Dissertationen: „Caesarean“

1

Handley-Derry, Frances. "Repeat elective caesarean: decision-making for women with a previous caesarean section." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=119507.

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Context: Among women with a prior caesarean section, 82.2% will have another caesarean delivery. The Society of Obstetrics and Gynaecology of Canada (SOGC) recommends that physicians offer medically eligible women with a previous caesarean section a trial of labour, to attempt a vaginal delivery. With greater inclusion of the patient in medical decision-making, it is important to understand women's part in this decision-making process. Objectives: To describe women's decision-making by looking at: 1) whether the decision was reported as primarily physician- or patient-driven 2) women's reasons for repeat caesarean section, 3) women's main information sources. Methods: For one year women booked for a repeat elective caesarean section, who were eligible for a trial of labour according to the 2005 guidelines of the SOGC, were approached with the survey in hospital post-partum, and invited to participate in the study. Chart review was used to determine eligibility, and obtain other medical characteristics. Results: Most of the women (77 %) reported being involved in the decision about their caesarean section. However, almost a quarter reported wholly physician-driven decisions (23 %). The main reasons women selected for a caesarean section related to their previous birth experience, and the physician's recommendation. Women born outside of Canada, with less education or who were allophones, were less likely to report using certain information sources, such as the Internet, and to find the information in the hospital-provided pamphlet useful. All in all, the women who received less information were more likely to report solely physician-driven decisions. Conclusion: Although patient involvement in decision-making is the norm, some decisions for caesarean section are made without the patient. Women's concerns, such as fear of a failed vaginal delivery, play an important role in this decision-making. Overall, immigrant women may understand less about their birth options than their Canadian peers. Addressing these concerns during pre-natal counselling may aid more fully informed consent, help assuage women's fears of vaginal birth and may increase the number of women attempting a trial of labour. Contexte : Parmi les femmes ayant déjà subi une césarienne, 82 % auront un autre accouchement par césarienne. La Société d'Obstétriques et Gynécologie du Canada (SOGC) conseille aux médecins d'offrir aux femmes éligibles l'option d'essayer un accouchement vaginal. Avec l'inclusion des patients dans les décisions médicales, il est important de comprendre le rôle des femmes dans ce processus de décision. Objectif : Décrire le processus de décision en évaluant : 1) si la décision vient premièrement du médecin ou du patient, 2) les raisons données par les femmes pour le choix d'une césarienne, 3) les principales sources d'information utilisées par les femmes. Méthodes : Au cours d'une année, les femmes enregistrées pour une césarienne, et éligible pour un accouchement vaginal selon le SOGC 2005, ont été approchées à l'hôpital postpartum et invitées à participer à l'étude. Le dossier médical a été utilisé pour déterminer l'éligibilité et d'autres caractéristiques médicales. Résultats : La majorité des femmes (77%) ont participé à la décision concernant le choix d'une césarienne, mais à peu près un quart (23 %) ont rapportée que la décision a été faite entièrement par le médecin. Les femmes ont indiqué que des raisons reliées aux peurs d'un accouchement vaginal, et aux recommandations du médecin, ont supporté le choix d'une césarienne. Les femmes nées ailleurs, avec moins de scolarité, ou allophones ont moins utilisé certaines sources d'informations, telles que l'Internet, et ont trouvé l'information dans le dépliant de l'hôpital moins utile. En général, les femmes ayant reçu moins d'information ont été plus susceptibles de rapporter une décision faite seulement par leur médecin. Conclusion : Bien qu'il y ait souvent la participation de la patiente dans le processus de décision, quelques décisions concernant le choix d'une césarienne sont faites sans la patiente. La peur d'un accouchement vaginal joue un rôle important dans la décision. Dans l'ensemble, les immigrantes pourraient moins bien comprendre leurs options d'accouchement que les femmes canadiennes. Considérer ces problèmes lors du suivi pré-natal pourrait aider au processus de consentement, soulager les peurs reliées à un accouchement vaginal, et peut-être augmenter l'acceptante d'un essai d'accouchement vaginal.

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2

Hillan, Edith M. "Outcomes of Caesarean section." Thesis, University of Glasgow, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.257964.

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3

Baston, Helen Amanda. "Women's experience of emergency caesarean birth." Thesis, University of York, 2006. http://etheses.whiterose.ac.uk/14082/.

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4

Churchill, Helen. "Caesarean birth : conflict in maternity services." Thesis, Middlesex University, 1994. http://eprints.mdx.ac.uk/6686/.

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This study investigates the history of caesarean section and women's experience of the operation today. There has been no systematic collection of historical data on caesarean section since 1944. This study now constitutes the most comprehensive compilation of the history of the operation to date. It illustrates the development of the medical ethos concerning women as patients and provides the background to the next phase of research: the experience of caesarean section. Previous research on caesarean section has exhaustively analysed the indications for the operation, reasons for the increasing rate and women's perceptions of abdominal delivery. This study differs in eliciting responses from women on a range of issues relating to caesarean birth in order to assess the quality of information given to women in hopital regarding the necessity for caesarean operations and analyse the effects of abdominal birth on women. Women's experiences were examined in a sample of 300 women who had delivered by caesarean section. Significant differences were found in reactions between women who had emergency operations and those whose caesareans were elective. The emergency caesarean women suffered more in all negative measures including increased feelings of pain and depression. Negative sequelae was found to relate to the unexpected nature of emergency operations and the use of general anaesthesia. Subjectively women report that they do not suffer as a result of caesarean birth, yet objectively it is clear that they do. This anomaly is attributed to the unequal relationship between women and doctors. Women feel grateful for the treatment offered by the doctors and therefore do not express dissatisfaction with their care. Recommendations are made suggesting practical ways in which maternity services, in respect of caesarean birth, can be improved.

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5

Taylor-Miller, Leanne. "Caesarean birth: too posh to push, or punished for not pushing? Exploring women's experiences of caesarean birth." Thesis, University of Auckland, 2010. http://hdl.handle.net/2292/6046.

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Caesarean birth is the mode of delivery for almost a quarter of births in New Zealand (NZ), and as the rate steadily rises, the expectation of a ��natural birth�� remains ubiquitous in society. Research investigating the impact of caesarean birth has previously demonstrated mixed findings regarding psychological outcomes, and recently caesareans have become topical with the addition of the idiom ��too posh to push�� to our lexicon. This implies that caesarean is an easy option, and may have shaped a sense of stigma against caesareans, particularly elective caesareans. The previous research demonstrating differences in psychological outcomes between planned and unplanned caesareans was conducted when caesarean birth was less common, and tended to be quantitative in design. The purpose of this qualitative research was to investigate the experiences of 32 women, including both first-time and non-first time mothers, who have undergone caesarean birth, half planned and half unplanned, in order to gain insight into their perceptions of their experiences and identify aspects that contributed to positive and negative experiences. Semi-structured interviews were used to explore their perceptions, including how they and others have reacted to their caesarean experience. These interviews were analysed using thematic analysis to identify themes to help to understand their experiences. This research supported a number of previous findings regarding caesarean birth including increased rates of induction associated with caesarean birth; differences in initial interaction between mother and infant for planned or unplanned caesareans; trust in medical experts; low occurrence of 'maternal' request for caesarean; and perceptions of societal attitudes towards caesarean. In addition, this research identified themes regarding the roles of expectations and preferences with the actual caesarean or breast feeding experience, influenced by individual and social factors. Negative outcomes were associated with a lack of reconciliation between actual experience, expectations and preferences; while positive outcomes were associated with effective reconciliation, through the development of rationales, applied both prospectively and retrospectively.

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6

Bedenko, Nadya. "Post traumatic stress disorder after childbirth : a comparison of vaginal, elective caesarean, emergency Caesarean and assisted instrumental deliveries." Thesis, University of Hull, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252606.

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7

Shakoor, Jenan Akbar. "Raised maternal body mass index and caesarean section." Thesis, University of Newcastle Upon Tyne, 2013. http://hdl.handle.net/10443/1800.

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Introduction Maternal obesity (defined as a body mass index (BMI) ≥30kg/m2) and overweight (defined as BMI 25-29.9kg/m2) have adverse implications for both the mother and the baby, including an increased risk of caesarean section. The prevalence of caesarean section among the UK obstetric population has been increasing in recent years. Evidence suggests that caesarean section in obese women may carry a higher risk of postoperative complications, such as haemorrhage, wound infection and delayed healing. These complications may result in a longer length of stay in hospital after caesarean delivery. To date, UK evidence on the association between maternal BMI and caesarean section has been limited. Aim The overall aim of my PhD was to investigate the association between maternal BMI and caesarean section within the North East of England. Methods and Results My PhD consists of three phases: Phase one: a review of the available published literature that investigated the association between maternal BMI and caesarean section rate. The review found that most studies been carried out in the US with only six from the UK. The review highlighted the need for further research in the UK. Phase two: an investigation of the association between maternal early pregnancy BMI and caesarean section using an existing dataset of 42,362 deliveries in five hospitals in the North East of England. The objectives of this phase were; to identify the caesarean section rate among five hospitals in the North East of England; to describe the caesarean section rate by booking BMI; and to examine the independent impact of BMI on caesarean section, adjusting for potentially confounding variables including maternal age, gestational age, birth weight, ethnicity and socio-economic status in overweight and obese pregnant women compared to pregnant women with recommended BMI. In phase two, the overall caesarean section rate was 20.6%; 28.4% of obese and 21.9% of overweight women delivered by caesarean section, compared to 17.8% of women with recommended BMI. After adjusting for available confounding factors, the adjusted odds ratio (aOR) for caesarean section among obese women was 1.81 (95%CI: 1.67-1.97; p<0.0005) and 1.29 (95%CI: 1.20-1.39; p<0.0005) among overweight women compared to women with recommended BMI. Thus, there was an almost two-fold increased risk of delivery by caesarean section among women who were obese at the start of pregnancy and an increased risk for women who were overweight. Phase three: a case note review of 205 women with a singleton pregnancy in 2008, aged ≥16 years and delivered by caesarean section in a district general hospital in the North East of England. The study hypothesis was that overweight and obese pregnant women have more post-caesarean section complications than pregnant women with recommended BMI, resulting in a longer length of stay in hospital. The results of this study showed that from 205 cases (28% of all caesarean section deliveries in 2008), 86 (42.0%) were to women with recommended BMI, 54 (26.3%) to overweight and 65 (31.7%) to obese women. The median length of maternal stay in hospital was three days, with an inter quartile range (IQR) of 2-3. Twelve (18.5%) obese women stayed in hospital after caesarean section for four days compared to five (9.3%) overweight and eight (9.4%) women with recommended BMI, (p=0.44) but this was not significant. There were no significant differences in postoperative complications or length of stay in hospital between overweight and obese pregnant women compared to women with recommended BMI. Conclusion Overall, my study confirms that obese and overweight women in the North East of England are at increased risk of caesarean section. Among women delivered by caesarean section, however, there was no association between maternal BMI and post-operative complications or length of stay in hospital.

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8

Naji, Osama. "Ultrasound studies of caesarean section scar in pregnancy." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/19445.

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Incomplete healing of CS scars has become a recognised sequel to this operation, and is associated with complications in later pregnancies. These can include caesarean scar pregnancy (CSP), a morbidly adherent placenta, scar dehiscence or rupture. To date there is uncertainty relating to the recognition of poor scar healing and the factors that lead to it. In recent years, there has been an increase in studies using ultrasound imaging to describe scars as deficient, or incompletely healed. However, these studies were carried out in the non-pregnant state, with a paucity of data to associate the described morphology of these scars to the functional integrity of the lower uterine segment (LUS) in subsequent pregnancy, or the actual performance in labour. We hypothesised that unenhanced transvaginal sonography (TVS) is a valid and reproducible method of assessing CS scars in pregnant women, and it can provide relevant clinical information on the effects these scars might have in pregnancy. To investigate the validity of TVS as the imaging modality of choice, we proposed a standardised approach for obtaining scar measurements. Furthermore we established a consensus agreement for nomenclature and methodology in imaging and reporting CS scars. We tested the reproducibility of the agreed methods throughout the course of pregnancy and our data showed that TVS could reliably delineate CS scar with good interobserver and intraobserver variability (IOV). We also investigated the influence of different scar dimensions on pregnant women from early pregnancy, during placental development, throughout the antenatal course and at delivery in terms of implantation sites, vaginal bleeding, and placental location, as well as the effects of scar changes on the final scar appearance at repeat CS, or during trials of vaginal birth after caesarean section (VBAC). Our data demonstrated that women who attended the early pregnancy assessment unit (EPAU) with a previous history of CS had more vaginal bleeding but similar spontaneous miscarriage rates in comparison to women without a history of CS. However, the implantation sites in the scarred uterus were significantly different from the non-scarred uterus. In the second trimester there were also significant differences in placental location. In the CS group there were more posterior and fewer fundal placentas than in the control group. We found that CS scars underwent significant changes to their shape and dimensions from the second trimester onwards. These scars were affected by the physical expansion of the gravid uterus and expanded accordingly in a cephalo- caudal pattern. Finally, we have demonstrated that certain scar measurements in the second trimester were associated with particular scar appearance at repeat caesarean delivery, and potentially predicted the likelihood of uterine scar rupture. We integrated this information and developed a prediction model on the likelihood of achieving successful VBAC from the earlier stages of pregnancy. In conclusion our data confirms that CS scar can be reliably assessed by ultrasound scan, and certain scar features are associated with complications that can be anticipated from as early as 6 weeks gestation. The results of our study provide important new information, which if validated externally may have significant bearing on our understanding of the impact of CS on the uterus, and the management of women planning to attempt a vaginal delivery after a previous CS.

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9

Tikkala, Jessica. "Trends in Caesarean Section Deliveries among nulliparous women." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48503.

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10

Murray, Susan Fairley. "Caesarean birth in the private sector in Chile." Thesis, Royal Holloway, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271704.

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11

Копиця, Тетяна Володимирiвна, Татьяна Владимировна Копица, and Tetiana Volodymyrivna Kopytsia. "Relationship between abnormal placentation and previous caesarean section." Thesis, Sumy State University, 2015. http://essuir.sumdu.edu.ua/handle/123456789/41289.

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12

Hesselman, Susanne. "Caesarean Section : Short- and long-term maternal complications." Doctoral thesis, Uppsala universitet, Obstetrik & gynekologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-327934.

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Caesarean section is a common major surgical procedure and long-term complications have not been fully investigated. By longitudinal population based register studies, based on National health registers and medical data records, maternal complications after caesarean delivery at subsequent labour (N=7 683), among extremely preterm births (N=406), and at remote gynaecologic surgery (N=25 354) were explored. In Paper I, uterine closure was investigated in respect to uterine rupture in a subsequent delivery after caesarean section. Uterine rupture occurred in 1.3 % of women with a previous caesarean section. There was no increased risk of uterine rupture with single compared with double layers for closure of the uterus (adjusted Odds Ratio 1.17, 95 % CI 0.78-1.70). Modifiable risk factors of uterine rupture in a trial of labour after caesarean section included induction of labour and use of epidural analgesia. In Paper II, maternal outcomes and surgical aspects of caesarean section in the extremely preterm period were assessed. Maternal complications were more frequently reported in extremely preterm- compared with term caesarean delivery. No increase in short-term morbidity was observed at 22-24 compared with 25-27 gestational weeks, but uterine corporal incisions were performed more frequently (18.1 % vs. 9.6 %, p=0.02). Furthermore, risk factors for abdominal adhesions after caesarean section and organ injury in remote gynaecologic surgery were analysed (Paper III and IV). Numbers of prior caesarean sections were the most important factor for formation of adhesions. Advanced maternal age, obesity, infection and delivery year 1997-2013 were factors associated with adhesions in conjunction with caesarean section. Organ injury occurred in 2.2 % of women undergoing benign hysterectomy. A history of caesarean section increased the risk (adjusted Odds Ratio 1.74, 95 % CI 1.41-2.15), but was only partly explained by the presence of adhesions. The organ affected depended on medical history; prior caesarean predisposed for bladder injury, prior bowel/pelvic surgery for bowel injury and endometriosis was associated with ureter injury at time of hysterectomy. In conclusion; data from National health registers indicates that caesarean delivery is associated with long-term complications, although the absolute risk of severe complications for the woman is low.

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13

Munday, Judy. "Perioperative temperature management for women undergoing Caesarean section." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103084/1/Judith%20Munday%20Thesis.pdf.

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Perioperative hypothermia is a significant problem for women undergoing caesarean section but this population has been previously neglected in internationally accepted evidence-based recommendations for thermal care in surgical patients. This three-phased, in depth exploration of the phenomenon, has advanced understanding of the effectiveness of methods to prevent perioperative maternal hypothermia, particularly for women receiving intrathecal morphine. Findings confirm that temperature decline is significant across this vulnerable population and support recommendations for the development of health service policies and thermal management guidelines that incorporate consistent use of combined, multi-modal, effective warming strategies employed both preoperatively and intraoperatively in the place of single interventions.

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14

Chung, Pui-yi Rebecca. "A clinical audit on Caesarean section indications and outcomes." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971003.

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15

Chung, Pui-yi Rebecca, and 鍾佩儀. "A clinical audit on Caesarean section indications and outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971003.

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16

Kumritz, Kranz Carla. "Caesarean sections on request : perceptions and positions (1996-2008)." Thesis, Durham University, 2013. http://etheses.dur.ac.uk/6908/.

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This thesis examines perceptions of caesarean sections on request from the mid-1990s to 2008, and in particular the meaning of the term and how this mode of delivery has affected doctors’ practice, as well as the opinions of expectant mothers. Within the field of obstetrics, caesareans on request represent a highly relevant issue, not only because a quarter of all births are currently by caesarean delivery. However, despite its relevance, this topic has not yet been the subject of substantial academic research. Caesareans on maternal request refer to caesareans with no clinical indications and thus no obvious medical justification – this fact in particular has stirred the medical world as well as evoking disputes among pregnant women. By exploring the views of medical professionals and mothers-to-be, this thesis uses an interdisciplinary approach, combining aspects of medical history and the social sciences. Furthermore, it goes beyond the clinical perspective by researching popular scientific publications, such as advice books and even debates on online forums. The phenomenon of caesareans on request suggests a change in indications, as well as a shift from caesarean delivery as an emergency intervention to a viable option. It involves an interaction between patient autonomy, risk assessment and prevention; furthermore, obstetric behaviour and changes in medical attitudes have played their part in providing the grounds for making maternal choice possible.

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17

de, Vries Bradley Stephen. "The Prediction and Prevention of Caesarean Section in Labour." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18544.

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Increasing caesarean section rates are a global phenomenon. It is widely believed many procedures are unnecessary and there are many opinions about what (if anything) to do about it. Attempts to limit the trend have had little noticeable success. This thesis is about reducing caesarean section in labour, and focuses on the concept that it can be predicted, and then prevented by induction of labour. Patterns of caesarean section over 27 years were described in two Sydney hospitals. The increase in primary caesarean sections was mostly due to increases in emergency procedures for slow labour, and elective procedures for malpresentation. Most of the overall increase was due to repeat procedures. Induction of labour before 40 weeks’ pregnancy reduced caesarean section rates for slow labour. Vaginal birth rates varied widely by indication for induction. Neonatal head circumference, cervical length, estimated fetal weight, and a combination of biparietal diameter and abdominal circumference were associated with caesarean section for slow labour. Demographic, clinical and ultrasound factors were included in a predictive model used in a protocol for a randomised trial of induction of labour at 39 weeks’ pregnancy. We also developed a method of creating centile birthweight standards which reflect fetal growth described by ultrasounds. Such charts could be used as part of a tool to screen for risk of perinatal mortality and enrolment into a randomised trial for improving perinatal outcomes. The work in this thesis adds to human knowledge by describing in detail how caesarean section rates and indications evolved over time. It adds to the understanding of associations between induction of labour, ultrasound, and demographic factors with caesarean section for slow progress in labour, allowing inferences to be made about how induction of labour prevents caesarean sections. It adds a new method for creating birth weight standards and a protocol for a randomised trial.

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18

Martin, Tracy Lee. "Evaluation of the Next Birth After Caesarean (NBAC) clinic." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/1109.

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Developing, implementing and evaluating models of care that reduce the caesarean section (CS) rate have been a health care priority in Australia since the 1990’s. There is minimal evidence examining models of care that aim to nurture women’s emotional well-being after CS; as well as providing consistent evidence-based information and promoting safe and successful vaginal birth in the subsequent pregnancy. Furthermore the experiences of midwives working in these models have been overlooked.

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19

Emmett, Clare Louise. "Decision Aids for Mode of Delivery after Previous Caesarean Section." Thesis, University of Bristol, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486120.

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Background: Pregnant women with one previous caesarean section (CS) must consider their preference for mode of delivery. For most this involves a choice between attempted vaginal birth after caesarean (VBAC) and elective CS. Decision aids are interventions designed to assist patients to make treatment choices and have been shown to be beneficial in a variety of health settings. Aim: To design and evaluate two computer-based decision aids to assist pregnant women with one previous CS with decision making about preferred mode of delivery. Methods: This thesis reports four components of the research 1) A qualitative interview study involving 21 postnatai women which explored women's experiences of decision making. 2) The developm~ntoftwo computer-based decision aids by a multidisciplinary team. 3) A qualitative piloting study involving 15 postnatal and 11 antenatal women. 4) A randomised controlled trial (RCT) to evaluate the two decision aids (Information Program or Decision Analysis Program) compared to usual care. 742 women with one previous CS participated in the RCT. The primary outcomes were decisional conflict at 37 weeks' gestation and actual mode of delivery. Results: The interview study established a need for the decision aids by highlighting potential inadequacies in the provision of information in routine care. The piloting study showed that the proposed decision aids were acceptable, usable and comprehensive. The RCT demonstrated that both decision aids reduced decisional conflict compared with usual care. There was also a suggestion that the VBAC rate was higher amongst women in the Decision Analysis Program group, in comparison with both other groups. Discussion: Pregnant women with one previous CS were found to benefit from access to either of the decision aids in addition to their routine clinical care. Further investigation is required ~o confirm whether the Decision Analysis Program could help to reduce the discrepancy between women's preferred and actual mode of delivery. Issues relating to the implementation of the decision aids must also be considered.

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20

Lam, Wai-yee Wendy. "Abdominal wound infection after caesarean delivery in a district hospital." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887122.

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21

Klingaman, Kristin. "Breastfeeding after a caesarean section : mother-infant health trade-offs." Thesis, Durham University, 2009. http://etheses.dur.ac.uk/102/.

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This thesis demonstrates the value of an anthropological perspective on informing appropriate breastfeeding support after caesarean section delivery. In contrast to epidemiological research that identifies distinct aspects of mother-infant interactions altered by this birth mode, my research explored the interrelated obstacles to breastfeeding from the mothers’ perspectives as the experiences were unfolding. I apply Trivers’s (1974) parent-offspring conflict model to conceptualise breastfeeding and predict realisation of infant feeding based on the interaction of maternal cost and infant benefit. The work adds the previously unstudied population of caesarean section-delivered breastfeeding dyads to the human life-history theory line of investigation. Postnatal ward and telephone semi-structured interview data were collected in Newcastle, England during 2006-09 with two groups of women. Phase 1 comprised participants who underwent either an unscheduled or scheduled caesarean section delivery (n = 75). Phase 2 involved women who experienced scheduled, non-labour caesarean section delivery and were randomly allocated an intervention or control cot for the entirety of their postnatal ward stay (n = 51). The impact of the infant side-car crib or standalone cot on breastfeeding was tested among the Phase 2 mothers by comparison of 35 overnight postnatal ward video recordings. The various aspects of women’s delivery and infant care were prioritised based on their knowledge of known risks and benefits. Intentions were carried out within the context of the support and opportunities available. Contrary to popular belief, the decision to undergo a caesarean section and deviation from prenatal breastfeeding intentions were undertaken because they seemed like the best or only option in the circumstances. Many women felt frustrated because of their postnatal limitations with caretaking for infants who were described as unexpectedly doing poorly. The absence of labour before the caesarean section was perceived to be beneficial by the mothers due to the intense pain of contractions and the undo “stress” vaginal parturition posed for the infant. However, the participants were surprised by being told by midwives after the delivery that (sub-clinically) poor infant condition was a common consequence of caesarean section. Some breastfeeding difficulty stemmed from “mucous” expulsion that had to occur before the babies could be “interested” in feeding. The peak mother-infant breastfeeding conflict was night-time after visiting hours. Midwifery and maternal concerns over the mothers’ lack of sleep prompted formula supplementation. As predicted, the side-car crib was associated with reduction of the maternal cost of breastfeeding. However, participants in the intervention group were not observed breastfeeding significantly more frequently than the control group as expected. The cost-benefit breastfeeding model suggests that high maternal cost and/or low perceived infant benefit was experienced to such a degree that mothers breastfed minimally despite the “huge difference” in infant access afforded by the side-car crib compared to the standalone cot. Regardless, data support the side-car crib as the better arrangement for mother-infant dyads who underwent a non-labour caesarean section due to the less potential infant risk observed and the benefit to maternal recovery. The utility of the parent-offspring conflict framework for predicting breastfeeding outcomes was supported by the association of reported reasons for breastfeeding intent and of bedsharing with breastfeeding frequency and duration. The thesis suggests that more detailed physiological information may enable families to better understand public health advice for exclusive breastfeeding and low caesarean section delivery rates. Breastfeeding after a caesarean section is affected by interrelated and compounding difficulties, so my single alteration in the postnatal environment did not resolve the impediments. An evolutionary perspective can assist in identifying populations at risk for suboptimal health outcomes and designing support to ameliorate mismatches between coevolved processes and routinely encountered conditions.

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22

Liao, Yi-Hui. "Profiling caesarean birth in Taiwan using quantitative and qualitative methods." Thesis, University of Ulster, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.514479.

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23

Lam, Wai-yee Wendy, and 林慰儀. "Abdominal wound infection after caesarean delivery in a district hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39724335.

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24

Dyer, Robert A. "Haemodynamic consequences of Spinal Anaesthesia for non-emergency Caesarean section." Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3026.

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Single shot spinal anaesthesia for caesarean section is currently accepted as the favoured method in the absence of contraindications, for reasons of safety and comfort. Firstly, there is an increased risk of failed intubation associated with general anaesthesia. Secondly, spinal anaesthesia, if practiced correctly, allows for a superior experience of the delivery and improved bonding with the infant. Maternal haemodynamic stability is desirable both for maternal and neonatal safety, and to diminish maternal side-effects such as nausea and vomiting. Therefore, after an extensive literature review, clinically relevant aspects of spinal anaesthesia were studied, with a view to contributing to knowledge which could improve safety and outcome. The central themes explored in this thesis were fluid management during spinal anaesthesia for caesarean section in healthy parturients, the haemodynamic effects of the vasoactive agents ephedrine, phenylephrine and oxytocin during spinal anaesthesia for caesarean section in healthy patients and in patients with preeclampsia, and short term neonatal outcome after spinal anaesthesia in patients with severe preeclampsia. Research methodology included non-invasive measures as well as the use of a pulse wave form analysis monitor to measure maternal cardiac output. A validation study was performed comparing this method with thermodilution in patients with postpartum complications of preeclampsia. Abstract viii The results of these studies showed that: The pulse wave form monitor employed showed acceptable limits of agreement with the thermodilution method. Crystalloid coload was associated with lower vasopressor requirements than conventional preload. Spinal anaesthesia was associated with afterload reduction, which was more pronounced in healthy patients than in preeclamptics. Ephedrine maintained or increased, and phenylephrine reduced maternal cardiac output in healthy patients. Oxytocin was associated with transient haemodynamic instability in healthy and preeclamptic patients, which was obtunded by phenylephrine in the healthy population. Spinal anaesthesia for caesarean section was associated with a greater umbilical arterial base deficit than general anaesthesia in patients with preeclampsia. Overall, these studies should contribute to improved knowledge of haemodynamic responses during spinal anaesthesia for caesarean section, and ultimately to improved maternal morbidity and mortality.

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Mason, Nicola Anne. "Women's stories of planned Caesarean birth in their first pregnancy." Thesis, University of Brighton, 2015. https://research.brighton.ac.uk/en/studentTheses/25d9db17-afb8-40cb-b7d8-ac0ea265cc1d.

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Caesarean birth accounts for a quarter of all births in England and is the most commonly performed operation. Despite this, little is known of how individual women experience planned Caesarean birth. Reviews of the literature reveal that rising rates of Caesarean birth are preceived to be problematic by women ,clinicians and policy makers but women's experiences are either absent from this debate or perceived as universally realised. This qualitative study involved listening to the stories of eight women to reveal how planned Carsarean birth was experienced, understood and constructed.

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Ahmed, Tasneem. "Trial of Labour or Elective Repeat Caesarean Section in Women who have had one previous caesarean section: An assessment of women's attitudes, knowledge and preferences." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32431.

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INTRODUCTION Caesarean section (CS) is one of the most frequently performed major abdominal surgeries in the world. There has been a global increasing trend in CS rates over the past three decades, particularly in women who have had one previous CS. Vaginal birth after caesarean section (VBAC) is a safe option and is still strongly recommended by all international authorities with success rates ranging from 60% to 80%. However, women's preference for VBAC vs elective repeat caesarean section (ERCS) remains very poorly understood in South Africa (SA) as very few studies have addressed women's preference for mode of delivery. Repeat caesarean delivery (CD) is reported as the single largest contributor to the escalating CS rate worldwide. So why do women choose repeat CD? Evidence suggests that fear, health care worker influence, social stigma, cultural practise and religious beliefs can significantly influence the attitude toward CS. South African data remains limited and we are yet to ascertain how women make their choice and what drives their specific preferences. The rationale behind this study therefore was to gain better insight into why the women in Cape Town choose VBAC or ERCS and to ascertain to what extent their knowledge, attitude and preferences influence their choice. In so doing, we were able to highlight key findings in order to attempt to reduce the increasing CS rate in our country. AIMS AND OBJECTIVES The primary objective was to explore women's knowledge, attitudes and preferences for VBAC or ERCS after one previous CS, from 36 weeks gestation, attending antenatal care at Mowbray Maternity Hospital (MMH) and New Somerset Hospital (NSH). The secondary outcome was to describe the major reasons for their preferred mode of delivery. METHODOLOGY A prospective descriptive study was conducted over four months, of pregnant participants with one previous lower uterine segment caesarean section (LUSCS), attending antenatal care at MMH and NSH. Participants were recruited from 36-41weeks gestation. Participants over the age of 18 years with one previous LUSCS were eligible for inclusion. Participants with a medical indication for CS were excluded. An interview-based questionnaire, previously 11 adapted for use in a Cape Town antenatal population regarding women's knowledge, attitudes and preferences for mode of delivery was conducted at a routine antenatal visit. In addition, basic obstetric and socio-demographic data was abstracted from their folders. A descriptive analysis of participants' preferences for mode of delivery was completed, with subgroup comparisons. The Fisher's Exact test was used in all the statistical analyses that involved categorical variables whilst continuous variables were analysed using t-tests. RESULTS The study included 100 participants who were eligible for VBAC. Of the participants, 51% preferred ERCS whilst 49% preferred VBAC. Married couples and those in co-habiting relationships, more frequently chose VBAC compared to single participants, who more frequently chose ERCS. Participants were greatly influenced by the opinion of the HCW, particularly if ERCS was suggested, they were likely to choose a CS (p=0.001). If a previous history of long or obstructed labour was reported, participants were inclined to choose ERCS. Fear was identified as a major determinant as 78.4% cited fear of vaginal birth as their reason for preferring a CS. History of previous CS (88.2%) and fear of the risks associated with VBAC were the main reasons cited for their preference. In the group who preferred VBAC, 89.8% were of the perception that VBAC would allow them to recover faster and 87.7% desired to be home sooner therefore, favouring their choice. Whether or not the participants had a previous vaginal delivery or VBAC, it did not affect their preference for mode of delivery in a statistically significant manner. CONCLUSION This study which explored knowledge, attitudes and preferences of women who had had one previous CS, concerning their preference for mode of delivery, is one of the first to be done in South Africa. Despite all participants being medically eligible for VBAC, only 49% preferred this option, the remaining 51% preferring ERCS. Significant determinants of their choice were unstable relationships, influence of the doctor, concern about uterine rupture and fear of labour and unpredictability. Knowledge of the complications of ERCS and VBAC was very limited. This information is useful to design further research to improve understanding of these issues and to design services in a way to overcome the identified problems. In particular, women must be provided non-biased evidence-based information in order to foster a relationship of trust with the health care worker, in assisting her to make an informed decision. Similarly improving respectful competent care of women in labour with better attention to alleviating labour pain, will assist in reducing fear.

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Mennill, Sally Elizabeth. "Prepping the cut : caesarean section scenarios in English Canada, 1945-1970." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/41975.

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At the beginning of the 21st century, Canadian public debates about caesarean section centre on the relative agency of mothers and medical professionals in choosing the preferred birthing method. A 2006 study at the University of British Columbia aims to determine why the Pacific has the highest caesarean rate in the country. According to its authors, BC’s rate is 27% despite the World Health Organization’s advocacy of a rate between 10 and 15 percent. The highlighting of this discrepancy in the pages of the popular Vancouver Sun typifies the public concern that today so commonly echoes professional unease. Sandwiched between the era of development and professionalization – 1900 to 1950 – explored in Mitchinson’s critical chapter on c-sections, and the widespread acceptance that occurred in the 1970s and beyond, lie the often overlooked years, 1945-1970, which first saw c-sections solidified in treatment and entrenched in medical and social discourses. At the end of WWII, Canadian mothers and medical professionals were about to embark on a quarter-of-a-century consideration of how reduction of risk in c-sections could contribute to positive outcomes. This dissertation examines the social, technological, professional, and discursive factors that converged throughout the post-war period in Canada, arguing that medical technological developments of this time period coupled with developments in the professionalization of obstetrics, the substantial broadening of state health infrastructure post-WWII, and a significant shift in ideological constructions of motherhood according to white, middle-class standards contributed to an increased comfort with the practice of caesarean section.

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Myshrall, Amy Catherine. "Codex Sinaiticus, its correctors, and the Caesarean text of the Gospels." Thesis, University of Birmingham, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433713.

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Green, Belinda. "Caesarean birth : the impact of clinical uncertainty on professional decision-making." Thesis, City University London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446318.

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Chaplin, Jacqueline. "Breastfeeding difficulty after caesarean section under regional anaesthesia: A phenomenological study." Thesis, Australian Catholic University, 2011. https://acuresearchbank.acu.edu.au/download/746c1902dd8ccfd6b3e0172f69a17cb7df9938b35d6f4372ef17368f5953bdf3/2392115/64821_downloaded_stream_46.pdf.

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This study explored the experiences of women with breastfeeding difficulties following a caesarean section under regional anaesthesia. Further, this research aimed to explore the difficulties women experienced initiating and establishing breastfeeding when their babies seemed indifferent or unable to latch to the breast. Caesarean delivery rates have increased progressively in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding to both the mother and baby are well recognised. However, breastfeeding problems are common in the initial postpartum period, particularly with mothers who have had a caesarean section. Despite high breastfeeding initiation rates, duration rates of exclusive breastfeeding continue to fall. An extensive review of the literature revealed that there are a number of factors that lead to difficulties breastfeeding following a caesarean section. These included the effects of caesarean delivery and regional anaesthesia, lack of skin to skin contact, formula supplementation, and inadequate postnatal care on infant behaviour and the initiation, establishment and duration of breastfeeding. However, no qualitative research was identified specifically relating to the lived experience of women having difficulties breastfeeding after caesarean section, identifying a significant gap in the literature. This study explores the lived experience of a group of mothers with breastfeeding difficulties after delivering by caesarean section under regional anaesthesia. The difficulties they were having centred on problems initiating and establishing breastfeeding their babies who seemed indifferent or unable to latch to the breast. Interpretive phenomenology was considered the most relevant approach for this research due to the methodologies ability to produce rich data in order to explore the essence of the lived experience. Purposeful sampling was employed to select eight participants who were interviewed in their homes two to three weeks after birth. Interviews were recorded, transcribed verbatim, and analysed using van Manen’s circular process of hermeneutical writing, underpinned by Heidegger’s hermeneutic V circle of understanding. The hermeneutical circle is a circle of interpretation that moves forward and backward between the parts and the whole. Through this interaction and understanding the data was reflected on and sub themes and themes were identified. Key themes included Unnatural birth, Natural instincts compromised, Helping mothers to mother, and Sabotage and defeat. These themes reflected the mothers’ journey through birth, the baby’s difficulty feeding, postnatal challenges and how the mothers’ felt in response to these challenges. Overall, the data illustrated that the mode of birth can interfere with the normal mechanisms of birth and the intrinsic desire of a baby held skin to skin to effectively latch and suckle. The key findings of the study included the concept that the four themes are bound inextricably together. Unnatural birth causes natural instincts to be compromised. Helping mothers to mother in a sensitive and supportive manner will help those instincts both maternal and infant, to be strengthened. Ensuring only breastmilk is consumed by breastfed infants helps ensure breastfeeding is not compromised and mothers can be assisted in their desire to breastfeed. These findings were further synthesised to create a supportive framework for breastfeeding after caesarean section. Central to this framework is the notion that encouraging and valuing normal birth, supporting the natural instincts of mother and baby and increasing breastfeeding support for mothers who birth by caesarean section is fundamental to midwifery care. These concepts formed the basis of recommendations for changes to midwifery clinical practice that could improve breastfeeding outcomes for women.

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Munro, Sarah. "Birth after caesarean : an investigation of decision-making for mode of delivery." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/58960.

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Background: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. Shared decision-making (SDM) interventions support women to make choices based on their informed preferences. To facilitate implementation of SDM it is necessary to understand the patient (micro), health services (meso), and policy (macro) factors that influence decision-making. Objectives: My objective is to explore attitudes toward and experiences with decision-making for mode of birth after caesarean section in British Columbia (BC) to identify factors that influence implementation of SDM. Methods: In-depth, semi-structured interviews were conducted with women eligible for VBAC, care providers, and health service decision makers recruited from three rural and two urban BC communities. Integrated knowledge translation (iKT) principles guided study design, while constructivist grounded theory informed iterative data collection and analysis. Findings were interpreted using complex adaptive systems theory (CAS). Results: Analysis of interviews (n=57) and CAS interpretation revealed that the factors influencing decisions resulted from interactions between the micro, meso, and macro levels of the health care system. Women formed early preferences for mode of delivery (after the primary caesarean) through careful deliberation of the social risks and benefits of mode of delivery. Physicians acted as information providers of clinical risks and benefits, with limited discussion of patient preferences. Decision makers serving large hospitals revealed concerns related to liability and patient safety. These stemmed from limited access to surgical resources, which had resulted from budget constraints. To facilitate mutual understanding among stakeholder groups, iKT activities included policy dialogues and the creation of a policy brief. Conclusion: To facilitate the effective implementation of SDM in clinical practice for mode of delivery after a previous caesarean section, it is necessary to address the needs of women, care providers, and decision makers. These include initiating decision support immediately after the primary caesarean, assisting women to address the social risks that influence their preferences, managing perceptions of risk related to patient safety and litigation among physicians, and access to surgical resources. Graduate and Postdoctoral Studies Graduate

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Wang, Cong Kerynn. "Caesarean delivery on maternal request: systematic review on maternal and neonatal outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942609.

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Johnson, Gina. "Exploring healthy pregnant women's decisions to opt for an elective caesarean section." Thesis, University of East London, 2006. http://roar.uel.ac.uk/3825/.

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The rate of Caesarean sections (CS) in the UK is on the increase. In the year 1989-90 the rate was 11.3% rising to 17% for the year 1997-98 (Marx et al, 2001). The World Health Organisation (WHO) recommends that no more than 15% of all births are by CS. Today in the UK 22% of all babies are born by CS (Song et al, 2004). Research by Jackson and Irvine (1998) and Marx et al (2001) suggests that maternal requests are an important factor in the increase. Marx et al (2001) report that the rate of elective CS has doubled in the UK in the last 10 years. However, there is little consensual information as to why more pregnant women are choosing Caesarean delivery. The media frequently portray such choices in terms of personal convenience, employing phrases such as "too posh to push". Such stereotypes, however, are unhelpful for understanding what may be a decision informed by complex social changes in attitudes to surgery and childbirth. Recently published NICE Guidelines (2004) have suggested that women who opt for elective CS may need to be counselled. However, this group of women may be well informed about the risks and benefits of Caesarean delivery, so this suggestion may be experienced as intrusive or undermining of their autonomy. The aim of this study was to explore factors that influence and inform a decision to have an elective CS. Participants were 6 women attending a London teaching hospital who indicated at their 20 week scan that they wished to have a CS. Inclusion criteria were: 1) singleton pregnancy deemed 'low risk' by a consultant obstetrician, 2) no previous history of CS or 3) a previous history of CS but vaginal birth was medically feasible, and 4) without acute mental health problems. Data were collected using individual semi-structured interviews. These were recorded on tape, transcribed and analysed using Interpretative Phenomenological Analysis. The 6 main themes that emerged in the analysis were general attitudes around childbirth, the decision to have children and experiences of pregnancy, the importance of choice, the perception of risks & benefits of Caesarean section and vaginal birth, the salience of knowledge and the influence of relationships with maternity staff. These findings are discussed in terms of their implications for understanding the decision making process leading to an elective CS and the ways in which women are advised and supported in coming to this decision.

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Paranjothy, Shantini. "Caesarean section rates in England and Wales : investigating variation between maternity units." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2004. http://researchonline.lshtm.ac.uk/682225/.

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In England and Wales, the Caesarean section (CS) rate is 21.5%, ranging from 6% to 66% between maternity units. The impact of a high CS rate on women's health and NHS resources is not clear. Case-mix differences should be taken into account to enable valid comparisons and exploration of factors contributing to this variation. An understanding of these factors is important to ensure quality of obstetric care. The aim of this thesis was to explore the variation in CS rates between maternity units and evaluate the impact of (I) case-mix and (ii) women's birth preferences using National Sentinel Caesarean Section Audit (NSCSA) data. Summary of NSCSA data: Phase 1 (01.05.2000 to 31.07.2000) • Information on 150,139 women giving birth in 216 maternity units in England and Wales. Variables collected include age, ethnicity, parity, number of previous CS, mode of onset of labour, gestation, presentation, mode of delivery and birth weight. Phase 2 (01.12.2000 to 31 .01 .2001) • Survey of 2,475 pregnant women from 40 selected maternity units. Variables include preferred type of birth. Case-mix data were also collected for all 32,536 women giving birth in these maternity units. The relationship between case-mix variables and CS (i) before labour and (ii) during labour was demonstrated using logistic regression. Using tese results, standardised CS rates were calculated for individual maternity units. Using meta-analytical techniques, the amount of variation in CS rates explained by case-mix adjustment was quantified. Data on preferred type of birth were available for 7% of women in Phase 2. Therefore various techniques for handling 'missing data' including multiple imputations were researched and applied to these data. Key findings: . The association between CS and case-mix variables vary for CS before labour and CS during labour. The odds of CS (before and in labour) increase with maternal age. Women from ethnic minority groups have lower odds of CS before labour, and increased odds of CS in labour. Women with a previous vaginal delivery have lower odds of CS, although the magnitude of this for CS before and in labour is markedly different. . Adjustment for case-mix explained 34% of the variance in CS rates between maternity units. • Adjustment for case-mix differences and women's birth preferences explained 45% of the variance in CS rates between maternity units in England and Wales. 3

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Magni, Bridget. "Incidence of intraoperative nausea and vomiting during spinal anaesthesia for caesarean section." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20291.

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The incidence of intraoperative nausea and vomiting during spinal anaesthesia for caesarean section. Background: Nausea and vomiting (IONV) during spinal anaesthesia (SA) for caesarean section (CS) is unpleasant and may interfere with surgery. We studied the incidence of IONV during elective CS, as well as the influence of ethnicity on this outcome. Methods: Two hundred and fifty eight healthy term patients undergoing SA for elective CS were recruited to this prospective observational study conducted at two Cape Town Level 2 hospitals. Standard practice was employed for SA for CS at UCT (University of Cape Town): 2 mL hyperbaric bupivacaine plus 10 μg fentanyl at the L3/4 interspace, and 15 mL/kg cry stalloid co - load. Spinal hypotension was managed with phenylephrine boluses according to a standard protocol. Nausea and/or vomiting were treated by restoration of blood pressure, and metoclopramide. Intraoperative complaints of nausea, and vomiting, were noted. Patients were also interviewed postoperatively as to any experience of intraoperative - or previous history of nausea. Results: Of the 258 patients enrolled in the audit, 112 (43.4%) were non - African and 146 (56.6%) were Black African patients. The overall incidence (95% CI) of nausea was 32% (0.27 - 0.38), with 20% occurring prior to - and 11% after the delivery. The overall incidence of vomiting was 7% (0.05 - 0.11), with 3.2% occurring prior to, and 3.8% after, delivery. The incidence of nausea and/or vomiting was 33% (0.28 - 0.40). Black Africans experienced significantly less nausea than non - African patients (36/145 [24.8%] vs 47/112 [42.0%] respectively, p = 0.004). There was no significant difference in the incidence of vomiting (10/14 5 [6.8%] vs. 8/112 [7.1%] respectively, p = 0.865). The odds of experiencing intraoperative nausea for patients with any blood pressure value <70% of baseline, were 2.46 (95% CI 1.40 - 4.33). Conclusions Though in keeping with international standards, the clinically significant incidence of nausea and/or vomiting of 33% requires adjustments to the management protocol for spinal hypotension. The inclusion of ethnicity as a risk factor for nausea during SA for CS should be considered.

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De, Cramer Kurt Guido Mireille. "Preparturient caesarean section in the bitch : justification, timing, execution and outcome evaluation." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/62575.

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It is known that the prevalence of CSs in some breeds approaches 100%. In addition, this study identified previous CSs, fewer than eight and more than 11 puppies per litter in Boerboel bitches as obstetric risk factors (resulting in emergency CSs and stillbirths). It also showed that a trial of labour after caesarean section was associated with considerable obstetric risks. In such high-risk pregnancies, using the signs of parturition to time elective CSs in the bitch is problematic, as by then there may already be foetal distress or demise. Also, the signs of parturition may present at an inconvenient time of the day, when staff shortages may impede professional service. This study aimed at solving these problems by investigating various means of predicting the day and time of onset of parturition (cervical dilatation) in the bitch. This study showed that a chemiluminescent immunoassay (Immulite® 1000 LKPW1) is a reliable replacement for a discontinued radio immune assay to measure PC in serum or plasma. It proved that the first day of cytological dioestrus (D0) is the most precise peri-oestrous predictor of the day of cervical dilatation. This study showed that the variation in the foetal biparietal diameter is too large to accurately predict readiness for CS and that the preparturient PC may be used to predict the time of cervical dilatation, thereby allowing timeous planned CSs in bitches where D0 is unknown. The use of medetomidine hydrochloride as premedicant combined with propofol as induction agent and sevoflurane as maintenance, is safe and is associated with good maternal and puppy survival rates at delivery, 2 h and 7 d after CSs. Performing elective CSs upon the first appearance of any degree of cervical dilatation proved successful. For bitches in this study with high-risk pregnancies, we proved that it is safe to perform fixed date preparturient CSs on D57 if the cervix has not dilated by then. This study showed that bitches have haematocrits at the time of cervical dilatation that are at the lower end of the normal reference ranges for non-pregnant dogs and that the decline in haematocrit associated with CS is similar for parturient (open cervix) and preparturient (closed cervix) CSs. As incidental findings, this study discovered two puppies sharing one placenta in each of two litters. The one case of placenta sharing proved to be monozygotic twins whilst the other case proved to be a case of dizygotic monochorionic canine foetuses with blood chimaerism and suspected freemartinism. This study provides the veterinary obstetrician with a protocol that can be used to safely perform elective CSs in a large proportion of the obstetric population at a convenient time of the day but more research is required with larger numbers to establish whether this practice is routinely safe and safe in all breeds. Die voorkoms van keisersnitte bereik 100% in sommige rasse. Hierdie studie het getoon dat ŉ vorige keisersnit, kleiner werpsels as agt en groter werpsels as 11 in die Boerboel, verloskundige risikofaktore is. Dit het ook getoon dat ŉ poging tot spontane kraam nadat ŉ teef voorheen ŉ keisersnit ondergaan het, geassosieer is met 'n aansienlike risiko van noodkeisersnitte en doodgebore hondjies. Om in sulke hoë risiko dragtighede te wag vir tekens van kraam voordat ŉ elektiewe keisersnit uitgevoer word is riskant, omdat fetale nood of dood reeds kon intree. Die tekens van kraam verskyn dikwels op ŉ ongeleë tyd van die dag, wanneer ŉ personeeltekort ŉ professionele diens belemmer. Hierdie studie was daarop gemik om hierdie probleme op te los deur verskeie metodes te ondersoek om die dag en tyd van aanvang van servikale ontsluiting in die teef te voorspel. Verskeie bevindings spruit uit die studie: ŉ Chemiluminessensie immunotoets (Immulite® 1000 LKPW1) is ŉ betroubare plaasvervanger vir ŉ gestaakte radioimmunotoets. Die eerste dag van sitologiese diestrus (D0) is die mees presiese en praktiese peri-estrus voorspeller van die dag van servikale ontsluiting. Die bipariëtale deursnit van honde fetusse tydens laat dragtigheid varieer soveel binne rasse en binne werpsels dat dit ongeskik is vir die akkurate en betroubare voorspelling van gereedheid vir keisersneë. Die voorgeboortelike progesteroon konsentrasie in die bloedplasma of serum dien as ŉ voorspeller van kraam in tewe waarvoor D0 nie bekend is nie. Die binneaarse toediening van 7 mg/kg medetomidine hidrochloried as premedikasie, gekombineer met 1–2 mg/kg propofol as induksiemiddel en 2% sevoflurane in suurstof vir die onderhoud van narkose vir keisersnit in tewe is veilig en lewer hoë oorlewings peile in tewe en kleintjies by geboorte, 2 ure en 7 dae na keisersnit. Keisersnitte wat uitgevoer word sodra die eerste tekens van servikale ontsluiting waargeneem word, is suksesvol. Hierdie studie het getoon dat vir tewe met hoë risiko swangerskappe, dit veilig is om preparturiente keisersnitte uit te voer in tewe met n geslote serviks, sewe en vyftig dae (D57) na D0 vir tewe met werpsels > 1 as die serviks teen daardie tyd nog nie ontsluit het nie. Tewe se hematokrit aan die begin van kraam stem ooreen met die laer normale waardes van vir nie-dragtige honde en dat vermindering in hematokrit geassosieer met parturiente keisersnitte (oop serviks) soortgelyk is aan bloedverlies geassosieer met preparturiente (geslote serviks) keisersnitte. Toevallige bevindings was dat twee fetusse uit elk van twee werpsels ŉ plasenta gedeel het. In een geval was die fetusse monosigotiese tweelinge en in die ander geval was hulle monochorionies en disigoties, met moontlike freemartinisme. Hierdie studie stel die veterinêre verloskundige in staat om elektiewe preparturiënte keisersnitte op ŉ geleë tyd van die dag uit te voer in ŉ hoë persentasie van die obstetriese populasie maar verdere navorsing met groter getalle word benodig om vas te stel of dit roetine gewys veilig is en veilig is in alle rasse. Thesis (PhD)--University of Pretoria, 2017. Production Animal Studies PhD Unrestricted

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Heasman, Lindsay. "Nutritional and endocrine manipulation of development and thermoregulation in the newborn lamb." Thesis, University of Nottingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285771.

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Golois, Eleni. "Caesarean section : the perspectives of obstetricians in a South Australian tertiary referral hospital /." Title page, table of contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09HS/09hsg627.pdf.

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Kingdon, Carol. "Re-visioning choice through 'Situated Knowledges' : women's preferences for vaginal or caesarean birth." Thesis, Lancaster University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.504174.

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Shikwambi, Hilma Inoukapo Taukondjele. "Non-elective caesarean sections in the Khomas Region, Namibia: implications for midwifery practice." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13315.

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Includes bibliographical references. Women who undergo caesarean section (CS) are likely to have a repeat CS in a subsequent pregnancy, thus increasing the CS rate in the country, which is not ideal in a resource constrained setting. The occurrence of high maternal mortality among women who have nonelective CS is usually due to indications for prior CS such as fetal distress, obstructed labour and eclampsia. In developing countries, there is a high rate of maternal deaths associated with major operative complications. This study was a retrospective, descriptive quantitative, clinical audit. The purpose was to identify the reasons for non-elective CS in two hospitals namely, the Windhoek Central hospital and Intermediate Katutura hospital, and the implications for Midwifery clinical practice. The research question was: What are the indications and intrapartum care factors for non-elective CS in the two hospitals, and what are the implications for Midwifery practice? The population consisted of records of women who had given birth by CS between 1st January 2012 and 30th June 2012 in the two hospitals. All available records of women who had non-elective CS during the study period were reviewed. Data was collected with individual data collection sheets and analysed using Statistica 11 software. A total of 838 records were reviewed. The CS rate was 1264/5296 (23.9%), the rate of nonelective CSs was 912/5296 (17.2%), and the proportion of non-elective CS was 912/1264 (72.2%). A total of 171/838 (20.4%) women were HIV positive. Seventy per cent (634/838) women had a CS for the first time, of which 290/634 (45.7%) were multigravida. Records were grouped according to Robson’s classification, a mutually exclusive and totally inclusive classification of CS. The Robson group making the largest contribution was nulliparous women with a single cephalic pregnancy, at greater than or equal to 37 weeks gestation in spontaneous labour (group 1) with 213/838=25.4%. Problems with the progress of labour were the most common reason why women had non-elective CSs during the study period. The study findings highlighted a high number of primary CS in low risk women with poor assessment of maternal wellbeing and progress of labour. Limited documentation of Midwifery intervention and care was noted suggesting inadequate Midwifery care. Training is required to render evidence based care.

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Carter, Sarah Anne. "The cascade of intervention : labour induction and caesarean section in the United Kingdom." Thesis, University of Southampton, 2018. https://eprints.soton.ac.uk/422170/.

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Labour induction and caesarean section are childbirth interventions experienced by a growing number of women globally each year. These two medical procedures are often linked in maternal health literature through the cascade of interventions, an intervention pathway defined by labour induction at the start of birth and operative delivery at the end. While the maternal indicators of labour induction have been well documented in countries such as the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom, and how the risk of labour induction is associated with operative delivery in the UK. This project examines the maternal risk factors of labour induction in the United Kingdom and how these indicators are related to the likelihood of operative delivery, using data from the Millennium Cohort Study. The thesis first uses logistic regression to explore which maternal characteristics are associated with labour induction in the United Kingdom, and determines that maternal educational qualifications and the deprivation of a woman’s electoral ward have significant associations with likelihood of labour induction. In the second analysis chapter, this project examines health care context by utilizing multilevel logistic regression to analyse if risk of labour induction varies by NHS Trust. Results from these analyses determine that risk of labour induction does vary by NHS Trust, the influence of maternal educational qualifications on labour induction risk varies by NHS Trust, and country of NHS Trust is a significant predictor of labour induction. Finally, in order to better understand how the cascade of intervention operates in the United Kingdom, the third analysis investigates the link between labour induction and type of delivery using multinomial logistic regression and KHB mediation analysis. This analysis finds that women who are induced are more likely to experience operative delivery, and that this relationship is mediated by epidural anaesthesia. Additionally, maternal height moderates the associations between labour induction, epidural, and delivery type, such that women between 1.60 and 1.69 metres tall are more at risk of operative delivery after labour induction and epidural than women at shorter or taller heights. This project finds that maternal demographic and socioeconomic indicators influence the risk of labour induction, and that the association between labour induction and operative delivery can be mediated by epidural anaesthesia and moderated by maternal height, within the health care context of the United Kingdom. Determining which women are more likely to experience labour induction and operative delivery in the UK can allow women to make more informed choices about their health care and can help support efforts to provide women with individualized, patient-centred care during their labours and births.

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Bayes, Sara Jayne. "Becoming Redundant: women’s experience of unwanted scheduled caesarean section - a grounded theory study." Thesis, Curtin University, 2010. http://hdl.handle.net/20.500.11937/294.

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Currently, one third of Australian childbearing women per annum have a caesarean section. Evidence strongly indicates, however, that most women enter into pregnancy expecting and wanting to give birth naturally. While a body of research exists that accounts for some aspects of how women experience caesarean section, the phenomenon has not previously been described in depth. The purpose of this study was to uncover and theorise how women processed and experienced a first caesarean recommended in pregnancy for a health reason.This Western Australian investigation was conducted using the Glaserian version of Grounded Theory methodology. Twenty-eight pregnant women who had been anticipating giving birth naturally, but were advised during pregnancy that they would need to give birth by caesarean section, agreed to participate in the study. Five sets of data were collected. The first comprised semi-structured in depth interviews with the 28 women both before and after the birth of their baby. Non-participant observations of women’s behaviours and interactions whilst they were in the operating theatre, including situation maps, written notes and pencil sketches, formed the second data set. The third and fourth sets of data consisted of semi-structured interviews held with participating women’s partners and with maternity health care professionals. Field notes formed the final set.The Grounded Theory that emerged was labelled Becoming Redundant. The theory comprises the core problem that anticipating and experiencing a scheduled caesarean section posed for women, namely Being Made Redundant, and the psychosocial process they undertook to manage it, labelled Regrouping. In total, eight major categories were identified. The four categories that contributed to the core problem were labelled Being robbed, Becoming a ‘persona non grata’, Off everyone’s radar and Left wanting. The categories in the regrouping process were labelled Trying to make it feel real, Travelling a new path blindly, Striving to be included whilst trying to behave and Treading water. In addition, four factors emerged from the data that moderated, or limited, women’s regrouping endeavours. These were titled Expecting birth would be natural, Hurtling towards ‘D-day’, The green drape and Caesarean section is hospital not women’s business.For 25 of the 28 women, needing and having a caesarean section was frightening, disempowering, distressing and in complete contrast with how they had expected and wanted their baby’s birth to be. The childbirth expectations of these 25 women were shattered as the hospital effectively took over their baby’s birth, and they were left with feelings of loss, grief and, in some cases, symptoms of emotional trauma. In response, women set about trying to accommodate the personal losses they incurred, and to transition to their ‘new reality’. The effect of the moderating factors, however, was to thwart women’s adaptation efforts. Consequently, when they were interviewed between 10 and 14 weeks after their caesarean section, these 25 women reported feeling cognitively and emotionally ‘stuck’ in their childbearing experience. They also described spending considerable energy and attention on trying to work out what had happened to them rather than focusing on their new baby.The remaining three women either experienced or responded to their scheduled caesarean section differently to the other 25; this was because of the absence of one or more of the moderating factors. Ultimately, however, only one of the women was left feeling positive, emotionally on a ‘high’ and free of regret after her baby’s birth.This Western Australian research highlights significant new findings about women who require a caesarean section for a health reason. The work makes an important and original contribution not only to the maternity literature, but to the body of knowledge concerning grief, traumatic stress and dissociation, and change transition. The theory of Becoming Redundant provides maternity care professionals, academics and consumers with previously unknown information about how women might experience, manage and be affected by unforeseen and unwelcome change during the childbearing episode, and has direct and important implications for the care of childbearing women. The disappointment, grief and/or traumatic stress that is likely to arise for a woman when her childbearing expectations can no longer be fulfilled must be anticipated, recognised, acknowledged and forestalled where possible. For women to integrate and move on from their childbirth experience and become fully engaged in motherhood, those who have had to ‘change track’ must be afforded the time, space and support to explore the meaning of the change, to fully mourn what they lose because of it, and to recapture their losses to the greatest extent possible.

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Colais, Paola <1975&gt. "Validity of Robson Ten Group Classification System for comparative evaluation of caesarean section." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2009. http://amsdottorato.unibo.it/1688/1/Colais_Paola_tesi.pdf.

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Colais, Paola <1975&gt. "Validity of Robson Ten Group Classification System for comparative evaluation of caesarean section." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2009. http://amsdottorato.unibo.it/1688/.

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Nippita, Tanya Ai Choo. "Variations in obstetric interventions in New South Wales, Australia." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17181.

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Aims To describe variation in caesarean section (CS) and induction of labour (IOL) rates and outcomes; determine ways of classifying IOL; describe variation in current IOL methods. Methods A systemic review examined different methods of IOL classification. Variation in hospital CS and IOL rates and outcomes used two linked population datasets and multilevel logistic regression models. To understand clinical decision-making around IOL, interviews were conducted in New South Wales (NSW) hospitals. Midwifery unit managers completed surveys for current IOL methods. Results  For nulliparae at term in NSW, overall variation in hospital CS rates decreased by 78% for prelabour CS, 52% for intrapartum CS following spontaneous labour and 9% following IOL after adjustment. Severe maternal and neonatal morbidity rates were not significantly different between hospitals.  A 10 group classification system for IOL was developed based on parity, previous CS, gestational age, number and presentation of the fetus.  In NSW 2010-2011, there was high unexplained variation in hospital IOL rates despite adjusting for patient factors. The greatest variation was for hospital rates of IOL among nulliparae at full term. There was generally no relationship between hospital IOL rate and adverse outcomes or intrapartum CS rates.  Variation in decision-making was based on the obstetrician’s perception of risk, their relationship with the woman, and resource availability. There was wide variation in clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with high IOL rates.  From 2008 to 2014, for district hospitals, there was an increase in balloon catheter use for cervical ripening and a significant increase in use of postmaturity protocols for IOL but no difference in use of prostaglandin protocols. For both district and tertiary hospitals, there was a reduction in the variation in the minimum and maximum oxytocin dosages. Conclusion There was much unexplained variation in hospital CS and IOL rates in NSW, which did not appear to result in differences in adverse outcomes. A novel classification system for women having an IOL was developed to allow similar populations of women having an IOL to be compared for research and quality improvement. Increased accountability and less variation in decision-making were associated with a lower hospital IOL rate. Increased use of protocols was associated with a reduction in practice variation, but it is uncertain whether it translates to better outcomes for mothers and babies.

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Shoemaker, Esther Susanna. "Childbirth Decision Making Processes: Influences on Mode of Birth After a Previous Caesarean Section." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35504.

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Background: An increasing proportion of Canadian women are experiencing a Caesarean section (CS) and a subsequent repeat CS. While CS can be necessary and lifesaving for mothers and their infants in some situations, it is also associated with greater morbidity risks to women and infants than vaginal birth. Clinical practice guidelines recommend the involvement of pregnant women in making decisions about mode of birth and shared decision making improves the informed consent process. This research examines the factors that influence mode of birth after a previous CS. Methods: Two cross sectional descriptive studies and a prospective pre-post cohort study with control were conducted to investigate the high use of repeat CS at the levels of health care providers, maternity care clients, and the organizational structure of a birthing unit. 1. Interviews and surveys with obstetricians, family physicians, midwives, and nurses were conducted to investigate the attitudes, values, and perceptions that guide their care practices for clients with a previous CS. The specific research question was: What are the factors that influence the practices of maternity care providers (obstetricians, family physicians, midwives, and nurses) regarding mode of birth after a previous CS? Data was analyzed using iterative deductive and inductive coding. 2. Interviews and surveys were conducted during pregnancy and after giving birth with healthy women who have had a previous CS to explore their decision making processes regarding mode of birth after a previous CS. The specific research question was: How do women eligible for a VBAC make decisions about their upcoming mode of birth? A thematic framework approach was used for data analysis. 3. Data from the Better Outcomes Registry and Network (“BORN”) Ontario was analyzed to examine the effectiveness of a hospital based strategy on overall proportions of CS and within Robson groups 1, 2a, and 5. The Caesarean section reduction (CARE) strategy includes interventions that target health care providers, pregnant women, and hospital policies. Results: 1. Maternity care providers would recommend a vaginal birth after CS (VBAC) for healthy pregnant women with a previous CS. They had different perceptions of the safety of birth to the health of women and infants and different approaches to engage in decision making during consultation. Providers believed women make their decision about mode of birth outside of the clinical consultation and often prior to their subsequent pregnancy. 2. The main themes that influenced the decisions of maternity care clients about mode of birth were mothers’ experiential reasoning regarding mode of birth and recovery, experiential knowledge from significant others, scheduling of CS regardless of the mode of birth decision, rating and prioritizing risks, fear of risks, and decisional conflict. When women discussed the factors that impacted their decisions about mode of birth six to eight weeks after they had given birth, the main themes were the recovery experience and fear related to the mode of birth. A lack of time during consultation was identified as a major barrier inhibiting shared decision making, specifically among clients of obstetricians. Other barriers included reliance on routine obstetric practices that are not evidence based. 3. Proportions of CS decreased at the intervention hospital by 3.9% (p=0.0006), from 30.3% (n=964) in 2009/10 to 26.4% (n=803) in 2012/13. During the same time frame, proportions of CS in the control group were stable with 28.1% (n=23,694) in 2009/10 and 28.2% (n=23,683) in 2012/13. Within the Robson classification system, the proportions of repeat CS among all low risk women with a previous CS decreased at the intervention hospital by 5.6% (p=0.0044) from 84.3% to 78.7%. In the control group, also fewer women had a repeat CS over the study period, but the decrease was smaller with 3.9% (p<0.0001) from 84.5% to 80.6%. Conclusion: A true shared decision making process addresses the power imbalance between providers and women through an incorporation of the clinical expertise of providers and the experiential expertise of pregnant women before reaching a decision about mode of birth. The use of routine obstetric practices that are not evidence based inhibited women to make decisions about their mode of birth. The introduction of the CARE strategy to a hospital birthing unit was associated with improvements in proportions of CS and VBAC among low risk women.

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Cluver, Catherine Anne. "Maternal position during caesarean section for preventing maternal and neonatal complications : a cochrane review." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17831.

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Thesis (MMed)--Stellenbosch University, 2011. ENGLISH ABSTRACT: Background: During caesarean section mothers can be in different positions. Theatre tables could be tilted laterally, upwards, downwards or flexed and wedges or cushions could be used. There is no consensus on the best positioning at present. Objectives: We assessed all available data on positioning of the mother to determine if there is an ideal position during caesarean section that would improve outcomes. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009), PubMed (1966 to 14 September 2009) and manually searched the references of retrieved articles. Selection criteria: Randomised trials of women undergoing caesarean section comparing different positions. Data collection and analysis: Two authors assessed eligibility, trial quality and extracted data. Results: We identified 17 studies with a total of 683 woman included. We included nine studies and excluded eight studies. Included trials were of variably quality with small sample sizes. Most comparisons had data from single trials. This is a shortcoming and applicability of results is limited. The incidence of air embolism was not affected by head up versus horizontal position (risk ratio (RR) 0.91; 95% confidence interval (CI) 0.65 to 1.26). We found no change in hypotensive episodes when comparing left lateral tilt (RR 0.11; 95% CI 0.01 to 1.94), right lateral tilt (RR 1.25; 95% CI 0.39 to 3.99) and head down tilt (mean difference (MD) -3.00; 95% CI -8.38 to 2.38) with horizontal positions or full lateral tilt with 15-degree tilt (RR 1.20; 95% CI 0.80 to 1.79). Hypotensive episodes were decreased with manual displacers (RR 0.11; 95% CI 0.03 to 0.45), a right lumbar wedge compared to a right pelvic wedge (RR 1.64; 95% CI 1.07 to 2.53) and increased in right lateral tilt (RR 3.30; 95% CI 1.20 to 9.08) versus left lateral tilt. Position did not affect systolic blood pressure when comparing left lateral tilt (MD 2.70; 95% CI -1.47 to 6.87) or head down tilt (RR 1.07; 95% CI 0.81 to 1.42) to horizontal positions, or full lateral tilt with 15-degree tilt (MD -5.00; 95% CI -11.45 to 1.45). Manual displacers showed decreased fall in mean systolic blood pressure compared to left lateral tilt (MD -8.80; 95% CI -13.08 to -4.52). Position did not affect diastolic blood pressures when comparing left lateral tilt versus horizontal positions. (MD-1.90; 95% CI -5.28 to 1.48). The mean diastolic pressure was lower in head down tilt (MD -7.00; 95% CI -12.05 to -1.95) when compared to horizontal positions. There were no statistically significant changes in maternal pulse rate, five-minute Apgars, maternal blood pH or cord blood pH when comparing different positions. Authors' conclusions There is limited evidence to support or clearly disprove the value of the use of tilting or flexing the table, the use of wedges and cushions or the use of mechanical displacers. Larger studies are needed. AFRIKAANSE OPSOMMING: Agtergrond: Tydens keisersnitte kan moeders in verskillende posisies wees. Teater tafels kan lateraal, opwaarts, afwaarts of gebuig word, of 'n wig en kussings kan gebruik word. Op die oomblik is daar geen konsensus oor die beste posisie nie. Doelwitte: Ons het alle beskikbare data oor die plasing van die moeder ondersoek, met die doel om 'n ideale posisie vir 'n verbeterde uitkoms tydens 'n keisersnit vas te stel. Metodes: Ons het die “Cochrane Pregnancy and Childbirth Group's Trials Register“ (September 2009), PubMed (1966 tot 14 September 2009) deursoek en die herwinde artikels se verwysings per hand nagegaan. Keuringskriteria: Gerandomiseerde proewe van vroue wat keisersnitte ondergaan het, is in verskillende posisies vergelyk. Data insameling en analise: Twee outeurs het die kwaliteit, die geskiktheid en data van die studie beoordeel. Resultate: Ons het 17 studies geidentifiseer wat 'n totaal van 683 vroue ingesluit het. Ons het nege studies ingesluit en agt uitgesluit. Die ingeslote studies was van wisselvallige gehalte en die monster groepe was klein. Die meeste vergelykings het data van enkele studies gegee. Dit is 'n tekortkoming en die bruikbaarheid van die resultate is beperk. Die plasing van kop-op teenoor horisontale posisie het die voorkomssyfer van lug embolisme nie geaffekteer nie.(risiko verhouding RR 0.91;95% 95% vertroue interval Cl 0.65 tot 1.26). Daar is geen hipotensiewe veranderinge gevind toe 'n vergelyking gemaak is tussen linker laterale kantel (RR 0.11; 95% Cl 0.01 tot 1.94) regter laterale kantel (RR 1.25; 95% Cl 0.39 tot 3.99) en kop-af kantel (“mean difference” MD -3.00; 95%Cl -8.38 tot 2.38) teenoor horisontale posisies of volle laterale kantel met 'n 15 grade kantel nie (RR 1.20;95% Cl 0.8. tot 1.79). Hipotensiewe episodes het verminder met hand verplasers (RR 0.11; 95% Cl 0.03 tot 0.45), 'n regter lumbale wig in vergelyking met 'n regter bekken wig (RR 1.64; 95% Cl 1.07 tot 2.53) en 'n vermeerdering van die regter laterale kantel (RR3.30; 95% Cl 1.20 tot 9.08) teenoor die linker laterale kantel. In die vergelyking tussen die posisie van linker laterale kantel (MD 2.70; 95% Cl -1.47 tot 6.87) of kop-af kantel (RR 1.07; 95% Cl 0.81 tot 1.42) teenoor horisontale posisies, of volle laterale kantel met 15 grade kantel (MD -5.00; 95% Cl -11.45 tot 1.45) het die posisie nie die sistoliese bloeddruk geaffekteer nie. Hand verplasers het 'n verminderde daling in gemiddelde sistoliese bloeddruk veroorsaak in vergelyking met linker laterale kantel plasing (MD -8.80;95% Cl-13.08 tot -4.52). In die vergelyking tussen linker laterale kantel en horisontale posisie was daar geen effek op die diastoliese bloeddruk nie (MD -1.90; 95% Cl -5.28 tot1.48). Die gemiddelde diastoliese druk was laer in die kop-af kantel (MD -7.00; 95% Cl -12.05 tot -1.95) in vergelyking met horisontale posisies. In die vergelyking tussen die verskillende posisies was daar geen betekenisvolle statistiese veranderinge in die moeder se polstempo, vyf minute Apgartellings, moederlike bloed pH of naelstringbloed pH nie. Outeur se gevolgtrekkings: Daar is beperkte getuienis om die waarde van kantel, buiging van tafel, die gebruik van wieë en kussings of die gebruik van maganiese verplasers te ondersteun of totaal te verwerp. Groter studies is nodig.

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Venter, Eben Kruger. "The Caesarean Section rate at Mowbray Maternity Hospital: Applying Robson's Ten group classification system." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29234.

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Background The United Nations (UN) aims to reduce the maternal mortality ratio (MMR) and improve access to reproductive health services. Caesarean sections (CS) are known to be associated with a raised mortality rate by a factor of 2.8 in addition to the raised morbidity rate (OR 3.1; 95% CI 3.0-3.3) compared to vaginal deliveries (VD). Globally, there has been a concerning trend in the caesarean section rate (CSR), rapidly increasing since the 1970’s, with some countries reporting CS rates as high as 40.5%. South Africa has a CSR of 25.7%, which is higher than the suggested rate by the World Health Organization (WHO) of 15%; a rate above which the WHO suggests no maternal and fetal benefit exists. Robson introduced a universal classification system for caesarean sections with 10 totally inclusive and mutually exclusive groups. Horak made use of the ten group classification system (TGCS) to calculate the CSR at Mowbray Maternity Hospital (MMH) and its referring midwife obstetric units (MOU) for 2009, and reported it as 20.7%. Since the completion of her study, the referral routes to MMH have changed and the management of HIV-associated illnesses has markedly improved. A period of 7 years has elapsed and it was thought to be an optimal time to repeat a review of the CSR and compare it with the rates from 2009. Objectives The study aims to calculate the CSR for MMH from January 2016 to June 2016. Analyses of the CSR within each Robson group will be done and compared to the rates from 2009. This will allow us to make recommendations, if appropriate, aimed at reducing the CSR. Methods A retrospective, observational study was performed at MMH in Cape Town. Data was collected from birth registers for January 2016 – June 2016. All women who delivered, including all caesarean sections and vaginal births, were entered into the study, provided the newborn was viable with a birth weight >500g. Parameters were recorded onto an electronic and password-protected Microsoft Excel® spreadsheet and were used to classify deliveries according to the Robson Classification system. To allow for comparison with Horak’s study, deliveries at MMH for January 2009 – June 2009 were selected and analyzed. All the data was analyzed with STATA software and presented in various graphical formats. Ethics approval was obtained from University of Cape Town’s Human Research Ethics Committee (HREC Ref: 539/2016). Results There were 4727 deliveries from January to June 2016, of which 2472 were vaginal births and 2255 were caesarean sections, giving rise to a CSR of 47.70% (95% CI 46.28- 49.13). Of all the caesarean sections performed, 62.7% were primary caesarean sections and 37.3% were repeat caesarean sections. Nulliparous women, compared to multiparous women without a history of a prior CS, were at higher risk for a CS if in spontaneous labour (OR 2.02; 95% CI 1.71-2.38) and if induced (OR 2.75; 95% CI 2.13- 3.53). Group 5 (women with a previous CS), with a CSR of 85.34% (95% CI 82.82-87.61) made the greatest contribution to the overall CSR. The overall CSR from January to June 2009 was 44.10% (95% CI 42.63-45.57), calculated from 4379 deliveries. There was a statistically significant increase in the CSR of 3.60% from 2009 to 2016. A similar significant increase was observed in the respective CS rates of Group 1 (5.59%), Group 2 (11.63%) and Group 10 (8.73%). Group 4 was the only group with a statistically significant decrease of 4.48% in its CSR. An additional 308 labour inductions were performed in 2016, however, women in 2016 were statistically significantly less likely to be successful in a vaginal delivery (OR 0.67; 95% CI 0.55-0.81 p<0.001) compared to women in 2009. Conclusion A CSR of 47.70% is acceptable for a secondary level hospital such as MMH. This figure is elevated, but appropriate, as the referral units that perform only low risk vaginal deliveries are excluded. A surge in the number of repeat caesarean sections performed and lower success rates for labour inductions were mostly responsible for the rise. Primary caesarean sections performed on patients directly result in a higher risk patient profile in the future, coupled with more repeat caesarean sections in subsequent pregnancies. This is supported by a 17.5% prevalence of previous CS in women in 2009 as opposed to the 20.79% of women with a prior CS in 2016. This study shows that a CS in the index pregnancy has sizeable effects on the care of a woman in subsequent pregnancies. This places more strain on the health system and ultimately affects service delivery to all patients. Theoretically it is possible to explore changes in management to curb the ever-increasing CSR, but one has to consider if such changes is acceptable and appropriate to the setting of MMH and the population it serves.

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Sonntag, Kim. "A retrospective review of surgical site infection following caesarean section at Mowbray Maternity Hospital." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22808.

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Introduction: Pregnancy related sepsis is a major cause of maternal mortality and morbidity in South Africa. Caesarean section (CS) is the most important risk factor in the development of puerperal infection, and surgical site infection (SSI) after CS increases maternal morbidity as well as medical costs. Mowbray Maternity Hospital (MMH), is a secondary level, public maternity hospital. The caesarean section rate at MMH has increased considerably over the last fifteen years, and the perception has been that there have been increasing numbers of patients developing SSI post-CS. This study was designed to look more closely at the incidence of SSI and to describe the patients identified with SSI. Methods: This was a retrospective observational study. Cases of severe SSI, as defined by the Centres for Disease Control and Prevention (CDC), following CS at MMH from December 2011 to December 2014 were identified. Following ethical approval, patient records were sourced, data collected and analysed using Stata and Statistica. Results: In the 3-year study period, 14982 CS were performed with 98 patients identified with severe SSI. Folders were retrieved for 96 patients, with 2 patients' folders missing and 29 patients with a missing maternity case record (MCR). The overall incidence of severe SSI was 0.65%, with an incidence of 0.88% in Year 1, 0.90 in Year 2 and 0.70 in Year 3. Of the cases, 79 (80.6%) had been in labour, 16 (16.3%) patients had had prolonged rupture of membranes (PROM) and 32 (32.7%) had prolonged labour, with a median of 5 vaginal examinations. An emergency CS was performed in 90 (91.8%) patients, 7 (7.2%) had an elective CS and 1 (1.0%) patient had this data missing. Deep incisional SSI was diagnosed in 74 (75.5%) patients and 24 (24.5%) patients were identified with organ/space SSI. Intravenous (IV) antibiotics was the main treatment in all 96 cases, with 23 (23.5%) patients requiring a wound debridement, 17 (17.2%) a laparotomy, which proceeded to a hysterectomy in 12 (12.3%) patients. In the majority of cases, no organism was cultured, Whereas multiple organisms were cultured in 16 cases, of which 12 were identified as MRSA, and 18 as Klebsiella pneumoniae. There were no maternal deaths or Intensive Care Unit (ICU) admissions. Discussion and Conclusion: The incidence of severe SSI is in keeping with other institutions, with the lowest incidence being found in Year 3, which may be explained by the change in referral population and/ or the full implementation of the Best Care Always (BCA) bundles of care. Of the 98 patients with severe SSI, 80.6% had been in labour, 32.7% had prolonged labour and 91.8% had an emergency CS performed. These are all factors which are known to increase the likelihood for development of post-CS SSI.

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Cavallaro, F. L. "Measuring the unmet need for caesarean sections in sub-Saharan Africa and South Asia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2172946/.

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Background. Caesarean sections are critical interventions in obstetric care. The unmet need for caesareans is an important indicator for monitoring emergency obstetric care coverage: several methods have been proposed, however there is no consensus on how to measure the unmet need for caesareans in sub-Saharan Africa and South Asia. Methods. First, trends in the caesarean rate by wealth were analysed in 26 countries in sub-Saharan Africa and South Asia using Demographic and Health Surveys, in order to identify groups with rates below 1% and 2%. Second, a global online survey was conducted on obstetricians’ opinions of the optimal caesarean rate. Third, linked hospital and population-based data were used to validate the Unmet Obstetric Need (UON) indicator in central Ghana, which measures the unmet need for surgery for absolute maternal indications (AMIs), and to investigate novel approaches using hospital data. Results. The caesarean rate was extremely low among poor women in most sub-Saharan African and South Asian countries. The median optimal caesarean rate reported by obstetricians worldwide was 20%, and there was a large variation in responses (IQR: 15-30%). The 1.4% threshold for the UON indicator was found not to be valid in Ghana. For most complications – including AMIs, among which caesarean rates were close to 100% – women were equally likely to have their need for caesareans met regardless of their educational level. Conclusion. The optimal caesarean rate remains unknown, and thus cannot be used as a benchmark for measuring the unmet need. The UON indicator does not produce valid estimates of AMI-related mortality avertable with caesareans, however caesarean rates below 1% probably indicate a critical unmet need for life-saving surgery. Comparing caesarean rates in hospitals by education is useful for determining whether population-based differences in the caesarean rate are partly explained by differential access to care within facilities.

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