Unplanned Births Research Articles

Planned Home Birth as a Safe Alternative to Hospital Birth for Low-Risk Women: A Systematic Review

Home birth is a widely practised norm among women in most developing countries. Studies continue to evaluate the safety of planned home birth (PHB) for low-risk women in high-income countries. However, such studies are scarce in Africa and other developing countries. The study examined PHB as a safe alternative to planned hospital birth for low-risk women. An electronic search was carried out on databases such as Medline database, Cochrane, Google Scholar, PubMed, and CINAHL to identify studies published in English from January 2007 to December 2017. A Meta-analytic study, systematic reviews, and observational (prospective and retrospective) studies were included in the literature reviews. The studies were analyzed using descriptive and narrative synthesis. The strength and or limitations of each study were assessed. Sixteen eligible articles were finally reviewed. PHB is equally safe in terms of complication (especially postpartum haemorrhage) compared to planned hospital birth. PHB would have a similar outcome in reducing maternal death for low-risk women if compared with planned hospital birth. Although neonatal asphyxia is mixed across studies, PHB is associated with a similarly low rate of neonatal intensive care unit admission. It was also indicated that there was no increase in neonatal mortality for PHB, especially for parous women. PHB compared to the hospital is associated with a similar low risk of maternal complications, maternal deaths, newborn complications, and newborn deaths, especially for parous women. Therefore, PHB is a safe alternative to hospital birth for low-risk women. While studies that are more recent are required to evaluate its feasibility and safety in developing countries, PHB (if properly attended) may reduce maternal and newborn complications and death associated with unplanned home births.

Midwives' experiences with accompaniment service work in Norway: A qualitative study.

The centralization of health services appears to be prevalent both in and outside Europe. As the distance to the nearest birth institution increases, so does the risk of unplanned births outside of an institution. A primary factor to prevent this is having a skilled birth attendant present. This study examines midwives' experiences of working in the accompaniment services in Norway. This was a qualitative interview study of 12 midwives working in the accompaniment services in Norway. Semi-structured interviews were conducted in January 2020. Systematic text condensation was used to analyze the data. The analysis identified four main themes. The midwives felt that accompaniment service work was a heavy responsibility, but it was professionally fulfilling. They felt that being on call was a lifestyle, and they were motivated by their relationships with the pregnant women. Presenting themselves as confident midwives helped the women to feel reassured. The midwives considered the cooperation within the health service to be key to good transport midwifery. The midwives who worked in the accompaniment services felt that their responsibility for caring for women in labor was challenging, but meaningful. Their professional knowledge was important for identifying the risk of complications and handling difficult situations. Despite carrying a heavy workload, they continued to work in the accompaniment services to ensure that women who had to travel long distances to birth institutions received appropriate help.

The Effect of Unplanned Home Birth on Maternal and Neonatal Outcomes: Systematic Review

Giriş: Planlanmamış ev doğumlarının maternal ve neonatal sonuçlar üzerinde etkisinin olduğu bilinmektedir. Amaç: Bu derleme, planlanmamış ev doğumlarının maternal ve fetal sonuçlar üzerine etkisini güncel çalışmalarla gözden geçirmek ve planlanmamış ev doğumlarının olumlu ve olumsuz yönlerini ortaya koymak amacıyla yapılmıştır. Yöntem: Sistematik derleme niteliğinde olan çalışma, 28 Ağustos- 27 Eylül 2020 tarihlerinde, Türkçe ve İngilizce dizinler taranarak yapılmıştır. Türk Medline, Sciencedirect, Google Akademik, Pubmed, Cochrane ve Ulusal Tez Merkezi veri tabanları kullanılarak ‘evde doğum, hastane dışı, hastane dışı doğum, evde doğum-hastane dışı doğum ve neonatal sonuçlar, evde doğum-hastane dışı doğum ve maternal sonuçlar’ anahtar kelimeleri ile aranmıştır.Bulgular: Bu sistematik derlemede planlanmamış evde doğumların maternal ve neonatal sonuçları olumsuz etkilediği saptanmıştır. Kadınların; yaş, gebelik sayısı, gebelik haftası, medeni durum ve sosyoekonomik özelliklerinin doğumların hastane dışında gerçekleşme olasılığı üzerinde etkili olduğu, planlanmamış evde doğum yapan kadınlarda daha fazla olumsuz maternal sonuç bildirildiği görülmüştür. Planlanmamış evde doğumlar sonucunda dünyaya gelen yeni doğanların doğum ağırlıklarının düşük olduğu, prematüre olma risklerinin yüksek olduğu, hastanede yatış sürelerinin daha uzun olduğu, klinik komplikasyon görülme oranları ile neonatal morbidite ve mortalite oranlarının daha yüksek olduğu belirlenmiştir. Planlanmamış evde doğum yapan kadınların yetersiz antenatal bakım aldığı saptanmıştır.Sonuç: Bu derlemenin sonucunda, kadınların maternal özelliklerinin hastane dışında doğum yapma olasılıklarını etkilediği, planlanmamış evde doğumların olumsuz maternal ve neonatal sonuçların yaşanma riskini artırdığı ve yetersiz antenatal bakım alma ile ilişkili olduğu bulunmuştur.

The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement.

Maternal obesity and cesarean birth disproportionately affect Black parturients; thus, prevention of cesarean birth is a key modifiable factor to improve pregnancy outcomes and reduce disparities. The primary driver of unplanned cesarean birth among people with higher body mass index is prolonged labor duration. However, strategies to optimize outcomes in these situations have not been established. We aimed to evaluate the influence of oxytocin augmentation on uterine activity and labor progression in nulliparas with obesity. This secondary analysis involved nulliparas with obesity (BMI ≥30kg/m2) who had spontaneous labor onset followed by oxytocin augmentation and an intrauterine pressure catheter. Using Linear Mixed Models, we evaluated relationships between uterine activity measured in Montevideo units (MVU), oxytocin dose, and rate of cervical dilation normalized by labor duration. In this diverse sample (35.6% Caucasian, 16.11% African American, 40.2% Hispanic) of nulliparas with obesity (n = 87; BMI 35.54 ± 4.38kg/m2), 31% ended labor with cesarean birth. Among those with vaginal birth, only 13% had MVU ≥200 prior to the final 2hours of labor. MVUs were only minimally responsive to oxytocin dose and were not associated with labor progression nor birth route. MVU measurements may not be useful to diagnose labor arrest in nulliparas with obesity. Optimizing care for birthing people with obesity is essential for improving perinatal outcomes and for reducing racial health disparities.

Contextualizing disparities in NTSV cesarean rates with county-level data

The rate of cesarean births among nulliparous women with a term singleton fetus in vertex presentation (NTSV) is a quality indicator for perinatal care. Black women are disproportionately affected by high rates of unplanned cesarean birth and are at increased risk for the associated complications. We sought to describe disparities in the county-level NTSV cesarean birth rate in the United States to understand how cesarean disparities vary by place.

Lived experiences and drivers of induced abortion among women in central Uganda.

Although unsafe abortions are preventable, they are one of the leading causes of maternal mortality and morbidity. Despite the serious potential health consequences, there is limited published information about drivers and challenges of obtaining abortions in restrictive settings such as Uganda. This limits efforts to improve programing for preventing unsafe abortion and providing comprehensive post abortion care. This study sought to understand the drivers and explain the lived abortion experiences among women from central Uganda, in an effort to promote greater access to safe reproductive healthcare services, and reduce unsafe abortions. This qualitative study included 40 purposely selected women who self-reported an abortion, living in Kampala and greater Rakai district, Uganda. They were part of a larger survey using respondent driven sampling, where seed participants were recruited from selected facilities offering post-abortion care, or through social referrals. Data were collected from May to September 2021 through in-depth interviews. Audio data were transcribed, managed using Atlas.ti 9, and analyzed thematically. The findings show that the underlying drivers stemmed from partners who were unsupportive, denied responsibility, or had raped/defiled women. Career and education decisions, stigma and fear to disappoint family also contributed. Women had feelings of confusion, neglect, betrayal, or shame after conception. Abortion and post-abortion experiences were mixed with physical and emotional pain including stigma, even when the conditions for safe abortion in the guidelines were satisfied. Although most women sought care from health facilities judged to provide safe and quality care, there was barely any counselling in these venues. Confidantes and health providers informed the choice of abortion methods, although the cost ultimately mattered most. The mental health of women whose partners are unsupportive or who conceive unintendedly need consideration. Abortion provided psychological relief from more complicated consequences of having an unplanned birth for women.

Preterm Birth: An Overview.

Birth order has a significant impact on perinatal and long-term outcomes. Preterm birth rates, ranging from 5% to 18%, are regrettably still high in industrialized and developing countries, making them the main contributor to infant mortality and morbidity. Infection, cervical pathology, uterine overdistension, progesterone deficiency, stress on the mother and fetus, allograft reaction, allergic phenomena, and likely more unknown factors are just a few of the causes of preterm birth syndrome. These several causes may improperly stimulate the usual pathway between the decidua and the fetal membranes, resulting in cervical ripening, membrane rupture, and uterine contractility. Some of the mechanisms underpinning these actions include receptors, chemokines, and inflammatory cytokines. For early identification, treatment, and avoidance of negative consequences, it is essential to understand the cellular and metabolic mechanisms that cause preterm labor. Clinicians and researchers are crucial to improving our knowledge of the biochemistry of preterm delivery, identifying risk factors, and creating treatments for this challenging condition. Intrauterine growth restriction and pre-eclampsia or eclampsia are frequent causes of suspected preterm births. "Spontaneous preterm births" occur after preterm labor that develops without warning with an early membrane rupture. It is thought that the condition that may cause these births may have several causes, such as uterine overdistension, vascular disease, infection, or inflammation. Unplanned preterm births have several reasons, including the black race, periodontal disease, low mother body mass index (BMI), and previous preterm births. A short cervical length and a high cervical-vaginal fetal fibronectin concentration are the two best signs of premature birth.

SEQUENCING OF PLANNED AND UNPLANNED BIRTHS AND IMPLICATIONS FOR MID- AND LATER-LIFE HEALTH AMONG NLSY79 WOMEN

Abstract Existing studies demonstrate that unplanned births (e.g., unwanted, mistimed) are associated with worse health for mothers in the short-term and—according to some preliminary evidence—in mid- and later-life. Yet as life course and reproductive career frameworks highlight, childbearing experiences often unfold over a number of years, with a considerable amount of diversity in pregnancy and birth experiences even for the same individual. For example, a person may have an unplanned birth in late adolescence followed by only planned births in early adulthood. In order to provide a more holistic understanding of how birthing experiences births are associated with midlife health, we use Sequence Analysis (SA) on the 1979 National Longitudinal Survey of Youth (NLSY79; N=3,992) to examine how patterning of planned and unplanned births is associated with physical and mental health at ages 50 and 60 (SF-12). Preliminary analysis indicates that compared to respondents with only planned births, respondents with unplanned birth(s) followed by planned birth(s) have worse physical and mental health at midlife, but there is no difference in health for respondents with only planned births, only unplanned births, and planned birth(s) followed by unplanned birth(s). Future analysis with SA will consider how more detailed sequences (e.g., timing, number and type, ordering, spacing) are associated with these mid- and later-life health outcomes, taking into account selection factors such as childhood SES and educational attainment. This project demonstrates the need for life course perspectives on the long-term health implications of unplanned births, recognizing diversity within and between individuals.

SEQUENCING OF PLANNED AND UNPLANNED BIRTHS AND IMPLICATIONS FOR MID- AND LATER-LIFE HEALTH AMONG NLSY79 WOMEN

Abstract Existing studies demonstrate that unplanned births (e.g., unwanted, mistimed) are associated with worse health for mothers in the short-term and—according to some preliminary evidence—in mid- and later-life. Yet as life course and reproductive career frameworks highlight, childbearing experiences often unfold over a number of years, with a considerable amount of diversity in pregnancy and birth experiences even for the same individual. For example, a person may have an unplanned birth in late adolescence followed by only planned births in early adulthood. In order to provide a more holistic understanding of how birthing experiences births are associated with midlife health, we use Sequence Analysis (SA) on the 1979 National Longitudinal Survey of Youth (NLSY79; N=3,992) to examine how patterning of planned and unplanned births is associated with physical and mental health at ages 50 and 60 (SF-12). Preliminary analysis indicates that compared to respondents with only planned births, respondents with unplanned birth(s) followed by planned birth(s) have worse physical and mental health at midlife, but there is no difference in health for respondents with only planned births, only unplanned births, and planned birth(s) followed by unplanned birth(s). Future analysis with SA will consider how more detailed sequences (e.g., timing, number and type, ordering, spacing) are associated with these mid- and later-life health outcomes, taking into account selection factors such as childhood SES and educational attainment. This project demonstrates the need for life course perspectives on the long-term health implications of unplanned births, recognizing diversity within and between individuals.

Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder

Women with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of becoming teenage mothers. Adverse effects of hormonal contraception (HC), including depression, may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage births in women with ADHD. The current study analyzed whether girls and young women with ADHD are at increased risk for depression during HC use compared with women without ADHD. A linkage of Swedish national registers covering 29,767 girls and young women with ADHD aged 15 to 24 years and 763,146 without ADHD provided measures of ADHD and depression diagnoses (International Classification of Diseases [ICD] code) and prescription of stimulant medication, HC, and antidepressant medication (Anatomical Therapeutic Chemical [ATC] code). Cox regression models applying an interaction term (ADHD diagnosis× HC use) evaluated the excess risk of HC-induced depression in women with ADHD. Women with ADHD had a 3-fold higher risk of developing depression, irrespective of HC use (adjusted hazard ratio [aHR]= 3.69, 95% CI= 3.60-3.78). Oral combined HC users with ADHD had a 5 times higher risk of depression compared with women without ADHD who were not using oral combined HC (aHR= 5.19, 95% CI= 4.94-5.47), and a 6 times higher risk in comparison with women without ADHD who were on oral combined HC (aHR= 6.10 (95% CI= 5.79-6.43). The corresponding risk of depression in women with ADHD who used a progestogen-only pill (aHR= 5.00, 95% CI= 4.56-5.49). The risk of developing depression when using non-oral HC was similarly moderately increased in both groups. Girls and young women with ADHD have an increased risk of developing depression when using oral HC compared with their unaffected peers. Information on risks with HCs as well as potential benefits with long-acting reversible contraceptives needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.

An investigation of the impact of the Global Gag Rule on women’s sexual and reproductive health outcomes in Uganda: a difference-in-differences analysis

In 2017, the Trump administration reinstated the Global Gag Rule (GGR), making non-U.S. non-governmental organisations ineligible for US government global health assistance if they provide access to or information about abortion. Little is known about the impact of the Trump administration’s GGR on women’s outcomes. Data for this analysis come from a panel of women surveyed in 2018 and 2019 in Uganda (n = 2755). We also used data from meetings with key stakeholders to create a detailed measure of exposure to the GGR within Uganda, classifying districts as more or less exposed to the GGR. Multivariable regression models were used to assess changes in contraceptive use, all births, unplanned births, and abortion from before to during implementation of the GGR. Difference-in-differences (DID) estimates were determined by calculating predicted probabilities from interaction terms for exposure/survey round. Descriptive analyses showed long-acting reversible contraceptive use increased more rapidly among women in less exposed districts after GGR implementation. DID estimates for contraceptive use were small. We observed a DID estimate of 3.5 (95% CI −0.9, 7.9) for all births and 2.9 (95% CI −0.2, 6.0) for unplanned births for women in more exposed districts during the period the policy was in effect. Our results suggest that the GGR may have attenuated Uganda’s recent progress in improving SRHR outcomes, with women in less exposed districts continuing to benefit from this progress, while previously increasing trends for women in more exposed districts levelled off. Although the GGR was rescinded in January 2021, the impact of these disruptions may be felt for years to come.

Individuals' Experiences of Having an Unplanned Cesarean Birth: A Qualitative Analysis.

The experience of an unplanned cesarean birth may be a risk factor for mood disorders and other challenges in the postpartum period, yet qualitative data on the patient experience are limited. We sought to understand individuals' experiences of having an unplanned cesarean birth. This was a secondary analysis of a prospective qualitative investigation among low-income postpartum individuals at a single-, tertiary-care center in which the primary aim was to evaluate patients' postpartum pain experience after a cesarean birth. Participants completed a 60-minute face-to-face interview on postpartum days 2 to 3. Only participants who labored prior to their cesarean birth were included in this analysis. Transcripts were analyzed by two separate authors using the constant comparative method. Themes are illustrated using direct quotes. A total of 22 individuals were included in this analysis; the majority (n=16, 72.7%) experienced a primary cesarean birth. Over half (n=12, 54.5%) identified as Hispanic and one-third (n=7, 31.8%) identified as non-Hispanic Black race and ethnicity. Four themes regarding the experience of a cesarean birth after labor were identified, including feelings of anguish, belief that vaginal birth is "normal," poor experiences with care teams, and feelings of self-efficacy. Subthemes were identified and outlined. In this cohort, individuals who experienced an unplanned cesarean birth after labor expressed feelings of self-blame, failure, and mistrust. Given the association of unplanned cesarean birth with mood disorders in the postpartum period, efforts to enhance communication and support may offer a means of improving individual experiences. · In this cohort, many individuals expressed negative feelings after an unplanned cesarean birth.. · Conversely, positive themes related to feelings of self-efficacy were identified.. · Efforts to enhance communication and support after an unplanned cesarean birth are warranted..

Unplanned out-of-hospital birth apparatus benefits: A paramedic simulation trial

Unplanned births outside of hospitals have becoming an issue in cities. The majority of healthcare professionals are paramedics. When performed alone, this event frequently causes them strain and anxiety. Their primary worries were the safety of mothers and newborns, as well as insufficient obstetrical equipment. As a result, our team developed a portable birth bed equipped with newborn safety devices for this research. One hundred fourteen paramedics of local area participated in this study and were divided into intervention and conventional group. In simulation trials, the study found that this safety intervention outperformed the conventional setup. We determined that our technology aided in the delivery of unusual babies. However, it requires additional research in the actual situation.

A Comparative Study-- Sex Education in China and Sweden

Politics, clan, and husband power significantly affect sex education for decades. Deeply rooted Confucianism keep Chinese people, sex is still a private subject in China. Although the country has carried out a series of measures, the improvement of sex education still faces challenges. Thus, this paper first examines the issues and challenges faced by China. In addition, the paper is enlightened by Sweden that possesses pioneering sex education. The findings revealed that sex education in Sweden not only aim to avoid unplanned births, but also deliver sexual knowledge and concept of interpersonal. Designing particular curriculum to deliver sexual knowledge for different ages students and incorporate sexual knowledge into other subjects. Besides, Sweden has well-designed organization and clinic which can popularize sexual knowledge from public. Learning from which is the pioneer of sex education, the curriculum of sex education should be delivered typically with discipline characteristics through biology, history, physical education and health, music, geography, and so on, to assure student acquire knowledge comprehensively. On the other hand, ideological change and policy support, innovative curriculum design and implementation, enhance sex education from public and community, and high-quality teacher training is the core to changing the current situation of China sex education.

The Pathophysiology of Labor Dystocia: Theme with Variations.

Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.

Uptake of Immediate Postpartum LARCs and Associated Factors among Mothers Who Gave Birth at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

Background Postpartum family planning is an effective strategy for reducing maternal and childhood morbidity and mortality by preventing unintended pregnancy and short interpregnancy intervals. Despite the paramount advantages of long-acting reversible contraceptives (LARC), their uptake remains low in Ethiopia. Therefore, the aim of this study was to assess the uptake of immediate postpartum LARC methods and its associated factors among women who gave birth in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Southern Ethiopia. Methods An institution-based cross-sectional study was conducted among 418 eligible mothers who were in the immediate postpartum period. Data were collected using a pretested structured questionnaire before their discharge from the hospital and analyzed by using SPSS version 20. The statistical significance was declared at P value less than 0.05. Results The uptake LARCs among immediate postpartum mothers was 25.4%. The most commonly reported reasons for not using LARC were preference to start contraception after six weeks of delivery (43.3%) and the need to use other methods of contraception (26%). Having unplanned birth (AOR: 1.97; 95% CI: 1.04-3.71) and receiving family planning counselling on LARCs during the postpartum period (AOR: 21.1; 95% CI: 6.49-68.66) were factors significantly associated with immediate postpartum LARC use. Conclusion Low utilization of immediate postpartum LARC uptake was found in the current study setting. There was increased utilization of immediate postpartum LARC among mothers who received family planning counselling during the postpartum period. Therefore, strengthening family planning counselling during the immediate postpartum period is crucial to enhance postpartum LARC use.

Advancing understanding of maternal age: correlating epigenetic clocks in blood and myometrium

BackgroundAdvanced maternal age is currently a term defined by chronological age. However, a group of biomarkers known as epigenetic clocks, which can predict morbidity and mortality, has been used to estimate measures of biological aging. Uterine myometrial function during the process of parturition may be influenced by aging, as labor dystocia, unplanned intrapartum cesarean birth, and postpartum hemorrhage are more common in older individuals. The purpose of this study was to evaluate the use of epigenetic clocks in maternal myometrium and blood for predicting age and to evaluate the correlation of epigenetic age between the tissues.ResultsWe compared epigenetic age in blood and myometrial samples provided by women undergoing planned cesarean birth at term gestation. Chronological age ranged from 20 to 50 with a median (IQR) age of 35.5(8) years. The MethylationEPIC BeadChip was used to obtain DNA methylation data, and then epigenetic age was calculated using the Horvath, Hannum, GrimAge, and PhenoAge clocks. Spearman correlations of epigenetic age with chronological age were calculated. We tested the relationship of epigenetic age in maternal blood to epigenetic age in myometrium. Age acceleration, for each clock, was also correlated between tissues. Twenty-seven participants provided samples, and 21 matched specimens were included in the final analysis after quality control. Spearman correlation between maternal chronological age and epigenetic age were significant in three of the four clocks (pan-tissue Horvath, Hannum, and GrimAge), for both myometrium and blood samples. Correlations between blood epigenetic age and maternal age ranged from 0.72 to 0.87 (all p < 0.001). Correlations between myometrial epigenetic age and maternal age were also significant (0.62–0.70, p = 0.002), though lower than correlations seen in blood. Maternal blood epigenetic age also correlated with epigenetic age in myometrium with each of these three clocks 0.60 (p = 0.004, Horvath), 0.63 (p = 0.003, Hannum), and 0.80 (p < 0.001, GrimAge). GrimAge age acceleration had the highest correlation between tissues among the clocks (0.49, p = 0.02).ConclusionsGiven the limited sample, this study provides insight into the potential use of epigenetic age derived from blood as a proxy for myometrial epigenetic age, which may be a useful biomarker in estimating myometrial biological age in relationship to myometrial dysfunction. GrimAge outperformed the other tested clocks in terms of concordance of epigenetic age and age acceleration between tissues; however, the Horvath and Hannum clocks may be useful depending on the outcome of interest in pregnancy.

Learning from women: Improving experiences of respectful maternity care during unplanned caesarean birth for women with diverse ethnicity and racial backgrounds

ProblemWomen from diverse ethnicity and racial backgrounds have few opportunities to share birth experiences to inform improvements in care. BackgroundRespectful maternity care is recognised as a global women’s health priority. Integrating that framework into diverse care systems and models may help bridge care gaps for women who had unexpected birth experiences, including unplanned caesarean birth. AimTo describe the experiences of women who had unplanned caesarean births and use knowledge gained to inform best practice recommendations that embody respectful maternity care. MethodsQualitative data were analysed from focus groups involving a convenience sample of 11 English speaking women, from diverse ethnic and racial backgrounds, with prior unplanned caesarean experience. Respectful maternity care was used as the lens for interpreting women’s narratives using Thorne’s interpretive description. The study site was an outpatient prenatal clinic within an urban academic, tertiary-care medical centre in the United States. FindingsTwo predominant, contrasting themes emerged: “not feeling well cared for” and “feeling well supported”. Positive experiences included sources of support and strength from the midwifery practice, group prenatal care, and a doula program. Eight domains of respectful maternity care were applied to findings, highlighting current positive institutional practices and proposing areas for future quality improvement. ConclusionKey practices promoting respectful maternity care include adequate communication and information sharing between pregnancy care providers and women, and a more robust informed consent process. Further emphasis on respectful maternity care is needed to support women to make shared decisions that best fit their circumstances and preferences.

Immediate vs Routine Postpartum Intrauterine Device Placement After Teen Pregnancy: A Cost-Effectiveness Analysis [A02

INTRODUCTION: The time surrounding a teen’s first pregnancy represents an ideal period to counsel on effective contraception and prevent additional unplanned pregnancies. It has yet to be examined if post placental intrauterine device (IUD) placement is cost effective in teenage patients relative to routine placement in the office. METHODS: A decision analytic model was built using TreeAge software to compare outcomes and costs among teenagers receiving either post placental or routine IUD placement. Outcomes, associated health care costs, and maternal quality-adjusted life years (QALY) were compared. All probabilities, utilities, and costs were derived from the literature. Costs were in 2021 US dollars with a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to assess how variation in baseline assumptions impacted model outputs. RESULTS: In a theoretical cohort of 300,000 teen births, post placental IUD placement yielded 35,620 more QALYs but cost $32 million more than routine placement. Post placental placement prevented 9,740 additional unplanned births—including 1585 preterm births—and 5595 abortions. Post placental placement was no longer cost effective when the likelihood of IUD removal within the next year rose from our baseline estimate of 0.14 to 0.46 or when the rate of subsequent unplanned teen pregnancy without an IUD fell to 0.007. CONCLUSION: Post placental IUD placement is cost effective for teenage patients from the maternal perspective. The cost effectiveness of the strategy is contingent on the likelihood of removal within the next year and of unplanned pregnancy without an IUD in place.

Primiparous and Multiparous Women's Mode of Birth and Negative Emotions.

Negative childbirth experiences may result in negative emotions that may lead to negative outcomes, such as post-traumatic stress disorder. We aimed to examine the differences in emotions between primiparous and multiparous women and mode of birth. We used a retrospective cross-sectional study design with three hundred and fifty women. Primiparous women reported higher levels of fear, lack of control, and dissociation emotions compared to multiparous women. The EmCs (emergency cesarean section) group experienced the most fear, lack of control, anger, and conflict emotions. It is important to conduct follow up work with women who underwent unplanned birth procedures since negative childbirth experiences may lead to further negative effects on women’s psychosocial health and well-being.