Preference For Cesarean Delivery Research Articles

Predictors of Pregnant Women's Decision to Opt for Cesarean Section in Romania.

In Romania, the latest official report indicates that more than half of the births (80,890 cases, representing 52.88% of the total) are performed by cesarean, a rate significantly higher than the World Health Organization (WHO) recommendation of 15-20%. This study aims to identify the predictors associated with women's decisions to opt for cesarean in Romania. An analytical cross-sectional observational study was conducted in the general population of Romania. The study was carried out over the course of 2023, with a total duration of four months. During this period, researchers targeted pregnant women from various regions of the country, regardless of their place of residence, age, or education level. The primary data collection tool was a self-administered online questionnaire, distributed via Google Forms, an accessible and efficient platform that allows for automatic response collection. The questionnaire was distributed online, particularly on social media platforms frequented by pregnant women, such as Facebook, Instagram, and TikTok. A total of 1,301 participants were validated. Socio-demographic and clinical factors significantly influence women's decisions to give birth by cesarean.Among these participants, 435 expressed a preference for cesarean delivery. Key predictors include fear of pain and concern for the child's health. Fear of pain at birth is the first predictor in Romanian women to choose cesarean (OR=2.09; 95% CI: 1.62-2.68). Concerns about the child's health do not increase the likelihood of opting for a cesarean. By utilizing valuable resources such as midwives and implementing strategies like birth plans, significant contributions can be made toward reducing the cesarean rate and improving the childbirth experience for women worldwide.

Prevalence and determinants of fear of childbirth among pregnant women in Egypt: A cross-sectional study

ProblemFear of childbirth (FOC) is a significant public health concern, and understanding its determinants is crucial for developing effective interventions to support women during pregnancy and childbirth. BackgroundFear of childbirth (FOC) is increasingly recognized as an essential psychological health concern among pregnant women globally. However, research elucidating the prevalence and multifaceted determinants of FOC in the Egyptian context remains scarce. This knowledge is pivotal to informing maternal health practices. AimThis study aimed to investigate FOC prevalence and its determinants among pregnant women in Egypt. MethodsA cross-sectional study was conducted among 460 low-risk pregnant women attending antenatal clinics in El-Beheira Governorate, Egypt, from February 2023 to July 2023. Data were collected using structured questionnaires on sociodemographic and obstetric profiles, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the Multidimensional Scale of Perceived Social Support. ResultsThe prevalence of FOC ranged from mild to severe, with 70.4% of women displaying some degree of fear and 11.3% exhibiting severe FOC. Key determinants associated with greater FOC were younger age, nulliparity, unplanned pregnancy, negative previous birth experiences, and preference for cesarean delivery. An inverse relationship was found between FOC and childbirth self-efficacy. ConclusionsThis study reveals a high FOC prevalence among Egyptian pregnant women, necessitating the need for systematic screening and tailored interventions to mitigate this concern, especially among high-risk groups like young, nulliparous mothers. Fostering childbirth self-efficacy may aid in reducing FOC. These findings can inform the enhancement of holistic maternal health practices in Egypt.

Preference and Associated Factors for Cesarean Delivery Among Pregnant Women: A Cross-Sectional Study.

A cesarean delivery is regarded as a comparatively favourable and secure approach to childbirth when contrasted with vaginal delivery. Over the past decade, its frequency has risen in both industrialized and developing nations. Maternal request for cesarean delivery has been explained for the escalating rate along with other factors like anxiety, fear of childbirth, previous cesarean delivery, previous negative vaginal birth experience, maternal age, maternal education, and socioeconomic factors. Hence, this study was undertaken to assess pregnant women's tendency to have a cesarean birth and to investigate the factors associated with the inclination for cesarean delivery. A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, a systematic sampling procedure was utilized, and 368 antenatal mothers after 36 weeks of gestation, who do not have any specific medical reasons against vaginal delivery were included in the study. Data collection was done by questionnaire. The information regarding socio-demographic factors, preexisting comorbidities, current obstetric risk factors, emotional factors, previous delivery experience, and their information preference toward the mode of delivery were collected. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. The preference for cesarean delivery and non-preference for cesarean delivery was 114 (30.9%) and 201 (54.6%), respectively whereas 53 (14.4%) participants remained neutral. The Chi-square analysis revealed a notable connection between the inclination towards a preference for cesarean delivery and factors such as obstetric score, parity, comorbidities, and among obstetric risk factors such as pregnancy after in-vitro fertilization (IVF), with a history of abortion, and having a prior history of cesarean delivery. Nevertheless, no meaningful association was observed between the preference for cesarean delivery and the remaining variables. On multivariate logistic analysis, independent variables like preexisting anxiety or depression, pregnancy through IVF, and having a history of previous cesarean delivery have increased the odds of preferring cesarean delivery. The independent variables like increasing gestational age, graduates, and unemployed have decreased the odds of preferring a cesarean delivery. In conclusion, the prevalence of cesarean delivery is influenced by a complex interplay of medical, cultural, socioeconomic, and healthcare system factors. While cesarean delivery is essential in cases of medical necessity, efforts should be made to avoid unnecessary cesarean delivery that does not provide clear benefits over vaginal delivery. Balancing the risks and benefits of cesarean delivery and promoting evidence-based obstetric practices are crucial for ensuring optimal maternal and infant outcomes.

Preference of cesarean delivery and its associated factors among pregnant women attending ante natal care at public health facilities of Debrebrehan City, Ethiopia: Cross-sectional study.

A Caesarean section is a surgical procedure used to prevent or treat life-threatening maternal or fetal complications. Women's delivery preferences have become a global issue of interest to many researchers and clinicians, especially given the ever-increasing rate of cesarean sections. There is limited data on the preference for cesarean delivery and its associated factors for Ethiopian women, particularly in the study area. The aim of the study is to assess the preference for cesarean delivery and its associated factors among pregnant women attending antenatal care at public health facilities in Debre Berhan, Ethiopia, in 2023. An institution-based cross-sectional study design was done from May 5-20, 2023, among 512 participants, and a multi-stage sampling technique was used. The data were collected by using interviewer-administered semi-structured questionnaires. The data were entered by Epi Data version 4.6 and then transferred to SPSS version 25 for analysis. With logistic regression, those variables with a p-value <0.25 in the bivariate analysis were candidates for multivariate logistic regression, and variables with a p-value <0.05 were considered statistically significant. The preference for a cesarean section was 26%, with a CI of 22.3% to 29.9%. Pregnant mothers who were not satisfied with their previous intrapartum care (AOR; 6.3 CI = (3.5-11), P = 0.01), had no knowledge about cesarean delivery (AOR; 2.9; 95% CI = 1.6-5.3), P = 0.01), had a previous history of spontaneous abortion (AOR; 3.1; 95% CI = (1.5-6.3), P = 0.001), lived in an urban area (AOR; 1.9; 95% CI = (1.0-3.5), P = 0.038), and had a current pregnancy-related problem (AOR; 4.8; 95% CI = 1.9-10), P = 0.001) were significantly associated with the preference for cesarean delivery. In this study, the preference for cesarean delivery was high as compared to the World Health Organization recommendation. Pregnant mothers who were not satisfied with their previous intrapartum care, had no knowledge about cesarean delivery, had a previous history of spontaneous abortion, had an urban residence, and had a current pregnancy-related problem were significantly associated with a preference for caesarean delivery. Clinicians who are working in the delivery room should improve their service provision by using patient-centered care to increase patient satisfaction.

Comparison of anesthesia professionals' preferences of delivery method with other health professionals

Objective: Work areas and clinical practices have an effect on cesarean rates, which are also high in health professionals. Anestehsia professionals and the health professionals who are far from surgical practices may have different views on delivery methods. In this study, it was aimed to investigate which delivery method between vaginal delivery and cesarean delivery was selected by the anesthesia professionals and the health professionals outside the operating room, and why they selected it. Material and methods: 137 anesthesia professionals and 151 health professionals who had never worked in the operating room were included in this study. The participants' ages, professions and methods of delivery and reasons were questioned by the survey method. Results: While 58.3% of all the participants preferred the cesarean delivery method at their first birth, 41.7% preferred vaginal delivery. The preference rates of anesthesia professionals for cesarean delivery (69.9%) were found higher than those of the professionals working outside the operating room (46.6%),(p<0.05). As the reason of preference for cesarean delivery, the option of “not putting the baby at risk” is higher among anesthesia professionals than the professionals outside the operating room (p<0.05). As the reason of vaginal delivery, “more physiological”, “fear of anesthesia and surgery”, “early recovery and desire to breastfeed baby” higher compared to anesthesia professionals (p<0.05). Conclusions: Knowing, practicing and seeing the anesthesia and surgical procedures every day have given the idea that these practices are simple, comfortable and have low risks, so the cesarean delivery rate has increased in anesthesia professionals.

Cesarean Delivery and Gender of Delivering Physicians: A Systematic Review and Meta-analysis.

To assess the association of the gender of the delivering physician and the odds of performing cesarean delivery. CINAHL, ClinicalTrials.gov, Cochrane Library, PubMed, Scopus and Web of Science from the first year of records through May 2020. We included studies that reported odds ratios (OR), or data allowing the calculation of ORs, for cesarean delivery performed by female and male delivering physicians. We also included studies that reported the preference of physicians for performing cesarean deliveries. Independent data extraction was carried out by at least two researchers. Standard inverse-variance random effects meta-analysis was used to generate overall ORs. Finally, in two separate meta-analyses, we analyzed 15 studies containing clinical data for 1,269,625 births, and 11 studies containing data for the preference for delivery mode of 4,911 obstetricians. Both the crude and adjusted odds of a cesarean delivery were lower for those performed by female physicians (crude OR 0.75, 95% CI 0.68-0.84, τ=0.029, adjusted OR 0.74, 95% CI 0.65-0.85, τ=0.031). We also found that female physicians had a lower preference for cesarean delivery in both crude and adjusted analysis (crude OR 0.59, 95% CI 0.36-0.96, I=77%, adjusted OR 0.58, 95% CI 0.40-0.84, I=67%). Female physicians are less likely to perform cesarean delivery and less likely to prefer it. This was observed across different health systems and populations. PROSPERO, CRD42020158442.

The effect of medical and social conditions on the mode of delivery: a prospective questionnaire-based study applied to 404 Turkish obstetricians.

To identify the factors that influence provider's decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians (p = 0.334) and between specialists, associate professors and professors (p = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle.

Prevalence and determinants of caesarean section in South and South-East Asian women.

BackgroundCaesarean section is considered a relatively preferable and safe method of delivery as compared to normal delivery. Since the last decade, its prevalence has increased in both developed and developing countries. In the context of developing countries viz., South Asia (the highest populated region) and South-East Asia (the third-highest populated region), where a significant proportion of home deliveries were reported,however, the preference for, caesarean delivery and its associated factors are not well understood.ObjectiveTo study the caesarean delivery in the South and South-East Asian countries and to determine the factors associated with the preference for caesarean delivery.MethodologyDemographic and Health Survey Data on from ever-married women of nine developing countries of South and South-East Asia viz., Vietnam, India, Maldives, Timor-Leste, Nepal, Indonesia, Pakistan, Bangladesh, and Cambodia have been considered. Both bivariate and binary logistic regression models were used to estimate the propensity of a woman undergoing for caesarean delivery and to assess the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery.ResultsObtained results have shown an inclination of caesarean delivery among urban than rural women and are quite conspicuous, but is found to be underestimated mostly among rural women. Caesarean delivery in general is mostly predisposed among women whose baby sizes are either very large or smaller than average, have a higher level of education and place of delivery is private medical institutions. The logistic regression also revealed the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. Based on nine South and South-East Asian countries an overall C-section prevalence of 13%, but based on institutional births its increase to 19%. The forest plot demonstrated that a significant inclination of C-section among urban than rural regions. In Meta-Analysis, very high and significant heterogeneity among countries is observed, but confirms that in terms of prevalence of C-section all of the countries follow independent pattern.ConclusionStudy of seven urban and four rural regions of nine South and South- East Asian countries showed, a significant inclination towards the caesarean delivery above the more recent outdated WHO recommended an optimal range of 10–15%and are associated maternal socioeconomic characteristics. In order to control unwanted caesarean delivery, the government needs to develop better healthcare infrastructure and along with more antenatal care related schemes to reduce the risks associated with increased caesarean delivery.

Mode of Delivery Preference Among Pregnant Nulliparous Women.

Background: Nearly a third of women in the United States deliver by cesarean at first childbirth. The extent to which women's prenatal mode of delivery preference contributes to the cesarean decision is not clear. Little research has measured pregnant nulliparous women's prelabor mode of delivery preference in relation to actual mode of delivery in the United States. Materials and Methods: A total of 3006 pregnant nulliparous women were asked about mode of delivery preference during pregnancy as part of the First Baby Study, a prospective study of women delivering in Pennsylvania hospitals, 2009-2011. Multivariable regression models were used to assess the association between women's preference for cesarean delivery and two decision stages: (1) the decision to have planned prelabor cesarean and (2) the intrapartum decision to have unplanned cesarean among those attempting vaginal delivery, adjusting for confounders. Results: Overall, 3.1% preferred cesarean delivery, 3.0% had no preference, and 93.9% preferred vaginal. Among those who preferred vaginal delivery, 4% had a planned cesarean; among those with no preference, 13.3% did; and among those who preferred cesarean, 33.7% did. In adjusted models, preference for cesarean was strongly associated with having planned prelabor cesarean (adjusted odds ratio [aOR] = 6.02; 95% confidence interval [CI] = 3.26-11.12), but was not significantly associated with unplanned cesarean among those who attempted vaginal delivery (aOR = 1.35; 95% CI = 0.77-2.38). Conclusions: Although preference for cesarean delivery among nulliparous women was uncommon, women who preferred cesarean were more likely to have planned prelabor cesarean delivery than those who preferred vaginal delivery.

Systematic review and meta-analysis of studies on delivery preferences in Brazil.

Cesarean delivery rates in Brazil are among the highest in the world. User preference is often mentioned as an important factor driving this. To identify, appraise, and synthesize the results of studies into delivery preferences in Brazil. MEDLINE, LILACS, and PsycINFO databases were searched, without language restrictions, using "delivery" and "preference" from inception to November 4, 2017. Cross-sectional or cohort studies with quantitative data on delivery preferences of lay persons in Brazil. Two reviewers performed study selection, quality assessment, and data extraction. A meta-analysis of proportions with a preference for cesarean delivery was performed, including subgroups analyses. There were 28 studies with 31071 participants included. The overall prevalence of preference for cesarean delivery was 27.2% (95% confidence interval [CI] 26.7%-27.7%; 28 studies, n=31071). Cesarean delivery preference was higher among multiparas with previous cesarean deliveries (58.0%, 95% CI 56.6%-59.3%; nine studies, n=5542) than among multiparas without prior cesarean deliveries (17.3%, 95% CI 16.4%-18.2%; eight studies, n=7903), and among women with private health insurance (44.3%, 95% CI 43.0%-45.6%; nine studies, n=6048) than among those who depended on the public healthcare system (22.7%, 95% CI 22.2%-23.3%; 20 studies, n=24314). Overall, most lay persons in Brazil did not prefer to deliver by cesarean.

Effect of second child intent on delivery mode after Chinese two child policy implementation: a cross sectional and prospective observational study of nulliparous women in Chongqing

ObjectivesTo assess the influence of second child intent on the delivery preferences and final delivery modes of nulliparous women, particularly caesarean delivery on maternal request (CDMR), after implementation of China’s...

Predictors of preference for caesarean delivery among pregnant women in Beijing.

ObjectiveTo evaluate factors associated with preference for caesarean or vaginal delivery among pregnant Chinese nulliparous and parous women.MethodsIn this cross-sectional study, a self-administered questionnaire was used to collect information on sociodemographic characteristics, preference/reasons for delivery mode, and knowledge of delivery complications.ResultsOf the 450 participants, 85 (18.9%) reported a preference for caesarean section (CS) pre-partum. Compared with women who would prefer a vaginal delivery, nulliparous women who preferred CS were more likely to be: ≥35 years; have no medical insurance; have had two or more pregnancies; have access to only one source of information about birthing options; knowledge of the complications of vaginal delivery and think doctors have no right to decide the type of delivery. For parous women who preferred CS, they were more likely to have had a previous caesarean delivery and live outside Beijing.ConclusionsFrom this study conducted at a large, maternity centre in Beijing, the proportion of pregnant women with preference pre-partum for CS was moderate and their reasons were varied.

Patterns and Associated Factors of Caesarean Delivery Intention among Expectant Mothers in China: Implications from the Implementation of China's New National Two-Child Policy.

Objective: This study explores the basic demographic characteristics of expectant mothers in the context of their intentions regarding mode of delivery, in particular, the preference for caesarean delivery, and analyzes the social and psychological factors that influence delivery preference. Method: A cross-sectional survey of pregnant women was conducted during June to August in 2015. This study adopted a stratified sampling method, and 16 representative hospitals in five provinces of China were included. Results: 1755 and 590 of expectant mothers in their first and second pregnancies, respectively, were enrolled in this study. 354 (15.10%) intended to deliver by caesarean section and 585 (24.95%) participants were uncertain prior to delivery. 156 (8.89%) of expectant mothers in their first pregnancy and 198 (33.56%) expectant mothers in their second pregnancy intended to deliver by caesarean section. Ordinal logistic regression analysis found that nationality, parity, trimester of pregnancy, and advanced maternal age were factors associated with intention to deliver by caesarean (ordered logistic regression/three-level caesarean delivery intention criterion; odds ratios p < 0.05). Conclusions: 8.89% of first pregnancy expectant mothers and 33.56% of second pregnancy expectant mothers intended to deliver by caesarean section. Any intervention program to reduce the rate of Caesarean delivery should focus on the Han population, older pregnant women, and expectant mothers in their second pregnancy, at an early gestation.

Survey of Obstetric Care and Cesarean Delivery Rates in Shanghai, China

China has one of the highest cesarean delivery rates in the world, with most cesareans done without indication. Observation of how perinatal care is delivered in a range of Shanghai hospitals was done to gain insight into the 50 percent cesarean delivery rate. A mixed methods approach combined a descriptive structured survey of obstetric services with standardized interview with obstetricians and qualitative observation of obstetric services in six different Shanghai obstetric facilities. The volume was extremely high: physicians in public hospitals routinely saw up to 80-120 prenatal patients per day. Frequent prenatal testing substituted for time spent in patient-doctor interactions. Family members were not allowed in delivery wards where women labored alone. Obstetrics services had low levels of nursing support and anesthesia for labor. Physical space favored rapid surgical turnover over longer labor. Physicians reported practical incentives to perform cesarean sections. Cesarean delivery was an efficient way to move patients through the systems observed, given the staffing and physical limitations of the public facilities. Physicians reported that patients and families perceived cesarean delivery as safer. Physicians also reported fear of charges of malpractice, for which they might be found to be financially liable or in physical danger. Societal expectations are high, and in a "one child" society, perception that cesarean section was safer may also have driven cesarean rates. Given the end of the One Child Policy, the preference for cesarean delivery may change.

Perinatal Outcome of Second Twin with Respect to Mode of Delivery: An Observational Study

With the advent of assisted reproductive techniques, multi-fetal pregnancies are on the rise. While caesarean section is the defined mode of delivery for triplets and higher order pregnancies, the picture for twin delivery is not so clear. While a trial for vaginal delivery is attempted, the second twin is considered vulnerable to complications. Whether this translates into worsened perinatal outcomes is not well defined. To study the perinatal outcome and to identify the various factors influencing the perinatal outcome of second twin with respect to mode of delivery. Data was collected from hospital birth records regarding the mode of delivery of viable twins (period of gestation >28 weeks) and outcome of second twin with respect to APGAR scores, NICU stay, neonatal morbidity and mortality, over a period of 12 months. Of the 93 pairs of twins delivered, in 21(22.6%) pregnancies both twins were delivered vaginally, in 70(75.2%) pregnancies both were delivered by caesarean section and in 2 (1.8%) pregnancies 1st twin was delivered by vaginal route and 2nd by caesarean. In the vaginal delivery group, 85.7% times both twins were in vertex position. In the caesarean group, vertex/non-vertex (38.57%) was the most common presentation followed by non-vertex /non-vertex (25.71%) and vertex/vertex (24.28%). Comparing the perinatal outcome of second twin in both groups, the odds for APGAR score ≤7 was 3.385 times (OR-3.384, 95% CI 1.2099- 9.4684, p=0.02) in the vaginal group compared to the caesarean group. There was no association (OR-1.054, 95% CI 0.3344- 3.3268, p=0.9) between neonatal morbidity of second twin compared to mode of delivery. All 3 perinatal deaths were in the vaginal group (all between 28-32 weeks of gestation). There is an increased preference for caesarean delivery in twin pregnancies except in cases where both the twins are in vertex position and not associated with any other maternal or fetal complication. However, the caesarean mode of delivery does not influence neonatal morbidity in second twin, except when the 1 minute APGAR score is ≤7.

Fear of Childbirth and Preference for Cesarean Delivery Among Young American Women Before Childbirth: A Survey Study.

Fear of birth and mode of delivery preferences are similar among pregnant and nonpregnant women, suggesting that attitudes toward birth are formed in young adulthood or earlier. Understanding why some young women fear birth and prefer obstetric interventions can inform public health initiatives aimed at reducing fear and promoting birth as a normal life event. We conducted an online survey with 752 American nulliparous young women to assess their preferences and attitudes toward childbirth. We identified explanatory variables associated with reported fear of childbirth and cesarean delivery (CD) preferences. A preference for CD was reported by 14 percent of young women and 27 percent had scores indicating elevated fear of birth. Fear of birth increased the likelihood of cesarean preference (adjusted relative risk (ARR) 3.84 [95% CI 2.49-5.95]) as did a family history of CD (ARR 1.65 [95% CI 1.13-2.42]). The likelihood of reporting elevated childbirth fear was increased among young women who reported concerns about the physical changes pregnancy and birth have on women's bodies (ARR 2.04 [95% CI 1.50-2.78]). Young women who reported a high degree of confidence in their knowledge about childbirth were significantly less likely to report childbirth fear (ARR 0.61 [95% CI 0.42-0.87]). Access to childbirth information was also associated with a decreased likelihood of fear of birth (ARR 0.75 [95% CI 0.59-0.95]). Young women reporting high levels of childbirth fear are nearly four times more likely to prefer a CD. Specific fears, such as worries over the influence of pregnancy and birth on the female body, need to be addressed before pregnancy.

Process of decision-making regarding the mode of birth in Brazil: from the initial preference of women to the final mode of birth.

The purpose of this article is to describe the factors cited for the preference for type of birth in early pregnancy and reconstruct the decision process by type of birth in Brazil. Data from a national hospital-based cohort with 23,940 postpartum women, held in 2011-2012, were analyzed according to source of funding for birth and parity, using the χ2 test. The initial preference for cesarean delivery was 27.6%, ranging from 15.4% (primiparous public sector) to 73.2% (multiparous women with previous cesarean private sector). The main reason for the choice of vaginal delivery was the best recovery of this type of birth (68.5%) and for the choice of cesarean, the fear of pain (46.6%). Positive experience with vaginal delivery (28.7%), cesarean delivery (24.5%) and perform female sterilization (32.3%) were cited by multiparous. Women from private sector presented 87.5% caesarean, with increased decision for cesarean birth in end of gestation, independent of diagnosis of complications. In both sectors, the proportion of caesarean section was much higher than desired by women.

Utilization of the prevention of parent-to-child transmission of HIV (PPTCT) services in a tertiary care hospital, Odisha, India

Aims: To assess seroprevalence of HIV among antenatal women and the extent of utilization of interventions to minimize the risk of mother-to-child transmission. Study Design: Descriptive cross-sectional study was carried out among antenatal women who attended integrated counseling and testing center (ICTC) of HIV. Sample sizes were determined from the number of pregnant women that attended ICTC. Place and Duration of Study: Data and samples were collected from a tertiary care hospital, Odisha, India during January 2009 to December 2012. Methodology: All pregnant women were counseled and tested for HIV by rapid test. All HIV-seropositive antenatal women (ANW) were linked to services and followed up for institutional delivery, single-dose nevirapine (sdNVP) prophylaxis, infant feeding options and testing of children at 18 months. Results: Out of 11,508 ANW registered and pretest counseled, 11,390 (98.97%) accepted HIV testing. Sixty women were found to be seropositive, thus showed seroprevalence rate of 0.53% (60/11,390). CD4 testing was carried out in all ANW and five (8.33%) were eligible for antiretroviral therapy (ART). Seven (11.67%) had opted for medical termination of pregnancy (MTP). All 48 ANW delivered institutionally, only 7 (14.58%) received cesarean delivery. Out of 46 live births, 5 (10.87%) ANW were on ART, 35/41 (85.37%) received sdNVP mother baby-pair prophylaxis and only 8/46 (17.39%) mother opted for replacement feeding. Twenty one children have reached 18 months till date and among them three (14.29%) were HIV-seropositive. All three were delivered vaginally, received sdNVP prophylaxis and were exclusively breast fed for 6 months. Conclusion: The HIV-seroprevalence rate among antenatal women was 0.53% and mother-to-child transmission (MTCT) rate was 14.29%. Reduction in MTCT rate needs pre or early antenatal HIV testing, prenatal antiretroviral medication, preference for cesarean delivery, 100% antiretroviral prophylaxis coverage and education on avoidance of breast-feeding. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18300 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.163-169

Bonding and breastfeeding after a cesarean delivery

Breastfeeding is associated with benefits to lifelong health, yet the rate of exclusive breastfeeding remains low in many industrialized countries. In the United States, less than one half of mothers breastfeed for 6 months, and only 15% do so exclusively [1]. Similarly, while more than 80% of mothers who reside in Italy initiate breastfeeding [2], only 55% of mothers who exclusively or predominantly breastfeed during the postpartum hospital stay still breastfeed 6 months after delivery, and fewer than 40% practice full breastfeeding within the first 6 months [3]. Mode of delivery, in particular cesarean delivery (CD), is widely believed to affect breastfeeding adversely. Some studies reported no association and others an inverse relation [4]. CD (prelabor or in-labor) has increased rapidly worldwide. It accounts for 31.8% of all births [5], and it is even more widespread in China and parts of South America, where rates are reported to be between 40% and 50% [6,7], figures far in excess of the WHO recommended rate of 15% [8]. The rise in elective prelabor CD is thus particularly concerning. In the United States, the number of elective CDs increased by 53% between 1996 and 2007 [9], whereas in England there was a 250% increase between 1980 and 2010, and currently 40% of all CDs are prelabor [10]. The contribution of maternal choice to the increasing elective CD rate is important. In the United Kingdom, 6–8% of pregnant women express a preference for CD [11], whereas in Australia, an increase in elective CD has not been accompanied by increases in potentially explanatory health related factors [12]. This finding should be interpreted with caution as maternal choice is not the only reason for elective CD, and there are a wide range of medical reasons that obstetricians recommend a prelabor CD [13]. Instead, in-labor cesarean delivery is often associated with the cumulative impact of different intrapartum interventions, which may affect a woman’s decision and ability to initiate breastfeeding. Therefore, better understanding of caesarean section rates, their consequences and their benefits will consent to professionals to monitor the quality of their practice to ensure that women can make the right feeding choice. Breastfeeding is considered the ideal way to provide nutrition to infants, and can significantly reduce infant morbidity. The World Health Organization (WHO) has developed the “Ten Steps to Successful Breastfeeding”, a strategy to support and improve breastfeeding [14], suggesting the use of standard definitions for breastfeeding outcomes. However, the duration of any and

Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences.

BackgroundAbout 20 million cesareans occur each year in the world and rates have steadily increased in almost all middle- and high-income countries over the last decades. Maternal request is often argued as one of the key forces driving this increase. Italy has the highest cesarean rate of Europe, yet there are no national surveys on the views of Italian women about their preferences on route of delivery. This study aimed to assess Italian women´s preference for mode of delivery, as well as reasons and factors associated with this preference, in a nationally representative sample of women.MethodsThis cross sectional survey was conducted between December 2010-March 2011. An anonymous structured questionnaire asked participants what was their preferred mode of delivery and explored the reasons for this preference by assessing their agreement to a series of statements. Participants were also asked to what extent their preference was influenced by a series of possible sources. The 1st phase of the study was carried out among readers of a popular Italian women´s magazine (Io Donna). In a 2nd phase, the study was complemented by a structured telephone interview.ResultsA total of 1000 Italian women participated in the survey and 80% declared they would prefer to deliver vaginally if they could opt. The preference for vaginal delivery was significantly higher among older (84.7%), more educated (87.6%), multiparous women (82.3%) and especially among those without any previous cesareans (94.2%). The main reasons for preferring a vaginal delivery were not wanting to be separated from the baby during the first hours of life, a shorter hospital stay and a faster postpartum recovery. The main reasons for preferring a cesarean were fear of pain, convenience to schedule the delivery and because it was perceived as being less traumatic for the baby. The source which most influenced the preference of these Italian women was their obstetrician, followed by friends or relatives.ConclusionFour in five Italian women would prefer to deliver vaginally if they could opt. Factors associated with a higher preference for cesarean delivery were youth, nulliparity, lower education and a previous cesarean.