to improve nurse performance.
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Affiliation(s)
- Joyce K Edmonds
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Edmonds); Science and Technology, Ariadne Labs, Boston, Massachusetts (Mr Woodbury and Drs Lipsitz, Weiseth, and Shah); Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts (Dr Farrell); Division of Maternal Fetal Medicine (Dr Gregory), Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Dr Greene)
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Factors Associated with Vaginal/Cesarean Birth Attitudes among Medical Students. Healthcare (Basel) 2022; 10:healthcare10030571. [PMID: 35327049 PMCID: PMC8954109 DOI: 10.3390/healthcare10030571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Polish perinatal care is facing a high, ever-increasing cesarean section (CS) rate that is currently at 43%. Crucially, reports have revealed that the attitudes, experiences, and skills of clinicians directly contribute to this elevated CS rate. Methods: This cross-sectional study, which included 748 Polish medical students, aimed to identify medical students’ attitudes regarding birth methods. A descriptive questionnaire was distributed via the academic email addresses of surveyed medical students. Group comparisons were performed using Welch’s t-test for continuous data or a Chi-squared test for categorical data. We also used the Mann–Whitney U test and Kruskal–Wallis H test. Results: Midwifery students (96.2%) were the most unified group of students, with most agreeing that VB (vaginal birth) presents a safer option for women at low risk for VB-related complications vs. cesarean section. Of Medical Faculty students, 68% believed that fewer complications typically occur during vaginal birth than during CS. Students in their final vs. initial years of study furthermore considered VB more beneficial for women than CS. Conclusions: An important factor identified at the individual clinician level is the presence of leadership and executive support. For medical students, we can interpret this as support from their trainers and supervisors.
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Vazquez Corona M, Betrán AP, Bohren MA. The portrayal and perceptions of cesarean section in Mexican media Facebook pages: a mixed-methods study. Reprod Health 2022; 19:49. [PMID: 35193590 PMCID: PMC8862237 DOI: 10.1186/s12978-022-01351-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mexico has one of the highest rates of cesarean sections globally at over 45%. There is limited research about social factors influencing these rates. This study explores the portrayal and perceptions of cesarean section in Facebook media pages to better understand the socio-cultural context of childbirth in Mexico. Methods This is a mixed-methods social media analysis using two data sources. First, to study the portrayal of cesarean section, we identified ten Mexican media Facebook pages with the largest audiences (based on number of page “likes”). We searched these pages for articles containing the word “cesárea” (Spanish for cesarean section), and posts (articles) were eligible for inclusion if they contained the word “cesárea”. Second, to understand perceptions of cesarean section portrayal, we extracted comment threads of each Facebook post sharing the included articles. We performed a qualitative thematic analysis of articles and a quantitative content analysis of comments. Results We included 133 Facebook posts depicting 80 unique articles and identified three major themes: (1) information about cesarean section, (2) inequality and violence against women, (3) governance failures. Cesarean section was portrayed as a lifesaving procedure when medical necessary, and riskier than vaginal birth, with a longer recovery time, and possible negative health consequences. We extracted comments from 133 Facebook posts, and 6350 comments were included. We inductively developed 20 codes to then classify comments under six major categories: (1) violence and discrimination, (2) health and health services, (3) mode of birth choice, (4) disbelief at information about cesarean section, (5) abortion, and (6) discontent at the government. Conclusions We found that Facebook media did not promote cesarean section over vaginal birth, and risks and consequences were mostly represented reliably. Perceptions about the portrayal of cesarean section showed strong discontent and distrust against providers and the health system, as well as rejection of factual information about the consequences of cesarean section. We documented gross gender inequality and violence against women, highlighting the urgent need for human rights approaches to maternal health to address these inequalities and prevent harmful practices. Our study also contributes to the emerging field of social media analysis, and demonstrates clear areas where social media communication can be improved. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01351-8. Cesarean section is a medical intervention that can save women and babies when there are complications during pregnancy or birth. Mexico has one of the highest rates of cesarean section in the world (45%); much higher than what we would expect. We do not fully understand why this is happening, but we think social influences are important. We know that traditional and social media are important social influences on health and health-seeking behaviors in other countries. In our study, we aimed to explore how cesarean section is portrayed in Facebook Mexican media pages, and how people (Facebook users) interacted with these articles. To do this, we identified the most popular Facebook media pages in Mexico. Next, we searched for all articles posted to these pages. We found 80 articles and studied them to understand how they discussed cesarean section. We found that media articles posted on Facebook did not encourage women to have cesarean section, and they correctly showed risks and consequences. Then, we explored the comments from Facebook users that were attached to these posts about cesarean section. We found 6350 comments, and classified each comment based on the what the Facebook users said. Lastly, we connected the main themes of the articles to the types of comments. We found that Facebook users distrusted the Mexican health system, rejected information about the consequences of cesarean section, and often responded with the content with sexist and aggressive comments against women. Our research shows that while there is accurate and useful information on social media about cesarean section, other social issues like gender inequality and violence may influence pregnancy and childbirth.
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Affiliation(s)
- Martha Vazquez Corona
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Perrotta C, Romero M, Sguassero Y, Straw C, Gialdini C, Righetti N, Betran AP, Ramos S. Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees. BMJ Open 2022; 12:e053419. [PMID: 35078842 PMCID: PMC8796244 DOI: 10.1136/bmjopen-2021-053419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore obstetricians', midwives' and trainees' perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. SETTING We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants. RESULTS Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. CONCLUSIONS Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
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Affiliation(s)
- Carla Perrotta
- School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | | | - Cecilia Straw
- School of Social Sciences, University of Buenos Aires, CEDES, Buenos Aires, Argentina
| | | | - Natalia Righetti
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Silvina Ramos
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
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30
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Dadgar S, Mousavi Vahed S, Afiat M. Peppermint drop effect on ileus following cesarean section. J Family Med Prim Care 2022; 11:1435-1442. [PMID: 35516656 PMCID: PMC9067208 DOI: 10.4103/jfmpc.jfmpc_1366_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/14/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objective: Intestine dysfunction and ileus are one of the cesarean section complications. medicinal herbs have been used to restore the postoperative intestinal function. Therefore, we decided to use a mint drop to improve bowel function after cesarean section. Methods and Materials: 102 women enrolled in the study. The patients were simply randomized and double blindly divided into two groups of 51 patients and giving them medication (mint drops) or placebo. Then, the initial evaluation included hearing the first bowel sound, having nausea and vomiting, the first gas passing feeling time, the first defecation feeling time, and duration of hospitalization was evaluated and compared between the two groups. Results: The mean time to hearing the first intestinal sounds was 9/05 ± 2/44 hours in the placebo group and 5/78 ± 1/25 hours in the treatment group. The interval between surgery and the first gas passing feeling time in the placebo group was 12/24 ± 3/91 hours and in the treatment group was 7/87 ± 2/02 hours. None of the patients had nausea and vomiting. Conclusion: Considering the significant difference between two groups in the meantime interval to hearing the first intestinal sound, the first gas passing feeling time, and the first defecation feeling time, we conclude that the peppermint drop is more effective than placebo in improving bowel function.
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Guntiñas A, Galocha C, Madurga R, Kirk J, Usandizaga R, Ángel Rodríguez-Zambrano M. Application of pelvic floor ultrasound during pregnancy to detect patients at risk of cesarean section due to failure of labor progression in a Spanish population. Eur J Obstet Gynecol Reprod Biol 2021; 269:102-107. [PMID: 34979363 DOI: 10.1016/j.ejogrb.2021.12.025] [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: 10/02/2021] [Revised: 11/20/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our study is aimed at evaluating the characteristics of the pelvic floor, assessed through transperineal ultrasound, since it may influence or increase the possibility of having a cesarean delivery, with the objective of acting on those variables that can be modified during pregnancy. STUDY DESIGN Transperineal ultrasound was performed on 109 primiparous pregnant women in their first trimester of pregnancy, recruited between May 2018 and February 2019, with the purpose of studying the hiatus area at rest, retention and Valsalva. We have reassessed them at the end of pregnancy and delivery data were recorded. We selected 8 patients as case-study, who had cesarean section delivery due to failure of labor progression. We selected 4 control-cases for each, reaching the total of 32 controls, with similar age and body mass index, to avoid obtaining a biased result from these data. RESULTS In the study of hiatal areas, patients who delivered by cesarean section had a smaller hiatal area at rest, during levator ani muscle contraction and during Valsalva maneuver, at all visits. In early pregnancy, the range of the resting hiatal area was 13.8 ± 2.0 cm2 for cesarean sections, compared to 16.2 ± 2.7 cm2 for vaginal deliveries with an OR of 0.57 (0.34-0.95, 95% CI). For hiatal area on Valsalva, the OR was 0.55 (0.35-0.88, 95% CI). Therefore, the smaller the hiatal area, the greater the possibility of cesarean section. At the end of pregnancy, between 34 and 36 weeks of gestation, the OR of hiatal area on Valsalva was 0.78 (0.60-1.00, 95% CI). CONCLUSION The hiatus area measured by transperineal ultrasonography at the beginning and at the end of the pregnancy may be useful to identify the patients who are at a higher risk of cesarean delivery due to failure of labor progression.
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Affiliation(s)
- Alicia Guntiñas
- Department of Obstetrics and Gynaecology, University Hospital HM Puerta del Sur, Avda Carlos V, 70. Móstoles, Madrid 28938, Spain.
| | - Carolina Galocha
- Department of Obstetrics and Gynaecology, University Hospital HM Hospitals, Montepríncipe, Madrid 28660, Spain
| | - Rodrigo Madurga
- Faculty of Experimental Science, Universidad Francisco de Vitoria, Madrid. Spain
| | - Janette Kirk
- Department of Obstetrics and Gynaecology, University Hospital HM Puerta del Sur, Avda Carlos V, 70. Móstoles, Madrid 28938, Spain
| | - Ramón Usandizaga
- Chief of Pelvic Floor Section at Department of Obstetrics and Gynaecology, University Hospital La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Miguel Ángel Rodríguez-Zambrano
- Chief of Department of Obstetrics and Gynaecology, University Hospital HM Puerta del Sur, Avda Carlos V, 70. Móstoles, Madrid 282938, Spain
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Colomar M, Gonzalez Mora F, Betran AP, Opiyo N, Bohren MA, Torloni MR, Siaulys M. Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital. BMJ Open 2021; 11:e053636. [PMID: 34916321 PMCID: PMC8679125 DOI: 10.1136/bmjopen-2021-053636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC. METHODS Three groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants' views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used. RESULTS 12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs' limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM's capabilities. All professionals agreed that women's acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model. CONCLUSION There are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders' concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay
| | - Franco Gonzalez Mora
- Health Sociology Unit, University of the Republic of Uruguay Faculty of Medicine, Montevideo, Uruguay
| | - Ana Pilar Betran
- 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
| | - Newton Opiyo
- 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, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Fruscalzo A, Reinecke K, Londero AP, Gantert M. Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study. BMC Pregnancy Childbirth 2021; 21:783. [PMID: 34798862 PMCID: PMC8603588 DOI: 10.1186/s12884-021-04245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. MATERIALS AND METHODS Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd-/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. RESULTS The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57-0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48-3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57-0.93, p = 0.010). CONCLUSIONS The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.
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Affiliation(s)
- A. Fruscalzo
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
- Present address: Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland
| | - K. Reinecke
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
| | - A. P. Londero
- Obstetrics and Gynecology, University Hospital of Udine, Udine, Italy
- Ennergi Research (non-profit organisation), Lestizza, UD 33050 Italy
| | - M. Gantert
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
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Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021; 6:bmjgh-2021-005671. [PMID: 34130991 PMCID: PMC8208001 DOI: 10.1136/bmjgh-2021-005671] [Citation(s) in RCA: 418] [Impact Index Per Article: 139.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. Methods We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available data, we calculated current regional and subregional weighted averages. We estimated trends by a piecewise analysis of CS rates at the national, regional and global levels from 1990 to 2018. We projected the CS rate and the number of CS expected in 2030 using autoregressive integrated moving-average models. Results Latest available data (2010–2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990. Subregions with the greatest increases were Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage point increase, respectively) while sub-Saharan Africa and Northern America (3.6 and 9.5 percentage point increase, respectively) had the lowest rise. Projections showed that by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans of which 33.5 million in LMIC annually) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia. Conclusion The use of CS has steadily increased worldwide and will continue increasing over the current decade where both unmet need and overuse are expected to coexist. In the absence of global effective interventions to revert the trend, Southern Asia and sub-Saharan Africa will face a complex scenario with morbidity and mortality associated with the unmet need, the unsafe provision of CS and with the concomitant overuse of the surgical procedure which drains resources and adds avoidable morbidity and mortality. If the Sustainable Development Goals are to be achieved, comprehensively addressing the CS issue is a global priority.
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Affiliation(s)
- Ana Pilar Betran
- 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, Geneve, Switzerland
| | - Jiangfeng Ye
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ann-Beth Moller
- 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, Geneve, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Michalik A, Wojcicka L, Czerwińska-Osipiak A, Zdun-Ryżewska A, Jakitowicz K, Olszewska J, Krauze M, Jakitowicz M. Preferences of women with low obstetric risk for cesarean or vaginal birth in Poland: Areas for intervention. Birth 2021; 48:265-273. [PMID: 33580575 DOI: 10.1111/birt.12537] [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: 05/06/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Poland, the rate of cesarean birth (CB) is 43%, which is much higher than the European average of 27%. Optimizing the CB birth rate is of critical importance, especially among women with low-risk pregnancies. However, the determinants of cesarean preference among low-risk women in Poland have not been well explored. METHODS This cross-sectional study included 1011 pregnant women and aimed to identify associations between selected determinants of women's preferences for CB vs. vaginal birth (VB) in Poland. A descriptive questionnaire was distributed online, and a theoretical model was validated against empirically gathered data. Group comparisons were performed using the Welch t test for continuous data or chi-square test for categorical data. All statistical analyses were performed using R (R Core Team, 2018). RESULTS The mean age of women preferring CB (30.46 years) was 1.25 years higher than that of women preferring VB (29.21 years). Pregnant women who expressed a preference for CB tended to be multigravid, inhabited cities, and were characterized by higher levels of anxiety and depression. Moreover, the majority of women who underwent a previous CB asserted their intention to repeat the procedure for the current pregnancy. CONCLUSIONS The primary factors that were correlated with high CB preference among the low-risk group included age, previous childbirth experiences, and anxiety. The underlying reasons that drive birth preferences remain poorly understood. However, women who have previously undergone difficult childbirth experiences and are afraid of pain require specialized care.
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Affiliation(s)
- Anna Michalik
- Department of Obstetrical and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Lucyna Wojcicka
- Department of Obstetrical and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
| | | | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Medical University of Gdansk, Gdansk, Poland
| | - Karolina Jakitowicz
- Department of Clinical Psychology and Neuropsychology, University of Gdansk, Gdansk, Poland
| | - Jolanta Olszewska
- Department of Obstetrical and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Krauze
- Department of Gynecologic and Obstetrical Didactics, Warsaw Medical University, Warsaw, Poland
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Ramos S, Romero M, Perrotta C, Sguassero Y, Straw C, Gialdini C, Righetti N, Betran AP. Optimizing the use of cesarean section in Argentina: design and methodology of a formative research for the development of interventions. Reprod Health 2021; 18:23. [PMID: 33499893 PMCID: PMC7836162 DOI: 10.1186/s12978-021-01080-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background While cesarean section is an essential life-saving strategy for women and newborns, its current overuse constitutes a global problem. The aim of this formative research is to collect information from hospitals, health professionals and women regarding the use of cesarean section in Argentina. This article describes the methodology of the study, the characteristics of the hospitals and the profile of the participants. Methods This formative research is a mixed-method study that will be conducted in seven provinces of Argentina. The eligibility criteria for the hospitals are (a) use of the Perinatal Information System, (b) cesarean section rate higher than 27% in 2016, (c) ≥ 1000 deliveries per year. Quantitative and qualitative research techniques will be used for data collection and analysis. The main inquiry points are the determining factors for the use of cesarean section, the potential interventions to optimize the use of cesarean section and, in the case of women, their preferred type of delivery. Discussion It is expected that the findings will provide a situation diagnosis to help a context-sensitive implementation of the interventions recommended by the World Health Organization to optimize cesarean section use. Trial registration IS002316 Plain English Summary Cesarean section is an essential medical tool for mothers and their children, but nowadays its overuse is a problem worldwide. Our purpose is to get information from hospitals, health professionals and women about how cesarean section is used in Argentina. In this protocol we describe how we will carry out the study and the characteristics of the hospitals and participants. We will implement this study in seven provinces of Argentina, in hospitals that have more than 1,000 births each year, had a cesarean section rate higher than 27% in 2016 and use the Perinatal Information System. We will gather information using forms, surveys and interviews. We want to identify the factors that decide the use of a cesarean section, the potential interventions that can improve the use of cesarean section and, in the case of women, the type of delivery they prefer. We expect that this study will give us a diagnosis of how cesarean section is used in Argentina, and that this will help to apply the interventions that the World Health Organization recommends to optimize the use of cesarean section in our specific context.
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Affiliation(s)
- Silvina Ramos
- CEDES: Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET/CEDES: Centro de Estudios de Estado Y Sociedad, Buenos Aires, Argentina
| | - Carla Perrotta
- School of Public Health, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Yanina Sguassero
- CREP: Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - Cecilia Straw
- Facultad de Ciencias Sociales, Universidad de Buenos Aires/CEDES: Centro de Estudios de Estado Y Sociedad, Buenos Aires, Argentina
| | - Celina Gialdini
- CREP: Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - Natalia Righetti
- CEDES: Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Ana P Betran
- Department of Reproductive Health and Research, UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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