Women Request Research Articles

“Too Posh to Push”: The Rise and Rise of a Catchphrase

The phrase "too posh to push" was coined over 14years ago to describe maternal request for cesarean section in the absence of clinical indications. The phrase was readily taken up and used by the United Kingdom media despite limited evidence that many women request cesarean sections or have an aversion to vaginal birth. The objectives of this study were to explore the way in which the phrase was used; the context and themes associated with it. To better understand the part the news media might play in public and health care professionals' perceptions, all articles using the phrase in eight UK national weekday newspapers from 1999 to 2011 (n=335) were subjected to content analysis. Key themes have changed over the years but some themes, such as celebrity cesareans, the risks of cesarean section, and the rising cesarean rate, have remained. Four different definitions of the term "too posh to push" were identified. Levels of usage of these terms changed over time. Misinterpretation of the National Sentinel Cesarean Section Audit results and a tendency to confuse elective cesarean section with maternal request for a cesarean have suggested that more "too posh to push" cesareans occurred than is probably the case. The phrase seems to have become well established. It is likely that press handling of the topic has continued to contribute to the impression that cesarean purely for maternal request is common. The association with celebrity continues to fuel press interest in the topic.

Breast cancer during pregnancy: a retrospective study on obstetrical problems and survival

ObjectivesBreast cancer is one of the most common cancers occurring in pregnancy. Data on survival of these patients and their obstetrical complications are still limited. Study designWe conducted a case–control, retrospective study to evaluate the overall survival (OS) of 22 patients with breast cancer in pregnancy (BCP) and 45 non-pregnant women with breast cancer (BC) matched for age, stage and hormonal status. ResultsSurvival of BCP and BC patients using Kaplan–Meier analysis was similar (86.4% in cases and 80% in controls p=0.392) and BCP patients had survival consistent with the stage of the disease, providing that the treatment had been in agreement with the recommended protocols. The overall incidence of premature delivery was 54.6% and complications were observed in three newborns out of 23 (13%). ConclusionsPreterm labor induction without any obstetrical indication following woman's request to continue chemotherapy outside pregnancy can be reduced by explaining the risks of early delivery and the lack of effects of many chemotherapeutic regimens on the fetus.

A Sport for Everyone? Inclusion and Exclusion in the Organisation of the First Olympic Modern Pentathlon

The Olympic Games in Stockholm, 1912, were the first taking place without connection to a world exhibition. Thus, the sports competitions took centre stage. The modern pentathlon was new in the programme. Though the sport met Pierre de Coubertin's ideological support and Viktor Balck's encouragement, its staging caused more problems than the organising committee originally expected: as hardly any pre-experiences with this competition existed, debates were frequent and agreements not always easily achieved. One of the greatest problem was related to the allowance of participants without own horse. Still 1 week before the competition started, the question of loan horses remained unsolved. At the same time, a woman's participation request troubled the organisers.This research aims at exploring the work of the organising committee when planning and implementing the first Olympic modern pentathlon in 1912. It focuses on two aspects which best reflect the power relations in society at that time and thereby provide insights into the strength of socially conditioned images of class and gender orders at the beginning of the twentieth century. The research is mainly based on an analysis of historical material from the Archives of the International Olympic Committee (IOC) in Lausanne and from the National Archives in Stockholm.

“I think it depends on the body, with mine it didn't work”: explaining young women's contraceptive implant removal

BackgroundOur study was conducted to learn more about why some young women (under 24) request “early” removal of the subdermal contraceptive implant (implant). Study DesignA qualitative study in which 20 young women were interviewed in-depth, along with nine health providers of the implant. This paper concentrates on the findings from the interviews with young women. ResultsOverwhelmingly, the reason given for removal was intolerable side effects, the most common being bleeding irregularities. Other hormonal side effects mentioned were mood swings, headaches and weight gain; and it was often a combination of factors that brought participants to a “tipping point” at which their negative experiences outweighed the positive attributes of the implant. Many participants felt that they had not been sufficiently warned about all possible side effects, and some were frustrated by delays encountered after they requested removal. ConclusionWomen need to be made aware of all possible side effects and be given more support once the implant is in place. In supporting women's contraceptive choice, clinicians need to accept that some women are unable to tolerate the implant and that encouraging retention without dealing with distressing side effects may be counterproductive.

An analysis of the murder of women in a 10-year period in Eskişehir Province located in western Anatolia in Turkey

Murder of women generally occurs as a result of violence by their husbands and relatives. We evaluated the female victims of murder in Eskişehir, located in western Anatolia, where the education level is high in this study. Our aim was to assess and discuss data related to the victims and murderers.A total of 141 women's murder cases were analysed in the study. After a legal process and the results of the autopsies during 2002–2011 in Eskişehir, 715 subjects found to have died as a result of murder were chosen. Cases were evaluated in terms of their age, marital status, education level, relationship to the murderer, reasons for violence, type of action and reasons for death.It was determined that 48.2% (n = 68) of the victims had been killed by the husband and 7.8% (n = 11) by the ex-husband. Murderers generally stated that the reason of murder was the woman's request for divorce or breaking up (n = 40, 28.4%).In compliance with the literature, the women were most commonly killed by their husbands in our study. Enhancing women's status and preventing violence against women will decrease such murders.

Women, Earmarks, and Substantive Representation

The purpose of this article is to demonstrate women's substantive impact on government by examining the earmark requests of the US House representatives. Women representatives are hypothesized to make more funding requests for women's issues than male representatives. Through use of OLS statistical analysis, women's issue earmark requests, as reported by the 111th congressional House members for the fiscal year 2010, serve as the dependent variable. Gender is a significant predictor of earmark requests even when controlling for the ideology, partisanship, and racial minority status of a House member. This finding is evidence of women's substantive representation in the form of earmark requests.

‘My pain was stronger than my happiness’: Experiences of caesarean births from Lebanon

Objectivethe rising trends in caesarean section have been partially attributed to women's requests. Many studies in developed and very few in developing countries have attempted to understand this phenomenon. This qualitative study explores experiences of women having caesarean section on demand in a middle-income country with a private health-care system. Designan inductive qualitative design, using face-to-face semi-structured interviews. Settingwomen were identified and recruited through a perinatal database and selected obstetricians' clinics in the Greater Beirut area in Lebanon. Participantsa purposive sample of women who had a caesarean childbirth within the four months preceding the interview, were visited for an interview at home using a semi-structured interview guide. Thematic content analysis was conducted on a sub-sample of 22 women who requested a caesarean birth. Findingslack of information about caesarean sections fosters women's fear from labour pain and acts as the main impetus for women to consider caesareans as the pain free alternative. Findings reveal health-care providers' role in reinforcing beliefs about caesarean sections being the way for pain free deliveries by overestimating the safety of the procedure and disregarding postpartum health issues. Key conclusion and implications for practicecaesarean birth is presented to women as a safe option for ‘pain free’ childbirth. This needs to be considered within the cultural context of understanding safety and pain as well as the dynamics of power in maternity care. Health-care professionals need to explore these dimensions and promote women's informed choice as well as encouraging the normality of birth.

The effects of low vs. higher protein yogurt consumed as afternoon snacks on appetite control and time to dinner request in healthy women

PurposeTo assess whether afternoon snacks of higher‐protein (14 g protein; HPY) vs. lower‐protein (5 g protein; LPY) yogurt lead to reduced hunger, increased fullness, and delayed eating vs. No Snack (NS).MethodsUsing a randomized crossover design, 46 women (age 28 ± 1 y; BMI 23.1 ± 0.4 kg/m2) were acclimated to each snack for 3 consecutive days. On day 4, the participants consumed a standard breakfast, at home, and came to our facility 1 hr prior to their habitual lunch time. A standard lunch was provided followed by their respective snack (160 kcal) consumed 3 h post‐lunch. Subjective appetite was assessed by VAS completed every 30 min throughout the afternoon until dinner was voluntarily requested.ResultsSnacking reduced hunger and increased fullness up to 2 h post‐snack vs. NS (p<0.001; both snacks); no differences were observed between snacks. NS led to the earliest request for dinner (2:13 ± 0:41 h post‐snack) vs. HPY (2:42 ± 0:38 h post‐snack; p<0.001) and LPY (2:37 ± 0:40 h post‐snack; p<0.001); no difference was found between snacks.ConclusionsAlthough both 160 kcal afternoon yogurt snacks led to reduced hunger, increased fullness, and delayed eating vs. no snacking, no differences were found between the low vs. higher protein yogurts. These data suggest that a 9 g protein differential is insufficient to alter appetite control and delay eating in healthy women. Funded by: General Mills, Inc.

Caesarean section at maternal request: An update

The argument for and against caesarean section performed at a woman's request in the absence of a medical indication has always been a source of extensive debate in the media and the medical professions. The National Institute for Health and Clinical Excellence (NICE) has published an updated version of its guidance on caesarean section which includes suggestions on how to respond to a woman's request for caesarean section, including offering operative delivery to those who want it. This article aims to explore recent research findings, in conjunction with the new guidance, and assess the impact these may have on current practice.

Terminations of pregnancy in the European Union

Please cite this paper as: Gissler M, Fronteira I, Jahn A, Karro H, Moreau C, Oliveira da Silva M, Olsen J, Savona‐Ventura C, Temmerman M, Hemminki E, the REPROSTAT group. Terminations of pregnancy in the European Union. BJOG 2011; DOI: 10.1111/j.1471‐0528.2011.03189.x.Objective To study the current legislation and trends in terminations of pregnancy in the European Union (EU).Design Data were collected on legislation and statistics for terminations of pregnancy.Setting Population‐based statistics from the EU member states.Population Women in reproductive age in the 27 EU member states.Methods Information on legislation was collected for all 27 EU member states. Statistical information until 2008 was compiled from international (n = 24) and national sources (n = 17). Statistical data were not available for Austria, Cyprus and Luxembourg.Main outcomes measures Terminations of pregnancy per 1000 women aged 15–49 years.Results Ireland, Malta and Poland have restrictive legislation. Luxembourg permits termination of pregnancy on physical and mental health indications; Cyprus, Finland, and the UK further include socio‐economic indications. In all other EU member states termination of pregnancy can be performed in early pregnancy on a women’s request. In general, the rates of termination of pregnancy have declined in recent years. In total, 10.3 terminations were reported per 1000 women aged 15–49 years in the EU in 2008. The rate was 12.3/1000 for countries requiring a legal indication for termination, and 11.0/1000 for countries allowing termination on request. Northern Europe (10.9/1000) and Central and Eastern Europe (10.8/1000) had higher rates than Southern Europe (8.9/1000). Northern Europe, however, had substantially higher rates of termination of pregnancy among teenagers.Conclusion A more consistent and coherent reporting of terminations of pregnancy is needed in the EU. The large variation of termination rates between countries suggests that termination of pregnancy rates may be reduced in some countries without restricting women’s access to termination. Sexual education and provision of access to reliable and affordable contraception are essential to achieve low rates of termination of pregnancy.

Las Dos Cosas: An Analysis of Attitudes of Latina Women on Non-Exclusive Breastfeeding

Non-exclusive breastfeeding among Latina women is commonly seen in the newborn period. The reasons behind las dos cosas ("both things") are not well understood but have included the beliefs that formula has vitamins and that adding formula will result in a chubbier baby, which is desirable. Many previous studies involved Mexican and Puerto Rican women living in the mainland United States. We performed detailed semistructured interviews with 17 Latina mothers in late pregnancy or the newborn period at a community hospital and an affiliated clinic in Massachusetts, serving a large Dominican population. Women were asked about their beliefs about breastfeeding, colostrum, and infant formula. Transcripts were analyzed using Nvivo 9 software (QSR International Pty. Ltd., Melbourne, Australia) to identify the frequencies of common trends. The most common reasons for introducing formula were treatment for insufficient milk, to keep the baby fuller longer, and planning for return to work. None of the women understood the potential risks of introducing formula on the establishment of breastfeeding, particularly on milk supply. Many thought that even limited amounts of breastfeeding were sufficient to produce a healthier child, failing to understand a negative dose-response effect of formula on health and milk production. While every woman saw breastfeeding as healthier, only one saw formula as unhealthy, an important distinction. None of the women expressed familiarity with medical recommendations around breastfeeding duration or exclusivity, with many believing that breastmilk alone would be insufficient to satisfy the hunger or nutritional needs of a growing child after as little as 3 months. Women consistently demonstrated a willingness to learn from health professionals. In counseling Latina women, it may be important to discuss the risks of formula to infant health, breastfeeding, and milk supply and to include the medical recommendations for breastfeeding exclusivity. Educational opportunities exist in the prenatal setting and when postpartum women request formula.

Comparação da adequação de solicitação de ecocardiograma entre hospitais público e privado

Aiming at improving the use of echocardiography tests, the Appropriateness Criteria (AC) were created by the American Society of Echocardiography (ASE)/American College of Cardiology (ACC). To compare the appropriateness profile of transthoracic echocardiography (TTE) requests in accordance with the AC, between a public University Hospital (UH) and a Private Hospital (PH), and verify which characteristics are associated with a better TTE request profile. We prospectively assessed 779 consecutive TTE requests in a PH (49.8%) and a UH (50.2%), with 55.6% of requests for women and 44.4% for men, aged 59.1 ± 15.7 years. The indications were classified as appropriate, inappropriate or non-classified, and adequacy to AC was correlated with age, patient gender, and the time since graduation of the requesting physician. The statistical analysis used Kappa coefficient and chi-square test. There was no significant difference regarding the adequacy profile of appropriate TTE requests in the two institutions (71% vs. 75%, p = 0.3). At PH, the factors associated with higher rates of appropriate tests were: female gender (p = 0.001) and age younger than 60 years (p <0.001). In the UH, physicians who had graduated between 5 and 10 years before had a higher rate of inappropriate requests (p = 0.02). The variables that were independent predictors of appropriate tests in the PH were: female sex (p = 0.001) and age <60 years (p = 0.001). In this evaluation, the PH and the UH profiles showed similar request appropriateness profiles. Female gender, time since graduation of the requesting physician and the patient's age influenced the appropriateness of requests.

The Israeli abortion committees' process of decision making: an ethical analysis

The Israeli law of abortions (1977) legally authorises hospital committees to decide upon women's requests for selective abortion. One of the law's clauses determines that abortions can be approved in...

Why women request cesarean section without medical indication?

Objective. To understand the reasons of the cesarean delivery on maternal request (CDMR) without medical indication would help to reduce the rates of unnecessary cesarean-delivery (CD). The objective of this study is to determine the basal knowledge of women regarding normal delivery (ND) and CD and also to assess their attitudes about CDMR, and to find out the reasons influencing those attitudes.Methods. The study included 400 women who completed a 45-item questionnaire that assessed their basal knowledge of ND, CD, and their attitudes and beliefs about the mode of delivery and CDMR.Results. Mean age of the study population was 32 ± 10.2 years (range 18–66). Majority of the women would choose the ND because of its ‘being completely natural’ (89%) and no anesthesia and operative risk related with ND (76%). Only 33% of the women indicated that ND might cause genital organ prolapse and/or stress urinary incontinence and just 26% and 24% of the women would choose CD to prevent pelvic organ prolapse and stress urinary incontinence, respectively. On the other hand, 50% and 54% of the women would indicate that they could choose CD in order to prevent labor pain and to minimize the risk of fetal distress during the labor. Furthermore, 47% of the women had an opinion that that CD could be performed by maternal request without medical indication. Educational level had no effect of CDMR although more educated women had more accurate knowledge about the some risk and benefits of ND and CD. Binary logistic regression analysis revealed that fear of labor pain (p = 0.02, OR: 15.0, CI: 0.494–0.966), maternal age (p = 0.01, OR: 6.3,CI: 1.00–1.05), and knowledge about the relation between the ND and pelvic organ prolapse/urinary incontinence (p < 0.001, OR: 4.8, CI: 0.549–0.966) were the independent prognostic variables for the CDMR .Conclusion. Although majority of the women had wrong idea or no idea about the risks and benefits of CD, nearly half of them indicated that women can always demand CDMR. This study shows that basal knowledge of the women should be improved by education.

Attitudes of Midwives in Sweden Toward a Woman’s Refusal of an Emergency Cesarean Section or a Cesarean Section on Request

A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician.

Past, Present and Future of the Cervical Cancer Screening in Latvia

The present descriptive study summarizes the historical activity on cervical cancer screening in Latvia, assesses the current screening situation, and defines the existing and expected obstacles and problems for the implementation of a proper organized population-based cervical cancer screening program in Latvia. Available data on cervical cancer burden were collected from Latvian cancer registry. Availability of trained medical staff and laboratory systems were obtained through the Latvian Association of Cytologists and the Health Compulsory Insurance State Agency of Latvia (HCISA). Cervical cancer incidence in Latvia is increasing since 1989 when the compulsory preventive gynecologic examinations were stopped. Cervical opportunistic screening program in Latvia should be performed by GPs. But only 30 out of 1470 GPs provide gynecological care for their patients while, out of 484 certified gynecology practitioners, 35 had direct contractual relationship with the HCISA while 398 had only an indirect contractual relationship with the Agency. Moreover, in Latvia, there are about 29 laboratory specialists employed with cytological testing with an average age of 57 years: 13 of them have already passed the retirement limit. Traditionally in Latvia, most women request gynecological services for preventive and health promotion reasons or in the case of having a gynecological disease. So the overloaded general practitioners and the lack of involvement of gynecologists are one of the main obstacles to solve for implementing an organized screening program in Latvia. Moreover insufficient availability of quality-assured services and resources for cytology testing and other services of the program, and for monitoring and evaluating the whole program, must be considered in the implementation of a comprehensive screening plan.t

Aspetti giuridici, deontologici ed etici della prescrizione medica degli estroprogestinici a scopo contraccettivo

Di fronte alla richiesta della donna, la prescrizione di sostanze estroprogestiniche con funzione contraccettiva è da considerarsi un atto cui il medico è tenuto, oppure al medico è lasciato uno spazio di libertà per opporsi alla richiesta e seguire i dettami della propria coscienza? La questione venuta alla ribalta con una sentenza del Tribunale di Milano (1997) è affrontata a partire da un’indagine ricognitiva di carattere giuridico relativa all’introduzione nel nostro ordinamento della contraccezione. Viene poi fatta la triplice distinzione: c.d. “contraccezione d’emergenza”, contraccettivi che potrebbero avere un’efficacia abortiva e contraccezione vera e propria. Mentre nel primo caso è possibile ricorrere all’art. 9 L. 194/1978 (obiezione di coscienza all’aborto), nel secondo e nel terzo la lettera e la ratio dell’art. 9 conducono ad una sua non applicabilità. Questo tuttavia non significa obbligare il medico a prestazioni contrarie alla propria coscienza o al proprio convincimento clinico. Alla luce di alcune norme della legislazione sanitaria e del codice deontologico emerge il ruolo centrale della fiducia rapporto medico-paziente e il criterio della libera scelta che presiede tale rapporto. Il carattere fiduciario basato sulla libera scelta, comprende anche la sfera delle convinzioni morali del medico. Questi può dunque contare su un margine di libertà per esprimere contrarietà a quanto richiesto da paziente e il paziente può avvalersi della sua libertà di cambiare medico.

Does planned caesarean section following a previous traumatic birth improve women's satisfaction?

BackgroundA proportion of women requesting Caesarean section (CS) do so due to a previous traumatic birth experience with the expectation that a CS will improve their next birth experience. Obstetricians...

Estudo P.O.I.S. (Pevenção da osteoporose nos idosos)

Introduction: In Portugal there are more than 500,000 people with osteoporosis (OP). In order to reduce the associated morbimortality, the Directorate General of Health and other scientific organizations recommend dual-energy X-ray absorptiometry (DEXA) in women > 65 years and men > 70 years, and supplementation with calcium 1000-1200 mg/day and vitamin D 700-800 IU/day in people > 65 years. Aim: Evaluate and guarantee the quality of calcium and vitamin D (Ca-VitD) prescription and of DEXA request, in the prevention of OP in elderly patients. Type of study: Descriptive and transversal. Place: Four primary care centers (PCC) on the Northern Region. Population: Elderly registered on the PCC studied. Methods: Studied dimension: technical-scientific quality. Unit of study: women aged 66-70 years and men aged 71-75 years, totalizing 400 elderly registered on the authors PCC. Evaluated professionals: 50 family doctors. Time period: 01.01.2006 to 30.04.2009. Type of data: process. Data source: SAM. Type of evaluation: internal. Criteria: 1. Prescription of Ca-VitD in women 2. Prescription of Ca-VitD in men 3. DEXA request in women 4. DEXA request in men. Data collecting: May 2009. Temporal evaluation: retrospective. Sample: of institutional basis. Type of intervention: educational. Results:According to the adopted quality standards, criterion 1 was good at PCC Chaves-I and Ermesinde and sufficient at PCC Leca da Palmeira and USF Oceanos. Criterion 2 was insufficient in all four PCC. Criterion 3 was good at PCC Chaves-I and Leca da Palmeira and sufficient at PCC Ermesinde and USF Oceanos. Criterion 4 was insufficient in all four PCC. Conclusion: The unknowledge of the recent recommendations and the higher implementation of OP prevention measures in women may explain these results. It is proposed a reassessment after the introduction of corrective measures, with meetings and disclosure of guidelines on the subject.

Unethical female stereotyping in reproductive health

Stereotypes are generalized preconceptions defining individuals by group categories into which they are placed. Women have become stereotyped as homemakers and mothers, with the negative effect of precluding them from other roles and functions. Legislation and judicial constructions show a history, and often a continuing practice, of confining women to these stereotypical functions. In access to reproductive and sexual health care, for instance, women's requests have been professionally subject to approval of their husbands, fathers or comparable males. Choice of abortion is particularly significant, because it embeds moral values. Women's capacity to act as responsible moral agents is denied by stereotypical attitudes shown by legislators, judges, heads of religious denominations, and healthcare providers who consider women incapable of exercising responsible moral choice. These attitudes violate ethical requirements of treating patients with respect and equal justice. They can also result in violations of human rights laws that prohibit discrimination against women.