Promoting Shared Decision Making About Birth After Cesarean in Haitian Women.

This was a pilot to develop culturally appropriate group counseling sessions for shared decision making about modes of birth after cesarean for Haitian Creole speakers. The curriculum was created by incorporating information identified by women and their providers in focus groups through the lens of Health Belief Model. Ten women attended a session. There was a 50% increase in women planning to labor after cesarean; nine stated the session gave them confidence to decide about their mode of birth; all were "very satisfied" with the session and would recommend it to others. The session was accepted as a method to improve women's decision making, feasible, effective, and could be integrated to improve shared decision making discussions for other non-English speaking women.

Listening to Haitian Women and their Health Care Providers: Insight into Shared Decision-making After Cesarean Section.

INTRODUCTION: Haitian women in Massachusetts have high rates of cesarean section and low rates of vaginal birth after cesarean, despite evidence suggesting that many are eligible to attempt vaginal birth after a previous cesarean. This qualitative study explored the cultural impact of previous surgical birth for Haitian women to inform the development of a patient-centered decision support program. METHODS: Key stakeholders included Haitian women with previous cesarean and their obstetric care providers. Haitian women participated in focus groups; care providers participated in focus groups and in-depth interviewing. RESULTS: Four prominent themes emerged surrounding childbirth decision-making: the importance of Haitian culture and beliefs; need for more information on birthing options; influence of family/friends; and pain as a considerable factor. CONCLUSION: We hypothesize that group counseling tailored to meet cultural values and needs of Haitian women may support all stakeholders as they work towards sharing decisions about birth after cesarean.

Obstetric Outcomes in Military Servicewomen: Emerging Knowledge, Considerations, and Gaps.

The number of women in the U.S. military is dramatically increasing. Similarly, the roles of active-duty women are greatly expanding, thus exposing them to new occupational risks. Determining the impact of pregnancy outcomes for women while in the military is difficult due to changing exposures over time, difficulty in utilizing appropriate comparison groups, and the lack of prospective investigations. Despite these limitations, it was concerning that the available data suggest that servicewomen delivering within 6 months of their first deployment have an increased preterm birth risk (adjusted odds ratio [aOR]: 2.1), and those with three prior deployments have an even greater risk (aOR: 3.8). Servicewomen also have an increased risk of hypertensive disorders with a rate of 13% compared with 5% in the general obstetric population. Furthermore, depression is higher for women who deploy after childbirth and are exposed to combat when compared with those who have not deployed since the birth of their child (aOR: 2.01). Due to the importance of this issue, prospective research designs are necessary to better understand and address the unique health care needs of this population.