Adaptation to cesarean birth: implementation of an international multisite study (original) (raw)
Related papers
Women's perceptions of caesarean birth: a Roy international study
Nursing science quarterly, 2011
The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.
Adaptation, postpartum concerns, and learning needs in the first two weeks after caesarean birth
Journal of Clinical Nursing, 2009
Aims. The purpose of this Roy Adaptation Model-based study was to describe women's physical, emotional, functional and social adaptation; postpartum concerns; and learning needs during the first two weeks following caesarean birth and identify relevant nursing interventions. Background. Studies of caesarean-delivered women indicated a trend toward normalisation of the caesarean birth experience. Escalating caesarean birth rates mandate continued study of contemporary caesarean-delivered women. Design. Mixed methods (qualitative and quantitative) descriptive research design. Methods. Nursing students collected data from 233 culturally diverse caesarean-delivered women in urban areas of the Midwestern and Northeastern USA between 2002-2004. The focal stimulus was the planned or unplanned caesarean birth; contextual stimuli were cultural identity and parity. Adaptation was measured by open-ended interview questions, fixed choice questionnaires about postpartum concerns and learning needs and nurse assessment of post-discharge problems. Potential interventions were identified using the Omaha System Intervention Scheme. Results. More positive than negative responses were reported for functional and social adaptation than for physical and emotional adaptation. Women with unplanned caesarean births and primiparous women reported less favourable adaptation than planned caesarean mothers and multiparas. Black women reported lower social adaptation, Hispanic women had more role function concerns and Black and Hispanic women had more learning needs than White women. Post-discharge nursing assessments revealed that actual problems accounted for 40% of identified actual or potential problems or needs. Health teaching was the most commonly recommended postpartum intervention strategy followed by case management, treatment and surveillance interventions.
Public Health, 2018
Objectives: Maternal and neonatal healthcare outcomes in Sub-Saharan Africa (SSA) remain poor despite decades of different health service delivery interventions and stakeholder investments. Qualitative studies have attributed these results, at least in part, to sociocultural beliefs and practices. Thus there is a need to understand, from an overarching perspective, how these sociocultural beliefs affect maternal and neonatal health (MNH) outcomes. Study design: A qualitative meta-synthesis of primary studies on cultural beliefs and practices associated with maternal and neonatal health care was carried out, incorporating research conducted in any country within SSA, using data from men, women and health professionals gathered through focus group discussions, structured and semistructured interviews. Methods: A systematic search was carried out on seven electronic databases, Scopus, Ovid Medline, PubMed, CINAHL Plus, Humanities and Social Sciences (Informit), EMBASE and Web of Science, and on Google Scholar, using both manual and electronic methods, between 1st January 1990 and 1st January 2017. The terms 'cultural beliefs'; 'cultural beliefs AND maternal health'; 'cultural beliefs OR maternal health'; 'traditional practices' and 'maternal health' were used in the search. Results: Key components of cultural beliefs and practices associated with adverse health outcomes on pregnancy, labour and the postnatal period were identified in five overarching factors: (a) pregnancy secrecy; (b) labour complications attributed to infidelity; (c) mothers' autonomy and reproductive services; (d) marital status, trust in traditional medicines and traditional birth attendants; and (e) intergenerational beliefs attached to the 'ordeal' of giving birth. Conclusion: Cultural beliefs and practices related to maternal and neonatal health care are intergenerational. Therefore, intensive community-specific education strategies to facilitate behaviour changes are required for improved MNH outcomes. Adopting practical approaches such as involving husbands/partners and communities in antenatal care services in a health facility and community settings can enhance improved MNH outcomes.
Changing childbirth: lessons from an Australian survey of 1336 women
Bjog-an International Journal of Obstetrics and Gynaecology, 1998
Objective To investigate the views and experiences of care in labour and birth of a representative sampleDesign Cross-sectional survey mailed to women 6–7 months after giving birth.Population All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death.Results After adjusting for parity, the risk status of the pregnancy, and social and obstetric factors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhelpful (midwives: adjusted OR 12.03 [95% CI 7–8–1 8.1, doctors: adjusted OR 6.76 [95% CI 4.–10.31); and having an active say in decisions only sometimes, rarely or not at all (adjusted OR 8.0 [95% CI 4.–16–11). In a separate regression analysis including parity, risk status, obstetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included participation in a shared antenatal care programme (adjusted OR 1.9 [95% CI 1.–3.1) and being of nonEnglish speaking background (adjusted OR 1.0 [95% CI 1.–2.1). The following factors lowered the odds of dissatisfaction: attending a birth centre (adjusted OR 0.34 [95% CI 0.–1.]) and knowing the midwives before going into labour (adjusted OR 0.8 [95% CI 0.–0.]).Conclusion The survey demonstrates the potential for ‘new’ models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal care taking into account women's views is a prerequisite for improvements in maternity care. of women who gave birth in Victoria, Australia in 1993.
Bulletin of The World Health Organization, 2007
Background The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. (1) The caesarean delivery rate in Canada increased steadily from 17.5% of deliveries in 1994-1995 to 23.7% in 2002-2003. (2,3) Moreover, caesarean delivery was associated with high maternal and neonatal complication rates and increased healthcare costs. (4-9) According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), vaginal delivery represents the safest route for the fetus and newborn in the first and subsequent pregnancies. (10) SOGC clinical practices guidelines contribute to the promotion of evidence-based practice and represent an appropriate means for reducing caesarean section rates in Canada. The challenge lies in implementing these guidelines. (11-15) Each clinical environment presents organizational, professional, maternal and cultural particularities. The identification of specific barriers and facilitators represents a new approa...
Social Science & Medicine, 1987
Abstractxesarean delivery, although classified by medical practitioners as major surgery, is simultaneously defined as childbirth by both specialists and laypeople. Women experiencing cesarean delivery, therefore, confront a contradiction which affects postpartum treatment by nursing staff and expectations by family and the postcesarean patient regarding appropriate responses to delivery. Elicitation of the explanatory models of cesarean patients in a private Dallas hospital indicates the ambiguity in the definition of the cesarean reflecting more general trends in American obstetrics. Further, the data demonstrate the limited influence of the natural childbirth movement and the acceptance of technological intervention at birth in this population.
Life
Birth is a physiological act that is part of the morpho-functional economy of the maternal body. Each stage in the act of birth has a predetermined pathway that is neurohormonally induced and morpho-functionally established through specific and characteristic adaptations. Like maternity, childbirth also has an important impact on the maternal body as a biological structure and psycho-emotional behavior. Cesarean section performed at the request of the mother with no medical underlying conditions besides the prolonged hospitalization risk can also cause breathing problems in children, delayed breastfeeding, and possible complications in a future pregnancy. Vaginal birth remains the path of choice for a physiological evolution pregnancy. Although erroneously considered safe and easy today, cesarean section delivery must remain an emergency procedure or a procedure recommended for pregnancies where birth is a risk to the mother and to the child, as cesarean section itself is a risk fac...
Maternity Care Services and Culture: A Systematic Global Mapping of Interventions
PLOS ONE, 2014
Background: A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings: Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions: The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address cultural factors that affect use of skilled maternity care.
Misrecognition of need: Women’s experiences of and explanations for undergoing cesarean delivery
Elsevier, 2013
International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women's accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).► In contrast to ‘maternal request’, most women felt their context necessitated cesarean. ► Cesarean as ‘emergency’ or ‘elective’ was largely unreflective of maternal experience. ► Mothers viewed labor prior to cesarean as wasted effort. ► Misrecognition of cesarean need arises from perceptions of the value and risks of labor. ► Medical training may need revision to support physiologic, vaginal childbirth.