Women Request Research Articles

Essure® removal in 10 steps

Many women request Essure® removal because of possible side effects related to the device itself. Laparoscopic Essure® removal in symptomatic women may be associated with improvement in quality of life. We aim to describe the surgical technique in ten steps in the accompanying video as the standardization of the laparoscopic Essure® removal procedure could help to diminish the risk of fractures of the device with this easy and safe 10-step procedure.

Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand

BackgroundIncreasing worldwide rates of cesarean section are of global concern. In recent years, cesarean births upon maternal request have become a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications.MethodsA descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women who preferred cesarean birth, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019. Data were analyzed using content analysis.ResultsMaternal reasons for cesarean preference were classified into six main categories: fear of childbirth, safety concerns related to health risk perceptions, negative previous birth experiences, positive attitudes toward cesarean birth, access to biased information and superstitious beliefs in auspicious birth dates. Most women had more than one reason for opting cesarean birth.ConclusionSeveral reasons for cesarean birth preference have been elucidated. One striking reason was superstitious beliefs in auspicious birth dates, which are challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth in order to prevent or diminish unnecessary cesarean births.

A Secondary Analysis of the LILAC Study Regarding Cesarean Birth by Maternal Request in Women Living with HIV.

Background:Latin America has the highest regional average cesarean birth rates. One potential driver is cesarean birth by maternal request (CBMR).Methods:We analyzed of a large prospective cohort study of HIV-infected women in six Latin American countries.Results:Comparisons were made between women who chose CBMR (n = 38) and women with a medical indication for cesarean (n = 683). The only variable associated with CBMR was onset of labor (AOR 0.3 [0.1,0.9], p = 0.04).Conslusion:Spontaneous labor reduced the likelihood of a woman living with HIV to pursue CBMR in a large Latin American cohort.

Caesarean section between doctrine to heresis. medicoethical and deontological view of caesarology: an opinion

Increasing the incidence of caesarean section is not in line with professional and deontological guidelines. Elective cesarean section prevents primordial prevention of chronic cardiovascular, gastrointestinal, imunological, endocrinological morbidity by peripartal programming. Elective non-medical indicated caesarean section is not a procedure that respects deontological, clinical etics, scientific and professional principles. It is like an unacceptable surgery outside the scope of medical ethics. Clientelism in high-risk clinical obstetric medicine is not a professional and deontologically correct category: a physician should not be a provider on request of healthy pregnant women with the potential to have a medically incorrect procedure and complications associated with it and to put a healthy pregnant/maternity and child status in the patient’s status. The financial, social, political and cultural components must not outweigh good clinical practice and the moral principles of medicine.

Gender Equality in New Public Management Movement Practice Based on the Perspective from Feminism of Virginia Woolf

Feminism is a common word for a complicated phenomenon, which deals with women’s standard, searches for the equality between men and women, and strives for eliminating the barriers preventing the liberation and development of the women. In the development of woman literature, there are many outstanding women writer and Virginia Woolf is a quite representative one. Her works had been studied by the authoritative scholars and enriched the feminist thoughts. And her work A Room of One’s Own is considered to be a feministic declaration, which also has its deep realistic influence. Her thoughts, the inequality between women and men cause women request equal status with men who lead to more and more feminist movement began. So until 20th century, the New Public Management Movement did people pay more attention to women’s rights and the feminist movement out broke.

Khol’â (the dislocation): An Analytical View of the Supreme Court’s Judges Compared to Islamic Jurisprudence

The Algerian legislator has developed several ways and methods to release the marital union. One of these is the Khol’â or the dislocation whereby the woman requests divorce from her husband in exchange for money that she offers to him. If the husband accepts both Khol’â or the dislocation and the offer, then there is no problem. In case he accepted the dislocation and rejected the offer, the judge would have to determine the allowance on the basis of the dowry of similar cases. Before the amendment of the family code in 2005 and due to the lack of clarity in the text, the judges’ opinions differed if the husband refused dislocation altogether. A woman may request Khol’â before completing the physical marriage procedures, that is, before consummation, and here we face the problem of the judges ’response to her request. This research paper aims to clarify the truth of what judges in general, and Supreme Court justices in particular, have said, regarding whether Khol’â is considered a pure right for women or men had a share in it. And, whether it is really not valid to divorce before consummation because it violates either the law or the provisions of Islamic law. In our research, we have used the descriptive and analytical methodology, in addition to the comparative method. At the end we have deduced that the judges used to stipulate the husband’s consent for the Khol’â. But now they have established that it is a pure right for women, especially after amending Article 54 of the family law. They are also almost unanimous in the non-permissibility of Khol’â before consummation, while the Supreme Court is settled on that. We have come to the conclusion that this does not have a legal basis, that means there is no text that prohibits it not even in Sharia, as the jurists of the four schools are all agreed upon its validity.

Community-based service requests and utilization among pregnant women incarcerated in jail.

Pregnant incarcerated women represent a unique population in the criminal justice system that has been largely overlooked in terms of their service-related needs. The present study examines 241 pregnant incarcerated women's service requests and preincarceration service utilization related to material help (e.g., food, housing), mental health (e.g., counseling), family services (e.g., home-visiting nurses), and health care (e.g., insurance). A subsample (n = 74) also provided information about service utilization following their release from jail. Analyses examined request and utilization patterns in relation to other sociodemographic risk experiences. Results show that specific risk factors such as age, as well as the accumulation of multiple risk factors, served as barriers to requesting and accessing community-based services. The present study illuminates unique challenges pregnant incarcerated women experience requesting and utilizing services. The results support the use of a gender-responsive, trauma-informed approach to better address the needs of these women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power

Caesarean delivery is a common and life-saving intervention. However, it involves an overall increased risk for short-term and long-term complications for both mother and child compared with vaginal delivery. From...

Abortion services and ethico-legal considerations in India: The case for transitioning from provider-centered to women-centered care.

Nearly a million Indian women lack access to safe and dignified abortion services from public healthcare facilities and instead opt to induce abortions by themselves or with the help from unskilled and unauthorized practitioners. Unsafe abortions account for an estimated 9% of all maternal deaths in India despite the legalization of abortion on all grounds since 1971 via the MTP Act. However, the Act technically does not make any provision for abortion based on a woman's request alone, subjecting her decision to the approval of her healthcare provider, limiting reproductive autonomy. Moreover, the problem of female feticide through sex-selective abortions has also contributed to a conflicting public agenda that prioritizes preventing the former over allowing women access to abortion services for other reasons. Women who are socio-economically, culturally, and educationally vulnerable and minors may experience further abortion related stigmatization. These ethico-legal considerations highlight the need for transition from a provider-centered to a woman-centered abortion service model.

A women’s right with limitations - global and European perspective on abortion decriminalization

Abstract Background The decriminalization of abortion is a controversial subject whose policies widely vary across the world. In some countries it is available upon request, at least up to the 24-week limit, while in others it is totally prohibited. This practice also raises ethical issues, since some defend access to abortion as a human right, while others condemn it, highlighting the embryo's right to life. This study aims to compare abortion decriminalization laws and the maximum gestational age limit for induced abortion in each country of the six WHO member states. Methods Data on abortion decriminalization laws and the maximum gestational age limit for induced abortion were collected from the Global Abortion Policies Database on the WHO website. Descriptive analysis of data considered absolute and relative frequencies. Comparison between regions considered the number of countries, including a deeper analysis for European context. Results Approximately 30% of reviewed countries have specific laws for abortion decriminalization, while in 48% it is still a prohibited practice. Among the 48 European countries, 29 have decriminalized abortion laws, a practice that is only considered in 5 of the 54 African countries. Considering abortion by women's request, accepted practices are valid between 8 and 24 weeks gestation, depending on each country. However, 12 weeks of gestation is the most frequent limit for abortion, and it is the threshold of increased bleeding risk for pregnant women. Conclusions No legal abortion practices are performed after fetal viability period, usually up to 24 weeks of gestation. There are relevant differences between six regions. While most high-income countries have decriminalized abortion, this practice is still prohibited in most South American and African countries, raising multiple public health issues. Cultural, sociological and healthcare context is expected to have a strong influence in decriminalization of abortion. Key messages Abortion is considered a human right but there are many countries that do not allow it, particularly in Africa and South America. Most European countries have abortion decriminalization laws.

Gender-targeted job ads in the recruitment process: Facts from a Chinese job board

We study how explicit employer requests for applicants of a particular gender enter the recruitment process on a Chinese job board, focusing on two questions: First, to what extent do employers’ requests affect the gender mix of a firm’s applicant pool? Second, how ‘hard’ are employers’ stated gender requests-- are they essential requirements, soft preferences, or something in between? Using internal data from a Chinese job board, we estimate that an explicit request for men raises men’s share in the applicant pool by 14.6 percentage points, or 26.4%; requests for women raises the female applicant share by 24.6 percentage points, or 55.0%. Men (women) who apply to gender-mismatched jobs also experience a substantial call-back penalty of 24 (43) percent. Thus, explicit gender requests do shape applicant pools, and signal a substantial but not absolute preference for the requested gender.

Clinician's and women's perceptions of individual barriers to vaginal birth after cesarean in Iran: A qualitative inquiry.

Background:High rate of repeat cesarean section and its complications are the results of cesarean tsunami in the last two decades in Iran. Vaginal birth after cesarean (VBAC) is an important alternative for repeat cesarean. However, the rate of VBAC in Iran is very low subject to some organizational and individual barriers is very low. This study explored the clinician’s and women's perceptions of individual barriers to achieve VBAC.Methods:In this conventional content analysis, 28 semi-structured interviews and one focus group discussion was conducted with health care providers including gynecologists, midwives and family physicians as well as prior cesarean section mothers attended one of the women's hospitals in Mashhad, Iran in 2017. Participants were selected through purposive sampling considering the strategy of maximum variation. Data were analyzed according to Graneheim and Lundman (2004) method using MAXQDA.10 software.Results:The theme of “obstacles to acceptance and committed actions” emerged from two categories of “psychological barriers” and “operational barriers". Psychological barriers included 'sense of danger”, “financial displeasure" and "negative attitude"; whereas, operational barriers consisted of 'barriers to decision making' and 'indolence'. Conclusion:Improving women's attitude via maternity care promotion, creating supportive environment, informing mothers about choice of birth mode and empowering them in shared decision making could influence women's VBAC request. Also organizing VBAC care team and creating motivations in medical team and hospital directors through reporting of research project outcomes on safety and benefits of VBAC could affect the VBAC rate.

Dissatisfaction of women with induction of labour according to parity: Results of a population-based cohort study

ObjectiveTo determine the factors associated with dissatisfaction in women whose labour was induced, according to parity. DesignProspective population-based cohort study. SettingSeven French perinatal health networks including 94 maternity units ParticipantsAmong 3042 consecutive women who underwent induction of labour (IoL) with a live foetus from November 17 to December 20, 2015, in participating maternity units, this study included the 1453 who answered the self-administered questionnaire about their experience of IoL at two months post-delivery. MeasurementsThe associations between women's dissatisfaction at two months post-delivery and the characteristics of their pregnancy, labour, and delivery were assessed with multivariable logistic regression models. Analyses were stratified for nulliparous and parous women. Multivariable mixed models were used to take a random effect for the maternity unit into account. FindingsThe response rate was 47.8% (n = 1453/3042). Overall, 30% of the nulliparous women were dissatisfied (n = 231/770) and 19.7% (n = 130/659) of the parous women. The specific independent determinants of dissatisfaction for nulliparous women were antenatal birth classes that failed to include discussion of IoL (OR: 2.68, 95% CI [1.37; 5.23]) and lack of involvement in the decision-making process (OR: 1.92, 95% CI [1.23; 3.02]). For the parous women, a specific determinant was a delivery that lasted more than 24 h (OR: 4.04, 95% CI [1.78; 9.14]). Determinants of maternal dissatisfaction common to both groups were unbearable vaginal discomfort (respectively, OR: 1.98, 95% CI [1.16; 3.37] and OR: 4.23, 95% CI [2.04; 8.77]), inadequate pain relief (respectively, OR: 5.55, 95% CI [3.48; 8.86] and OR: 9.17, 95% CI [5.24; 16.02]), lack of attention to requests (respectively OR: 3.81, 95% CI [2.35; 6.19] and OR: 5.01, 95% CI [2.38; 10.52]), caesarean delivery (respectively, OR: 5.55, 95% CI [3.41; 9.03] and OR: 4.61, 95% CI [2.02; 10.53]) and severe maternal complications (respectively, OR: 2.45, 95% CI [1.02; 5.88] and OR: 5.29, 95% CI [1.32; 21.21]). Key conclusions and implications for practiceTo reduce dissatisfaction in nulliparous women, IoL should be discussed during antenatal birth classes and women should be made to feel that they shared in the medical decision to perform IoL. For parous women, care providers should inform them that the duration of delivery may exceed 24 h. Continuous support for all women during IoL should pay closer attention to vaginal discomfort, pain and women's requests. Postpartum discussions with mothers should be arranged to enable conversation about the experience of unexpected events.

ПРИРЕЧЕНІ НА СМЕРТЬ: АБОРТИ І АБОРТНИЙ ТУРИЗМ

The purpose of the study is to group the countries of the world according to the availability and legality of abortion and to identify patterns of development of tourist flows of abortion tourism. The research methodology includes a system of methods and techniques: monographic method (used to process materials from literary sources and Internet resources), statistical method (used to assess the prevalence of abortion), cartographic method (used to visualize the legality and availability of abortion around the world), classification method (used to group countries according to the criterion of the level of availability and legality of abortion). Research results. The geography of tourist flows of one of the types of medical tourism (abortion tourism) was analyzed. It arose as a result of the possibility of obtaining medical procedures abroad, prohibited or restricted in their own country. Attention was focused on the factors of legality and accessibility of these medical services in the countries. There are four groups of countries on the availability of abortion: 1) freedom of abortion; 2) abortion for medical and socio-economic reasons; 3) abortion for medical reasons and in other exceptional cases; 4) complete ban. The right to terminate a pregnancy at the woman's request is guaranteed in 71% of developed countries and in 16% of developing countries. Most countries that restrict abortion throughout the territory or in its separate administrative units - this is the state of Africa and South Asia and Latin America. But abortion tourism is the most intensive in Europe. The controversy over abortion has not abated. The two main groups in discussion call themselves "for choice" (with an emphasis on women's right to choose) and "for life" (with an emphasis on the unborn child's right to life). The scientific novelty of the work is that the proposed grouping of countries according to the legality and availability of abortion, outlines the factors of abortion tourism. The main directions of tourist flows of abortion tourism in Europe are determined. The practical significance of the results of the work is that they can be used to shape the tourism policy of Ukraine, as the state is involved in the field of abortion tourism as a recipient of tourist flows. The results of the study also contribute to solving social and demographic problems in the context of depopulation and deteriorating public health. After all, abortions are factors that negatively affect the reproduction of the population and women's health.

False beliefs about the indications of caesarean section in the Romanian population

There has been a considerable increase in the number of caesarean sections (C-sections) in the last 30 years. Between 2009 and 2017, Romania has reported an increase with 32.1% of the number of C-sections. The consensus regarding the obstetrical indications of the caesarean section has changed. This is mainly due to improvement in appreciating more specific fetal death risks or fetal hypoxemia, and to allow pregnancy for severe medical conditions (kidney transplant, valvular cardiac prostheses etc.). The caesarean section rate is also increased by the number of C-sections at the patient’s request. Some patients request a caesarean delivery without a valid medical indication because they are afraid of episiotomy, of prolonged and painful labor, vaginal trauma or urinary incontinence associated with a vaginal birth or because of some false medical beliefs. Our article focuses on evidence-based medicine on false beliefs about the indications of the C-section in Romania, the intriguing tale of how pregnant women request a C-section, sometimes encouraged by healthcare givers. The analyzed indications which are misbelieved are: fetal nuchal cord, oligohydramnios at term for normally structured fetuses, maternal obesity, fetal macrosomia, the 40-week pregnancy, hepatitis B and C, human papillomavirus (HPV) infection, and uncomplicated myopia.

Women’s “Gender Capital” Experiences in Conjugal Housing Consumption: Understanding a New Pattern of Gender Inequality in China

This article looks into the phenomenon that many women request men to provide a house for marriage in contemporary Chinese society. Going beyond explanations such as that the skewed sex ratio motivates men to engage in a Darwinian race and that some women have materialistic mating ideology, through a feminist engagement of Bourdieu’s concept of capital, I explicate how women wield their gender capital (in particular, the female capital) in the negotiation of conjugal housing consumption. I argue that women’s re-inscription of the “less-capable” female role should be differentiated from a simple return to tradition; it is more likely to be their protection-seeking strategy to counteract the increased uncertainty in relationships and the perceived gender inequality in marital life. The intergenerational dynamics in such negotiation process are also discussed. The study asserts that the gendered advantage enjoyed by some women in conjugal property negotiation has its root in the ongoing structural and gender constraints towards women. Such operation of gender capital therefore does not embody the liberation of women; it ironically traps both genders in a vicious circle of inequality.

TRIDENT-2: National Implementation of Genome-wide Non-invasive Prenatal Testing as a First-Tier Screening Test in the Netherlands

The Netherlands launched a nationwide implementation study on non-invasive prenatal testing (NIPT) as a first-tier test offered to all pregnant women. This started on April 1, 2017 as the TRIDENT-2 study, licensed by the Dutch Ministry of Health. In the first year, NIPT was performed in 73,239 pregnancies (42% of all pregnancies), 7,239 (4%) chose first-trimester combined testing, and 54% did not participate. The number of trisomies 21 (239, 0.33%), 18 (49, 0.07%), and 13 (55, 0.08%) found in this study is comparable to earlier studies, but the Positive Predictive Values (PPV)-96% for trisomy 21, 98% for trisomy 18, and 53% for trisomy 13-were higher than expected. Findings other than trisomy 21, 18, or 13 were reported on request of the pregnant women; 78% of women chose to have these reported. The number of additional findings was 207 (0.36%); these included other trisomies (101, 0.18%, PPV 6%, many of the remaining 94% of cases are likely confined placental mosaics and possibly clinically significant), structural chromosomal aberrations (95, 0.16%, PPV 32%,) and complex abnormal profiles indicative of maternal malignancies (11, 0.02%, PPV 64%). The implementation of genome-wide NIPT is under debate because the benefits of detecting other fetal chromosomal aberrations must be balanced against the risks of discordant positives, parental anxiety, and a potential increase in (invasive) diagnostic procedures. Our first-year data, including clinical data and laboratory follow-up data, will fuel this debate. Furthermore, we describe how NIPT can successfully be embedded into a national screening program with a single chain for prenatal care including counseling, testing, and follow-up.

VBAC or not VBAC? Improvement of performance and outcome indexes with the promotion of care safety

Abstract Background In a multidisciplinary approach to Quality Management System and humanization of care, we aimed at evaluating the characteristics that influence the request of women to carry out Vaginal Birth after Cesarean (VBAC). Methods Skills have been improved, with the use of tests on dummies and case by case assessments. For the psychological-motivational study we have adopted: Informed consent, Semi-structured interview and Big Five Questionnaire. The women were recruited by both Gemelli and Cristo Re Hospital: the women following the counseling decided to undergo a second Caesarean Section (CS) (41, control group) and women who decided to complete a VBAC (22, experimental group). Results The analysis of the data shows that the women of the VBAC group are in the average between 31-35 years (57%), 80% has an education = or > at the 3rd level and the choice of the VBAC was conditioned by the partner (64%). The women of the control group are in average > 35 years (51%), 60% have a higher average education and the influence on the choice is oriented by the gynecologist/obstetrician (64%). From the personality test a statistically significant difference emerges between the dimensions Energy and Mental Opening. Past experience influences the choice of the next birth: women who are inclined to a second CS considered the previous CS as a positive event (66%) while only 36% in the VBAC group; 64% of this was the recovery of the painful post-surgery and a certain type of difficulty in the care of the child, in breastfeeding, of having suffered from post-partum mood alterations, which is why they chose to undertake a Trial of Labor After Cesarean. Conclusions The deeper knowledge of women as well as the preparation and safety of the same operators has shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team, leading to an improvement in outcomes and performance indexes. Key messages The promotion of care safety also improves the performance indexes through continuous training to the operators and the study of psychological aspects that lead to the choice to carry out a VBAC. Good Clinical Practice shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team.

Maternal request for cesarian birth without medical indication in a group of healthy women: A qualitative study in Jordan

ObjectiveTo explore women's reasons for requesting an elective cesarian birth without medical indication and to describe the factors that affect their decision to choose a cesarian birth. DesignA descriptive qualitative content analysis approach was used for the gathering and analysis of data. Interviews were held with 35 first-time mothers. The participants were recruited by using a purposive sampling method. Interviews were begun with the same question which sked about women's reasons for requesting cesarian birth without medical indication. Other questions were used to facilitate the interview and elicit the factors that led this group of first-time Jordanian mothers to choose a cesarian birth. SettingA private hospital in Amman, the capital of Jordan, was selected as the location for the data gathering process. Data collection and analysis were conducted concurrently and interviews were discontinued when data saturation was reached. ParticipantsThe participants consisted of 35 first-time mothers recruited by using a purposive sampling method. FindingsSocio-demographic, economic status, and childbirth culture played an important role in influencing women's requests for an elective cesarian. Women made their decision based on the lived negative experience of other women and were driven and supported by their social network. Five themes that reflected the reasons for elective cesarian birth without medical indication were identified: (1) fear of vaginal birth process, (2) concerns about future sexual life, (3) need for humanized birth, (4) personal reasons, and (5) decision-making process. Conclusions and implicationsThe women's reasons for choosing cesarian birth without medical indication and the factors influencing the women's decision-making process were complex and interrelated and reflect a lack of appropriate informed choice about elective cesarian. The findings therefore suggest that healthcare policy makers need to attend to the reasons and the factors that influence women's decision-making about cesarian birth in order to promote the trend of women having a vaginal birth. Evidence-based knowledge and strategies to reduce elective caesareans should be disseminated to healthcare providers in maternity settings. Future explorations of this issue should address obstetricians’ and midwives’ views and attitudes about cesarian birth without medical indication.

An ethical framework for counseling about mode of delivery for desired psychosocial benefit in pregnancies complicated by severe fetal anomalies

Abstract Background A fetal diagnosis poses ethical challenges when a woman requests elective cesarean delivery for psychosocial reasons. We address the ethical challenges of counseling such patients. Case presentation A 36-year-old G4P2012 has chosen to continue a pregnancy despite a high likelihood of trisomy 18. At 36.5 weeks she was admitted for preeclampsia with severe features and requested to be delivered by primary cesarean section. Due to the poor prognosis associated with trisomy 18, the patient’s request for cesarean delivery was declined even when her baby changed to breech presentation with Category 2 fetal heart rate (FHT). The patient subsequently experienced a traumatic stillbirth and post-traumatic shock disorder (PTSD). Conclusion The obstetrician’s goal should be to transform the patient’s request into an informed decision. The obstetrician should explain that, while a cesarean could increase the likelihood of a live birth, it will not alter long-term neonatal outcomes and entails net biomedical risk for the current and future pregnancies. The obstetrician should ensure that the patient understands these clinical realities. The obstetrician should support the patient’s decision-making about whether to accept the risks of cesarean delivery for psychosocial benefit. The obstetrician should initiate counseling during prenatal visits to empower the patient with information to meaningfully exercise her autonomy. If the patient makes an informed decision for cesarean delivery, it becomes ethically permissible. Plans regarding intrapartum management and mode of delivery should be documented in case the patient is delivered by a physician who was not involved in prenatal counseling.