Medicalized Birth and the Construction of Risk

2016 ◽  
Author(s):  
Daisy Deomampo
Keyword(s):  
High Risk ◽  
Cesarean Section ◽  
Social Control ◽  
Cesarean Delivery ◽  
Cesarean Sections ◽  
Surrogate Mother ◽  
Surrogate Mothers ◽  
Medical Technologies ◽  
Gestational Surrogacy

Extending the discussion of physician racism in chapter 5, chapter 6 explores the ways in which doctors provide medical technologies and treatments to surrogate mothers, arguing that doctors racialize women who become surrogate mothers in ways that construct the surrogate mother and her pregnancy as always and already high-risk. This chapter contends that this construction contributes to the justification of excessive medicalization in surrogate pregnancies. The chapter shows how doctors rely on practices of social control and excessive medicalization to control women’s pregnancies, which culminate in soaring rates of cesarean sections among surrogate mothers. This chapter illuminates how gestational surrogacy and cesarean delivery are inextricably intertwined; these interrelated processes stem from practices that racialize this group of women as inherently risky. The chapter concludes with an analysis of the ways in which surrogates understand and negotiate these practices of medicalization and social control, focusing on their views and experiences of cesarean section.

scholarly journals Formulating an anesthetic plan using a list of high-risk pregnant women on cloud-based business communication tools: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Junnosuke Kimura ◽  
Kento Kawamura ◽  
Manami Minoura ◽  
Ayako Hiramoto ◽  
Yoshifumi Suga ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Business Communication ◽  
Communication Tools ◽  
Case Presentation ◽  
Emergency Cesarean

Abstract Background We report a case in which a list of high-risk pregnant women on cloud-based business communication tools was useful in formulating an anesthetic plan for unscheduled cesarean section. Case presentation A 37-year-old woman, who had been prescribed icosapentate for hypertriglyceridemia, received an antenatal anesthetic evaluation for possible cesarean delivery, and it was agreed that the anesthetic method for emergency cesarean section was general anesthesia if the surgery would take place within 7 days after the discontinuation of the drug, and regional anesthesia if it would take place any time later. Then this agreement was uploaded on the cloud-based business communication tools, and updated until she delivered her baby via unscheduled cesarean section. Conclusions A cloud-based business communication tools was useful in formulating an anesthesia plan for a patient undergoing a cesarean delivery. However, more discussion would be needed to utilize it in security.

Potentially Preventable Primary Cesarean Sections in Future Placenta Accreta Spectrum

2021 ◽  
Author(s):  
Kathy C. Matthews ◽  
Andrew S. Quinn ◽  
Stephen T. Chasen
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Placenta Accreta ◽  
External Cephalic Version ◽  
Cesarean Sections ◽  
Medical Indication ◽  
Placenta Accreta Spectrum ◽  
Primary Cesarean Delivery ◽  
Insured Patients ◽  
Privately Insured

Background Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated. Objective The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum. Study Design This was a single-center retrospective cohort study of women with pathology-confirmed placenta accreta spectrum from 2007 to 2019. Primary cesarean sections were categorized as potentially preventable or unpreventable based on practice consistent with the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine “Safe Prevention of the Primary Cesarean Delivery” recommendations. Fisher's exact test and Mann-Whitney U-test were used for comparison with p <0.05 considered statistically significant. Results Seventy-two patients had pathology-confirmed placenta accreta spectrum over the course of the study period, 15 (20.8%) of whom required a cesarean hysterectomy at the time of primary cesarean section. Fifty-seven patients had placenta accreta spectrum in a pregnancy following their primary cesarean section. Of these, 29 (50.9%) were considered potentially preventable. Most were performed without clear medical indication (37.9%) or for fetal malpresentation without attempted external cephalic version (37.9%). The remainder were due to arrest of labor not meeting criteria (17.2%) and abnormal or indeterminate fetal heart patterns with documented recovery (6.9%). Of the 11 patients without clear medical indication for primary cesarean section, eight (72.7%) were patient-choice cesarean sections and three (27.3%) were for suspected fetal macrosomia with estimated fetal weights not meeting criteria for cesarean delivery. There was no difference in the incidence of potentially preventable primary cesarean sections before and after the ACOG-SMFM “Safe Prevention of the Primary Cesarean Delivery” publication (48.8 vs. 57.1%, p = 0.59). Privately insured patients were more likely to have a potentially preventable primary cesarean section than those with Medicaid (62.5 vs. 23.5%, p = 0.008) and were more likely to have a primary cesarean section without clear medical indication (81.8 vs. 18.2%, p = 0.004). Conclusion Many patients with placenta accreta spectrum had a potentially preventable primary cesarean section. Most were performed without clear medical indication or for malpresentation without attempted external cephalic version, suggesting that at least a subset of placenta accreta spectrum cases may be preventable. This was particularly true for privately insured patients. These findings call for continued investigation of potentially preventable primary cesarean sections with initiatives to address concerns at the patient, provider, and hospital level. Key Points

scholarly journals Improving the Management of High-Risk Pregnancies with the Use of the Robson Classification

2020 ◽  
Vol 42 (08) ◽  
pp. 448-453
Author(s):  
Mario Dias Correa Junior ◽  
Bárbara Moreira Ribeiro Trindade dos Santos ◽  
José Reinaldo Correa Roveda ◽  
Laura Carolina Menezes Vieira Silva ◽  
Larissa Silva Guimarães ◽  
...  
Keyword(s):  
High Risk ◽  
Cesarean Delivery ◽  
Lower Risk ◽  
Positive Impact ◽  
Risk Groups ◽  
University Hospital ◽  
Cochrane Library ◽  
Cesarean Sections ◽  
Robson Classification ◽  
Maternity Hospitals

Abstract Objective To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification. Methods Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases. Results There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups, while the rate among the higher-risk groups remained stable. Conclusion The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.

scholarly journals Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam

2022 ◽  
Vol 19 (2) ◽  
pp. 884
Author(s):  
Doan Thi Thuy Duong ◽  
Colin Binns ◽  
Andy Lee ◽  
Yun Zhao ◽  
Ngoc Minh Pham ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Exclusive Breastfeeding ◽  
Urban Areas ◽  
Maternal Education ◽  
Fetal Loss ◽  
Cesarean Sections ◽  
Normal Birth ◽  
Breastfeeding Intention ◽  
The Relationship

Background: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. Methods: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020–2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. Results: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31–0.96, p = 0.034). Conclusions: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.

scholarly journals The case of a pregnant woman with ARDS due to COVID-19 treated with Hydroxychloroquine, Azithromycin, and Remdesivir and delivery of a healthy baby during mechanical ventilation through cesarean section

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Adria Madera-Acosta
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Pregnant Woman ◽  
High Risk ◽  
Cesarean Section ◽  
Cesarean Delivery ◽  
Clinical Outcomes ◽  
Pregnant Female ◽  
Healthy Baby ◽  
Increase Risk

We are in the midst of a pandemic due to SARS-CoV-2. Pregnancy was identified among the risk factors for worse clinical outcomes in multiple studies. The optimal therapy in this group of patients remains to be defined. Here we present the case of a 39 years old Caucasian pregnant female at 31 weeks of gestation who was treated successfully with hydroxychloroquine, azithromycin, remdesivir, prone therapy, and cesarean delivery of a healthy baby while on mechanical ventilation. The SARS-CoV-2 remained positive until the 39th day of hospitalization. We discussed the pathophysiology of the increase risk of infections during pregnancy and particularly the high risk of microthombosis and coagulopathy due to COVID-19. Ultimately the contribution of the medications used to the favorable outcomes remained unknown being more likely that the delivery helped resolve the infection.

Increased rates of cesarean sections and large families: a potentially dangerous combination

2017 ◽  
Vol 45 (5) ◽  
Author(s):  
Ahmed M. Saleh ◽  
Joachim W. Dudenhausen ◽  
Badreldeen Ahmed
Keyword(s):  
Immune System ◽  
Cesarean Section ◽  
Cesarean Delivery ◽  
World Health ◽  
Safe Procedure ◽  
Cesarean Sections ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
The World ◽  
Large Families

AbstractRates of cesarean sections have been on the rise over the past three decades all over the world, despite the ideal rate of 10–15% that had been set by the World Health Organization (WHO) in 1985, in Fortaleza, Brazil. This epidemic increase in the rate of cesarean delivery is due to many factors which include, cesarean delivery on request, advanced maternal age at first pregnancy, decrease in number of patients who are willing to try vaginal birth after cesarean delivery, virtual disappearance of vaginal breech delivery, perceived increase in the weight of the fetus and increase in the number of women with chronic medical conditions such as Diabetes Mellitus and congenital heart disease in the reproductive age. There is no doubt that cesarean delivery is a safe procedure and it is getting safer and safer for many reasons. However, like all other surgical procedures it is not without risks both to the mother and the new born. There is a substantial increase in the incidence of morbidly adherent placenta and the risk of scar pregnancy. In the Middle East and many African and Asian countries women tend to have large families. The number of previous cesarean section deliveries is directly proportional to the risk of developing morbidly adherent placenta. Morbidly adherent placenta is the most common cause of emergency postpartum hysterectomy, which is often associated with multiple surgical complications, severe maternal morbidity and mortality. The increased rates of cesarean sections lead to increased rates of scar pregnancies, which can have lethal consequences. Cesarean delivery has a negative impact on the infant immune system. This effect on the infant led to the introduction of a new concept called “Vaginal seeding”. This refers to the practice of transferring some maternal vaginal fluid to the infant born via cesarean section in an effort to enhance its immune system.

scholarly journals Publisher Correction: Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005–2015

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
L. Cegolon ◽  
G. Mastrangelo ◽  
G. Maso ◽  
G. Dal Pozzo ◽  
L. Ronfani ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Vaginal Birth ◽  
Vaginal Birth After Cesarean ◽  
North Eastern ◽  
Friuli Venezia Giulia

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

New possibilities of the use of surgical lasers in obstetrics

1997 ◽  
Vol 78 (6) ◽  
pp. 434-438
Author(s):  
I. F. Fatkullin
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Postoperative Complications ◽  
Cesarean Section ◽  
Laser Welding ◽  
Comparison Group ◽  
Obstetrics And Gynecology ◽  
Septic Complications ◽  
Basic Group ◽  
Section Operation

The laser welding suture of peritoneum in pregnants and in women in labor with high risk of pyo-septic complications is used in cesarean section operation. In the basic group the postoperative complications are three times as little than in the comparison group. The promise of the use of the biological laser @welding@ in obstetrics and gynecology to improve technology and results of surgical treatment especially in delivery of women with high risk of pyo-septic complications is noted.

Primary cesarean section in term, low-risk multiparous women: a single clinic retrospective observational study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kimitoshi Imai MD
Keyword(s):  
Observational Study ◽  
Cesarean Section ◽  
Breech Presentation ◽  
Vaginal Birth ◽  
Low Risk ◽  
Retrospective Observational Study ◽  
Vacuum Extraction ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Multiparous Women

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

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