scholarly journals Women's Views on Mode of Birth in Public Hospitals in Argentina: Inputs From a Formative Research to Optimize the Use of Caesarean Section

2021 ◽  
Author(s):  
Carla Perrotta ◽  
Mariana Romero ◽  
Yanina Sguassero ◽  
Natalia Righetti ◽  
Celia Gialdini ◽  
...  
Keyword(s):  
Pain Management ◽  
Caesarean Section ◽  
Quantitative Methods ◽  
Mode Of Delivery ◽  
Formative Research ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Postpartum Women ◽  
Maternity Hospitals ◽  
Mode Of Birth

Abstract BackgroundThis paper reports on women's perspectives on the birth mode in five public maternity hospitals in Argentina. The study is a formative research study component aimed at tailoring interventions to reduce unnecessary caesarean section (CS) use. MethodsParticipants were postpartum women aged ≥15 years old in five hospitals in the provinces of Salta, Corrientes, Tucuman, Santa Fe and Buenos Aires City. Hospitals completed an institutional survey indicating the availability of obstetric services. The fieldwork was carried out from November 2018 to June 2019. Trained interviewers gathered data on obstetric history, companionship, mode of delivery preferences, and general opinion on vaginal and caesarean section births through semi-structured interviews. The interviews were coded and analysed with standard quantitative methods. ResultsThe five hospitals had a CS rate between 29.2 and 45.5. Four institutions indicated limited access to epidural and other pain management strategies and a restricted antenatal education schedule. The sample included 621 postpartum women with a mean age of 26 years (± SD 6). 60% of them had a vaginal birth (VB). More than 90% of women in three hospitals favoured VB, and in two, 67% (p<0001). CS preference was associated with giving birth in those two hospitals and the numbers of miscarriages adjusting by maternal age and previous pregnancies. The reasons for preferring a VB included faster recovery, feeling ready, and considering it more natural. Most women chose CS as the best mode of birth to avoid birth pain. CS disadvantages included post-procedure pain, dependence on others to take care of her or the baby afterwards, and prolonged time in the hospital. Six out of ten women would have liked to be asked by their providers about the MOB of choice. ConclusionsWomen giving birth in public maternity hospitals of Argentina preferred a vaginal delivery to a caesarean section. There is an ongoing need to improve access to pain management during labour and vaginal birth and include women's opinions along the decision-making process for selecting the mode of childbirth. Hospitals with a lower preference for VB will require additional efforts to understand women's needs and values. Trial registration: IS002316

scholarly journals Women’s Views and Preferences for Mode of Birth in Public Hospitals in Argentina: a Mixed-methods Study

2021 ◽  
Author(s):  
Carla Perrotta ◽  
Mariana Romero ◽  
Yanina Sguassero ◽  
Natalia Riguetti ◽  
Celina Gialdini ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Pain Management ◽  
Caesarean Section ◽  
Post Partum ◽  
Public Hospitals ◽  
Advantages And Disadvantages ◽  
Management Interventions ◽  
Maternity Hospitals ◽  
Mode Of Birth ◽  
Las Mujeres

Abstract Background: This research explores women’s preferences for mode of birth (MOB) and their opinions on the advantages and disadvantages of MOB in public maternity hospitals with caesarean section (CS) rates higher than 30% in Argentina.Methods: Five public hospitals participated in this sequential mixed methods research. Post-partum women took part in semi-structured interviews which gathered information on obstetric history, MOB preferences, companionship, opinions on each MOB and if they would have liked to be asked about their MOB. The interviews were subsequently coded for quantitative analysis. A multiple regression model was run to explore variables associated with preferred MOB. Results: The interviews took place during eight weeks in 2019. The participating hospitals had limited availability to pain management interventions during birth. Participants were 621 women with a mean age of 26 +6. Forty percent had had a previous caesarean section (CS). Women gave birth accompanied in more than 80% of vaginal births and in less than 35% of caesarean sections. Six out of ten women would have liked to be asked about the MOB of choice. In three hospitals, the preference for vaginal birth (VB) was more than 90% and in two, 67%. Preference for MOB was strongly associated with the hospital in which the birth took place. The reasons for preferring a VB included faster recovery, feeling ready, and considering it more natural, while the disadvantages reported included birth pain and not getting anaesthesia. The most frequent reason for preferring a CS was to avoid birth pain. Women in hospitals with lower preference for VB expressed safety as a CS advantage. The disadvantages of a CS included post-procedure pain, dependence on others to take care of her or the baby afterwards and prolonged time in the hospital compared to a VB. Conclusions: Women giving birth in public hospitals in Argentina prefer VB. Safety emerged as a theme in hospitals in which women had less preference for VB. Women’s accounts indicate the need to improve access to holistic pain management during VB as well as to participate women in their desirable MOB. Trial registration: IS002316 Abstract in additional language.Spanish Introducción: Las tasas de cesárea continúan aumentando en Latinoamérica. El diseño de intervenciones no clínicas para reducir cesáreas innecesarias requiere incorporar las preferencias de las mujeres sobre modalidad de parto preferida (MDP).Métodos: El estudio se realizó en cinco hospitales públicos en Argentina a través de un diseño mixto. Las mujeres fueron entrevistadas después del parto durante 8 semanas durante el año 2019. Les preguntamos su MDP preferida, las ventajas y desventajas de cada modalidad y el acompañamiento durante el parto. Las respuestas se codificaron y se analizaron cuantitativamente. Analizamos si las preferencias variaban según variables de las mujeres o de los hospitales. ResultadosLos cinco hospitales participantes reportaron limitado acceso a anestesia epidural. Participaron 621 mujeres, edad media 26 +6, 40% con cesárea previa. El 80% tuvo acompañamiento durante el parto vaginal (PV) y menos del 30% durante la cesárea. Seis en 10 mujeres hubieran preferido que les preguntaran sobre sus preferencias de parto. En tres hospitales el 90% de las mujeres prefiere PV y en dos hospitales el 67% prefiere un PV. La preferencia por la MD se asoció solamente al hospital en donde ocurrió el parto. Las razones de la preferencia por PV fueron recuperación más rápida y sentirse más preparadas. La razón más frecuente para preferir una cesárea fue la de evitar el dolor de parto y las desventajas se centraron en el dolor postoperatorio, la falta de independencia durante el postparto y el tiempo prolongado en el hospital.Conclusiones Las mujeres en hospitales públicos en Argentina prefieren el PV sobre la cesárea, pero con diferencias entre hospitales, indicando la necesidad de adaptar intervenciones. Debemos trabajar para mejorar el manejo del dolor de parto, garantizar el acompañamiento en cesáreas e incorporar las preferencias de las mujeres en la decisión del MP.

scholarly journals Incidence and Determinants of Caesarean Section in Shiraz, Iran

2020 ◽  
Vol 17 (16) ◽  
pp. 5632
Author(s):  
Mahnaz Zarshenas ◽  
Yun Zhao ◽  
Colin W. Binns ◽  
Jane A. Scott
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Financial Incentives ◽  
Multinomial Logistic Regression ◽  
Mode Of Delivery ◽  
Alternative Methods ◽  
Relative Risk Ratio ◽  
Healthy Weight ◽  
Natural Childbirth ◽  
Maternity Hospitals

The rate of Caesarean section (CS) without medical indication has increased markedly worldwide in the past decades. This study reports the incidence of CS and identifies the determinants of elective and emergency CS as separate pregnancy outcomes in a cohort of Iranian women. Mothers (n = 700) of healthy, full-term infants were recruited from five maternity hospitals in Shiraz. The association between maternal socio-demographic and biomedical factors with mode of delivery was explored using multivariable, multinomial logistic regression. Most mothers underwent either an elective (35.4%) or emergency (34.7%) CS. After adjustment, women were more likely to deliver by elective CS than vaginally if they were older (≥30 year) compared to younger mothers (<25 year) (Relative Risk Ratio (RRR) 2.22; 95% Confidence Interval (CI) 1.28, 3.84), and had given birth at a private hospital (RRR 3.64; 95% CI 1.79, 7.38). Compared to those educated to primary or lower secondary level, university educated women were more likely to have undergone an elective (RRR 2.65; 95% CI 1.54, 4.58) or an emergency CS (RRR 3.92; 95% CI 2.27, 6.78) than a vaginal delivery. Similarly, overweight or obese women were more likely than healthy weight women to have undergone an elective (RRR 1.91; 95% CI 1.27, 2.87) or an emergency CS (RRR 2.02; 95% CI 1.35, 3.02) than a vaginal delivery. Specialist education of obstetricians and midwives along with financial incentives paid to private hospitals to encourage natural delivery may help in the reduction of unnecessary CS in Iran. In addition, to increase their childbirth knowledge and self-efficacy, pregnant women need to have the opportunity to attend purposefully designed antenatal childbirth preparation classes where they receive evidence-based information on natural childbirth and alternative methods of pain control, as well as the risks and indications for CS.

scholarly journals CARDIOTOCOGRAPHY

2018 ◽  
Vol 25 (10) ◽  
pp. 1537-1545
Author(s):  
Muhammad Ikram ◽  
Amna Javed ◽  
Shafqat Mukhtar
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Vaginal Birth ◽  
Cross Sectional ◽  
Group A ◽  
Group B ◽  
Labour Room

Introduction: The cardiotocography (CTG) is more commonly knows aselectronic fetal monitoring (EFM). A cardiotocography measures the fetal heart and the frequencyof uterine contractions. Using two separate disc shaped transducers. Objectives: The objectiveof this study is to co-relate the intrapartum cardiotocography monitoring with fetomaternaloutcome. Study Design: Cross sectional analytical study. Setting: Department of Obstetricsand Gynaecology, Shaikh Zayed Hospital, Lahore, Pakistan. Period: From September 2012 toMarch 2013 (Six Months). Patient & Method: Total 60 patients (pregnant females) fulfilling theinclusion criteria were selected for this study, who were admitted in labour room in early andactive labour. In group A normal CTG monitoring and in Group B women with abnormal CTGmonitoring. Maternal outcomes in terms of mode of delivery and fetal outcome (APGAR Score,neonatal seizures, admission to nursery and time of neonatal discharge were seen). Result: Themean age in group A was 26.13+3.90 years and in group B was 26.53+4.17 years. The meangestational age in group A was 38.40+1.50 weeks and in group B was 36.60+1.59 weeks. Ingroup A, 25 (83.3%) woman were delivered through spontaneous vaginal birth and 4(13.4%)women, who were delivered by caesarean section (for all indication except fetal distress), 1(3.3%) woman by assisted vaginal birth (for all other indications). In group B there were 7(23.8%)women who delivered through spontaneous vaginal birth. 3(10%) women by assisted vaginalbirth (for abnormal CTG monitoring) and 20(66.7%) women by caesarean section (for abnormalCTG). In group A, there were 7(23.3%) neonates who were admitted in nursery, while in groupB, there were 19(63.3%) neonates, who were admitted in nursery. Conclusion: Intrapartumexternal fetal cardiotocography is not a single indicator of fetal distress. An increased caesareansection rate in babies with a pathological cardiotocography stresses on the need for additionaltests to differentiate hypoxic fetuses from non-hypoxic.

scholarly journals Comparative study of maternal and fetal outcome in patients with Vaginal Birth after caesarean section and elective repeat caesarean section

2020 ◽  
Vol 11 (4) ◽  
pp. 5473-5480
Author(s):  
Poonam Kalburgi ◽  
Sanjaykumar Patil
Keyword(s):  
Caesarean Section ◽  
Prospective Observational Study ◽  
Institutional Delivery ◽  
Mode Of Delivery ◽  
Fetal Monitoring ◽  
Fetal Outcome ◽  
Vaginal Birth ◽  
Group 2 ◽  
Vaginal Birth After Caesarean ◽  
Group 1

Women after delivering her first baby by section have a choice about mode of delivery for her second baby. The study was planned to compare maternal and perinatal outcome between VBAC and repeat elective LSCS in patients with prior one LSCS and their complications. A prospective observational study was carried out in department of obstetrics and . Total 180 cases of previous LSCS who were eligible for vaginal delivery were recruited 90 in each group as per consent given by them. Group 1: Vaginal Birth after section Group 2: elective repeat section. It was observed that majority of the patients group 1(51.1%) and group 2 (47.8%) were in age group of 25 to 30 years. More than 25kg/m2 BMI was found in 18(20%) cases of VBAC group and 30(33.3%) cases of LSCS group pregnancy interval was significantly lower in LSCS group compared to VBAC group. Mean birth weight was 2.832 kg to 2.917kg in both group. with improved maternal care, close fetal monitoring and institutional delivery for a previous one section, VBAC is considered safer than repeat elective section in carefully selected patient.

scholarly journals Successful vaginal birth after caesarean section in patient with Ehler-Danlos syndrome type 2

2011 ◽  
Vol 4 (4) ◽  
pp. 164-165 ◽  
Author(s):  
Hemant Maraj ◽  
Michelle Mohajer ◽  
Deepannita Bhattacharjee
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Genetic Defect ◽  
Vaginal Birth ◽  
Previous Caesarean Section ◽  
Inherited Disorders ◽  
Vaginal Deliveries ◽  
Danlos Syndrome ◽  
Vaginal Birth After Caesarean

We present the case of a 31-year-old woman with Ehler-Danlos syndrome (EDS) type 2. She had a previous caesarean section and went on to have an uncomplicated vaginal birth in her last pregnancy. To our knowledge, this is the first case of a successful vaginal birth after caesarean section in a patient with EDS. EDS is a multisystem disorder involving a genetic defect in collagen and connective-tissue synthesis and structure. It is a heterogeneous group of 11 different inherited disorders. Obstetric complications in these patients include miscarriages, stillbirths, premature rupture of the membranes, preterm labour, uterine prolapse, uterine rupture and severe postpartum haemorrhage. There has been much controversy over the appropriate mode of delivery. Abdominal deliveries are complicated by delayed wound healing and increased perioperative blood loss. Vaginal deliveries may be complicated by tissue friability causing extensive perineal tears, pelvic floor and bladder lesions. Our case highlights that in specific, controlled situations it is possible to have a vaginal delivery even after previous caesarean section in patients with EDS.

scholarly journals Vaginal birth after caesarean section: why and how?

2017 ◽  
Vol 6 (12) ◽  
pp. 5554
Author(s):  
Vidyadhar B. Bangal ◽  
Satyajit Gavhane ◽  
Vishesha Yadav ◽  
Kunal Aher ◽  
Dhruval Bhavsar
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Section Rate ◽  
Mode Of Delivery ◽  
Vaginal Birth ◽  
Maternal Complications ◽  
History Of ◽  
Spontaneous Onset ◽  
Vaginal Birth After Caesarean

Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC.

scholarly journals Use of music during vaginal birth and caesarean section: an interprofessional survey

2021 ◽  
Author(s):  
Philip Hepp ◽  
Markus Fleisch ◽  
Kathrin Hasselbach ◽  
Tanja Fehm ◽  
Nora K. Schaal
Keyword(s):  
Caesarean Section ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Mode Of Delivery ◽  
Vaginal Birth ◽  
Negative Effects ◽  
Descriptive Data ◽  
Beneficial Effects ◽  
Personal Relation ◽  
Medical Indications

Abstract Purpose Evidence abounds about the beneficial effects of music on patients and healthcare professionals for many medical indications. This study aimed to evaluate the dissemination and use of music in the obstetrical setting. Methods Invitations to an online survey were sent to physicians and midwives of all obstetrics departments in Germany. The survey gathered descriptive data as well as information about the personal relation to music and the use of it during vaginal birth (VB) and caesarean section (CS) and whether data about positive or negative effects of music were known to the participant. Results In total, there were 293 respondents. The 47% that had the means to play music during CS stated that music was played in 15% of the cases. Most respondents have the means to play music during VB (97%). Music is played in 38% of VB. Regardless of the mode of delivery, music was estimated to be positive for team communication and patient communication. It was also deemed calming and mood lifting on the respondents. Regarding the patient, music during CS and VB was rated as being positive on all scales. Listening to music was recommended more often during VB (66%) than CS (38%). Conclusions Although healthcare professionals are mostly aware of the beneficial effects of music in obstetrics, our study shows that music plays a more important role during VB than during CS in Germanys obstetrical wards. There is a lack of equipment to play music in operation theatres where CS take place.

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