Dissertations / Theses on the topic 'Caesarean births'
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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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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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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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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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Carniel, Emilia de Faria. "Caracterização dos recem-nascidos e de suas mães, a partir das declarações de nascidos vivos de Campinas (SP), no ano de 2001." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308139.
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Orientadores: Andre Moreno Morcillo, Maria de Lurdes ZanolliDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Os Sistemas de Informação em Saúde são fundamentais para o conhecimento da situação de saúde da população e o direcionamento das políticas de saúde. O Sistema de Informações sobre Nascidos Vivos (SINASC) do Ministério da Saúde, cujo instrumento de coleta de dados é a Declaração de Nascido Vivo (DNV), foi implantado com o intuito de obter informações para subsidiar propostas para o grupo materno-infantil. Por meio de estudo transversal, que analisou 14.444 DNVs de Campinas (SP) em 2001, estudou-se a viabilidade da utilização dos dados do SINASC para descrever o perfil de mães e recém-nascidos (RNs) e determinar fatores de risco para baixo peso de nascimento (BPN), parto cesáreo e gravidez na adolescência. Este perfil foi identificado por: local de ocorrência do parto, características sociodemográficas maternas, gestacionais, do parto e dos RNs. Os fatores de risco foram determinados pela correlação entre as variáveis, utilizando análise de regressão logística. A proporção de captação do SINASC foi de 99,1%, e as DNVs foram preenchidas em quase 100% dos itens. A maioria dos nascimentos ocorreu em hospitais, sendo o maior percentual de filhos de moradoras das áreas dos Distritos de Saúde (DS) Noroeste e Sudoeste (com baixas condições de vida), onde ocorreram os piores resultados. O percentual de mães adolescentes foi de 17,8%; a maior concentração de nascimentos foi para mulheres com 20 a 34 anos; 60,6% não trabalhavam fora, 35,9% não tinham companheiro, 37,8% tinham até sete anos de escolaridade e 47,1%, de oito a onze anos. A paridade foi variável, sendo a maior ocorrência entre mulheres sem filhos ou com um; 99,6% compareceram pelo menos uma vez ao pré-natal; 74,4% realizaram mais de seis consultas. Associou-se à gravidez na adolescência: morar em DS com baixas condições de vida, não ter ocupação ou companheiro. As adolescentes grávidas apresentaram risco de pré-natal inadequado. A maioria das gestações foram únicas, a termo, com RNs masculinos, brancos, com pequena proporção de hipóxia e com 1,0% de anomalias. O percentual de prematuridade foi de 7,1%. Houve alta incidência de cesarianas, sendo maior o risco nas gestações duplas e nos partos prematuros e para mulheres com companheiro, as maiores de 20 anos, as com melhor escolaridade, as trabalhadoras fora do lar, as moradoras em DS com melhores condições, as com mais consultas, as primíparas, com um ou dois filhos. A média de peso ao nascer foi 3.142g; 25,7% dos RNs nasceram com peso insuficiente e 9,1% com baixo peso. Associou-se ao BPN: prematuridade, baixa escolaridade materna, menos de sete consultas e RNs femininos. A configuração da DNV não permitiu identificar partos da rede pública ou da rede privada e incluir adequadamente as mulheres em união consensual. Os agrupamentos do número de consultas de pré-natal não estão de acordo com o parâmetro do Ministério da Saúde. Este estudo mostrou que há viabilidade da utilização dos dados do SINASC para o planejamento de ações de saúde. Além disso, a distribuição dos resultados, pelos diferentes DS, mostrou que o perfil do grupo materno-infantil não é homogêneo na cidade
Abstract: Health Information Systems are fundamental to the knowledge of health status of the population and to manage health policies. The Information System on Live Births (SINASC) was developed by the Brazilian Health Ministry and designed to improve quality of information on newborns and on pregnant women, in order to support health proposals to infant-maternal group. This system has been implemented since 1990 and Live Birth Certificate (LBC) is the document to collect data. Throughout a cross-sectional study 14,444 LBC from the city of Campinas, SP, in 2001, were analysed in order to determine SINASC's viability. Mothers' and newborns' profiles were described and risk factors for low birth weight (LBW), caesarean-sections and pregnancy in adolescence were showed. The profiles were described according to mothers¿ social-demographic characteristics and those related to their pregnancies and to the newborns. The assessment of the association among variables was performed through logistic regression. The study showed excellent coverage of the SINASC (99.1%) and almost 100% of the variables were filled. Most of the births occured in health services of the city and the higher proportion was of babies from women who lived in Health District (HD) Northwest and Southwest (in low conditions of life), where the worst results occured. The percentage of adolescent mothers were 17.8%; the highest proportion of births was among women between 20 and 34 years old; 60.6% of all mothers didn't have jobs, 35.9% were single; 37.8% studied until seven years and 47.1% studied for about eight and eleven years. The number of children were variable, but the higher concentration was on women with no children or just one. Almost all women at least had one prenatal care appointment; 74.4% had more than six medical visits. Pregnancy in adolescence was associated with women living in low conditions of life, without husbands or incomes and who had inadequate prenatal care. Most of the gestations were single and the babies were mature, most of them were male, white, born with a low proportion of hipoxia and 1% of them showed malformations. The percentage of premature babies were 7.1%. The incidence of caesarean-sections was very high (54.9%) and the risk factors for them were: twin gestations, premature birth and women with husbands, having better education level, with jobs, living in good places, having more prenatal care visits, with no children and with one or two. The average birth weight was 3,142g; 25.7% of the babies were born weighing between 2,500g and 2,999g and 9.1% of them weighing less than 2,500g. The risk factors for LBW were: premature birth, low educational level, less than seven prenatal care visits and female baby. This study showed the viability of SINASC to help plan health activities for the infant maternal group. Furthermore, the results in different HD, showed that the mothers¿ and newborns¿ characteristics are different in the city
Mestrado
Saude da Criança e do Adolescente
Mestre em Saude da Criança e do Adolescente
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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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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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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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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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Daniel, Joseph A. "Comparison of caesarian section and vaginal birth in pigs /." free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9962516.
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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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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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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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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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Watkyns, Ann Frances. "Sensory over-responsivity in children of 3-5 years: A descriptive, analytical study." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30806.
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BACKGROUND: Sensory over-responsivity (SOR) is a type of Sensory Modulation Disorder (SMD), where the individual has an over-responsive behavioural reaction to non-harmful or non-threatening sensory stimulation, which is out of proportion to the stimulus. SOR can negatively impact a child’s engagement and performance in their daily life. SOR is frequently diagnosed by occupational therapists, and deep pressure is an important facet of the treatment of SOR by occupational therapists. Prior research (Alberts & Ronca, 2012) indicates that the component of pressure in the vaginal birth process aids the infant’s neurophysiological adaption to extra-uterine life. This component is absent in elective caesarean section births. This study therefore set out to determine whether method of birth could be associated with SOR, as well as investigating demographic and other variables linked to SOR. It was hypothesised that there would be a higher prevalence of SOR in children aged 3-5 years born by elective caesarean section compared to those born by vaginal birth. The study objectives were: • To establish a profile (demographic and variables linked to SOR) of participants (mother-child dyads) by birth method group (CS or vaginal delivery) • To determine the prevalence of SOR by birth method • To establish if there is a statistically significant difference in SOR and birth method • To establish which variables (for example birth weight, jaundice, birth complications) are associated with SOR METHOD: A quantitative, descriptive, analytical study was conducted with a sample of 91 children between the ages of 3 years 0 months and 4 years 11 months. Children across various language, cultural and socio-economic groups were recruited and allocated to two groups based on their method of birth - vaginal delivery and elective caesarean section. Caregivers of each child completed the Short Sensory Profile 2 (SSP2) questionnaire as well as a demographic information questionnaire. The scores for SOR were calculated for each participant, and prevalence of SOR between the two birth method groups was compared. Demographic variables were tested for significance between the two groups. The variables showing a significant difference were further analysed to determine any association with SOR. RESULTS: There were 91 participants, 58 in the VB group and 33 in the CS group. Mothers in the VB group gave birth at a younger age (U = 499.0, p < .001), were of a lower income level (chi-square = 11.49, df = 2, p = .003) and more likely to be single (Fishers exact p (2-tailed) = .037). The children in the VB group were of a greater gestational age (U = 472.5, p = .001), had a shorter time period before the first breastfeed (U = 478.0, p = .006), and had fewer sleeping difficulties (Fishers exact p (2-tailed) = .003). The prevalence of SOR for the total sample was 22%. There was a significant association in SOR prevalence and birth method (Fishers exact p (2-tailed) = .034), with greater prevalence in the VB group (29%) as opposed to the elective CS group (9%). There were statistically significant associations between SOR and maternal age (U = 380.5, p = .004), marital status (Fishers exact p (2-tailed) = .003) and time after birth to the first breastfeed (U = 394.5, p = .049). CONCLUSION: There was a statistically significant difference in SOR between the two birth method groups, with higher prevalence in the VB group. This was thought to be linked to cultural and language challenges associated with the use of the SSP2, and the impact of low socio-economic circumstances on child development and the ability to regulate sensory input. Recommendations include developing and validating a culturally appropriate sensory profile questionnaire, available in the most common official languages to facilitate the accurate assessment of sensory modulation of all children living in South Africa. In addition, there is a need to test the birth method hypothesis in demographically balanced groups.
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Berger, Neil F. "The effect of caesarean section birth and birth hypoxia on CNS function in the rat, modulation by genes and interaction with anesthesia." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape2/PQDD_0035/MQ64317.pdf.
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Berger, Neil F. "The effect of Caesarean section birth and birth hypoxia on CNS function in the rat : modulation by genes and interaction with anesthesia." Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30341.
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Using a rat model, it has been demonstrated that C-section birth and birth hypoxia have long-term effects on several CNS parameters. While previous studies have used decapitated dams to perform C-sections, the purpose of experiment 1 was to develop a more clinically relevant model using controlled amounts of anesthetic. The findings show that the level of maternal anesthesia used is an important factor influencing neonatal systemic and CNS oxygenation during C-section birth. In experiment 2 indicators of systemic and CNS hypoxia were measured in rat born by C-section with varying concentrations of anesthetic and periods of added global anoxia. Anesthesia was shown to reduce the rate of recovery from global anoxia. Experiment 3 was designed to determine if different rat strains were differentially vulnerable to the long-term effects of C-section birth on amphetamine-induced locomotor activity. The findings from this study indicate that genetic factors and C-section birth interact in producing long-term CNS effects. The findings presented show how variations in birth procedure and genetic factors might interact to cause long-term alterations in CNS function.
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Rhodes, Kate. "Experiences of women who elect for a Caesarian section following a previous traumatic birth." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12377/.
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The aim of this phenomenological study was to explore women’s experiences of an Elective Caesarean Section (ECS) following a previous Traumatic Birth (TB). Thirteen women who had undergone an ECS following a TB were either interviewed or provided written accounts of their experiences. Data from these sources were analysed using Interpretative Phenomenological Analysis (IPA) (Smith, Flowers and Larkin, 2009). Five main themes were identified: ‘cautiously moving forward into the unknown: the drive to reproduce’, ‘attempting to make the unknown known’, ‘the longed for, positive birthing experience’ , ‘a different post-natal experience’ and ‘the interaction of the two experiences’. These findings were considered in relation to previous research; relevant theoretical perspectives were considered including those attached to Post-Traumatic Stress Disorder (PTSD). Post-traumatic stress reactions may increase during subsequent pregnancy impeding on women’s ability to consider facing another ‘unknown’ natural birth and domineering their decision to elect for a CS. An ECS following a TB may provide women with the controlled experience and high levels of care they long for. Such experiences could be redemptive and have positive outcomes for women’s relationships and wellbeing. These results highlight the importance of providing women in this position with information and choice regarding a subsequent birth. They also stress that prevention of women carrying Post Traumatic Stress (PTS) reactions into their subsequent pregnancies is imperative. Future research would benefit from focussing on the development and trialling of effective screening tools for PTS reactions following birth.
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Klimpel, Jill M. "Performing Modernity through Birth: Exploring High Rates of C-Sections in São Paulo, Brazil." Ohio University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1321638880.
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Van, Reenen Samantha Lynne. "The stress, coping and parenting experiences of mothers who gave birth by unplanned Caesarean section / Samantha Lynne van Reenen." Thesis, North-West University, 2012. http://hdl.handle.net/10394/8773.
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Pregnancy and childbirth are important life experiences in a woman’s
psychosocial and psychological development. For many women, vaginal birth is
still considered an integral part of being a woman and becoming a mother.
Furthermore, it is thought to promote maternal well-being through helping women
to match their expectations to experiences. For these women, a failed natural
birth can be a psychological, psychosocial, and existential challenge that can
result in significant and far-reaching consequences for their psychological wellbeing.
Research, especially recent research, on the experiences of women who most
wanted to, but were unable to deliver their babies naturally is relatively rare. This
is surprising given the potential implications of these experiences on a mother’s
emotional well-being, as well as for her feelings towards her new baby.
Nevertheless, literature on the topic presents a coherent perspective on the
problem and indicates that these women experience difficulties in adapting to not
being able to fulfill their dream of delivering their baby naturally. There is no
existing research on the subjective experiences of South African women who delivered their babies by unplanned Caesarean section. This study therefore
aimed to contribute to knowledge that may fill this gap to some extent.
Through purposeful sampling, ten mothers who had wanted to deliver their
babies naturally, but had not been able to for whatever reason, were selected as
the study sample. Various aspects of their birth experiences were explored in indepth
phenomenological interviews. This allowed the researcher to probe certain
aspects offered by participants in order to understand and explore their
contributions in as much depth as possible. A semi-structured, open-ended
approach allowed for the exploration of relevant opinions, perceptions, feelings,
and comments in relation to the women’s unplanned Caesarean experiences.
The transcribed data was synthesized within a framework of phenomenological
theory, where women’s experiences were analyzed and explored in an attempt to
understand how participants made sense of their experiences.
The different aspects of women’s experiences were explored in three substudies.
The results are reported in three manuscripts/articles.
Research suggests that post-partum adjustment difficulties are influenced by the
potentially virulent stress reactions generated in response to a perceived birth
trauma. The objective of the first article was to explore women’s labour and
birthing accounts with specific regard to the subsequent stress responses
experienced. The stress responses experienced by the women in this study both prior to, and during the Caesarean section were predominantly anxiety-based.
This was distinguished from the post-partum period, where women described
having experienced more depressive symptoms. Post-traumatic stress
responses are associated with negative perceptions of the birth, self and infant.
The experience of adverse emotional consequences during the post-partum
period can undermine a woman’s ability to successfully adapt to her role as a
mother, meet the needs of her infant, and cope with post-partum challenges.
The second article highlighted the possible impact of women’s unexpected and
potentially traumatic childbirth experiences on initial mother-infant bonding. The
unplanned Caesarean sections left mothers feeling detached from the birthing
process and disconnected from their infants. Passivity, initial separation, and
delayed physical contact further compromised mother-infant interaction. Postpartum
physical complications and emotional disturbances have important
implications for a woman’s perceptions of herself as a mother and her ability to
provide for her infant, her self-esteem, and feelings of relatedness with her baby.
Adverse responses to a traumatic birth experience could therefore influence the
establishment of a maternal role identity, the formation of balanced maternal
attachment representations, the caregiving system, and ultimately initial motherinfant
bonding.
In the third article, women’s experiences were contextualized in relevant coping
resources and strategies. The processes occurring during a traumatic birth experience, such as during an unplanned Caesarean section, could be
influenced by perceived strengths when coping with the stress related to the
incident. The mothers in this study described several factors and coping
strategies that they perceived to have been effective in reducing the impact of
their traumatic birth experiences. These included active coping strategies,
problem-focused coping strategies, and emotion-focused coping strategies.
Coping strategies could result in reassessment of the birth process, and be
associated with a more positive, acceptable and memorable experience.
This study contributes to nursing, midwifery and psychological literature, by
adding to the professional understanding of the emotional consequences of
surgical delivery on South African childbearing women. This exploration therefore
has important implications for preventative measures, therapeutic intervention,
and professional guidance. However, the restricted sample may limit the
generalizability of results. Further investigation of the experiences of a larger,
more biographically and culturally diverse population could be instrumental in the
development of knowledge and understanding in this field of study.Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013
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Arey, Kelly Marie. "Examination of Birth Outcomes with Mode of Delivery for Breech Presentation." VCU Scholars Compass, 2007. http://hdl.handle.net/10156/1686.
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Dzeaye, Ngah Veranyuy. "Prolactin and testosterone levels in first-time fathers with skin-to-skin contact with their infants soon after birth by caesarean section." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/5939.
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Roux, Samantha Lynne. "An exploratory study of mothers perceptions and experiences of an unplanned Caesarean section / Samantha Lynne Roux." Thesis, North-West University, 2010. http://hdl.handle.net/10394/4943.
Full textAbstract:
Objective The present study aimed to explore women's perceptions and experiences of childbirth by unplanned Caesarean section. Background New motherhood is characterised as a profound change, and research suggests that the psychological effects of childbirth can be significant and far–reaching for some women. The processes occurring during a traumatic birth experience could affect a woman's emotional and psychological state, and she may experience considerable adjustment difficulties in adapting to unfulfilled expectations of delivering her baby naturally. Methods In–depth interviews explored 10 women's lived experiences of childbirth, after which thematic content analysis was used to synthesise data. The elements of phenomenological theory served as a broad framework for the structuring, organizing and categorizing of data, with interpretation aimed at gaining a greater understanding of women's internalised childbirth accounts. Findings Women described their contact with medical personnel, as well as the physical, environmental, and emotional aspects of their unplanned Caesarean sections, as distressing and traumatic. A sense of loss of control was the most significant contributor to women's negative childbirth experiences. Feelings of failure and disappointment were primarily related to unmet expectations and a lack of preparedness. Negative experiences were mediated by attentive caregiving, inclusion in decision–making, and support from loved ones.Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2011.
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Tradefelt, Klara, and Ali Shale Mohamed. "Förlossningsrädsla : Före och efter förlossning." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-296614.
Full textAbstract:
Sammanfattning I Sverige är förekomsten av förlossningsrädsla sedan tidigare uppskattad till 20 % (Eriksson & Nilsson, 2009). Denna relativt höga andel förlossningsrädda kvinnor gör det angeläget att som barnmorska kunna identifiera de riskfaktorer som gör att kvinnor som löper risk att utveckla eller redan lider av förlossningsrädsla. Syfte: Det övergripande syftet var att undersöka prevalens av förlossningsrädsla i sen graviditet och under förlossningen, mätt ett år efter förlossning. Syftet var också att undersöka om det finns skillnader gällande graden av förlossningsrädsla före och efter förlossning mellan olika grupper av kvinnor. Metod: En longitudinell kohortstudie utförd i form av en enkätstudie, uppdelad i tre enkäter. Det var 153 mödravårdsmottagningar i Sverige som inkluderades i studien. Antalet studiedeltagare vid första enkäten var 3284 och i den tredje 1360 studiedeltagare. Resultat: I sen graviditet var prevalensen förlossningsrädsla 26,4 %. Ett år efter förlossningen var det en snarlik prevalens, 28,4%, det vill säga ingen skillnad. De kvinnor som genomgått akut kejsarsnitt eller en instrumentell förlossning hade en ökad förlossningsrädsla uppmätt ett år efter förlossningen (M=7,35) jämfört med innan förlossningen (M=5,53). Slutsats: Då resultatet visar att kvinnor som genomgått ett akut kejsarsnitt eller en instrumentell förlossning har en signifikant ökad grad av oro och rädsla uppmätt ett år efter förlossningen, är det av stort värde att följa upp dessa kvinnor, att erbjuda dem stöd i tid inför nästkommande graviditet och förlossning. Det kan vara för sent att sätta in insatser när kvinnan redan är gravid. Det är också av värde att i största möjliga mån sträva efter en vaginal förlossning med bra stöd, information, smärtlindring och förebyggande av komplikationer.Abstract The prevalence of fear of birth in Sweden has been estimated at 20 % (Eriksson & Nilsson, 2009). Because of this relatively high number of women with fear of birth it is crucial that midwives are able to identify the risk factors associated with developing fear of birth and identify women who experience fear of birth. Aim of study: The overall aim was to examine the prevalence of women experiencing fear of birth during late pregnancy and during birth, examined one year after giving birth. Moreover, the aim of the study was to investigate if there were differences in the level of fear of birth before and after giving birth between different groups of women. Method: A longitudinal cohort study was conducted by means of three self-report questionnaires. There were 153 Swedish prenatal clinics included in the study. The number of participants in the first questionnaire were 3284 and the in the third 1360 participants. Results: During late pregnancy the prevalence of fear of birth was 26.4%. One year after the delivery there was similar prevalence, 28.4%, namely no difference. The women whom have had an emergency caesarean section or an assisted delivery had higher degree of fear of birth one year after delivery (M=7,35) compared to before giving birth (M=5,53). Conclusion: The result of the study shows that women that had an emergency caesarian section or an assisted delivery experienced a significantly higher level of fear and concern measured one year after delivery, therefore it would be of great importance to conduct a follow-up with these women. It is also important to offer them early support before their next pregnancy and delivery. It could be too late to do this when the woman is already pregnant. It is also important, to the greatest extent possible, to aim for a vaginal delivery with the help of good support, information, pain management and prevention of complications.
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Hoffmann, Franziska. "Untersuchung der Patientenzufriedenheit nach abdominaler Schnittentbindung." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-160135.
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Objective:
We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined.
Method:
Online survey of women who had at least one CS
Results:
We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS .
The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions.
Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed.
Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required.
In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved.
Conclusions:
A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.
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Larsson, Birgitta. "Treatment for childbirth fear with a focus on midwife-led counselling : A national overview, women’s birth preferences and experiences of counselling." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326007.
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Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being. Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling. Methods: Study I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy. Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden. Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.
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Escuriet, Peiró Ramón 1968. "Modelos de organización de los servicios de atención al parto : efecto sobre la provisión de servicios y los resultados." Doctoral thesis, Universitat Pompeu Fabra, 2015. http://hdl.handle.net/10803/319718.
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Existen diferentes modelos para la provisión de servicios de atención al parto y distintos factores relacionados con la organización de los servicios en los que se atiende a las mujeres.
En esta tesis se exploran los resultados de la atención al parto en Cataluña, y se comparan los resultados de 64 hospitales en base al tipo de financiación y también al volumen de partos anuales que se atiende en cada centro hospitalario. En este trabajo también se evalúa el impacto de una política sanitaria para implantar un modelo de atención al parto normal, basado en un concepto fisiológico y que
promueve un uso racional de los recursos sanitarios disponibles.
Para contextualizar el trabajo se ha realizado una exploración de diferentes modelos de atención en varios países industrializados, se han buscado los indicadores más utilizados en Europa, para la evaluación de este tipo de atención, y se han elaborado indicadores específicos y adecuados al contexto catalán.
Para la exploración de los diferentes modelos de atención y de los indicadores para la evaluación más utilizados en Europa se ha realizado una revisión crítica de la bibliografía y de diferentes bases de datos. Además se han realizado entrevistas con expertos. Para la comparación de los resultados se han extraído los diagnósticos y procedimientos relacionados del Conjunto Mínimo Básico de Datos (CMBD) registrados en el Servei Català de la Salut. Además, se han agrupado los hospitales según el tipo de financiación y según el volumen de partos atendidos y se han comparado los resultados de todos los partos únicos de entre 37 a 42 semanas de gestación.
Las conclusiones más relevantes son que el tipo de financiación y el volumen de partos atendidos en los hospitales tienen un efecto significativo en las intervenciones obstétricas investigadas en Cataluña. Por otra parte, la realización de episiotomía ha descendido de forma significativa y la incidencia de lesiones perineales graves se ha mantenido por debajo del 1% en todos los hospitales de
Cataluña.There are different models of maternity care and also other factors related to the organisation of services in which women are attended to. In this thesis the results of delivery of birth care in Catalonia are investigated, and the outcomes of 64 hospitals are compared according to the type of financing and volume of births attended to in each hospital. This thesis also evaluates the impact of the undertaken maternity care policy for the implementation of the normal childbirth model of care and to promote a rational use of the existing health care resources. For the contextualization of this work, some models of care in different industrialized countries are explored, and also it has been identified the most widely used indicators for the assessment of maternity care in Europe. Then specific and appropriate indicators for the Catalan context have been developed. To get information on different models of care and to know what indicators are used in the European context, it has been conducted a critical review of literature, an exploration on several database and also interviews with experts. A number of selected diagnoses and procedures have been obtained from the Minimum Basic Data Set (MBDS) recorded in the Catalan Health Service for the comparison of outcomes. Hospitals have been grouped by type of financing and by the volume of births attended to. All singleton births between 37 to 42 weeks of pregnancy have been included on the analysis. The most relevant conclusions are the type of funding and the volume of births in hospital have a significant effect on the obstetric interventions investigated in Catalonia. Also episiotomy has decreased significantly, and the incidence of severe perineal trauma has remained below 1% in all hospitals in Catalonia.
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Coxell, Judith. "Caesarean birth trends in South Australia: 1985 - 2007." Thesis, 2013. http://hdl.handle.net/2440/82551.
Full textAbstract:
The aim of this study was to find the reasons for the increase of caesarean birth in South Australia between 1985 and 2007, during which the caesarean rate increased from 18 per cent to 33 per cent. In South Australia between 1985 and 2007, 108 941 women gave birth by caesarean section, of which 48 056 women delivered a baby by elective caesarean and 60 885 women gave birth by emergency caesarean. The study database consisted of de-identified birth details of 434 682 women and their babies from the mandatory collection of public and private hospital mothers who gave birth in South Australia between 1985 and 2007. Between 1991 and 2007, 37 376 private patients gave birth by caesarean section (18 227 elective and 18 494 emergency) and 47 916 public patients gave birth by caesarean section (19 149 elective and 45 571 emergency caesarean births). The public patient caesarean birth rate increased from 19 per cent in 1991 to 28 per cent in 2007 and the private patient caesarean birth rate increased from 26 per cent in 1991 to 42 per cent in 2007. This thesis investigates caesarean birth data under three main areas: place of birth (for example, regional or metropolitan hospitals; public or private hospitals); demographic characteristics of mothers who gave birth (for example, age of mother and occupation of father); and, the relationship between caesarean birth and socio-economic disadvantage (using the Index of Relative Social Disadvantage scores measured from Australian Census data) in the Adelaide Statistical Division. The caesarean rate has increased in both metropolitan and regional hospitals, with a higher caesarean rate in private compared with public hospitals. A first birth by caesarean was more likely to be an emergency followed by further births which were elective caesareans. The median age of women giving birth by caesarean in private hospitals between 1991 and 2007 has increased from 30 to 33 years of age, and, in public hospitals the median age has increased from 27 to 29 years of age. The father’s occupation as tradespersons was associated with the highest rate of caesarean delivery. Women of most socio-economic advantage had a higher rate of caesarean delivery, a lower rate of gestational diabetes and their babies a lower rate of fetal distress, than more disadvantaged women. Previous reasons given for the increase of caesarean birth rates included the increasing age of mothers, changes in private health insurance policy, malpractice claim fears of medical staff, a shortage of eligible midwives, and, the funding case-mix system for hospitals. A recent Commonwealth Government Maternity Services Review recommends the training of more eligible midwives to give mothers a greater choice of birth models of care. The Australian Medical Association has asked for the collection of comparable birth data to assess this change in birthing policy direction.Thesis (M.A.) -- University of Adelaide, School of Social Sciences, 2013
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Burrage, Lorraine M. "Maternal overweight and obesity : the risk of Caesarean birth /." 2005.
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Meddings, Fiona S., F. M. Phipps, Melanie Haith-Cooper, and Jacquelyn Haigh. "Vaginal birth after caesarean section (VBAC): exploring women's perceptions." 2007. http://hdl.handle.net/10454/2830.
Full textAbstract:
This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background.¿
The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology.¿
Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results.¿
This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions.¿
Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice.¿
This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.
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Meddings, Fiona S., Phipps Fiona E. MacVane, Melanie Haith-Cooper, and Jacquelyn Haigh. "Vaginal birth after caesarean section (VBAC): exploring women's perceptions." 2007. http://hdl.handle.net/10454/6691.
Full textAbstract:
yesAims and objectives. This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background. The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites’ choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology. Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results. This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions. Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice. This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.
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Sayed, Muhammad Shafique. "Delivery after a previous caesarean section at the Chris Hani Baragwanath Hospital." Thesis, 2008. http://hdl.handle.net/10539/4939.
Full textAbstract:
Abstract
Introduction
Chris Hani Baragwanath (CHB) hospital has 20 000 deliveries per annum, with 25%
by caesarean section (CS). Therefore, vaginal birth after caesarean section (VBAC) is
an important delivery option. We questioned the reasons for the low VBAC success
following trial of labour (TOL). The primary objective was to determine the
proportion of eligible patients attempting TOL and the VBAC success rate. Secondary
objectives were to establish reasons for failed VBAC, predictive factors for VBAC,
and maternal and neonatal morbidity and mortality.
Methodology
A retrospective descriptive study by record review, analysing demographic, obstetric
and delivery outcome variables of women with one prior CS in a subsequent
pregnancy.
Results
From the 340 patients eligible for VBAC, 287 (84.4%) attempted TOL and 53
(15.6%) had an elective repeat caesarean section (ERCS). VBAC success was 51.6%
(148/287). Prelabour rupture of membranes and prolonged latent phase of labour
resulted in 40% of failed VBAC. Successful VBAC was associated with a higher
parity, lower birth weight and lower gestation (p<0.001). Positive predictors of
successful VBAC were previous vaginal birth (p=0.004), previous VBAC (p=0.038),
previous CS for malpresentation (p=0.012), birth weight <3500g (p=0.003), and
gestation ≤ 39 weeks (p<0.001). Negative predictors were previous CS for cephalopelvic
disproportion (p=0.003) and women with no prior vaginal deliveries (p<0.001).
There was no maternal mortality. Complications however, included 2 uterine ruptures,
2 uterine dehiscences, 4 hysterectomies, and one intrapartum fetal death. Adverse
maternal outcomes were increased with TOL compared to ERCS (p=0.038), and more
so with failed compared to successful VBAC (p=0.002). Adverse neonatal outcomes
were also increased with TOL compared to ERCS (p=0.048), however there was no
difference in neonatal outcomes between failed and successful VBAC (p=0.420).
Conclusion
VBAC remains a viable option for patients with one prior CS in this setting, despite a
lower VBAC success than developed countries. Failed VBAC due to prelabour
rupture of membranes and prolonged latent phase of labour remains a problem.
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hwang, syin-hwei, and 黃馨慧. "The pregnant process of expectant mothers who have experience of a caesarean birth and decided to have vaginal birth." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/18117185470080604857.
Full textAbstract:
碩士國立臺灣大學
護理學研究所
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Abstract The main purpose of this study, from the viewpoint of expectant mothers who have experience of a Caesarean birth and decided to have vaginal birth, is to thoroughly understand the pregnancy progresses before birth. By utilizing Field Method, as nursing staffs and observer being the participant, 10 such multigravidas were recruited and relevant information was collected from 28 weeks of pregnancy to procreation. During the routine pregnant checks at an interval of one or two weeks, research subjects were contacted, provide with required nurse care and consultation. After the strategy was definitive, home visits were scheduled for profound interviews and instructions of birth, respiration and relaxation. All contacts, spontaneous talking and non-verbal actions of expectant mothers during this period were recorded as records of behavior and process. The verbal actions related to behavior process were then systemically sorted, analyzed, and concluded by Content Analysis. From these research results, the pregnant process of expectant mothers, who have experience of a Caesarean birth and decided to have vaginal birth, could be concluded into 3 stages: Stage 1: the stage for vaginal birth being undecided 1.Unification negative experience of the first birth (1)Feeling helpless from the starting of labor pain to decision of operation (2)Cold and horrible experiences of a Caesarean section (3)Horrible and perplexed experience of post-operative hospitalization (4)Suffering from slow recovery after returning home and doubt about incapable of giving natural birth 2.Thinking of the purpose for choosing natural birth A.In psychological aspect: (1)Being afraid of the recurrence of profound and unforgettable pain (2)Expecting to experience the real procreation (3)Anxiety for achieving the procreation (4)For the purpose of self-approval (5)Considering for birth in future B.In physical aspect: (1)Hoping to maintain the physical integrity (2)Keeping the health of self and the baby Stage 2: the transitional stage for deciding to have a natural birth 1.Vacillating decision and struggle (1)Confliction of VBAC information (2)Doubtfulness on the safety of mother and baby to be through the procreation process (3)Uncertainty on the capability of giving natural birth (4)Worry about the sequela of loose vagina 2.Devoting to search for information and assurance (1)Exerting to search VBAC related knowledge for evaluation (2)Searching supporting system for adopting VBAC manner of giving birth (3)Seeking safety assurance on VBAC from medical staffs. Stage 3: the stage post transition for deciding to have a natural birth self preparation for challenge 1.Exerting to search for knowledge related to VBAC birth 2.Referring to the experience of predecessors for references 3.Self-encouraging to augment the self-confidence 4.Adopting the life styles beneficial for easy delivery From the analysis results of this study, it was known that there was a sequential variation for pregnant processes of expectant mothers, who have experience of a Caesarean birth and decided to have vaginal birth. Different experiences and desires of expectant mothers in various stages were also overall presented. These processes were rather arduous and lonely but they faced these difficulties with extreme persistence and effort. This will be helpful for clinical nursing staffs to understand the inner world of expectant mothers, who have experience of a Caesarean birth and decided to have vaginal birth, as well as to provide consultation for adequate nursing cares. Key words: vaginal birth after a caesarean birth, decision, pregnant process
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Wang, Keshu. "Association Between caesarean delivery and childhood adiposity: results from a portuguese birth cohort study." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/88611.
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Wang, Keshu. "Association Between caesarean delivery and childhood adiposity: results from a portuguese birth cohort study." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/88611.
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Seedat, Bibi Ayesha. "Comparison of a private midwife obstetric unit and a private consultant obstetric unit." Thesis, 2008. http://hdl.handle.net/10539/5680.
Full textAbstract:
Background: The role of Midwife Obstetric Units (MOUs) as lead caregivers for low
risk pregnancies has been a topic of much debate in recent years. It has been
suggested that MOUs are more cost effective, and have a less interventionist approach
to low risk pregnancies, when compared to Consultant Obstetric Units (COUs).
Objectives: The primary objective of this study was to compare intrapartum delivery
procedures, methods of delivery, and maternal and neonatal wellbeing for low risk
pregnancies between a MOU and a COU. The second objective was to investigate the
predictors of key outcomes such as caesarean sections and perineal tears. The research
was carried out at a private obstetric unit in Gauteng from January 2005-June 2006.
Materials and Methods: The study design was a retrospective cohort study, by
means of a record review of routinely collected data. 808 subjects (212 COU and 596
MOU patients) satisfied the criteria for a low risk pregnancy during the defined period
and were included in the analysis.
Results: Overall the MOU had fewer interventions than the COU, but had very
similar maternal and neonatal outcomes. MOU patients were less likely to have an
epidural than COU patients (p<0.001), and more likely to utilise a bath for pain relief
(p<0.001). The MOU was also less likely to induce a patient than the COU (p=0.002).
Primiparous patients accounted for more than 95% of the caesarean section (C/S) rate
(p<0.001), with the COU performing 2.2 times more C/S on primiparous patients than
the MOU. Vaginal birth in the MOU was 2.6 times more likely to be an underwater
birth (UWB) than the COU (p<0.001). Positive predictors for C/S were COU care,
primiparous status and induction of labour. UWB was a positive predictor for grade 1
and 2 perineal tears. There were no maternal or neonatal deaths, in either unit, during
the study period.
There were no significant differences between the MOU and COU for maternal
morbidity indicators (tears, postpartum haemorrhage, and retained placenta) or
neonatal morbidity indicators (Apgar < 7 at 5 minutes and neonatal ICU admission).
Conclusion: The MOU had fewer intrapartum interventions (epidurals and induction
of labour) and lower C/S rates than the COU for low risk pregnancies, yet maternal
and neonatal outcomes were similar. This study suggests that the MOU can function
just as effectively as the COU for low risk pregnancies. Therefore the establishment
of more MOUs would have immense resource implications for both the public and
private health sectors in South Africa.
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Lazarus, Kim Yael. "Exploring maternal identity formation of first time mothers who gave birth through a non-elective caesarean section." Thesis, 2017. https://hdl.handle.net/10539/26348.
Full textAbstract:
This is a research project submitted in partial fulfillment of the requirements for the degree of Masters in Clinical Psychology in the department of Psychology, University of the Witwatersrand, Johannesburg, 8 December 2016.The performance of Caesarean sections is increasing around the world. In recent years, South Africa has seen a substantial rise in the number of Caesarean section deliveries. Literature has focused on the incorporation of the maternal role into a women’s identity post-partum in general. However, less emphasis has been placed on how an unplanned method of delivery such as a non-elective Caesarean section influences this process against a backdrop of societal and self-imposed expectations. The current study explored the process of maternal identity formation of first time mothers who delivered their babies through a non-elective Caesarean section. The sample consisted of six first time mothers who gave birth through a non-elective Caesarean section. This is a qualitative, Interpretative Phenomenological Analysis (IPA) research design that utilized semistructured interviews. The data was analyzed with the use of thematic analysis. Findings indicated that there is a strong need for mothers to be seen as ‘good enough’ and this impacts their ability to process their own birthing experience. There seems to exist negative judgment by other mothers and society in general around delivering through a Caesarean section; however the nature of this stigma cannot be named due to its impact on maternal identity. Other important themes that emerged include flexibility and control, the importance of support, and the psychological role of labor as a means of preparation for processing the idea of giving birth through a non-elective Caesarean section.
MT 2019
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Petrovska, Karolina. "Choosing vaginal breech birth : discourses of breech birth in contemporary society." Thesis, 2017. http://hdl.handle.net/10453/102736.
Full textAbstract:
University of Technology Sydney. Faculty of Health.[Aim] Most breech presenting babies are born by elective Caesarean section. Very few are born vaginally, with even fewer accounting for planned, rather than unplanned, vaginal birth. Despite maternity services in middle and high income countries offering limited support for planned vaginal breech birth, some women continue to seek this option for birth. Little is known about these women and how socio-cultural views impact on their decision-making for birth. The aims of this research were to understand how social discourse in contemporary society impact on women’s decisions for vaginal breech birth; explore how and why women make decisions for this birth option; and identify strategies for clinicians to support women considering vaginal breech birth. [Methods] A multi-methods study was undertaken in which four different approaches were employed to gather data for this project. The approaches were taken in four parts: 1) semi-structured interviews with 22 women who opted for a vaginal breech birth in Australia; 2) an international online survey of 204 women between April 2014 - January 2015 who sought a vaginal breech birth; 3) an analysis of internet forum discussions; and 4) a content analysis of online news media to explore how breech presentation and birth are portrayed. [Findings] Social discourse in contemporary society holds a strong belief that Caesarean section is the safe way to manage the birth of a breech baby. Planned vaginal breech birth has a limited profile in society and is seen as a high risk option. These views may be the result of limited clinical support for this birth option. Despite this resulting in anxiety for women when decision-making for this mode of birth, women seeking a vaginal breech birth feel strongly about bodily autonomy and their ability to give birth. They are able to transcend negative views of others and display a determination in finding supportive care for birth. These findings are presented in Chapters 4-8, which outline the results and conclusions arising from this study. [Conclusion and implications] Clinical recognition of vaginal breech birth as a legitimate option for women may address socio-cultural perceptions of risk relating to this birth option. Strategies to increase the profile of vaginal breech birth in clinical settings include the development of high level policy supporting this birth option, increasing availability of vaginal breech birth services and targeted training programs for clinicians. This in turn may normalise the option of vaginal breech birth in socio-cultural contexts and facilitate a more positive experience for women seeking this mode of birth.
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Derbie, Engida Yisma. "Obstetrical interventions during labour and birth: an examination of effects on breastfeeding, neonatal mortality and children’s educational outcomes." Thesis, 2020. https://hdl.handle.net/2440/135370.
Full textAbstract:
Background
Obstetrical interventions during labour and birth are essential for perinatal care as part of any contemporary obstetric practice. Various underlying biological mechanisms have been proposed in linking obstetrical interventions during labour and birth with breastfeeding, infant’s health and children’s neurodevelopmental outcomes at later life. These mechanisms include changes in the gut microbiota composition, exposure to different levels of physical stress and stress hormone surges during labour and delivery, as well as epigenetic alteration of gene expression. The available evidence regarding the effect of obstetrical interventions during labour and birth on short-and long-term outcomes is limited. For instance, much of the available evidence was generated from high-income countries. Moreover, many of the previous studies were hampered by non-longitudinal study designs, small sample sizes and inconsistent findings, which may be due to suboptimal control of confounders and other biases. This thesis addresses these issues and utilises data from low-, middle- and high-income country settings.
Aims
The overarching aim of this thesis is to examine the effect of obstetrical interventions during labour and birth on breastfeeding indicators (early initiation of breastfeeding, exclusive breastfeeding under 6 months, and children ever breastfed), neonatal mortality and children’s educational outcomes at eight years of age.
Specifically, the aims include:
-To estimate the prevalence and examine sociodemographic factors associated with caesarean section in Ethiopia.
-To examine the changing temporal association between caesarean birth and neonatal death in Ethiopia from 2000 to 2016 as well as to provide an interpretation of the associations using the ‘Three Delays Model’ in the context of Ethiopia.
-To investigate the effect of caesarean section on breastfeeding indicators—early initiation of breastfeeding (within 1 hour), exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in each of the 33 countries in sub-Saharan Africa, as well as to summarise the magnitude of these within-country effects in an overall estimate using random-effects meta-analyses.
-To examine the effect of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on children’s educational outcomes at eight years of age.
-To estimate the effect of elective induction of labour at 39 weeks of gestation as compared with expectant management on children’s educational outcomes at eight years of age. Methods
Data for this thesis were drawn from the Demographic and Health Surveys (DHS) and the South Australian Early Childhood Data Project (SAECDP). The DHS are widely available high-quality data sources from low- and middle-income countries. The SAECDP is an established project that encompasses high-quality whole-of-population linked administrative data from state and federal sources in South Australia. The DHS data from 33 low- and middle-income countries in sub-Saharan Africa were used for the first three studies while the SAECDP data from South Australia were used for the final two studies in this thesis. The use of these two different data sources allowed this thesis to capture the effects of obstetrical interventions during labour and birth on women’s breastfeeding practices, neonatal health and children’s educational outcomes across diverse health system resource settings. For each study, the potential confounding was identified based on a priori subject matter and expert knowledge as well as through the use of the Directed Acyclic Graphs (DAGs). The analytic approaches to answer the aims of this thesis included the modified Poisson regression (Log-Poisson regression), augmented inverse probability weighed (AIPW) estimator, negative control outcome (a tool for detecting confounding and bias), random-effects meta-analysis as well as an application of the ‘Three Delays Model’.
Results
In the first study, the national caesarean section rate increased from 0.7% in 2000 to 1.9% in 2016, with increases across 7 of the 11 administrative regions in Ethiopia. In the adjusted analysis, women who gave birth in a private health facility had a 78.0% higher risk of caesarean section (adjusted prevalence ratio (aPR) (95% CI) 1.78 (1.22 to 2.58) when compared to women who gave birth in public health facility. Having four or more births was associated with a lower risk of caesarean section compared to first births (aPR (95% CI) 0.36 (0.16 to 0.79)). In the second study, in Ethiopia, the adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI, 0.29 to 3.19) in 2000 to 2.81 (95% CI, 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. On the other hand, the aggregate-level analysis revealed that increased caesarean section rates were correlated with a decreased proportion of neonatal deaths.
In the third study, the within-country analyses in sub-Saharan Africa showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI, 0.17 to 0.33) in Tanzania to 0.89 (95% CI, 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI; 0.34 to 0.98) in Angola to 1.93 (95% CI; 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI, 0.82 to 1.02) in Gabon to 1.02 (95% CI, 0.99 to 1.04) in Gambia. The meta-analysis combining effect estimates from 33 countries in sub-Saharan Africa showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI, 0.48 to 0.60)). However, the pooled effects indicated there was little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI; 0.88 to 1.01) and children ever breastfed (pooled aPR, 0.98 (95% CI; 0.98 to 0.99) among caesarean versus vaginally born children.
In the fourth study, after adjusting for confounding, the risk differences comparing five-minute Apgar scores of 0-5 with Apgar score of 10 for children scoring at/below the national minimum standard (NMS) on the National Assessment Program—Literacy and Numeracy (NAPLAN) tests for each domain were: reading (0.07 (95% CI -0.16 to 0.29)), writing (0.27 (95% CI -0.14 to 0.68)), spelling (0.15 (95% CI -0.10 to 0.40)), grammar (0.04 (95% CI -0.21 to 0.29)) and numeracy (0.21 (95% CI -0.04 to 0.45)). Risk differences for children performing at/below the NMS were also evident when Apgar score of 6 were compared with Apgar score of 10.
In the fifth (last) study, after adjusting for confounding, the average treatment effects (ATEs) comparing elective induction of labour at 39 weeks of gestation with expectant management for children scoring at/below the NMS on each domain were: reading (0.01 (95% CI -0.02 to 0.03)), writing (0.02 (95% CI -0.00 to 0.04)), spelling (0.01 (95% CI -0.01 to 0.04)), grammar (0.02 (95% CI -0.01 to 0.04)) and numeracy (0.03 (95% CI 0.00 to 0.05)).
Conclusions
The findings from this thesis present a comprehensive analyses of the effect of obstetrical interventions during labour and birth on breastfeeding, neonatal mortality and children’s educational outcomes at eight years of age by utilising data from low-, middle-, and high-income countries. The findings of Study 1 highlighted that there were large disparities in caesarean section use in Ethiopia, demonstrating unequal access. The results from Studies 2, 3 and 4 suggest that obstetrical interventions during labour and birth (caesarean section and Apgar score) have an influence on neonatal mortality, breastfeeding and children’s educational outcomes at later age. However, the findings of Study 5 suggest that elective induction of labour at 39 weeks of gestation as compared with expectant management did not affect children’s educational outcomes at eight years of age.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2020
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Chamisa, Judith Audrey. "Zimbabwean Ndebele perspectives on alternative modes of child birth." Thesis, 2013. http://hdl.handle.net/10500/14384.
Full textAbstract:
The study explored cultural perspectives of the Zimbabwean Ndebele on alternative modes of childbirth. A qualitative generic, exploratory and descriptive design guided the study. The problem is that alternative modes of birthing are not acceptable to the Zimbabwean Ndebele. Women who give birth through alternative modes of birthing, which include caesarean section (CS) instrumental deliveries (ID) and any other unnatural modes are stigmatised. Data were collected from purposively selected samples of women who had given birth through alternative modes of birthing, spouses, mothers-in-law, community elders, sangomas (traditional healers) and traditional birth attendants (TBAs) using individual unstructured in-depth interviews, structured interviews and focus group interviews (FGIs). Data were analysed through use of qualitative content analysis which involved verbatim transcripts. Interpretations of narrations of data and script reviewing were done while simultaneously listening to audio-tapes which were transcribed in the IsiNdebele the language that was used to collect data. Data were then translated into English to accommodate all readers.
Accounts of all the informants that were interviewed point to effects of supernatural ancestral powers, infidelity and use of traditional and herbal medicines as cause for “tiedness” (labour complications), a concept that showed a strong thread throughout the study. Study findings illuminated that traditional practices are culture-bound and the desire is to perpetuate the valued culture.
Recommendations made from the study are; cultural orientation of local and foreign health workers, cultural consultation and collaboration with sangomas (traditional healers) and particular recognition of the significance of the study as a cultural heritage of the Zimbabwean Ndebele society. Further research on how women and their spouses cope with the grieving process after experiencing the crisis and grief following CS is recommended. With all the recommended areas addressed, Zimbabwean Ndebele would find alternative modes of birthing acceptable.Health Studies
D. Lit. et Phil. (Health Studies)
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Tegegne, Teketo Kassaw. "Spatial patterns of maternal health service utilisation and determinant factors in Ethiopia." Thesis, 2020. http://hdl.handle.net/1959.13/1421575.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Access to and utilisation of maternal health services are very limited in low- and middle-income countries. Maternal morbidity and mortality are very high in these countries due to the limited access to and use of maternal health services. This is the case in Ethiopia, where a high number of maternal deaths occur every year. A geographically linked data analysis using population and health facility data is valuable for mapping maternal health service access and use. It also enables the identification of both the demand- and supply-side factors associated with the use of this service. This study aimed to assess the geographic variations and determinants of maternal health service use in Ethiopia. This thesis used data from national population and health facility-based surveys. The two datasets were linked using geographic data linking methods. After linking these datasets, spatial analyses were carried out to identify geographic variations in maternal health service use in Ethiopia. Multilevel analyses were also undertaken to identify determinants of maternal health service use in Ethiopia. There were wide geographic variations in maternal health service use across Ethiopia. Maternal health service use was influenced by both demand- and supply-side factors. Women and their spouses’ education, parity, household wealth and place of residence were the most important demand-side factors in using maternal health services. Geographic access to and the availability of maternal health services, and the service readiness of healthcare facilities, were the most important supply-side factors. There are geographic variations in maternal health service use in Ethiopia, revealing critical gaps in service availability and readiness. This indicates a need for targeted future investment to increase access to and use of these services, which in turn will contribute to the reduction of maternal morbidity and mortality.
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Stahl, Katja. "Betreuungszufriedenheit von Wöchnerinnen in deutschen Krankenhäusern. Konstituierende DImensionen, Rolle des Geburtsmodus und Gesamtzufriedenheit." Doctoral thesis, 2012. https://repositorium.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-2012102510452.
Full textAbstract:
Hintergrund: Die Bedeutung der intra- und postpartalen Betreuungserfahrung für die psychische und physische Gesundheit von Mutter und Kind ist weitgehend anerkannt. Aktuelle Daten aus größeren Untersuchungen im deutschen klinischen Kontext liegen nicht vor. Die Evidenzen zur Betreuungszufriedenheit in Abhängigkeit vom Geburtsmodus sind uneinheitlich, der Einfluss einzelner Betreuungsdimensionen auf die Gesamtzufriedenheit ist speziell im Bereich der postpartalen Versorgung wenig untersucht. Ziel: Ermittlung der Dimensionen der intra- und postpartalen Betreuungserfahrungen in deutschen Kliniken, Analyse des Einflusses des Geburtsmodus auf diese Dimensionen sowie Prüfung des Einflusses der Dimensionen auf die Betreuungszufriedenheit insgesamt. Methode: Analyse der Daten aus 235 postalischen Befragungen in 129 geburtshilflichen Abteilungen, durchgeführt vom Picker Institut Deutschland gGmbH zwischen 2002 und 2009. Teilnehmerinnen: 16.315 Wöchnerinnen, die ihr Kind nach der vollendeten 37. Schwangerschaftswoche in einem deutschen Krankenhaus zur Welt gebracht haben. Ergebnisse: Ermittelt wurden 9 Dimensionen, die die intra- und postpartale Betreuung, die postpartale Schmerzlinderung sowie Hotelaspekte der Versorgung im Krankenhaus abbilden. Generell zeigte sich eine hohe Zufriedenheit, jedoch wird die postpartale Betreuung kritischer beurteilt als die intrapartale Betreuung. Es zeigte sich eine unterschiedliche Betreuungszufriedenheit bei Frauen mit geplanter und ungeplanter Sectio, mit einer Tendenz zu höherer Unzufriedenheit bei letzteren. Im Vergleich zu Frauen mit vaginaler Geburt sind Frauen mit geplantem Kaiserschnitt mit der ärztlichen Betreuung zufriedener (OR 0,7, 99% KI 0,6 - 0,9), Frauen mit ungeplantem Kaiserschnitt mit der Hebammenbetreuung unzufriedener (OR 1,5, 99% KI 1,3 - 1,9) und Frauen sowohl mit geplanter als auch ungeplanter Sectio mit der postpartalen Schmerzlinderung unzufriedener (OR 1,8, 99% KI 1,5 - 2,1 bzw. OR 1,8, 99% KI 1,6 - 2,0). Die Dimension Betreuung auf der Wochenbettstation weist den mit Abstand stärksten Einfluss auf die Zufriedenheit mit der klinischen Betreuung insgesamt auf. Darüber hinaus sind es vor allem die Dimensionen mit Fokus auf der Interaktion mit den betreuenden Fachkräften, die maßgeblich die Gesamtzufriedenheit beeinflussen. Der subjektive Gesundheitszustand, die Zuversicht, mit dem Kind zuhause zurecht zu kommen, und die Verweildauer erwiesen sich als weitere wichtige Prädiktoren der Zufriedenheit mit den Betreuungsdimensionen und der Gesamtzufriedenheit. Schlussfolgerung: Die maßgebliche Bedeutung der interpersonellen Betreuungsaspekte sowie die kritischere Beurteilung der postpartalen Betreuung im Vergleich zur intrapartalen bestätigen sich auch für den deutschen klinischen Kontext. Der Geburtsmodus scheint insbesondere für die Zufriedenheit mit der intrapartalen Betreuung sowie der postpartalen Schmerzlinderung eine Rolle zu spielen. Die größere Unzufriedenheit mit der postpartalen Schmerzlinderung bei Kaiserschnittgeburt deutet auf die Notwendigkeit eines effektiveren Schmerzmanagements hin. Vor dem Hintergrund der negativen Auswirkungen starker Schmerzen auf den Aufbau der Mutter-Kind-Beziehung sollte die Entscheidung zum geplanten Kaiserschnitt ebenso wie der Einsatz von Interventionen, die einen ungeplanten Kaiserschnitt begünstigen, sehr sorgfältig abgewogen werden. Den konstituierenden Dimensionen und Einflussfaktoren der postpartalen Betreuungszufriedenheit sollte mehr Aufmerksamkeit gewidmet werden, insbesondere mit Blick auf effektive Betreuungskonzepte und eine systematische Verzahnung mit der ambulanten Betreuung.
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Hoffmann, Franziska. "Untersuchung der Patientenzufriedenheit nach abdominaler Schnittentbindung." Doctoral thesis, 2012. https://ul.qucosa.de/id/qucosa%3A13134.
Full textAbstract:
Objective:
We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined.
Method:
Online survey of women who had at least one CS
Results:
We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS .
The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions.
Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed.
Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required.
In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved.
Conclusions:
A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.
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Bayou, Yibeltal Tebekaw. "Maternal health care seeking behaviour and preferences for places to give birth in Addis Ababa, Ethiopia." Thesis, 2014. http://hdl.handle.net/10500/18766.
Full textAbstract:
PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia.
DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study.
METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care.
RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services.
Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities.
Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication.
CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously.Health Studies
D. Litt.. et Phil. (Health Studies)
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Begum, Mumtaz. "The incidence, risk factors and implications of type 1 diabetes: whole-of-population linked-data study of children in South Australia born from 1999-2013." Thesis, 2020. http://hdl.handle.net/2440/128227.
Full textAbstract:
The aim of this doctoral thesis was to study the incidence, risk factors and outcomes of type 1 diabetes for children in South Australia, born from 1999-2013. The incidence of type 1 diabetes has doubled in the last four decades in many countries including Australia, and has substantial individual and economic consequences. Evidence from studies on type 1 diabetes aetiology and its implications is mixed. In this thesis, the linkage of multiple population-wide administrative data over 15 years, and use of rigorous epidemiological approaches has resulted in a better understanding of the risk factors and implications of type 1 diabetes. There are four studies in this doctoral thesis. In the first descriptive study, the incidence of type 1 diabetes was estimated by individual and area-level socioeconomic characteristics among children (aged ≤11 years) in South Australia, born from 2002-2013. Findings of the study showed that type 1 diabetes incidence rates differed depending on the measures of socioeconomic characteristics. Individual-level indicators showed higher type 1 diabetes incidence among more advantaged children, however, there was no clear area-level socioeconomic patterning of type 1 diabetes. Area-level measures of socioeconomic position are likely to have a greater risk of misclassification from true socioeconomic position, which suggests that the use of area-level measures may be misleading. Socioeconomic position is a major determinant of health and can modify the risk factors of type 1 diabetes. For example, as per hygiene hypothesis, the socioeconomically dis-advantaged children are less likely to have type 1 diabetes, which is supported by the findings of individual-level socioeconomic patterning of type1 diabetes in the first study. In addition, socioeconomically disadvantaged women are less likely to have a caesarean birth and more likely to smoke in pregnancy. I chose to study these two risk factors of type 1 diabetes because the evidence was inconsistent, and some studies had methodical limitations. Evidence about the effect of caesarean section on childhood type 1 diabetes is mixed; ranging from very small or no risk to 20-30% increased risk. A prevailing theory is that exposure to the gut and vaginal microbiota during a vaginal birth protects against type 1 diabetes. Therefore, in the second study, the impact of caesarean birth on childhood type 1 diabetes (aged ≤15 years) was estimated. This involved linking multiple administrative datasets of children in South Australia, born from 1999-2013. The question was extended to whether type 1 diabetes risk differed for children born by prelabour or intrapartum caesarean to further test the idea of microbiota exposure on type 1 diabetes. That is because children born by prelabour caesarean do not get exposure to maternal vaginal microbiota, and intrapartum caesarean births may have some exposure. Findings of the study obtained from Cox proportional hazard regression analysis showed a negligible 5% higher incidence (HR = 1.05, 95% CI 0.86-1.28) for caesarean births compared with normal vaginal delivery, with wide confidence intervals including the null. Contrary to the hypothesis of a higher type 1 diabetes risk for prelabor caesarean (because of non-exposure to maternal vaginal microbiota) type 1 diabetes risk for intrapartum caesarean was slightly higher (HR = 1.08, 95% CI 0.82-1.41) than prelabor caesarean (HR = 1.02, 95% CI 0.79-1.32). This negligible risk of type 1 diabetes for children who had caesarean birth, either prelabor or intrapartum, and the potential for unmeasured confounding suggested that birth method induced variation in neonatal microbiota might not be involved in modifying type 1 diabetes risk. Like caesarean section, maternal smoking in pregnancy is also a debated risk factor for childhood type 1 diabetes. Evidence about maternal smoking on childhood type 1 diabetes is inconsistent; studies have been small, and many did not adjust for important confounders or address missing data. In the third study of this doctoral thesis, the effect of maternal smoking in pregnancy on childhood type 1 diabetes was estimated using Cox proportional hazard regression analysis, once again by linking multiple administrative datasets of children in South Australia, born from 1999-2013. The analytical approach for this study ranged; from Cox proportional hazard analysis with adjustment for wide range of confounders using the SA ECDP linked data, involving multiple imputation for missing data; to conducting meta-analysis in order to get more precise estimate. But smoking is notoriously residually confounded, therefore, I made special efforts to investigate the possibility of residual confounding by using a negative control and E-value. The findings demonstrated that maternal smoking in pregnancy was associated with a 16% (HR 0.84, 95% CI 0.67, 1.08) lower childhood type 1 diabetes incidence, compared with unexposed children, which was also supported by the meta-analytic estimates of population-based cohort studies (HR 0.72, 95% CI 0.62, 0.82) and case-control studies (OR 0.71, 95% CI 0.55, 0.86). The negative control outcome and E-value analyses indicated the potential for residual confounding in the effect of maternal smoking on childhood type 1 diabetes. Triangulation of evidence from this study along with the results of similar population-based studies, suggested a small reduced risk of childhood type 1 diabetes for children exposed to maternal smoking in pregnancy. However, the mechanisms linking maternal smoking in pregnancy with childhood type 1 diabetes require further investigation. In the fourth study of this thesis, the impact of childhood type 1 diabetes on children’s educational outcomes in year/grade 5 at age ~10 were estimated, linking population-wide data of children in South Australia, born from 1999-2005. In this study, a doubly-robust analytical method called augmented inverse probability weighting (AIPW) was used to compute the average treatment effect of type 1 diabetes on children’s educational outcomes. AIPW gives an unbiased estimate if either the outcome model or the treatment model is correctly specified. The findings of this study demonstrated that children with type 1 diabetes are not disadvantaged in terms of educational outcomes in year 5, potentially reflecting improvement in type 1 diabetes management in Australia. In summary, the work in this doctoral thesis has demonstrated that type 1 diabetes incidence differed depending on the measure of socioeconomic position. The hygiene hypothesis was only supported by the individual-level socioeconomic pattering of type 1 diabetes incidence in South Australia. The involvement of birth method induced variation in neonatal microbiota in type 1 diabetes was not supported by the caesarean and childhood type 1 diabetes study. Despite the evidence of residual confounding in the estimate of maternal smoking in pregnancy on childhood type 1 diabetes, triangulation of the evidence suggested small reduced risk for children exposed to maternal smoking in pregnancy, but further research will be needed to understand the mechanism. The findings of similar educational outcomes for children with and without type 1 diabetes, highlighted the importance of improvements in diabetes management.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2020
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Van, der Westhuizen Werner Lukas. "Women's experiences of hypnotherapy as psychological support for high-risk pregnancy." Diss., 2014. http://hdl.handle.net/10500/14144.
Full textAbstract:
In this study, the use of hypnotherapy in high-risk pregnancy is explored from an ecological systems perspective through two case studies. Each case study is described in detail. They explore the experiences of two women during their pregnancy and giving birth, with specific reference to the pregnancy risks and their use of hypnotherapy. The study provides the reader with an in-depth understanding of the use of hypnotherapy before, during and after birth.Psychology
M.A. (Psychology)