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First-time mothers' wish for a planned caesarean section: Deeply rooted emotions
... For descriptions of the authors, publication year, country, aim, setting/ recruitment, participants, data collection, and data analyses of the studies, see Table 1. Eight studies focused on women's perspectives [25][26][27][28][29][30][31][32], two studies focused on clinicians' perspectives [33,34] and four studies investigated both women's and clinicians' perspectives [35][36][37][38]. ...
... The two thematic syntheses included 14 qualitative studies, involving 242 women and 141 clinicians from five countries (Table 1). Four studies were conducted in the United Kingdom [25,33,37,38], four in Australia [26,27,29,32], three in Norway [30,35,36], two in Sweden [31,34], and one in Canada [28]. The participants were recruited from hospitals [28][29][30][31][32][33][34][35][36]38], from prenatal clinics [33,34,37,38], and through advertisements in newspapers [26,27]. ...
... Four studies were conducted in the United Kingdom [25,33,37,38], four in Australia [26,27,29,32], three in Norway [30,35,36], two in Sweden [31,34], and one in Canada [28]. The participants were recruited from hospitals [28][29][30][31][32][33][34][35][36]38], from prenatal clinics [33,34,37,38], and through advertisements in newspapers [26,27]. ...
Background
Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women’s and clinicians’ attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS.
Methods
The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual.
Results
The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000–2022), involving 242 women and 141 clinicians. From the women’s perspectives, two themes arose: women regarded CS as the safest mode of birth; and women’s rights to receive support and acceptance for a CS request. From the clinicians’ perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women’s rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options.
Conclusion
Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman’s birth preferences, they also felt the need to resist a woman’s request for CS and encourage her to give birth vaginally due to the associated increases in health risks.
... Also, Participants' reasons for not opting for CS include promiscuity, laziness, fear of childbirth, pain, and a curse to a disrespectful woman. These ndings compare favorably with [25][26]2]. These ndings suggest that a woman may avoid CS because of the negative societal construction of CS. ...
... As such, women in this study, even though they knew the bene ts of CS, were interested in vaginal delivery to be recognized as women in their social context. These ndings from the above theme clearly de ne a woman and womanhood as largely based on a woman's ability to deliver vaginally and give birth to many children, which most of the participants wanted to achieve, as reported previously [25,27,2]. These women may resist CS in their subsequent deliveries, given that CS deprives them of being recognized as "women." ...
... This corroborates the nding of [2], which also showed that women in the study experienced some form of social abuse in their respective communities after undergoing CS. While some were seen as less of a "woman," others were teased [25], and others were poorly received at home. In a previous study, women similarly reported this issue [27]. ...
Introduction: The study sought to determine the prevalence of cesarean section among women who delivered at the Tamale Teaching Hospital. Cesarean section is performed when a vaginal delivery is risky to the baby and mother. Even though the benefits of Caesarean section are known to women, many would often opt for vaginal delivery to boost their social recognition as women.
Methods: The design was a hospital-based descriptive cross-sectional study among women within the Tamale Metropolis. The study employed a qualitative method. There were four focus group discussions to elicit information from women who experienced Caesarean Section.
Results: Many of the participants had good knowledge about the risk and effects of a Caesarean Section. Respondents with cesarean section experience did not have a choice to decline in the study hospital because all were emergency cases. The belief of respondents about cesarean section was influenced by friends and relatives. Some of the reasons assigned for not opting for a cesarean section were; fear of complications, uncertainty regarding the pain during and after the procedure, and the fact that it is not a natural phenomenon. The perception of society regarding womanhood strongly emerged as an order of socialization and revealed that women who experienced Caesarean section go through ridicule in their respective communities.
Conclusion: There is a growing trend of misconception about cesarean section. The Ministry of Health in Ghana should ensure that all health personnel, especially nurses and midwives, have location-based training on sociocultural beliefs about Caesarean section.
... Some women who wanted to give birth by CS had positive views on the birthing method. The reasons they stated were that CS is a way of being under control or that it controls pain and anxiety [23,25,[31][32][33][34]36,39,41,42,[44][45][46]48,52,54,57,59,[62][63][64][65]67,70]. The attributes of CS described hinged on qualities associated with organization and control (including planning and predictability), and the avoidance of pain, the confluence of which reduced anxiety during birth. ...
... The possibility to plan day and time was described hinged on qualities associated with organization and control over the timing of the birth [23,34,39,40,42,61,67,70,74]. This is related with the idea of CS as a more civilized way to give birth [23,25,40,[42][43][44]50,59,62,63]. ...
... The possibility to plan day and time was described hinged on qualities associated with organization and control over the timing of the birth [23,34,39,40,42,61,67,70,74]. This is related with the idea of CS as a more civilized way to give birth [23,25,40,[42][43][44]50,59,62,63]. It was referred as modern and technologically advanced form of childbirth. ...
Background:
Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women's preferences for mode of birth and factors underlying preferences for CS.
Methods:
Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual.
Results:
We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women's partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence).
Conclusions:
A wide variety of factors underlie women's preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.
... A review of the literature revealed that a number of interrelated complex reasons and factors are likely to increase the rate of elective cesarian births, including fear of normal vaginal birth involving labor pain (Faisal et al., 2014;Mi and Liu, 2014;Schantz et al., 2016), fear of neonatal and maternal injury (Fenwick et al., 2010;Faisal et al., 2014), and fear of developing complications after a normal vaginal birth such as urine incontinence, sexual dysfunction, and vaginal prolapse (Bagheri et al., 2013;Schantz et al., 2016). Other researchers have found that women believe a cesarian birth is the only secure and safe mode for giving birth (Sahlin et al., 2013). Other studies found that some women have low confidence in maternity care providers (Mi and Liu, 2014) and report negative experiences of healthcare in hospitals (Regan et al., 2013;Sahlin et al., 2013) which influence their decision, while some women choose to have a cesarian in order to select the exact date of birth (Tarney, 2014). ...
... Other researchers have found that women believe a cesarian birth is the only secure and safe mode for giving birth (Sahlin et al., 2013). Other studies found that some women have low confidence in maternity care providers (Mi and Liu, 2014) and report negative experiences of healthcare in hospitals (Regan et al., 2013;Sahlin et al., 2013) which influence their decision, while some women choose to have a cesarian in order to select the exact date of birth (Tarney, 2014). Other women perceive cesarian birth as a source of profitable surgery compared to the vaginal mode of birth (Mi and Liu, 2014). ...
... As regards the decision-making process itself, researchers have reported that most women's decisions are supported and encouraged by family members and physicians (Manesh et al., 2011;Sanavi et al., 2012;Abbaspoor et al., 2014). Their decision is also affected by the structure of the healthcare system, which include factors such as the influence of the private health sector, willingness to pay for the procedure, lack of accountability of physicians, and lack of legal support for obstetricians in handling cases (Sahlin et al., 2013;Schantz et al., 2016). Other factors that have been identified are related to healthcare providers and include professionals' casual attitudes to surgery, variations in professional practice style, medico-legal considerations, and financial incentives to practice in a manner that is efficient (Faisal et al., 2014;Mi and Liu, 2014;Schantz et al., 2016). ...
Objective:
To explore women's reasons for requesting an elective cesarian birth without medical indication and to describe the factors that affect their decision to choose a cesarian birth.
Design:
A descriptive qualitative content analysis approach was used for the gathering and analysis of data. Interviews were held with 35 first-time mothers. The participants were recruited by using a purposive sampling method. Interviews were begun with the same question which sked about women's reasons for requesting cesarian birth without medical indication. Other questions were used to facilitate the interview and elicit the factors that led this group of first-time Jordanian mothers to choose a cesarian birth.
Setting:
A private hospital in Amman, the capital of Jordan, was selected as the location for the data gathering process. Data collection and analysis were conducted concurrently and interviews were discontinued when data saturation was reached.
Participants:
The participants consisted of 35 first-time mothers recruited by using a purposive sampling method.
Findings:
Socio-demographic, economic status, and childbirth culture played an important role in influencing women's requests for an elective cesarian. Women made their decision based on the lived negative experience of other women and were driven and supported by their social network. Five themes that reflected the reasons for elective cesarian birth without medical indication were identified: (1) fear of vaginal birth process, (2) concerns about future sexual life, (3) need for humanized birth, (4) personal reasons, and (5) decision-making process.
Conclusions and implications:
The women's reasons for choosing cesarian birth without medical indication and the factors influencing the women's decision-making process were complex and interrelated and reflect a lack of appropriate informed choice about elective cesarian. The findings therefore suggest that healthcare policy makers need to attend to the reasons and the factors that influence women's decision-making about cesarian birth in order to promote the trend of women having a vaginal birth. Evidence-based knowledge and strategies to reduce elective caesareans should be disseminated to healthcare providers in maternity settings. Future explorations of this issue should address obstetricians' and midwives' views and attitudes about cesarian birth without medical indication.
... 31 Only two studies reported ethnicity, where the significant majority of women were Caucasian (85% and 97%, respectively). 18,37 Six studies enrolled only primipara, [24][25][26][27][28]35 four enrolled only multipara, 33,34,36,37,39 while six included primipara and multipara. 23, [28][29][30]32,37 Eleven studies included the views of pregnant women in their third trimester (weeks 29-40), with two including women from week 20 and 26. ...
... 23, [28][29][30]32,37 Eleven studies included the views of pregnant women in their third trimester (weeks 29-40), with two including women from week 20 and 26. 34,35 Eight studies collected data on women's relationship status. [24][25][26]32,33,[35][36][37] All women who participated in the studies were in a relationship or married, with the exception of one participant in the study by Lagomarsino et al., who was single. ...
... 34,35 Eight studies collected data on women's relationship status. [24][25][26]32,33,[35][36][37] All women who participated in the studies were in a relationship or married, with the exception of one participant in the study by Lagomarsino et al., who was single. 32 Of the ten studies which reported educational status, seven found that the majority of participants had a university education, [22][23][24]26,30,37 while two contained a majority of participants with a secondary school education 25,32 and one a primary school education. ...
Background:
Cesarean rates have increased significantly over the past decade. The reasons for this are both complex and context specific, and have significant consequences for health resources. The aim of this systematic review was to assess published, peer-reviewed, and gray qualitative literature on the reasons behind cesarean delivery on maternal request (CDMR).
Methods:
A systematic search of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases was performed for all relevant articles published between January 2006 and June 2016. Reference lists of all included studies were also searched in addition to select web-based sources. Studies were included if they qualitatively evaluated women's preferences for CDMR, with no geographic restriction. Findings from the studies were narratively and thematically synthesized.
Results:
Sixteen studies were included in this review. Three themes were identified as to why women choose CDMR, which were: social norms, emotional experiences, and personal experiences. A woman's decision was often shaped by various influences including family, friends, and the media. In addition, previous experience of childbirth and interactions with health care professionals contributed to a strong preference for CDMR. CDMR provided women with a sense of control over the birth and diminished feelings of fear.
Conclusions:
The reasons behind CDMR are multifactorial and complex. Situation-specific cultural factors, fear of pain during childbirth, previous experience, and interactions with health care professionals are likely to have led to the increase in CDMR. Multifaceted, context-specific approaches are required if there is to be a reduction in CDMR rates.
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital [8,14], most of which are without medical indication [8,15]. The causes for the high rate of caesarian section have been studied [8,[16][17][18][19][20]. Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section [21]. Evidence showed that 10-20% of all women have negative birth experiences [7]. ...
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital [8,14], most of which are without medical indication [8,15]. The causes for the high rate of caesarian section have been studied [8,[16][17][18][19][20]. Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section [21]. Evidence showed that 10-20% of all women have negative birth experiences [7]. ...
Background:
Childbirth is considered as the most challenging psychological event in a woman's life. It has a major effect on women's lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women's perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women's perception about it.
Methods:
This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 h after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one.
Results:
The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Furthermore, seven subthemes were obtained including 'loss threat', 'stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support.
Conclusions:
This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital (8,14), most of which are without medical indication (8,15). The causes for the high rate of caesarian section have been studied (8,(16)(17)(18)(19)(20). Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section (21). Evidence showed that 10-20 percent of all women have negative birth experiences (7). ...
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital (8,14), most of which are without medical indication (8,15). The causes for the high rate of caesarian section have been studied (8,(16)(17)(18)(19)(20). Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section (21). Evidence showed that 10-20 percent of all women have negative birth experiences (7). ...
Background: Childbirth is considered as the most challenging psychological event in a woman's life. It has a major effect on women’s lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women’s perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women's perception about it.
Methods: This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 hours after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one.
Results: The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Furthermore, seven subthemes were obtained including 'loss threat’, ‘stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support.
Conclusions: This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital (8, 14), most of which are without medical indication (8, 15). The causes for the high rate of caesarian section have been studied (8,(16)(17)(18)(19)(20). Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section (21). ...
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital (8, 14), most of which are without medical indication (8, 15). The causes for the high rate of caesarian section have been studied (8,(16)(17)(18)(19)(20). Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section (21). ...
Background: Childbirth is considered as the most challenging psychological event in a woman's life. It has a major effect on women’s lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women’s perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women's perception about it.
Methods: This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 hours after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one.
Results: The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Furthermore, seven subthemes were obtained including 'loss threat’, ‘stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support.
Conclusions: This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital [8,14], most of which are without medical indication [8,15]. The causes for the high rate of caesarian section have been studied [8,[16][17][18][19][20]. Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section [21]. Evidence showed that 10-20% of all women have negative birth experiences [7]. ...
... In recent years, the rate of cesarean section is 48% in Iran that has increased to 87% in some private hospital [8,14], most of which are without medical indication [8,15]. The causes for the high rate of caesarian section have been studied [8,[16][17][18][19][20]. Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section [21]. Evidence showed that 10-20% of all women have negative birth experiences [7]. ...
Background : Childbirth is considered as the most challenging psychological event in a woman's life. It has a major effect on women’s lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women’s perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women's perception about it. Methods : This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 hours after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one. Results: The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Furthermore, seven subthemes were obtained including 'loss threat’, ‘stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support. Conclusions: This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
... Most of them are without medical indication (8,15). The causes for the high rate of caesarian section have been studied (8,(16)(17)(18)(19)(20). Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing of cesarean Sect. (21). ...
... The causes for the high rate of caesarian section have been studied (8,(16)(17)(18)(19)(20). Sahlin et al. (2013) mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing of cesarean Sect. (21). Evidence showed that 10-20 percent of all women have negative birth experiences (7). ...
Primiparous Women’s Experiences of Normal Vaginal delivery in Iran: A qualitative study Abstract Background: Childbirth is considered as the most challenging psychological event in women's life. It has a powerful effect on women’s lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women’s perception about normal vaginal delivery (NVD) experience, it is necessary to explore the primiparous women's perception about it. Methods: This qualitative study with a descriptive content analysis approach was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 hours after normal vaginal birth among primiparous women. The Sampling started from June to October in 2016. Interviews continued till data saturation. Data saturation was achieved in the 14th interview but for assurance, it continued until the 17th one. Results: The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Also, seven sub themes were obtained including 'loss threat’, ‘stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support. Conclusions: This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process and what they experience during this process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
... The fear of spontaneous child birth (tocophobia) may also a major contributing factor for the request for elective caesarean section. 24 The incidence of this condition is estimated between 6% and 10%. 24,25 In the present study, the incidence of CS rate was found to be 35.9% ...
... 24 The incidence of this condition is estimated between 6% and 10%. 24,25 In the present study, the incidence of CS rate was found to be 35.9% during the study period. ...
Background: Today, there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in India, even with the lack of evidence supporting considerable maternal and perinatal benefits with higher CS rates. The main objective of our study was to find the incidence of CS rate, auditing the data on the basis of modified Robson criteria, factors responsible for the most common group, to know the changing trends of CS and finally put forth the strategies to reduce CS rate.Methods: This is a retrospective study of 472 CS cases carried out in a tertiary care hospital during the year 2016. All the cases were grouped according to the modified Robson criteria and the data was analyzed. The data were grouped into 3 different slots of 4 months each (FF = first four months; MF = middle four months and LF = last four months of the year 2016).Results: A significant increasing trend was observed in the groups of 2B and 5C where as a significant decreasing trend was noticed in 6C and 7C. The most common indications for caesarean delivery were cephalo-pelvic disproportion (CPD) (28%) and fetal distress (22%) in group 1 whereas in group 2A CPD, fetal distress and failed induction were found to be 12%, 24% and 30% respectively.Conclusions: The change in trend has been noticed in the last few months particularly in 2B and 5C groups suggesting that there is a change in the attitude of obstetricians in conducting caesarean deliveries before the onset of labour rather than performing CS after the onset of labour. Targeting 2B along with 5C would help our efforts in reducing the CS rate.
... However, the rise in cesarean section rates should not be viewed in isolation from changes in society. On the contrary, financial (7,8), social (9)(10)(11)(12)(13), and cultural (8,(14)(15)(16)(17) elements appear to play an important part. These factors-taken together with the public perception that a cesarean delivery is now an almost risk-free procedure-might well be contributing to the rise in the number of cesarean sections performed (18). ...
... N o doubt there are systematic psychosocial differences between women who request a cesarean section and those wishing vaginal delivery (14). In addition to fear of giving birth vaginally, there is also an association with numerous other factors such as fear of complications for the child, previous traumatic births, depression, abuse, and other psychosomatic/psychiatric reasons (9)(10)(11)(12). Since the number of children born per woman has markedly decreased, for some patients the -32, 40, e1-e3) risk of perinatal mortality or intrapartum fetal asphyxia is too high, even at only 0.45 to 3 per 1000 births (e64-e67). ...
Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined.
This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and guidelines of the Association of Scientific Medical Societies in Germany (AWMF).
The increased rates of cesarean section are thought to be due mainly to changed risk profiles both for expectant mothers and for their yet unborn children, as well as an increase in cesarean section by maternal request. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. This development may perhaps be explained by an increasing tendency toward risk avoidance, by riskadapted obstetric practice, and increasing media attention. The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies.
Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.
... Many first-time pregnant mothers opt for a cesarean section due to fear of childbirth pain without realizing that they must endure significant pain after the operation (Gholami & Salarilak, 2013;Puia, 2018). Additionally, each cesarean surgery leads to internal adhesions that ultimately result in chronic and prolonged pain in the following years, for which there is no definitive treatment (Sahlin, Carlander-Klint, Hildingsson, & Wiklund, 2013). ...
This study aimed to compare the behavioral and psychological problems in children born by natural birth and cesarean section in Iran. The sample size of this research was 1133 individuals (642 cesarean and 491 natural birth), who were selected through convenience sampling method. The data collection tool for behavioral problems was the Rutter questionnaire, collected through direct interviews with the parents. The results indicated that the type of birth (natural or cesarean) has an effect on children's behavioral and psychological problems. The p-value for each of the problems such as social maladjustment, antisocial behaviors, inattention, aggression and hyperactivity, depression, and anxiety was less than 0.05, showing a significant difference in observed behavioral and psychological problems.
... [31][32][33][34] The term tokophobia is mainly used in Scandinavia and the Anglo-American countries to describe strong fear of spontaneous childbirth. 35,36 Jenabi et al. 37 summarized the data in a systematic review and defined other reasons for CDMR: fear of urinary incontinence, pelvic floor and vaginal trauma, doctor's suggestion, time of birth, previous infertility, infertility, anxiety for gynecologic examination, anxiety for loss of control, to avoid long labor, anxiety for lack of support from the staff, fear of feces, emotional aspects, body weight of the infant at birth, and abnormal prenatal examination. In the same systematic review, demographic reasons such as advanced maternal age, parity, occupation, education, maternal obesity, family status, decreasing level of religiosity, household income, number of living children, and age at marriage were identified. ...
Elective cesarean delivery on maternal request is a challenging topic of discussion for patients, their families, and clinicians. Efforts to reduce the rate of cesarean deliveries should include the proportion of cesarean deliveries at term that occur solely due to maternal request rather than a maternal or fetal indication. Additionally, clinicians should follow good clinical practice, which includes family counseling, discussions on the benefits and potential risks of elective cesarean delivery, timing of delivery, and ethical and legal considerations. Furthermore, there is the need for a sustained workforce of perinatal clinicians and staff trained in the appropriate technique and management of operative complications. This article reviews global rates of elective cesarean on maternal request and outlines FIGO's good practice recommendations for counseling expectant mothers and the conduct of elective cesarean versus vaginal delivery.
... Therefore, they cannot profit from the usual preparation for childbirth. In this case, a group training program can help these women reduce the feeling of humiliation and loss of dignity (Sahlin et al. 2013). Due to the fear of natural childbirth, the cesarean section is chosen by 71% of the mothers in the Sharia study (Shariat et al. 2002) and 36% in the Ryding study (Ryding et al. 1998). ...
Aims
This study was designed and implemented to compare the effect of prenatal education on the fear of natural birth in pregnant women.
Subject and method
This research was a semi-experimental study with a control group conducted on 96 pregnant women in Mashhad. People were randomly allocated to face-to-face and virtual groups. The Wijma childbirth experience/expectation questionnaire version A and the midwifery personal information form were used as pre-test and post-test tools.
Results
In the face-to-face and virtual groups, the average scores before and after the intervention were different, which indicated a decrease in fear of Natural childbirth in pregnant women, which was statistically significant. The changes in fear of natural childbirth score were significantly different between the three groups, and these changes were higher in the face-to-face group than in the other two groups.
Conclusion
Attendance in natural childbirth preparation classes in face-to-face and virtual training methods positively affects the fear of natural childbirth. Therefore, encouraging and supporting women to participate in training courses increase the women’s desire for natural childbirth.
... The causes for the high rate of caesarian section have been studied. Sahlin M, et al. [14] mentioned that negative child birth experience is one of the contributing factors on women's tendency for choosing cesarean section. Evidence showed that 10-20% of all women have negative birth experiences [15]. ...
Introduction and Objective: Childbirth may be a stressful event for some women and trauma that some of them experienced during childbirth can cause Post-Traumatic Stress Disorder (PTSD). The aim of this study was to compare the frequency of PTSD among women with Normal Vaginal Delivery (NVD) and cesarean section (C-Section).
... Those women mostly thought C-section as safe and easy because of the "anxiety for not being able to stand the labor pain, harm the baby and fear of death". In the studies conducted in Turkey, it was determined that mainly reasons of maternal request for a C-Section were fear of childbirth, not putting the baby at risk and unwillingness to feel the pain (Atan et al. 2013;Boz, Teskereci, & Akman, 2016;Sahlin, Carlander-Klint, Hildingsson, & Wiklund, 2013;Sercekus et al., 2015). In a systematic review study; fear of childbirth, fear of labor pain, anxiety for loss of control, anxiety for fetal injury-death, anxiety for lack of support from the staff are determined to be main reasons for C-section on maternal request (Jenabi et al., 2019). ...
Background: Birth is a crucial event in a woman’s life. Mode of birth preference women’ can be affected by many physiological, psychological and sociocultural factors.
Aim: The aim of this study was to explore the nulliparous women’s perceptions of birth, experiences for mode of birth preference and decision-making processes.
Methods: A qualitative descriptive design was chosen and 24 interviews were conducted. Data were collected through in-depth, face-to-face interviews from August to September 2019. Semi-structured interviews were recorded with a voice recorder. Data were analyzed through thematic analysis.
Results: Three main themes emerged (perception of birth, reasons mode of birth preferences, decision-making process) with twelve sub-themes (fears about childbirth and childbirth related problems, excitement: having a baby; healthy and natural, purification and regeneration, faster recovery and self-sufficiency, real motherhood,
early interaction and breastfeeding, fears of postpartum pain and surgery process, safe and easy; experienced women and social media, health providers).
Conclusion: Revealing the perceptions of birth and mode of birth preferences of pregnant women is significant in terms of increasing the quality of perinatal care and ensure a conscious participation of women a shared decision-making process.
... Most of these social factors identified in our study were commonly observed across multi-countries worldwide: fear of childbirth [14,[22][23][24][25][26][27][28], lack of self-efficacy for childbirth [22,29,30], and belief that CS is superior to vaginal delivery [10,14,[31][32][33], wealthier family [7,13], and private hospital [14,34]. Additionally, determinants of decision making such as a belief that CS is a part of a woman's autonomy [10,14,35], the strong impact by media [19,36], and/or family and friends [14,19,22,29,37] are consistent with previous studies. ...
The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%-15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were 'request for Caesarean section,' 'mental strain of obstetricians,' and 'decision-making process.' To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.
... In relation to high-income settings, a study from Australia (N = 14) found that first-time mothers who had requested a CS constructed VB as dangerous and believed VB would result in physical injury to both themselves and/or their baby. 94 Studies from Canada (N = 17), 92 Sweden (N = 12), 102 the US (N = 168), 101 the UK (N = 115) 103 and Taiwan (N = 20) presented similar findings. 97 Studies that investigated why women request a repeat CS over a VBAC also highlighted perceptions of safety as key (Taiwan, N = 21). ...
Background:
The optimal caesarean section rate is estimated to be between 10-15%; however, it is much higher in high and many middle-income countries and continues to be lower in some middle and low-income countries. While a range of factors influence caesarean section rates, women's mode of birth preferences also play a role. The aim of this study was to map the literature in relation to women's mode of birth preferences, and identify underlying reasons for, and factors associated with, these preferences.
Method:
Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined.
Findings:
A total of 65 studies were included. While the majority of women prefer a vaginal birth, between 5-20% in high-income countries and 1.4 to 50% in low-middle-income countries prefer a caesarean section. The six main reasons or factors associated with a mode of birth preference were: (1) perceptions of safety; (2) fear of pain; (3) previous birth experience; (4) encouragement and dissuasion from health professionals; (5) social and cultural influences; and (6) access to information and educational levels.
Conclusion:
To help ensure women receive the required care that is aligned with their preferences, processes of shared decision-making should be implemented. Shared decision-making has the potential to reduce the rate of unnecessary interventions, and also improve the willingness of women to accept a medically-indicated caesarean section in low-income countries.
... In their study that investigated antenatal education perceptions of parents who became mother and father for the first time, Sahlin et al. found that 56% of women and 62% of men found antenatal training a positive experience, and 68% of women and 63% of men stated that the training was useful during birth. [34] In this study, parallel to the related literature and the study conducted by Sahlin et al., fathers who had features of planning pregnancy and receiving information about birth and who were provided with training in relation to birth were found to have lower trait anxiety scores in comparison to the fathers who were not given any training. ...
Objective: This study aims to identify the effect of the training given to fathers - who did not attend any prenatal preparatory classes throughout their partner’s pregnancy period- after admission to the hospital for birth on the their anxiety level.Methods: The study was designed and conducted as a cross-sectional, randomized controlled experimental one. The study included 105 fathers, 56 fathers in the experimental group and 49 fathers in the control group. The data were collected socio-demographic information form; interview form in relation to birth; Spielberger State / Trait Anxiety Inventory (STAI). Results: Comparison of the fathers in the experimental (39.32±8.94) and control group (43.69±8.35) in terms of the trait anxiety scores showed that trait anxiety scores of the fathers in the experimental group were significantly lower than those of the control group. As to the comparison of the state anxiety mean scores of the fathers in the experimental and control group, while no statistically significant differences were detected between the groups before the training, state anxiety scores of the fathers in the experimental group (35.21±8.42) were found to be significantly lower than those of the control group fathers (42.85±11.03) who were not provided with any training. Conclusion: In comparison to the fathers who did not receive any information, the state anxiety levels were found to be lower in the fathers who were systematically informed about the hospital, birth process, newborn and postnatal period while waiting for the birth outside the delivery room.
... Desta forma, o trabalhador de saúde necessita investir no sentido de reverter esta escolha, garantindo que a mulher compreenda os riscos e os benefícios de sua tomada de decisão. 22 Nesta conjuntura o processo de tomada de decisão para optar pela cesariana eletiva pode ser dividido em três fases: pré-decisão (fase da percepção de risco), em decisão (fase de avaliação de riscos) e pós-decisão (fase de marchar para a frente sem medo). Dependendo da fase que a mulher se encontra são vivenciadas diferentes preocupações. ...
RESUMOObjetivo: conhecer a participação da mulher na tomada de decisão sobre o tipo de parto vivenciado. Método: revisão integrativa de literatura de artigos completos em inglês, português ou espanhol, utilizando recorte temporal de janeiro de 2004 a janeiro de 2014, por meio das Bases de dados LILACS, MEDLINE e da biblioteca virtual Scielo. Utilizou-se como descritores Parto Normal, Parto humanizado, Cesárea, Tomada de Decisões e Pesquisa Qualitativa, sendo utilizado os operadores boleanos “and” e “or” como ferramenta para o cruzamento. Resultados: foram considerados relevantes à temática deste estudo 16 artigos, categorizados em dois eixos temáticos: Parto normal pós cesárea e Cesárea: Decisão médica ou decisão materna? Conclusão: os estudos permitiram perceber que é preciso persistir na busca pela humanização do processo de parturição, abdicando de ações padronizadas, intervenções tecnológicas e medicalizadoras que desconsideram a decisão da mulher sobre o processo de parturição vivenciado. Descritores: Parto Normal; Parto Humanizado; Cesárea; Tomada de Decisões; Pesquisa Qualitativa.ABSTRACTObjective: to know the participation of the woman in the decision-making about the type of birth experienced. Method: integrative review of literature in full articles in English, Portuguese or Spanish, using a temporal cut from January 2004 to January 2014, using the LILACS, MEDLINE and SCIELO virtual libraries. We used as descriptors Normal Childbirth, Humanized Childbirth, Cesarean Section, Decision-Making and Qualitative Research, using the "and" and "or" Boolean operators as a tool for crossing. Results: 16 articles categorized in two thematic axes were considered relevant to the topic of this study: Vaginal birth after cesarean and Cesarean section: medical decision or maternal decision? Conclusion: the studies made it possible to perceive that it is necessary to persist in the search for the humanization of the parturition process, abdicating standardized actions, technological and medicalizing interventions that disregard the woman's decision about the process of parturition experienced. Descriptors: Natural Childbirth; Humanizing Delivery; Cesarean Section; Decision-Making; Qualitative Research.RESUMEN Objetivo: conocer la participación de la mujer en la toma de decisión sobre el tipo de parto vivenciado. Método: revisión integradora de la literatura trabajos completos en Inglés, portugués o español, utilizando marco temporal de enero 2004-enero 2014, a través de las bases de datos LILACS, MEDLINE y biblioteca virtual SciELO. Se utilizó como descriptores Parto Normal, Parto humanizado, Cesárea, Toma de Decisiones e Investigación Cualitativa, siendo utilizado los operadores boleanos "and" y "or" como herramienta para el cruce. Resultados: fueron considerados relevantes a la temática de este estudio 16 artículos, categorizados en dos ejes temáticos: Parto normal post cesárea y Cesárea: Decisión médica o decisión materna? Conclusión: los estudios permitieron percibir que es necesario persistir en la búsqueda por la humanización del proceso de parturición, abdicando de acciones estandarizadas, intervenciones tecnológicas y medicalizadoras que desconsideran la decisión de la mujer sobre el proceso de parturición vivenciada. Descriptores: Parto Normal; Parto Humanizado; Cesárea; Tomada de Decisiones; Investigación Cualitativa.
... 5,6 Financial, social and cultural elements appear to play an important role. [7][8][9][10][11][12][13][14][15][16][17] These factors are taken together with the public perception that a cesarean delivery is now an almost risk-free procedure and this might be contributing to the rise in the number of CS. 18 It is important, therefore, to study the rising cause of CS rates across lower and middle income countries (LMIC). An earlier study from Bangladesh (2007-2008) of 400 CS conducted suggested that 12.5% CS rate but has no clear medical indication recorded. ...
Background: Bangladesh recently became a middle income country and despite of its relatively low skilled birth attendance (26.5%) nevertheless experience a rise in caesarean section (CS) rate. But now the rate of CS increased almost seven fold from 3.5% in 2004 to 23% in 2016. Objective: To find out the cause and incidence of caesarean section among the primigravid mother in Rajshahi medical college hospital performed in between January 2017 to December 2017. Methods: This prospective type of observational study was performed in Rajshahi Medical College Hospital (RMCH) over a period of one year from January 2017 to December 2017. All primigravida who underwent caesarean section in RMCH were included. Result: During the study period there were 11018 deliveries. Overall CS rate was 40.98%. The rate in primi was 30.70% and last year it was 25.58%. Conclusion: The vast majority of CS was not medically indicated. A number of policies and program had been launched to counteract this increasing rate of CS but virtually there was no impact. TAJ 2018; 31(2): 54-58
... First-time women requesting planned CS do not always present with a clinically significant fear of childbirth, but have more negative expectations of vaginal delivery compared to women planning for vaginal delivery [11]. A qualitative study from Sweden showed that primiparous women requesting cesarean section often expressed deeply rooted emotions about natural birth since early adulthood [12]. Reasons reported among 91 Swedish women requesting CS in first pregnancy were fear of birth, safety issues, birth history of relatives, fear of pain and history of sexual abuse [13]. ...
Background
Pregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature. In order to find adequate, targeted treatment and preventive strategies, we need a better understanding of this phenomenon. The aim of this study is to provide a qualitative exploration of maternal requests for a planned cesarean section in Norway, in the absence of obstetric indications.
Methods
A descriptive qualitative study was conducted consisting of 17 semi-structured, in-depth interviews with women requesting cesarean section and six focus group discussions with 20 caregivers (nine midwives, 11 obstetricians) working at a university hospital in Norway. Data were analyzed with Systematic Text Condensation, a method for thematic cross-case analysis.
Results
Fear of birth emerged most commonly as a result of a previous traumatic birth experience that prompted a preference for a planned cesarean to avoid a repetition of the trauma. For some women in our study, postnatal care and the puerperal period were their crucial past experiences, and giving birth by planned cesarean was seen as a way to ensure mental rather than physical capability to care for the expected child after birth. Others were under the impression of being at high risk for an emergency C-section, and requesting a planned one was based on their perceived risk. Such perceptions included having a narrow pelvis, hereditary factors or previous birth outcomes. Some primiparas requested a planned cesarean based on a deep-seated fear since their early teens, accompanied by alienation towards the idea of giving birth. Some obstetricians participating in our study also experienced requests that lacked what they regarded as any well-grounded reason or significant fear.
Conclusions
Behind a maternal request for a planned cesarean section are various rationales and life experiences needing carefully targeted attention and health care. Previous births are an important driver; thus, maternally requested cesareans should be regarded partly as an iatrogenic problem.
Electronic supplementary material
The online version of this article (10.1186/s12884-019-2250-6) contains supplementary material, which is available to authorized users.
... There is minimal research that provides evidence about what women want after their caesarean section (CS). Most of the research about what women want is around their decisions to have a CS or not ( Althabe and Belizán, 2017;Fuglenes et al., 2012;McAra-Couper et al., 2012;Sahlin et al., 2013 ). ...
Objective: To explore women's experience of skin-to-skin contact and what women want in the first two hours after a caesarean. Design: Audio recorded interviews were conducted with women as a part of a larger video ethnographic research study where video recordings, observations, field notes, focus groups and further in-depth interviews were conducted. Setting: A metropolitan hospital in Sydney, Australia. Participants: Twenty-one women who had a caesarean section were involved in interviews around six weeks postpartum. Analysis: The transcribed interviews were thematically analysed. Findings: Women wanted their baby to stay with them and have skin-to-skin contact, even if they felt apprehensive about providing this care. An overarching theme was, ‘I want our baby’. Several subthemes also emerged: ‘I felt disconnected when I was separated from my baby’, ‘I want to explore my naked baby’, ‘I want my partner involved‘, and ‘It felt right’. Key Conclusions: Despite the challenges of providing skin-to-skin contact in the operating theatre and recovery, health professionals and institutions should recognise the importance of advocating for what women want including keeping women, their partners and babies together and encouraging continuous maternal and infant contact and skin-to-skin contact.
... They found that Polish mothers who had vaginal births had significantly lower breastfeeding self-efficacy than mothers who gave birth via cesarean section. This results could be explained that in some women, cesarean section may be a favored method of delivery, especially among mothers who fear childbirth ( Fenwick et al., 2010 ), who want a more controlled and safe way of having a baby ( Sahlin et al., 2013 ), and who see a medical or technical approach to giving birth positively ( Lobel and DeLuca, 2007 ). Results from an Argentina study suggested that positive mood states increase levels of self-efficacy while negative mood lessens it ( Medrano et al., 2016 ). ...
Background
Breastfeeding self-efficacy refers to a mother's confidence about her ability to breastfeed, which has been found to shape her choice about whether or not to do so. It depends on social and psychological factors and has not previously been studied in postpartum Vietnamese women.
Purpose
The purpose of this study was to explore factors related to breastfeeding self-efficacy and its predictors among postpartum Vietnamese women.
Methods
This cross-sectional study was conducted on 164 postpartum women in Tu Du hospital in Vietnam from August to September 2017. The study used the Breastfeeding Self-Efficiency Scale (BSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Edinburgh Postnatal Depression Scale (EPDS) to explore factors affecting breastfeeding selfefficacy. Independent t-test, ANOVA, Pearson's correlation coefficient, and hierarchical linear regression were used to determine the relationship between independent variables and the dependent variable. Results: Breastfeeding self-efficacy was related to mothers' age, mother's occupation, previous breastfeeding experience, mode of delivery, skin-to-skin contact with the baby, and extent of breastfeeding in the hospital. It was also positively correlated with social support and was significantly lower in women with more postpartum depression. Independent variables predicted 36.8% of breastfeeding self-efficacy in the hierarchical linear regression.
Conclusion
Strategies to foster breastfeeding self-efficacy should focus on decreasing the incidence of postpartum depression and promoting social support for breastfeeding. Health care providers should screen for and pay close attention to signs of postpartum depression. Moreover, health care providers should offer adequate support tailored to the mother's needs and involve her social network in breastfeeding education.
... Cesarean delivery on maternal request refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of a standard medical /obstetrical indication for avoiding vaginal birth. 1,2 It is estimated that 4-18% of all cesarean sections are done on maternal request; however, estimates are difficult to come by. 3 While uncommon in the past, a recent national audit in the United Kingdom revealed that 7% of all elective cesarean sections were performed for precisely this reason. 4 Not surprisingly, 69% of the obstetricians, when come across a woman requesting for cesarean delivery, would comply with such a wish. ...
Background: Cesarean delivery on maternal request refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of a standard medical/obstetrical indication for avoiding vaginal birth. The aim of the study was to find out the reasons behind, and the incidence of women preferring Cesarean section in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, over a period of one year from 1st April 2015 to 31st March 2016. All women who underwent Cesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period of one year was 2574. There were 1346 (52.29%) vaginal deliveries and 1228 (47.7%) cesarean deliveries. Among 1228 Cesarean deliveries, 87 (7.08%) had maternal request as their indication. Majority of them were in the age group of more than 35 years. Multigravidae opted for Cesarean delivery more than primigravidae (59 multigravidae vs 28 primigravidae). Among the various reasons for women requesting delivery cesarean were tocophobia, refusal of trial of labor after Cesarean section (TOLAC), concurrent sterilization, prolonged infertility and treatment conception, afraid of neonatal outcome (previous adverse neonatal outcome) and astrological concerns.Conclusions: Many of the women opted for Cesarean delivery in our study for preventable reasons like painless labor and concurrent sterilization which would have been easily avoided by prior counseling starting from antenatal period and by providing labor analgesia. Patient education and personal involvement of the treating obstetrician in counseling the patient and emotional support during labor can reduce Cesarean delivery for maternal request.
... Particularly, psychological factors seem to strongly influence this important choice which consists in undergoing a surgical procedure in the absence of any maternal or fetal indications and correlated with more morbidity and mortality compared to the vaginal delivery [7][8][9][10][11]. The most common reasons behind this choice are tokophobia [13,14,16] and previous or referred negative birth experience [17], were found regarding MMPI-2 scores which crossed the " normal " range. Compared to controls, women in cases group had more frequently clinically significant scores concerning the following psychopathological characteristics (Table 4 ...
Objective: To investigate the psychological profile of a sample of new mothers, who requested an elective
caesarean section (CS), compared with a group of women who had a CS in emergency. Furthermore, the study
examined psychiatric, environmental, medical and obstetrical risk factors related to the mother’s choice of an elective CS, in order to develop specific intervention strategies.
Methods: A sample of 16 mothers aged 34.88 ± 8.53 years were enrolled and assessed using a semi-structured
face-to-face interview, the Minnesota Personality Inventory Test-2 (MMPI-2) and the Edinburgh Postnatal Depression Scale (EPDS). The sample was divided in two groups: cases (8 women who had an elective CS) and controls (8 women who had a CS in emergency).
Results: The analysis identified a statistical significance among the two groups with a higher prevalence
in cases’s group of: previous mood disorders (100% of the cases group), maternal comorbidities (100% of the
cases group), neuroticism (MMPI-2’s scale ‘NEGE’: p=0.013), ‘defensive’ attitude (MMPI-2’s scale ‘K’: p=0.013),
hypochondria (MMPI-2’ scale ‘Hs’: p=0.046), health concerns (MMPI-2’s scale ‘Hea’: p=0.013) and depression
(MMPI-2’s scales ‘D’: p=0.012 and ‘Dep’: p=0.023; EPDS’s scores: p=0.007), with a general tendency to have
higher scores of psychopathology (p=0.033). No statistical significance was found concerning socio-demographic information and obstetrical risk factors.
Conclusion: Women who chose CS without medical indications showed more somatic anxiety levels, expressed
with a hypochondriac rumination and an obsessive way to control their body. This seems associated with more
neuroticism and more symptoms of depression which may lead to a higher risk of develop postnatal depression. Gynaecologists should pay attention to the reasons behind the mother’s choice of an election CS by ensuring a detailed psychological counselling and try to mitigate levels of anxiety and fears related to the childbirth.
... Международные исследования приводят следующие данные: 4–18% от общего числа кесаревых сечений приходятся на долю операций, которые были проведены по просьбе рожениц при отсутствии медицинских показаний. М. Сахлин с коллегами [7], изучая первородящих женщин, попытались выяснить основания таких просьб и в целом выделили четыре группы женщин, которые: 1. «всегда знали», что никаких вариантов, кроме кесарева сечения, для них не существует; 2. воспринимали кесарево сечение как более безопасный и контролируемый способ родоразрешения; 3. имели негативный опыт обращения в органы здравоохранения; 4. боялись осуждения со стороны ближнего окружения , активно склоняющего их в сторону кесарева сечения как наилучшего варианта родов. Таким образом, авторы заключают, что за добровольным отказом от физиологических родов могут стоять различные основания. ...
In recent decades, the increasing worldwide problems in the reproductive sphere of people, the problem of preserving reproductive health of the population has become very topical, it requires joint medical and psychological efforts. This article presents a review of more than 70 modern English-language scientific publications devoted to the study of psychological and psychosomatic peculiarities of men, women and couples with reproductive disorders and psychological predictors and consequences of these problems. The best known and the least explored psychological aspects of reproductive disorders are highlighted, the results of research are described, also R. Linder’s psychotherapeutic method of preventing premature births is outlined. The article has two parts: the first part presents the research of psychosomatic aspects of male and female reproductive diseases, including infertility; the second one is devoted to psychological and psychosomatic disorders of women during pregnancy and childbirth.
... Dies könnte die Grundlage eines gesundheitsfördernden Beratungskonzeptes in deutschen Geburtskliniken darstellen. Es gibt bereits Studien, in denen Frauen während ihrer ersten Schwangerschaft zu ihrem Kaiserschnittwunsch befragt wurden [37] oder in welchen sie im Nachhinein über diesen Wunsch Auskunft gaben [12] [30]. Diese Arbeit soll den Fokus des Forschungsinteresses dagegen auf dem Prozess der Veränderung des ursprünglichen Geburtswunsches legen und somit die Perspektive der deskriptiven Entscheidungstheorie einnehmen. ...
Background: Primiparous women who request an elective cesarean are counseled at the hospital where they want to give birth. As a result some pregnant women change their mind and aim for a vaginal birth. Objective: Exploration of the experiences of women, who requested a cesarean section but changed their mind and experienced a normal vaginal birth, with regard to the change in the decision making process and to relevant aspects of the professional advice received. Methods: Using Schütze’s method, narrative interviews with five women were conducted 10 to 24 months after their first labor. The evaluation was performed according to the ("documentary") method by Bohnsack/Nohl. Results: The participants of this study stated that sufficient time, a trustworthy atmosphere and acceptance were important aspects of the counseling session. Two women completely changed their subjective attitude and decided to attempt a normal birth rather than opt for a cesarean (subjective distancing). This change was brought about either by evidence-based information on the advantages and disadvantages of both modes of birth, or by becoming convinced of the value of experiencing a normal birth. Three women were strengthened in the belief that they were capable of giving birth normally by the assurance of individual support, effective pain control, or the explicit recommendation of a trusted expert (motivated distancing). Conclusion: Professionals such as midwifes, physicians and/or psychologists can give health promoting and preventive advice to pregnant primiparous women opting for an elective cesarean section by integrating the identified aspects of counseling and knowledge of various options in the decision making process.
... In our experience, women with severe fear of childbirth do not often benefit from nor do they even attend normal antenatal preparatory classes in standard prenatal care, because of the dissimilarity of feelings towards childbirth (intense fear and shame). The important role of group psychoeducation is to share different and contradictory feelings in order to normalise and diminish feelings of inferiority and lack of dignity, which are common among women with fear of childbirth [48]. With support, participants can deal with and accept different emotions and possible setbacks during pregnancy and childbirth. ...
Every 10th pregnant women suffers from severe fear of childbirth. It causes anxiety and physical symptoms during pregnancy, and may interfere with mother-infant bonding. Caesarean sections on maternal request are rising worldwide. The major indication is fear of childbirth. There is no clinical guideline regarding how to help these women.
This present study was designed to investigate the background factors of fear of childbirth; to assess the methods to screen fear of childbirth; analyse the effect of group psycho-education on delivery mode, delivery experience, costs and postnatal psycho-social well-being; and also to evaluate the psychiatric morbidity of women with fear of childbirth.
We tested the fear of childbirth questionnaire in the Finnish population and simultaneously gathered the obstetrical background information of 1,348 pregnant women. We used the Fear of Childbirth VAS for the first time in measuring fear of childbirth. With a cut-off of Fear of Childbirth VAS > 5.0, the sensitivity is 98%, and the specificity is 67% for severe fear of childbirth. Nulliparous women have more fear of childbirth than parous women. Women who were more afraid of childbirth preferred caesarean section as delivery mode. Women who had have previously delivered by caesarean section or had vacuum-assisted delivery, were more fearful. The Fear of Childbirth VAS is a simple method for screening fear of childbirth.
In a register-based study, we analysed specialised care with psychiatric diagnoses and psychotropic medication of 2,500 women with fear of childbirth and 5,000 control women. The prevalence of mental health problems was higher (54%) among women with fear of childbirth than among control women (34%). The most common mental disorders were anxiety disorders and depression. Mental health problems should be acknowledged in maternity care.
In randomised study, nulliparous women were screened for fear of childbirth, and 371 women with severe fear of childbirth were included in our study. These women were randomised into an intervention group and conventional care. The intervention consisted of six times of group psycho-education with mindfulness relaxation exercises led by a psychologist during pregnancy and one session postnatal. Women in the intervention group had more often normal vaginal delivery (63% vs. 48%) than women in the control group. The childbirth experience was less frightening for women in the intervention group, regardless of the delivery mode. Group psycho-education improved maternal adjustment and reduced the risk of postnatal depressive symptoms. The costs of group psycho-education were saved in delivery costs, and thus this treatment causes no additional expenses to conventional care. By providing nulliparous women with group psycho-education, more resources can be appointed to parous women with fear of childbirth in special maternity care.
... In our experience, women with severe fear of childbirth do not often benefit from nor do they even attend normal antenatal preparatory classes in standard prenatal care, because of the dissimilarity of feelings towards childbirth (intense fear and shame). The important role of group psychoeducation is to share different and contradictory feelings in order to normalise and diminish feelings of inferiority and lack of dignity, which are common among women with fear of childbirth [48]. With support, participants can deal with and accept different emotions and possible setbacks during pregnancy and childbirth. ...
Background:
Previous studies on the treatment of women with fear of childbirth have focused on the delivery mode. Women with fear of childbirth often suffer from anxiety and/or depression, and treatment therefore also needs to target postnatal psychological well-being and the early mother-infant relationship.
Methods:
Three hundred and seventy-one nulliparous women out of 4575 scored ≥100 in prospective screening (Wijma Delivery Expectancy Questionnaire, W-DEQ-A), indicating severe fear of childbirth. These women were randomised to psychoeducative group intervention with relaxation (n = 131; six sessions during pregnancy, one postnatal) or to conventional care (n = 240) by community nurses (referral if necessary). Psycho-emotional and psychosocial evaluations [Edinburgh Postnatal Depression Scale (EPDS), social support, Maternal Adjustment and Attitudes (MAMA), Traumatic Events Scale (TES) and the Wijma Delivery Experience Questionnaire (W-DEQ-B)] were completed twice during pregnancy and/or 3 months postpartum.
Results:
Postnatal maternal adjustment (MAMA mean score 38.1 ± 4.3 versus 35.7 ± 5.0, p = 0.001) and childbirth experience (mean W-DEQ-B sum score 63.0 ± 29 versus 73.7 ± 32, p = 0.008) were better in the intervention group compared with controls. In hierarchical regression, social support, participating in intervention, and less fearful childbirth experience predicted better maternal adjustment. The level of postnatal depressive symptoms was significantly lower in the intervention group (mean sum score 6.4 ± 5.4 versus 8.0 ± 5.9 p = 0.04). There were no differences in the frequency of post-traumatic stress symptoms between the groups.
Conclusions:
In nulliparous women with severe fear of childbirth, participation in a targeted psychoeducative group resulted in better maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms, compared with conventional care.
... Also in the Cheung study (2006) through interviews with 52 postnatal Chinese women, in different socio-economic levels in the first week and eight months after a CS, and to understand women's interpretations of their own CS decision-making, it was found that decision-making for CS was influenced by women's social position, culture and levels of knowledge (Cheung et al., 2006). Sahlin (2012) reported that deeply-rooted emotions had a great influence on Swedish women's tendency to a planned CS (Sahlin et al., 2013). Our results showed that women's tendency towards undergoing a natural childbirth was greatly influenced by the cultural and religious acceptance of normal childbirth. ...
to describe women's perceptions of choosing a particular birth method; normal childbirth or caesarean section in the absence of medical indications.
a descriptive qualitative content analysis was used for data gathering and analysis. Interviews were held with 18 pregnant and postnatal women. The participants were recruited using a purposive sampling method. Interviews were begun with a general question and were followed with specific questions.
three semi-public and public hospitals and two health care centres in an urban area of Iran were the locations of data gathering. Data analysis and data collection were conducted concurrently and interviews were discontinued when data saturation was reached.
the participants consisted of 18 women (four pregnant and 14 postnatal) recruited using a purposive sampling method.
'socio-economic and cultural norms' was the main theme that emerged in this study. Four other categories comprised the content of interviews: 'cultural and religious acceptance', 'social acceptance', 'psychological-social support', and 'economical acceptance'.
socio-cultural, religious and economical norms in the Iranian society play main roles in the selection of the birth method by Iranian women. Health care policy-makers are expected to attend to the factors influencing women's decision-making on the childbirth method to reduce the number of unnecessary caesarean sections.
... In our experience, women with severe fear of childbirth do not often benefit from nor do they even attend normal antenatal preparatory classes in standard prenatal care, because of the dissimilarity of feelings towards childbirth (intense fear and shame). The important role of group psychoeducation is to share different and contradictory feelings in order to normalise and diminish feelings of inferiority and lack of dignity, which are common among women with fear of childbirth [48]. With support, participants can deal with and accept different emotions and possible setbacks during pregnancy and child- birth. ...
The increase in the numbers of women fearing childbirth and requesting cesarean sections call for new forms of antenatal treatment.
Finnish nulliparous women experiencing severe fear of childbirth (experimental group, n = 102) attended 5 group sessions with a psychologist, once together with a midwife, during the third trimester. One session was held 3 months after the delivery. Each session consisted of a discussion of fear and feelings towards the impending birth and parenthood in a psychotherapeutic atmosphere and of relaxation exercises focused on an imaginary childbirth. The results were compared with those of 85 women treated for fear of childbirth by 2 appointments with an obstetrician (conventional treatment).
Before the sessions, among the women in the experimental group, scored fear of childbirth, on a scale of one to ten, was 6.9+/-2.0 (SD), which is similar to the score of those receiving conventional treatment (6.0+/-1.6). After the sessions, 84 women in the experimental group (82.4%) and 57 in the conventional treatment group (67.1%) chose to have a vaginal delivery (p = 0.02). The women in the experimental treatment group rated the helpfulness of the sessions 8.5+/-1.6 on a scale where 10 was maximum help and 1 no help at all, and mentioned "sharing their feelings" twice as often as "receiving information" as the most helpful factor in relieving fear.
Group psychoeducation and relaxation exercises were well received and rated as very helpful. More cesarean section requests were withdrawn than in the comparison group and in previous studies.
Objective: To study the demographic characteristics of pregnant ladies and factors contributing towards rise in cesarean section on maternal request to aid the obstetricians in decision making.
Study Design: Cross sectional analytical survey.
Place and Duration: Gynecology Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2019 to Mar 2020.
Methodology: One hundred and fifteen women of child bearing age requesting cesarean section were included in the study. Demographic details were noted. A study proforma was filled for determinants of primary and secondary tocophobia and factors that may be improved for vaginal delivery.
Results: A total of 115 patients with mean age of 27.99 years were included. Amongst them, 88 (76.5%) were Punjabi with 92 (80%) living in rural area. Primigravida were 11 (9.6%), 83 (72.2%) had previous lower segment cesarean section and 3 (2.6%) had vaginal delivery. For primary tocophobia, 22 ( 24.4%) experienced anxiety. Fear of labor pains was seen in 20 (19.2%) and lack of control in 27 (26%). For secondary tocophobia, 15 (37.5%) were fearful of prolonged labor and 5 (22.5%) of sub optimal birth outcome. In women with previous one cesarean section, 13 (14.8%) correlated negatively with birth experience and 20 (22.7%) found timed cesarean section convenient. For vaginal delivery, pain relief was preferred by 19 (20.2%) and 31 (33%)
wanted pain relief and attendant.
Conclusion: Better understanding of fears behind maternal request for cesarean section can lead to improved attitudes towards vaginal delivery. The negative perceptions of pregnant ladies should be addressed in antenatal.........
This chapter will cover different strategies to modify clinical risk factors of placenta accreta spectrum to reduce their global upraising incidence.
Objective: Women have the right to make choices during pregnancy and birth that sit outside clinical guidelines, medical recommendations, or normative expectations. Declining recommended place or mode of birth, routine intervention or screening can be considered 'non-normative' within western cultural and social expectations around pregnancy and childbirth. The aim of this review is to establish what is known about the experiences, views, and perceptions of women who make non-normative choices during pregnancy and childbirth to uncover new understandings, conceptualisations, and theories within existing literature.
Methods: Using the meta-ethnographic method, and following its seven canonical stages, a systematic search of databases was performed, informed by eMERGe guidelines.
Findings: Thirty-three studies met the inclusion criteria. Reciprocal translation resulted in three third order constructs - ‘influences and motivators’, ‘barriers and conflict and ‘knowledge as empowerment’. Refutational translation resulted in one third order construct – ‘the middle ground’, which informed the line of argument synthesis and theoretical insights.
Key Conclusions and implications for practice: The findings of this review suggest that whilst existing literature from a range of high-income countries with similar healthcare systems to the UK have begun to explore non-normative decision-making for discrete episodes of care and choices, knowledge based, theoretical and population gaps exist in relation to understanding the experiences of, and wider social processes involved in, making non-normative choices across the UK maternity care continuum.
Aims of the study
This study aims to determine females’ views, experiences, and attitudes regarding the cesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan.
Design
This is a cross‐sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications, and reasons for performing CS were investigated.
Settings
The participants were recruited from all Jordan cities by Social media and emails.
Findings
Most of the respondents stated that the source of there knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.=8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labor pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%).
Conclusions and implications
This study indicated that Jordanian females not have reliable sources of information about CS. This leads to lower awareness of CS and its complications and, as expected, CS is more likely to be performed by privately insured women.
Background: The caesarean section rate in Norway and in the western world has increased greatly from around 1970. The reasons are only partially known. The relation between labour progression and outcome to previous burdensome life events and mental health problems has been scarcely investigated. In the various sub studies of this dissertation, we have examined some aspects of fear of birth and the desire to be delivered by caesarean section, the outcome of the first labour in women who have been subject to rape in adulthood or to sexual abuse in childhood, as well as analysed the birth experiences of some of the women with a history of having been raped. The aim of this dissertation is to seek answers to and illuminate the following research questions:
Is there a relationship between mental health burdens and a request for caesarean section?
Are there differences in demographic factors or in mental health burdens in women who fear
birth, with and without an expressed desire for elective caesarean?
Can a request for caesarean in women who fear birth, be changed through a crisisoriented
intervention?
Will a change of attitude in the counsellor´s approach, from ‘autonomy’ to ‘coping’, lead to a
higher proportion of women who request caesarean section changing their wishes and giving birth
vaginally?
Are there differences in the progression and outcome of the first labour in women who have
experienced rape in adulthood, compared to women who have not?
Are there differences in the progression and outcome of the first labour in women subjected to
childhood sexual abuse, compared with women who were raped in adulthood, and women with no
history of sexual assault or abuse?
How is the first childbirth experienced by women who have a history of being raped in adulthood?
What kind of care in labour do they consider as helpful for other women with such a history?
Material and methods
The study material is taken from a cohort of 808 women who were referred to the Mental
Health Team at the Department of Obstetrics and Gynaecology, University Hospital of North
Norway, in the period 2000-2007. Both qualitative and quantitative methods are used. Data
were collected from referral letters, antenatal and labour records, from a questionnaire
survey sent to women two to four years after the birth in question, and from qualitative
interviews. In the data analyses for studies I-IV, descriptive and analytic statistics are used. In
study VI, qualitative content analysis is used.
Study I describes demographic features, mental health problems, and outcome of labour in
164 women with a fear of birth, with and without an expressed desire to be delivered by
caesarean section.
Study II describes a newly developed crisis-oriented intervention given to 86 women with
fear of birth and a request for caesarean section. The women’s psychosocial burdens, changes in their wishes for caesarean after the intervention, outcome of labour, satisfaction with the treatment, and their wishes for mode of delivery in future childbirth, are described.
Study III analyses predictors for change in request for caesarean section and for vaginal birth in 193 women who received a crisis-oriented intervention, and whether an attitudinal change in the counsellor’s approach, from ‘autonomy’ to ‘coping’ will increase the proportion of women who change their request for caesarean and go on to give birth vaginally.
Study IV compares the duration of labour and birth outcomes of the first labour in 50
women with a history of rape in adulthood, with 150 controls from the same population of
parturient, who had no known history of sexual assault.
Study V compares the duration of labour and birth outcomes of the first labour in 185
women subject to childhood sexual abuse, 47 women with a history of rape in adulthood, with 141 controls from the same population of parturient, with no known rape or sexual abuse history.
Study VI is based on qualitative interviews with 10 women who had experienced rape. The
study examines and illuminates their first childbirth experience and their advice for birth care they regard as good for women with a history of rape.
Results
Fear of birth in the women in these studies was accompanied by extensive mental health problems. Eighty per cent reported previous anxiety and/or depression, 32% had eating disturbances, and 72 % had been subject to abuse. Half of the women with fear of birth expressed a desire for caesarean section. Women requesting caesarean had more severe fear of birth, previous anxiety and depression, traumatic birth experience, and distrust of health personnel and fewer of them had received treatment for their mental health problems, than in the group without a request for caesarean (study I). A crisis-oriented intervention emphasising the development of a trusting relationship and alliance between the counsellor and the woman, led to 86 % of the women changing their request for caesarean. Most of the women were satisfied with having changed their request, and of those who had given birth vaginally, 93 % stated they would prefer vaginal birth in the future
(study II). When the counselling midwife’s attitude and approach emphasized coping more of the women (95 %) changed their request for caesarean, and more women (80 %) give birth vaginally (study III). There were large differences in duration and outcome of the first labour in women who had experienced rape as adults, after the age of 16, and women who had been subject to childhood sexual abuse. Those who had been raped had a significantly prolonged second stage of labour (120 vs 55 minutes), 15 times the risk of caesarean section and 13 times the risk for instrumental vaginal delivery, compared to controls with no known history of sexual assault or abuse (study IV). Women who had been subject to childhood sexual abuse had approximately the same duration and outcome of labour as control women (study V). The informants described intrusive memories of being back in the rape trauma during labour, independent of mode of delivery. After the birth they were retraumatised, and had feelings of being objectified, dirtied, and alienated. They identified good interaction with the birth attendant as the determining factor in order to have the best possible outcome of labour (study VI).
The studies contribute new knowledge about the importance of meeting the labouring woman in a way that inspires trust, being open for both biological and psychosocial factors that can influence fear of birth and the desire for caesarean section. This knowledge about how burdensome life events can impinge on the course and outcome of first childbirth. The results must nonetheless be seen in light of the selection bias for our population, which consists of women referred to the Mental Health Team in pregnancy because their problems were so intrusive.
Conclusion
Behind fear of birth and request for caesarean section lie many unprocessed life events and mental health burdens. To start processing these events is essential in order to change the desire for caesarean. A crisis-oriented intervention, with focus on coping, leads to most women who requested caesarean changed their mind, and give birth vaginally. Primiparous women who have been raped in adulthood have significantly prolonged second stages of labour and increased risk of operative delivery, both caesarean and vaginal. The rape trauma is reactivated in these women, independent of mode of delivery. They described how routine care and procedures in labour contributed to such reactivation. The symptoms of retraumatisation persisted long after the birth, and they were in a state of mental imbalance that disturbed the natural tasks of motherhood. Women subjected to child sexual abuse have a course and outcome of first labour resembling that of women with no history of
abuse or assault. Previous mental health burdens can give rise to reactions in pregnancy and
during labour which can influence labour outcome. Mental health problems and burdensome life events such as sexual abuse or assault are themes which should be inquired about as part of routine antenatal care. This knowledge should have consequences for how birth attendants care for women in labour.
The aim of this study was to describe the overall health-related quality of life (HRQoL) in women five years after the birth of their first child as well as the HRQoL in relation to mode of delivery.
545 first-time pregnant women, drawn from a hospital situated in Sweden, consented to be included in a cohort. Five years after the birth of the first child, 372 (68%) women agreed to participate in a follow-up study. HRQoL was measured using the Swedish Health-Related Quality of Life Survey (SWED-QUAL) questionnaire. Socio-demographic background and variables related to pregnancy and childbirth were collected using a self-report questionnaire.
Overall, the HRQoL was perceived to be good. Suboptimal scores were obtained for the three variables: Sleeping problems, Emotional well-being - negative affect and Family functioning - sexual functioning. Women having a vaginal birth, an instrumental vaginal birth or women who underwent caesarean section on maternal request were more likely to report better perceived HRQoL than women who had undergone an emergency caesarean section or caesarean section due to medical indication.
This study demonstrates that the overall HRQoL of the women in the cohort was reported as good. Mode of delivery was associated with differences in HRQoL five years after birth of the first child. Our result suggests that some differences in perceived HRQoL persist in the long term.
Copyright © 2015 Elsevier B.V. All rights reserved.
Few studies have examined the mode of birth among women with fear of childbirth, and the results are conflicting. The objective of this study was to assess the association between fear of childbirth and cesarean delivery in North European women.
A longitudinal cohort study was conducted among 6,422 pregnant women from Belgium, Iceland, Denmark, Estonia, Norway, and Sweden. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire during pregnancy and linked to obstetric information from hospital records.
Among 3,189 primiparous women, those reporting severe fear of childbirth were more likely to give birth by elective cesarean, (OR, 1.66 [95% CI 1.05-2.61]). Among 3,233 multiparous women, severe fear of childbirth increased the risk of elective cesarean (OR 1.87 [95% CI 1.30-2.69]). Reporting lack of positive anticipation, one of six dimensions of fear of childbirth, was most strongly associated with elective cesarean (OR 2.02 [95% CI 1.52-2.68]). A dose-effect pattern was observed between level of fear and risk of emergency cesarean in both primiparous and multiparous women. Indications for cesarean were more likely to be reported as "nonmedical" among those with severe fear of childbirth; 16.7 versus 4.6 percent in primiparous women, and 31.7 versus 17.5 percent in multiparous women.
Having severe fear of childbirth increases the risk of elective cesarean, especially among multiparous women. Lack of positive anticipation of the upcoming childbirth seems to be an important dimension of fear associated with cesarean delivery. Counseling for women who do not look forward to vaginal birth should be further evaluated.
© 2015 Wiley Periodicals, Inc.
Objective:
to add to knowledge around women's perceptions of their preparation for and actual experience of a recent scheduled caesarean birth.
Design, participants and setting:
a mixed method study incorporating a postal survey and one-on-one interviews was used. The survey provided feedback on resources to prepare women for their caesarean birth such as a positive birth class, DVD and birth plan. Women were also invited to participate in an interview to share perceptions of their preparation and actual birth experience. Participants attended the only public obstetric tertiary hospital in Western Australia and experienced their caesarean birth between August and December 2012 (n=256). Frequency distributions and univariate comparisons were employed for categorical data, whereas thematic analysis was undertaken with transcripts to extract common themes.
Findings:
data reflect 46% (117 out of 256) of women returned a postal survey. The interview option was removed after three months of data collection, when 38 women were interviewed and data saturation was reached. Of the 61% (71 of 117) who completed a birth plan, 59% (42 of 71) felt it was used to guide their care. Only 38% (44 of 117) were able to stay together with their (baby and partner) in recovery. Thematic analysis revealed a positive theme suggesting their experience 'couldn't have been 'better' with sub-themes: 'involved in care'; 'informed the whole way through'; 'magical for him to be near me' and 'everything was done brilliantly'. Negative reflections centred around 'we were just a number' and included four sub-themes: 'no option'; 'still had questions'; 'separated from him and her' and 'none of it happened'.
Conclusion:
acknowledgement that a scheduled caesarean section is more than a surgical procedure, but a birth is paramount. For women to have a positive birth experience we must respect their wishes within their birth plan and embrace a family friendly model, where mothers, partners and babies can stay together.
Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code.
Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data.
The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p<0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables.
The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.
The aim of this study was to investigate the indications for cesarean sections in the early 1990s as compared to the middle 2000s.
Retrospective cohort study.
Data were collected from original obstetrical records in a tertiary hospital in 1992 and 2005.
The total cesarean delivery rate rose from 11% to 20%. The main indications for an elective cesarean in 1992 were a pathological fetal lie or a uterine factor. The dominant indication for an elective cesarean in 2005 was a psychosocial indication defined as maternal fear of childbirth or maternal request without any co-existing medical indication. Presumed fetal compromise and prolonged labor remained the main indications for urgent and emergency cesareans. No apparent alterations in population characteristics could be identified for these years.
The increased rate of elective cesareans for psychosocial indications would reflect altered attitudes towards mode of delivery in the childbearing population and among obstetricians. We suggest that extended support from community antenatal care should be provided and that standardized keys aiding a physician in decision-making procedures concerning the cesarean section practice should be developed.
Analysis of patient surveys carried out in Germany, Sweden, Switzerland, the United Kingdom, and the United States in 1998-2000 revealed high rates of problems during inpatient hospital stays. Problems with information and education, coordination of care, respect for patients' preferences, emotional support, physical comfort, involvement of family and friends, and continuity and transition were prevalent in all five countries. These dimensions of patients' experience appear to be salient and relevant in each of the five countries, but attempts to develop international rankings based on this type of evidence will have to overcome a number of methodological problems.
Objective To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.
Design National survey.
Setting Swedish antenatal clinics.
Population 3283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999–2000).
Methods A questionnaire was mailed shortly after the first antenatal visit.
Main outcome measures Women's preferences for mode of delivery.
Results 3061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience.
Conclusions Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.
Opting for a home birth or requesting a cesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study was to compare background characteristics of women who chose these very different birth methods and to see how these choices affected factors of care and the birth experience.
This descriptive study employed a secondary data analysis of a sample of women who gave birth from 1997 to 2008, including 671 women who had a planned home birth and 126 women who had a planned cesarean section based on maternal request. Data were collected by means of questionnaires. Logistic regression with crude and adjusted odds ratios (OR) with a 95 percent confidence interval (95% CI) was calculated.
Women with a planned home birth had a higher level of education (OR: 2.3; 95% CI: 1.5-3.6), were less likely to have a high body mass index (OR: 0.1; 95% CI: 0.01-0.6), and were less likely to be smokers (OR: 0.2; 95% CI: 0.1-0.4) when compared with women who had planned cesarean sections. When adjusted for background variables, women with a planned home birth felt less threat to the baby's life during birth (OR: 0.1; 95% CI: 0.03-0.4), and were more satisfied with their participation in decision making (OR: 6.0; 95% CI: 3.3-10.7) and the support from their midwife (OR 3.9; 95% CI: 2.2-7.0). They also felt more in control (OR: 3.3; 95% CI: 1.6-6.6), had a more positive birth experience (OR: 2.9; 95% CI: 1.7-5.0), and were more satisfied with intrapartum care (OR: 2.3; 95% CI: 1.3-4.1) compared with women who had a planned cesarean section on maternal request.
Women who planned a home birth and women who had a cesarean section based on maternal request are significantly different groups of mothers in terms of sociodemographic background. In a birth context that promotes neither home birth nor cesarean section without medical reasons, we found that those women who had a planned home birth felt more involvement in decision making and had a more positive birth experience than those who had a requested, planned cesarean section.
To explore whether women view decision-making surrounding vaginal or caesarean birth as their choice.
Longitudinal cohort study utilising quantitative (questionnaire, routinely collected data) and qualitative (in-depth interviews) methods simultaneously.
A large hospital providing National Health Service maternity care in the UK.
Four-hundred and fifty-four primigravid women.
Women completed up to three questionnaires between their antenatal booking appointment and delivery. Amongst these women, 153 were interviewed at least once during pregnancy (between 24 and 36 weeks) and/or after 12 moths after birth. Data were also obtained from women's hospital delivery records. Descriptive statistical analysis was performed (survey and delivery data). Interview data were analysed using a seven-stage sequential form of qualitative analysis.
Whilst many women supported the principle of choice, they identified how, in practice their autonomy was limited by individual circumstance and available care provision. All women felt that concerns about their baby's or their own health should take precedence over personal preference. Moreover, expressing a preference for either vaginal or caesarean birth was inherently problematic as choice until the time of delivery was neither static nor final. Women did not have autonomous choice over their actual birth method, but neither did they necessarily want it.
The results of this large exploratory study suggest that choice may not be the best concept through which to approach the current arrangements for birth in the UK. Moreover, they challenge the notion of choice that currently prevails in international debates about caesarean delivery for maternal request.
Caesarean section (CS) is not an option that women in Sweden can chose themselves, although the rise in CS rate has been attributed to women. This study describes obstetricians' and midwives' attitudes towards CS on maternal request.
A qualitative descriptive study, with content analysis of 5 focus group discussions where 16 midwives and 9 obstetricians participated.
The overarching theme was identified as "Caesarean section on maternal request-a balance between resistance and respect". On the one hand, CS was viewed as a risky project; on the other hand, request for a CS was understood and respected when women had had a previous traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear. Five categories were related to the theme. Overall, our findings indicate that caregivers blamed the women for the increase, they considered the management of CS on maternal request difficult, and they suggested preventive methods to reduce CS and means to strengthen their professional roles. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: Both midwives and obstetricians considered the management of CS on maternal request difficult, and the result showed that they balanced between resistance and respect. The result also showed that the participants stressed the importance of professionals advocating natural birth with evidence-based knowledge and methods to prevent maternal requests. Ongoing discussions among health professionals on attitudes and practice would strengthen their professional roles and lead to a decrease in CS rates in Sweden.
a growing number of childbearing women are reported to prefer a caesarean section in the absence of a medical reason. Qualitative research describing factors influencing this preference in pregnant women is lacking.
to describe Australian women's request for caesarean section in the absence of medical indicators in their first pregnancy.
advertisements were placed in local newspapers inviting women to participate in a telephone interview exploring women's experience of caesarean section. Thematic analysis was used to analyse data.
two states of Australia: Queensland and Western Australia.
a community sample of women (n=210) responded to the advertisements. This paper presents the findings elicited from interviews conducted with 14 women who requested a caesarean section during their first pregnancy in the absence of a known medical indication.
childbirth fear, issues of control and safety, and a devaluing of the female body and birth process were the main themes underpinning women's requests for a non-medically-indicated caesarean section. Women perceived that medical discourses supported and reinforced their decision as a 'safe' and 'responsible' choice. KEY CONCLUSIONS AND RECOMMENDATIONS FOR PRACTICE: these findings assist women and health professionals to better understand how childbirth can be constructed as a fearful event. In light of the evidence about the risks associated with surgical birth, health-care professionals need to explore these perceptions with women and develop strategies to promote women's confidence and competence in their ability to give birth naturally.
There is an extensive literature concerning caesarean section at maternal request, where no obstetric indication exists, yet little information about what motivates women to request such a delivery.
This paper aims to ask women who had undergone maternal-request primary elective caesarean delivery about the reasons for their choice, their level of satisfaction with the delivery and their future childbearing plans.
Anonymous postal survey of women who have undergone maternal-request primary caesarean section in private maternity hospitals in the eastern states of Australia.
The response rate was 68%, and 78 completed surveys were included in the study. The most common reason given was, 'I was concerned about risks to the baby' (46%). On a scale from 1 (totally unsatisfied) to 10 (completely satisfied), the mean satisfaction rating reported was 9.25/10 (95% confidence interval: 8.89, 9.60). Only eight respondents (10%) stated an intention for more than two caesarean deliveries.
Women who underwent maternal-request caesarean delivery most commonly did so from concerns for the baby. Respondents were highly satisfied with their delivery, and few wished for more than two children.
This article describes three paradigms of health care that heavily influence contemporary childbirth, most particularly in the west, but increasingly around the world: the technocratic, humanistic, and holistic models of medicine. These models differ fundamentally in their definitions of the body and its relationship to the mind, and thus in the health care approaches they charter. The technocratic model stresses mind-body separation and sees the body as a machine; the humanistic model emphasizes mind-body connection and defines the body as an organism; the holistic model insists on the oneness of body, mind, and spirit and defines the body as an energy field in constant interaction with other energy fields. Based on many years of research into contemporary childbirth, most especially through interviews with physicians, midwives, nurses, and mothers, this article seeks to describe the 12 tenets of each paradigm as they apply to contemporary obstetrical and health care, and to point out their futuristic implications. I suggest that practitioners who combine elements of all three paradigms have a unique opportunity to create the most effective obstetrical system ever known.
To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.
National survey.
Swedish antenatal clinics.
3,283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999-2000).
A questionnaire was mailed shortly after the first antenatal visit.
Women's preferences for mode of delivery.
3,061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience.
Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.
to study the outcome of labour and women's perceptions of being referred after onset of labour.
a comparative study carried out between October 1998 and April 1999.
prospective parents in Stockholm, Sweden are offered a choice of which of the five hospitals in which they want to give birth. In reality, there is a lack of maternity beds in Stockholm to implement this policy and therefore nearly 10% of labouring women are being referred during labour.
the study population was selected from one of the five hospitals. Included in the study were 266 labouring women, with a 37-42 weeks uncomplicated pregnancy, fetus presenting by the vertex and spontaneous onset of labour. During pregnancy, all the women had chosen the same labour ward where they planned to deliver. However, at the onset of labour half of the women, case group I (n = 133) were referred to another maternity unit due to lack of space in the labour ward. For every referred woman a control woman matched for age, parity and date of delivery was selected, with the same inclusion criteria, except being referred, control group II (n = 133).
a questionnaire with closed and open questions was posted to the women after birth and used to collect quantitative and qualitative data on the outcome of labour and the women's perceptions of referral during labour.
routines such as epidural analgesia (EDA) (p<0.002), episiotomies (p<0.015) and morphine/pethidine during labour (p<0.023) were more common in the referred group. The women in the referred group considered to a higher extent that referral during labour had affected their emotional state (p<0.001). Women in both groups had been worried during pregnancy by the thought of having to be referred when labour had started and the referral had caused practical problems, stress and a feeling of not being welcome in the referral labour ward. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: referral during established normal labour may affect labour outcome, and the possibility that they may be referred worries women during pregnancy. Maternity policies and practices should be organised so that caring goals, such as continuity of care and women's' participation in birth planning, can be met.
It has traditionally been considered inappropriate for women to have an elective caesarean section on request in an uncomplicated pregnancy. In previous studies, female obstetricians and midwives have been questioned on their preferred mode of delivery. This study asked 344 women attending a routine antenatal booking clinic what mode of delivery they would prefer in an uncomplicated pregnancy and why. Of the women questioned, 14.5% opted for an elective caesarean section at 39 weeks' gestation. The main reasons being to avoid maternal trauma, to avoid a prolonged labour and for fetal wellbeing. A caesarean section may have some potential benefits over a vaginal delivery and it is hard to refuse a well-informed woman an elective caesarean section on request, even if it results in a further rise in the rate of caesarean section.
To estimate the contribution of changes in maternal characteristics (namely, age, parity, prepregnancy weight, weight gain in pregnancy, smoking status) and obstetric practice (namely, labor induction, epidural anesthesia, delivery by an obstetrician, midpelvic forceps delivery) to recent increases in primary cesarean delivery rates.
We studied all deliveries in Nova Scotia, Canada, between 1988 and 2000 after excluding women who had a previous cesarean delivery (n = 127,564). Logistic regression was used to study the effect of changes in maternal characteristics and obstetric practice on primary cesarean delivery rates. The effect of changes in midpelvic forceps delivery was examined through ecologic Poisson regression.
Primary cesarean delivery rates increased from 13.4% of deliveries in 1988 to 17.5% in 2000. This was due to increases in cesarean deliveries for dystocia (14% increase), breech (24% increase), suspected fetal distress (21% increase), hypertension (47% increase), and miscellaneous indications (73% increase). Adjustment for maternal characteristics reduced the temporal increase in primary cesarean delivery rates between 1988-1991 and 1998-2000 from 21% (95% confidence interval [CI] 16%, 25%) to 2% (95% CI -2%, 7%). Additional adjustment for obstetric practice factors further reduced period effects. Midpelvic forceps delivery was significantly and negatively associated with primary cesarean delivery (P =.001).
Recent increases in primary cesarean delivery rates are a consequence of changes in maternal characteristics. Obstetric practice, which has altered due to changes in maternal characteristics and concerns related to fetal and maternal safety, has also contributed to increases in primary cesarean delivery.
Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth.
A prospective study using between-group comparisons.
About 600 antenatal clinics in Sweden.
A total of 2,662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year.
Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics.
Elective and emergency caesarean section and overall childbirth experience.
In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience.
At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.
The suggestion that planned cesarean birth is gaining acceptance among women has led some physicians to advocate the need for a trial of primary planned cesarean section versus planned vaginal birth in healthy women with singleton cephalic pregnancies at term. This paper reviews published studies of nulliparous women's views of mode of birth collected in the antenatal period, examining why women may express a preference for cesarean birth and exploring implications for the debate about the need for a trial.
A systematic literature review was undertaken of Cochrane, CINAHL, EMBASE, MEDLINE, and PsycINFO using the MeSH heading "cesarean section" and four free text spellings of "cesarean," or "birth" or "delivery," near truncated synonyms of 17 words meaning expressed preference. Studies of nulliparous women with a medical indication for cesarean birth, studies where a woman's preference for mode of birth was reported in the postpartum period, surveys of midwives or obstetricians, and opinion and non-English language papers were all excluded.
Nine papers were included in the review, which reported rates of women expressing a preference for cesarean birth that ranged from 0 to 100 percent at recruitment. However, the papers raised specific methodological, conceptual, and cultural issues that may have influenced women's preferences for mode of birth in the populations studied. These issues included the timing and frequency of data collection, complexity of factors determining individual women's decision making, and influence of societal norms.
Little evidence is available that an increasing cultural acceptance of cesarean delivery will bring about support for a trial among pregnant nulliparous women. Further qualitative research investigating the influence of both obstetric and psychosocial factors on women's views of vaginal and cesarean birth is required.
Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning.
Three hundred and twenty-eight pregnant women from two different groups, "cesarean section on maternal request" (n=84), and "vaginal delivery group" (n=242) completed the self-report inventory Karolinska Scales of Personality at 37-39 gestational weeks in pregnancy.
A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p<0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p<0.003) and Socialization (p<0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale.
Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not.
Elective primary Caesarean section (EPCS), Caesarean section performed at a woman's request in the absence of a recognized obstetrical indication, is becoming increasingly common. Recent articles and opinions in both the medical and lay press have polarized this issue. The purpose of this study was to determine the opinions and choices of nulliparous and multiparous women with respect to mode of delivery.
All women attending antenatal clinics at Kingston General Hospital from May to August 2005 were invited to participate in a confidential survey. Basic demographic data including maternal age, level of education, parity, and previous mode of delivery were collected. Respondents who had had a previous Caesarean section were excluded from data analysis. The questionnaire provided a written statement of potential benefits and risks of an EPCS compared with vaginal delivery; no other counselling was provided. Respondents were asked if EPCS should be offered to all women and whether they would choose EPCS if given the choice. Respondents were also asked to indicate the most and least influential factors in their decision.
Responses were received from 107 nulliparous women and 103 multiparous women. Thirteen percent of nulliparas (14/107) stated that they would choose EPCS if given the option, compared with 5% of multiparas (5/103). Fifty-one percent of nulliparas (55/107) and 28% of multiparas (29/103) believed that EPCS should be offered to all women receiving antenatal care. The most and least important reasons, chosen from a list, for requesting or declining EPCS varied between nulliparas and multiparas. The convenience of scheduling permitted by Caesarean section was not important for either multiparas or nulliparas. The perceived risks of vaginal delivery were commonly cited by both nulliparas and multiparas as reasons for requesting EPCS, whereas the risks of Caesarean section for the baby or for future pregnancies were the most commonly cited reasons to decline EPCS in both groups. Regardless of the decision to request or decline EPCS, cost to the health care system was not an important factor for either nulliparas or multiparas.
The majority of pregnant women surveyed would not request an EPCS. However, a significant number of pregnant women, both nulliparous and multiparous, felt that women should be given the option of undergoing EPCS.
to investigate factors associated with having a caesarean section, with special emphasis on women's preferences in early pregnancy.
a cohort study using data from questionnaires in early pregnancy and 2 months after childbirth, and data from the Swedish Medical Birth Register.
women were recruited from 97% of all antenatal clinics in Sweden at their booking visit during 3 weeks between 1999 and 2000, and followed up 2 months after birth.
a total of 2878 Swedish-speaking women were included in the study (87% of those who consented to participate and 63% of all women eligible for the study).
Of 236 women who wished to have their babies delivered by caesarean section when asked in early pregnancy, 30.5% subsequently had an elective caesarean section and 14.8% an emergency caesarean section. The logistic regression analyses showed that, a preference for caesarean section in early pregnancy (odds ratio [OR] 9.63, 95% confidence interval [CI] 5.94-15.59), a medical diagnosis (OR 9.03, 95% CI 5.68-14.34), age (OR 1.08, 95% CI 1.03-1.13), parity (OR 0.58, 95% CI 0.37-0.91), a previous elective caesarean section (OR 15.11, 95% CI 6.83-33.41) and a previous emergency caesarean section (OR 18.29, 95% CI 10.00-33.44) was associated with having an elective caesarean section. Having an emergency caesarean section was associated with a preference for a caesarean section (OR 2.59, 95% 1.61 to 4.18), a medical diagnosis (OR 4.12, 95% CI 2.91-5.88), age (OR 1.08, 95% CI 1.05-1.12), primiparity (OR 3.34, 95% CI 1.78-6.27), a previous emergency caesarean section (OR 10.69, 95% CI 6.03-18.94), and a previous elective caesarean section (OR 7.21, 95% CI 2.90-17.92).
a woman's own preference about caesarean section was associated with the subsequent mode of delivery. Asking women about their preference regarding mode of delivery in early pregnancy may increase the opportunity to provide adequate support and possibly also to reduce the caesarean section rate.
Rates of caesarean section are of concern in both developed and developing countries. We set out to estimate the proportion of births by caesarean section (CS) at national, regional and global levels, describe regional and subregional patterns and correlate rates with other reproductive health indicators. We analysed nationally representative data available from surveys or vital registration systems on the proportion of births by CS. We used local non-parametric regression techniques to correlate CS with maternal mortality ratio, infant and neonatal mortality rates, and the proportion of births attended by skilled health personnel. Although very unevenly distributed, 15% of births worldwide occur by CS. Latin America and the Caribbean show the highest rate (29.2%), and Africa shows the lowest (3.5%). In developed countries, the proportion of caesarean births is 21.1% whereas in least developed countries only 2% of deliveries are by CS. The analysis suggests a strong inverse association between CS rates and maternal, infant and neonatal mortality in countries with high mortality levels. There is some suggestion of a direct positive association at lower levels of mortality. CS levels may respond primarily to economic determinants.
The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience.
A prospective group-comparison cohort study.
Danderyd Hospital, Stockholm, Sweden.
First-time mothers (n= 496) were recruited to the study in week 37-39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between 'caesarean section on maternal request', 'caesarean section due to breech presentation' and 'controls planning a vaginal delivery'.
The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).
Expectations prior to delivery and experiences at 3 months after birth.
Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001).
Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support.
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Cesarean section without medical reason
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- R Adestad
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- A Hildingsson
Karlstr om, A., R ˚ adestad, I., Eriksson, C., Rubertsson, C., Nystedt, A., Hildingsson, I., 2010. Cesarean section without medical reason, 1997 to 2006: a Swedish register study. Birth 37 (1), 11–20.
Indication for caesarian section on maternal request. Sexual and Reproductive Health Care
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- I Hildingsson
Wiklund I., Andolff E., Lilja H., Hildingsson I., Indication for caesarian section on maternal request. Sexual and Reproductive Health Care. In press.
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