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1.
Contraception ; 96(1): 41-46, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28578151

RESUMO

OBJECTIVE: To describe sterilization completion rates after vaginal delivery and indications for unfulfilled procedures. STUDY DESIGN: We used labor and delivery operating room and delivery logs to identify all women over 20years of age with a completed live vaginal birth beyond 24weeks gestation over a 33-month period (March 1, 2012 to November 30, 2014). We reviewed the electronic medical records of all of these patients and identified those who requested a sterilization procedure as indicated in a physician's admission note or antenatal record. RESULTS: We identified 3514 live vaginal births beyond 24weeks gestation during the study period of which 219 requested postpartum sterilization. Sterilization occurred in 114 (52%). The most common reason for unfulfilled procedures was lack of valid federally mandated consent (n=46 [44%]). Fifty-nine percent (27 of 46) of these women had little or no prenatal care. Only one (0.5%) woman had documented completion of consent with the required time elapsed prior to delivery and no consent form available. Of the women with valid consent documentation, the most common indication for an unfulfilled procedure was patient refusal (n=30 [51%]). Body mass index was an independent predictor of an unfulfilled procedure (p<.001) among women with adequate consent. CONCLUSIONS: Inability to complete federally mandated consent is a principal cause of unfulfilled postpartum sterilization and primarily affects women desiring sterilization who lack sufficient prenatal care. Of women who meet consent criteria, the primary reason women eligible for sterilization did not undergo the procedure was due to withdrawing their request. IMPLICATIONS: Because women commonly do not undergo a requested sterilization after vaginal deliveries, antepartum counseling should include alternate contraception choices. Documented consent that fulfills all federally mandated criteria remains the most common barrier to requested sterilization after vaginal delivery; providers and policymakers should work together to help unburden women from this mandate.


Assuntos
Parto Obstétrico/métodos , Período Pós-Parto , Esterilização Tubária/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Termos de Consentimento/estatística & dados numéricos , Anticoncepção/métodos , Aconselhamento , Feminino , Idade Gestacional , Humanos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Tempo
2.
Sex Reprod Healthc ; 10: 62-69, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27938875

RESUMO

OBJECTIVES: To examine whether race and reported history of abortion are associated with abortion stigma and miscarriage stigma, both independently and comparatively. STUDY DESIGN: Self-administered surveys with 306 new mothers in Boston and Cincinnati, United States. MAIN OUTCOME MEASURES: Abortion stigma perception (ASP); miscarriage stigma perception (MSP); and comparative stigma perception (CSP: abortion stigma perception net of miscarriage stigma perception). RESULTS: Regardless of whether or not they reported having an abortion, white women perceived abortion (ASP) to be more stigmatizing than Black and Latina women. Perceptions of miscarriage stigma (MSP), on the other hand, were dependent on reporting an abortion. Among those who reported an abortion, Black women perceived more stigma from miscarriage than white women, but these responses were flipped for women who did not report abortion. Reporting abortion also influenced our comparative measure (CSP). Among those who did report an abortion, white women perceived more stigma from abortion than miscarriage, while Black and Latina women perceived more stigma from miscarriage than abortion. CONCLUSIONS: By measuring abortion stigma in comparison to miscarriage stigma, we can reach a more nuanced understanding of how perceptions of reproductive stigmas are stratified by race and reported reproductive history. Clinicians should be aware that reproductive stigmas do not similarly affect all groups. Stigma from specific reproductive outcomes is more or less salient dependent upon a woman's social position and lived experience.


Assuntos
Aborto Induzido/psicologia , Aborto Espontâneo/psicologia , Atitude Frente a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estigma Social , Adulto , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Reprodutiva/organização & administração , Autoimagem , Estados Unidos , Adulto Jovem
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