Cesarean Group Research Articles

Effects of Unanticipated Cesarean Section on Mothers, Infants, and Their Interaction in the First Month of Life

The impact of an unanticipated primary cesarean section on the mother, on the infant, and on their interaction was studied during the perinatal period and at 1 month following delivery. Thirty-four mother-infant pairs participated in the study. Fourteen subjects delivered by nonelective, nonemergency cesarean section. Twenty mothers, who delivered vaginally, served as the controls. All subjects had attended a series of prepared childbirth classes. Maternal questionnaire and infant observational data were collected on day 2 and on day 30. Mother-infant interactions in teaching and play sessions were assessed on day 30. The cesarean group was found to have a higher number of obstetrical complications, an increased incidence of maternal depression, and a more difficult convalescence. Previous experience with children emerged as an important mediating variable in the analysis of maternal affective status. No infant behavioral differences were detected as a function of mode of delivery. The discussion highlights the interventions that can be utilized to minimize the negative emotional consequences for women who deliver by cesarean section.

Frequency, spacing, and outcome of pregnancies subsequent to primary cesarean childbirth

A prospective study was conducted to determine the frequency, spacing, and outcome of pregnancies that occur subsequent to primary cesarean childbirth. A cohort of 5513 women, pregnant for the first time and with these pregnancies terminating with a live birth via cesarean childbirth, were followed for 5 years with use of the vital records registration system of the New York State Department of Health. Also followed was a group of women whose first pregnancy terminated with a live birth via vaginal delivery. The cesarean childbirth study group was found to have had 11% fewer pregnancies terminating during the follow-up period than did the vaginal delivery group. Subsequent live births among the cesarean delivery study group were, on the average, 1 week shorter in gestation and lower in birth weight than those of the vaginal delivery group. However, there was no excess of very low- or low-birth weight infants among the cesarean delivery study group. There was no difference between study groups in the spacing of subsequent pregnancies.

Mortality From Abortion and Childbirth

This response to an earlier article on maternal mortality by LeBolt and others argues that mortality rates of women having an abortion should be separately compared to women having vaginal delivery and women having cesarean delivery, the latter being subject to higher mortality rates partly because of the ocmplications that lead to the cesarean and partly because of increased risks inherent in the abdominal route. Maternal mortality following a cesarean is approximately 100/100,000 live births, roughly 10-20 times higher than mortality following vaginal delivery. The incidence of cesarean section generally ranges from 10-20% of deliveries; assuming the national figure to be 10%, some 90% of the 22,257 live births reported by LeBolt, or 2,253, were due to cesarean deliveries. Using these figures, the maternal mortality rate for vaginal deliveries would be 1.1/100,000 live births, less than the death-to-case rate of 1.9/100,000 legal abortions reported by LeBolt. The maternal mortality rate for cesarean deliveries would then be approximately 53 times greater than that for legal abortion, but the mortality rate for legal abortion would be almost twice as high as that for vaginal deliveries. Even if the effect of artificially lowering the mortality rate for vaginal deliveries because high-risk mothers are more likely to have cesarean deliveries were eliminated by adjusting for preexisting medical conditions between the vaginal and cesarean delivery groups, the increased rate of mortality associated with childbirth would still be accounted for by cesarean deliveries.

Women??s Perceptions of Vaginal and Cesarean Deliveries

Three groups of women were compared to determine their perceptions of giving birth and the relationships between those perceptions and their degree of participation in decision making, the type of anesthesia for delivery, and the presence of their husbands at the births. Forty women had vaginal deliveries; 39 had emergency cesareans, and 43 had planned cesareans. All the women were interviewed and completed self-administered questionnaires two to four days after delivery. The three groups had significantly different perceptions of the birth experience with the emergency cesarean birth group having the most negative perception. Among women having cesareans, more positive perceptions were associated with regional anesthesia, presence of their husbands at delivery, and greater participation in decision making. Women in the cesarean groups were less likely to breast feed, and those having planned cesareans were least likely to attend childbirth classes. Many of the women were unaware of the options available to them that could influence the birth experiences.

Emergency caesarian section: A research study of the mother/child relationship of a group of women admitted expecting a normal vaginal delivery

This study follows a group of women who had their first babies by emergency caesarian section under a general anaesthetic and compares them with a control group who had a normal vaginal delivery. The emergency caesarian sections were not done for a clear cut medical emergency but for reasons such as foetal distress, prolonged labour, suspected cephalopelvic disproportion—all criteria open to different clinical judgment. The mothers and babies were seen one month, one year and three years after delivery. Significant differences were found between the attitude and behaviour of the caesarian group of mothers and that of the control group of mothers. There must be serious doubts about the need for an emergency caesarian delivery in this sample. They were a problem group of women as difficult to follow up as to deliver. In their histories there was a trend toward more difficulties in their past and present relationships. Did they need more sensitive handling during delivery to avoid an emergency caesarian section? Professionals frequently find anxiety hard to bear and need to act rather than attempt to understand the origin of the pain. It is easy to overlook the subtle long term effects of the action when it appears to solve the immediate problem.

Possible effects of emergency caesarian section on the mother--child relationship.

This study was a pilot project to explore the mother-child relationship in a group of mothers delivered by emergency caesarian section and to compare them with a control group of mothers delivered by normal vaginal delivery. The mothers delivered by caesarian section had a period of amnesia after the birth so that their recollected first contact with their baby was later than the control group and at one month the mothers delivered by caesarian section had much less eye-to-eye contact with their baby. There were differences in attitudes and behaviour between the caesarian and control group of mothers at one month and at one year. The mothers delivered by caesarian section had more doubts about their capacity to care for their babies, were more depressed with symptoms and felt their babies did not become a person until later. There were no differences between the two groups of children in general behaviour and development although the babies delivered by caesarian section were larger and this difference persisted through to one year. This caesarian group of mothers found adjusting to the birth of their first baby and parenthood more difficult than the control group of mothers.

Effects of a support group on the emotional impact of cesarean childbirth.

Childbirth by cesarean, especially when unexpected, can be a source of acute emotional distress, stemming from unmet expectations for childbirth and the experience of major surgery, among other factors. Some women experience negative feelings months or years after the birth. A difficult cesarean birth experience has potential negative effects on a woman's relationship with her spouse or infant. Cesarean support groups play an important role in the prevention of emotional distress by facilitating the resolution of the birth experiences and allowing women to plan and prepare for more positive birth experiences in the future.

Cesarean Support Groups

In the context of the natural childbirth movement and a recent sharp rise in the cesarean birthrate, an unexpected cesarean can be a source of acute psychological stress. Cesarean support groups provide information, peer emotional support, a reference group and role models, and an opportunity to help others, as well as increasing consumer activism in the health care system. Illustrations are drawn from participant observation in two support groups and interviews of selected participants.

Postnatal mortality, bodyweight gain and wool production to two years of age of lambs surviving caesarean or stressful vaginal birth.

SUMMARY This experiment tested the hypothesis that prolonged, stressful vaginal birth in sheep results in injury to the fetal CNS manifest by meningeal haemorhage, thereby causing increased neonatal mortality or depressed production of affected survivors. Mortality, bodyweight gain and wool production to 740 days of age were measured in single‐reared Merino lambs surviving caesarean (caesarean group) or artificially prolonged vaginal birth (delayed group). Total mortality of live births in the delayed group was higher than that in the caesarean group (38.7% v. 23.7%, p < 0.025). Virtually all the difference was due to higher neonatal mortality in the delayed group within 7 days of birth compared to the caesarean group (34.2% v. 17.1%, p < 0.01). As meningeal haemorrhage was detected at autopsy of the delayed group only, the additional mortality was attributed to birth injury to the fetal CNS. Fifty‐three per cent were affected, at prevalences relative to time of death after birth strongly suggestive of a dose‐response to varying levels of birth injury. Meningeal lesions were present in all lambs dying within 3 hours of delivery and in 32% of those dying over the next 7 days. In the latter the lesions were associated invariably with evidence of starvation and cold injury, implying a causal relationship between the presence of meningeal haemorrhage and impaired feeding activity and cold injury. Although stressful birth and presumed sub‐lethal injury to the fetal CNS had no permanent adverse effect on the growth and wool production of survivors, there was equivocal evidence of a birth related temporary residual handicap, as the mean growth rate of the delayed group born in 1973 was significantly lower than that of the caesarean group during a three‐monthly period of pasture shortage.Stressful vaginal birth clearly increased the level of neonatal mortality. The results also demonstrated the pathological significance of meningeal haemorrhage as an index of stressful birth and presumed damage to the fetal CNS, and strongly suggested the probable role of such injury in the pathogenesis of the starvation‐mismothering‐exposure complex.

Developmental follow-up of infants delivered by Caesarean section and general anesthesia

Infants delivered by caesarean section and general anesthesia were compared with those delivered vaginally with local-regional or no anesthesia. At birth the caesarean group showed less optimal obstetric medications and complication scores, maternal attitudes to labor and delivery, and maternal and infant blood pressures, but the group did not differ on examiner or mother assessments of neonatal behaviors. At 4 months the vaginal group was more optimal on Denver adaptability, maternal state—trait anxiety, and maternal diastolic blood pressures, but the caesarean section mothers rated their infants more optimally on temperament, expressed more realistic expectations of developmental milestones, and received, along with their infants, more optimal face-to-face and feeding interaction ratings. At 8 months there were no differences on developmental assessments, but whereas blood pressures were higher in caesarean mothers and infants, these mothers again assessed their infants as having more optimal temperaments. These results are discussed in the context of an emergency caesarean altering the mother's perceptions of her infant.

Comparison of Primiparas?? Perceptions of Vaginal and Cesarean Births

Twenty primiparous mothers who had cesarean births were compared with 30 primiparous mothers who had vaginal deliveries to determine differences in their perceptions of the birth experience. The effect of general versus regional anesthesia on the satisfaction level of the cesarean mothers was also investigated. All subjects were between 20 and 32 years of age, were interviewed within 48 hours postpartum, and completed a 29-item questionnaire that measures maternal perceptions about the labor and delivery experience. Satisfaction with the birth experience was significantly lower among cesarean mothers and among those who had general anesthesia. The cesarean group displayed greater hesitancy in naming their infants and tended to view their deliveries as abnormal and having social stigma. The presence of a support person in the operating room for a cesarean birth seemed to lessen anxiety among these mothers. These findings suggest that a cesarean birth has a negative impact on the mother's perceptions of her labor and delivery experience. There is a need for further study of factors that can enhance this experience for families.

POSTPARTUM HYSTERECTOMY FOR STERILIZATION

Abstract Population control is of vital concern to everyone and, since many patients are seeking surgical sterilization following delivery, various forms must be immediately available. In this series, 241 patients had an elective total abdominal hysterectomy for sterilization following delivery. Of these, 108 had a cesarean hysterectomy and 133 had a postpartum hysterectomy. Morbidity was highest in the cesarean hysterectomy group and lowest when the hysterectomy was done on the third postpartum day. Ninety-five per cent of patients went home within a week of surgery, 58 per cent had no complication, and patient acceptance was high. Hysterectomy following delivery can be a beneficial proceedure from both a sterilization and a gynecologic viewpoint because many patients with gynecologic disease will require surgery in the near future and, in certain populations, follow-up care is unreliable. It is desirable for patient convenience and from an economic standpoint because only one hospitalization is required.

Postpartum hysterectomy for sterilization

Population control is of vital concern to everyone and, since many patients are seeking surgical sterilization following delivery, various forms must be immediately available. In this series, 241 patients had an elective total abdominal hysterectomy for sterilization following delivery. Of these, 108 had a cesarean hysterectomy and 133 had a postpartum hysterectomy. Morbidity was highest in the cesarean hysterectomy group and lowest when the hysterectomy was done on the third postpartum day. Ninety-five per cent of patients went home within a week of surgery, 58 per cent had no complication, and patient acceptance was high. Hysterectomy following delivery can be a beneficial proceedure from both a sterilization and a gynecologic viewpoint because many patients with gynecologic disease will require surgery in the near future and, in certain populations, follow-up care is unreliable. It is desirable for patient convenience and from an economic standpoint because only one hospitalization is required.

Fetal plasma steroids in relation to parturition. II. The effect of gestational age upon umbilical plasma corticosteroids following hysterotomy and Caesarean section.

SummaryTotal plasma corticosteroid levels were measured by competitive protein binding assay in matched umbilical arterial and venous samples obtained immediately following delivery of 78 infants by Caesarean section. At 38 to 40 weeks gestation, the mean umbilical arterial levels (±S.E.) were 94.9 ± 10.0 ng./ml. following elective Caesarean section and 142.2 ± 23.7 ng./ml. following emergency Caesarean section in labour. The corresponding mean venous levels were 132.3 ± 10.0 ng./ml. and 172.9± 19.1 ng./ml. Within the emergency Caesarean section group, corticosteroid levels were related to the stage of labour. In fetuses obtained by hysterotomy, the mean heart blood level of plasma corticosteroids was 16.3±3.6 ng./ml. at 12 to 16 weeks gestational age. Within the elective Caesarean group, corticosteroid levels increased with gestational age, reaching a peak at 35 to 37 weeks gestation.

REVIVAL OF VAGINAL BREECH DELIVERY

BACKGROUND: Since the publication of term breech trail there had been a dramatic changeworldwide from selective to planned Cesarean Section for all women with breech presentation at term.This high cesarean section rate led to adverse consequences in subsequent pregnancy &on futurefertility. Choice of safest mode of delivery has always been a dilemma.OBJECTIVE: Prospective interventional study. This study was done to determine the safety of vaginalbreech birth in terms of neonatal & maternal complications, so that to encourage the trend of breechdelivery in carefully selected cases & to discourage the trend of routinely recommending cesareansection for all gravidas with fetus in breech presentation at term. The study was conducted atDepartment of Obstetrics & Gynae Mardan Medical Complex from January 2010 to December 2015.PATIENTS & METHOD: About 809 patients with singleton pregnancy with breech presentation wereincluded. Decision about mode of delivery was taken on the basis of clinical judgment and ultrasoundwhich was further reviewed in the light of rate of progress during labour .Delivery was conducted byexperienced obstetrician. Mother & infants were followed up to 6 wks post partum. The primaryoutcome was neonatal mortality, infant mortality & serious infant morbidity.RESULTS: out of 809 total patients with breech presentation, 714 were planned for vaginal delivery674 delivered (83%) while 40 pts (5%) had emergency Cesarean Sections.95 patients (12%) hadElective cesarean section. In the delivery group two (0.29%) neonates had serious neonatal morbidity. Inthe cesarean group there was no serious neonatal morbidity. Infection & blood loss was greater in thecesarean group. There were no serious maternal complications in the vaginal delivery group. Thedifference between neonatal morbidity, perinatal mortality &neonatal mortality between the two groupswas not significant.CONCLUSION: Vaginal breech delivery is still a safe option which better suits the clinical situation&problems of our patients .In our set up, Cesarean section should not be routinely advised to patientswith breech presentation no matter it may be the best management option in developed countries.Careful case selection & vigilant monitoring of progress of labour will save many patients fromunnecessary section without costing extra morbidity & mortality.KEY WORDS: Breech presentation, Breech Delivery, Cesarean section, Apgar score.

Comparative studies of the effects of normal and caesarian delivery upon later manifestations of anxiety

Summary o 1. A pilot study is reported. It describes the psychiatric evaluation of a group of 38 Caesarian born adults. 2. The comparison of the Caesarian born group with two other groups outlines the relative absence of somatic symptoms accompanying stress or expressed as part of the anxiety syndrome. 3. It is postulated that the absence of these somatic elements in adult life is related to the absence of those somatic impressions which usually occur during the normal processes of labor and birth. 4. The data are interpreted as giving some support to the theory of birth as a “traumatic” experience of great importance to the individual's later life expressions of stress and anxiety. 5. The re-emphasis of birth as a meaningful experience points out new directions for further enquiry and research.