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Cesarean Birth (cesarean + birth)
Selected AbstractsTaiwan's High Rate of Cesarean Births: Impacts of National Health Insurance and Fetal Gender PreferenceBIRTH, Issue 2 2007Tsai-Ching Liu PhD ABSTRACT: Background: Taiwan has a high rate of cesarean section, approximately 33 percent in the past decade. This study investigates and discusses 2 possible factors that may encourage the practice, one of which is fetal gender difference and the other is Taiwan's recently implemented National Health Insurance (NHI). Methods: A logistic regression model was used with the 1989 and 1996 National Maternal and Infant Health Survey and with the 2001 to 2003 NHI Research Databases. Results: Using survey data, we found a statistically significant 0.3 percent gender difference in parental choice for cesarean section. However, no statistically significant difference was found in the rate of cesarean section before and after NHI implementation. Conclusions: Taiwan's high cesarean section rate is not directly related to financial incentives under NHI, indicating that adjusting policy to lower financial incentives from NHI would have only limited effect. Likewise, focusing effort on the small gender difference is unlikely to have much impact. Effective campaigns by health authorities might be conducted to educate the general population about risks associated with cesarean section and the benefits of vaginal birth to the child, mother, and society. (BIRTH 34:2 June 2007) [source] Assessing the Effects of Age, Gestation, Socioeconomic Status, and Ethnicity on Labor InductionsJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2007Barbara L. Wilson Purpose: To evaluate the likelihood of cesarean births, related to race, ethnicity, socioeconomic status (SES), maternal education and age, and gestational status for labor inductions on primiparous and multiparous women. Design and Methods: A retrospective descriptive correlational design was used with 1,325 women scheduled for induction at a large tertiary hospital in a southwestern U.S. state from January 1 through December 31, 2005. Birth outcomes were matched against inpatient hospital scheduling induction logs to verify the reason for induction, whether elective or clinically indicated. Findings: Age and gestation had nonlinear and significant associations with cesarean birth. Elective inductions for primiparous women significantly increased the likelihood of cesarean delivery. The independent effect of being a primiparous woman with an elective induction increased the probability of a cesarean birth by 50%, but this association was not significant for multiparous women. Mother's educational level was a significant predictor for cesarean births with multiparous women being induced. Ethnicity and SES did not increase the odds of cesarean delivery following labor induction for either primiparous women or multiparous women. Conclusions: Elective inductions for primiparous women increased the probability of cesarean births. Elective labor induction for primiparous women should be offered with caution, particularly for women with advanced maternal age. [source] Patient Problems, Advanced Practice Nurse (APN) Interventions, Time and Contacts Among Five Patient GroupsJOURNAL OF NURSING SCHOLARSHIP, Issue 1 2003Dorothy Brooten Purpose: To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs. Design and Methods: Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n=39); (b) women with unplanned cesarean birth (n=61), (c) high-risk pregnancy (n=44), and (d) hysterectomy (n=53); and (e) elders with cardiac medical and surgical diagnoses (n=139). Logs containing recordings of all APN interactions with participants, APN time and type of patient contact were content analyzed with the smallest phrase or sentence representing a "unit." These units were then classified using the Omaha Classification System to determine patient problems and APN interventions. Groups were compared concerning total amount of APN time, number of contacts per patient, and mean length of time per APN contact. All studies were conducted in the United States. Findings: Groups with greater mean APN time and contacts per patient had greater improvements in patients' outcomes and greater health care cost savings. Of the 150,131 APN interventions, surveillance was the predominant APN function in all five patient groups. Health teaching, guidance, and counseling was the second most frequent category of APN intervention in four of the five groups. In all five groups, treatments and procedures accounted for < 1% of total APN interventions. Distribution of patient problems (N=150,131) differed across groups reflecting the health care problems common to the group. Conclusions: Dose of APN time and contacts makes a difference in improving patient outcomes and reducing health care costs. Skills needed by APNs in providing transitional care include well-developed skills in assessing, teaching, counseling, communicating, collaborating, knowing health behaviors, negotiating systems, and having condition-specific knowledge about different patient problems. [source] Study of subjectivity in the perception of cesarean birthNURSING & HEALTH SCIENCES, Issue 1 2005Chai Soon Park rn Abstract This study defined the structural patterns of subjectivity in the perception of cesarean birth. Q methodology was used on 71 statements collected through interviews with seven persons and a literature review followed. Twenty-nine Q samples were selected and administered to 22 persons, and four types of subjectivity were revealed by the QUANL PC Program. Type 1, or the ,naturalist', is characterized by a passive tendency and dislikes artificial methods, feeling that they are performed for hospital income and the trend for social preference. Type 2, ,logical thinker', thinks that cesarean birth should be selected if there are obstetric complications and severe anxiety about labor, even though it results in low intimacy with the baby. Type 3, ,maternal instinctivism', values the maternal-baby relationship and the sense of accomplishment from childbirth. Type 4, ,egocentric', thinks that cesarean section should be chosen when the woman has severe anxiety about labor or when the obstetric condition becomes dangerous. Before commencement of the patient's labor pains, the nurses and medical personnel who are participating in the delivery should assess the structural pattern on parturient woman's subjectivity in the perception of cesarean section. As a further step, they should encourage the woman and her family to participate in the decision-making process for considering the type of delivery the mother wants. [source] Making Choices for Childbirth: A Randomized Controlled Trial of a Decision-aid for Informed Birth after Cesarean,BIRTH, Issue 4 2005Allison Shorten RN ABSTRACT:,Background:Decision-making about mode of birth after a cesarean delivery presents challenges to women and their caregivers and requires a balance of risks and benefits according to individual circumstances. The study objective was to determine whether a decision-aid for women who have experienced previous cesarean birth facilitates informed decision-making about birth options during a subsequent pregnancy. Method:A prospective multicenter randomized controlled trial of 227 pregnant women was conducted within 3 prenatal clinics and 3 private obstetric practices in New South Wales, Australia. Women with 1 previous cesarean section and medically eligible for trial of vaginal birth were recruited at 12 to 18 weeks' gestation; 115 were randomized to the intervention group and 112 to the control group. A decision-aid booklet describing risks and benefits of elective repeat cesarean section and trial of labor was given to intervention group women at 28 weeks' gestation. Main outcome measures included level of knowledge, decisional conflict score, women's preference for mode of birth, and recorded mode of birth. Results:Women who received the decision-aid demonstrated a significantly greater increase in mean knowledge scores than the control group (increasing by 2.17 vs 0.42 points on a 15-point scale)(p < 0.001, 95% CI for difference = 1.15,2.35). The intervention group demonstrated a reduction in decisional conflict score (p < 0.05). The decision-aid did not significantly affect the rate of uptake of trial of labor or elective repeat cesarean section. Preferences expressed at 36 weeks were not consistent with actual birth outcomes for many women. Conclusion:A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict. However, little evide nce suggested that this process led to an informed choice. Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice. Further work needs to examine ways to enhance women's power in decision-making within the doctor-patient relationship. (BIRTH 32:4 December 2005) [source] Cesarean Delivery in Shantou, China: A Retrospective Analysis of 1922 WomenBIRTH, Issue 2 2000Wang-ling Wu MD Background:In China the cesarean section rate increased significantly during the past four decades. This study examined the frequency and indications of cesarean birth in Shantou, a southern city in China.Methods:An analysis was conducted of the medical records of 1922 women who had cesarean deliveries at Shantou City 2nd People's Hospital between January 1990 and December 1997. The medical records of 10,490 women who gave birth during this period were examined.Results:The average rate of cesarean delivery during the 8-year period was 19.4 ± 2.3 percent (means ± standard error). From 1990 to 1997 the cesarean delivery rates ranged from 11.05 to 29.9 percent, respectively, although during this period the total annual number of deliveries decreased significantly from 1683 to 951. The rates of the most common indications per 100 women for cesarean delivery were failure to progress (23%), premature rupture of membranes (20%), fetal distress (19.4%), breech presentation (18.1%), uterine scar (14.6%), and prolonged pregnancy (11.3%).Conclusion:The cesarean delivery rate in Shantou, China, has increased steadily and significantly between 1990 and 1997, despite a decrease in the total number of births during the same period. This study showed that on an individual basis vaginal delivery was often possible and reduction of the cesarean delivery rate could be achieved safely by paying greater heed to appropriate indications. [source] Assessing the Effects of Age, Gestation, Socioeconomic Status, and Ethnicity on Labor InductionsJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2007Barbara L. Wilson Purpose: To evaluate the likelihood of cesarean births, related to race, ethnicity, socioeconomic status (SES), maternal education and age, and gestational status for labor inductions on primiparous and multiparous women. Design and Methods: A retrospective descriptive correlational design was used with 1,325 women scheduled for induction at a large tertiary hospital in a southwestern U.S. state from January 1 through December 31, 2005. Birth outcomes were matched against inpatient hospital scheduling induction logs to verify the reason for induction, whether elective or clinically indicated. Findings: Age and gestation had nonlinear and significant associations with cesarean birth. Elective inductions for primiparous women significantly increased the likelihood of cesarean delivery. The independent effect of being a primiparous woman with an elective induction increased the probability of a cesarean birth by 50%, but this association was not significant for multiparous women. Mother's educational level was a significant predictor for cesarean births with multiparous women being induced. Ethnicity and SES did not increase the odds of cesarean delivery following labor induction for either primiparous women or multiparous women. Conclusions: Elective inductions for primiparous women increased the probability of cesarean births. Elective labor induction for primiparous women should be offered with caution, particularly for women with advanced maternal age. [source] | ||||||||||