Cesarean effects on adolescents' birth experiences: counterfactual analysis

Abstract Introduction The birth experience of adolescents is understudied even though they are a particularly vulnerable population to experience a negative birth event, given that they exhibit many known risk factors. Objective To ascertain whether a cesarean birth mediates the impact of infant complications on the birth experience of adolescent mothers. Methods Using a secondary analysis of data collected from 303 postpartum adolescents previously evaluated for depression and post-traumatic stress, we employed counterfactual causal analysis to determine if delivery type mediated the birth experience at different levels of depression. Noted limitations pertain to methodological assumptions and computational feasibility as well as potential sample bias. Results We found that the mediating effect of delivery mode depended on the adolescent's depression level as well as on the specific operationalization of the birth experience. At low levels of depression, the odds of a negative birth appraisal were reduced by around 30% when operationalized as a single item subjective rating. In contrast, at high levels of depression, the odds of a negative birth experience increased by 80% when operationalized as an Impact of Event Scale (IES) subconstruct. Conclusion Depression level plays a pivotal role in moderating how delivery mode mediates the birth experience. The direction of impact also depends on how the birth experience is operationalized.

Maternal attachment and breastfeeding behaviors according to type of delivery in the immediate postpartum period

Summary Introduction: Breastfeeding is nutritious and has physiological benefits regarding the immunological aspect; also, it has an important role on maternal attachment and on raising a healthy baby. Objective: Our study was conducted to analyze maternal attachment and breastfeeding behaviors in the immediate postpartum period of mothers who had vaginal and cesarean birth. Method: This descriptive and comparative study was conducted with women who sought the childbirth clinic of a university hospital in Izmir, Turkey. In the study, 175 mothers were attended; 83 of them had vaginal birth and 92 had cesarean birth. Data were collected by using Demographic Identification Form, Maternal Attachment Inventory and LATCH Breastfeeding Assessment Score Tool. Descriptive and correlational statistics were used for data analysis. Results: We found that Maternal Attachment Inventory and the LATCH breastfeeding charting system of mothers that had vaginal birth was higher than that of mothers who had cesarean delivery. There was a positive correlation between Maternal Attachment Inventory and LATCH total score average for both cesarean and vaginal birth. Conclusion: Mothers who delivered their babies by cesarean section had problems related to maternal attachment and breastfeeding more often than those who delivered vaginally.

Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae

Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.

Representações e experiências das mulheres sobre a assistência ao parto vaginal e cesárea em maternidades pública e privada / Women's representations and experiences with vaginal and cesarean delivery in public and private maternity hospitals

Este estudo analisa as diferentes representações e experiências quanto ao parto vaginal e cesárea de mulheres de diferentes estratos sócio-econômicos, bem como a natureza das relações profissionais de saúde/usuárias no contexto institucional em que estão inseridas. A pesquisa de natureza qualitativa foi desenvolvida em três maternidades do Município do Rio de Janeiro, Brasil, sendo uma pública, uma conveniada com o SUS e uma particular, com mulheres que tiveram os dois tipos de parto. Os resultados revelam que o modelo de organização dos serviços público e privado apresentam variações que produzem diferentes tipos de assistência e de relação entre os profissionais de saúde e as usuárias, dando forma a experiências distintas entre as mulheres pesquisadas. Todavia, ao empreendermos uma crítica assentada nas relações de gênero, podemos verificar que o modelo de assistência ao parto permanece submetendo quem deve ser sujeito e reproduzindo o projeto da medicalização - mesmo que este processo se manifeste de formas diferenciadas entre os grupos estudados -, o que reduz o campo da assistência e inviabiliza um lugar de poder diferenciado das usuárias.

This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and women's submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of women's empowerment during childbirth.

Aspectos polêmicos na indicação da cesariana / Polemical aspects of the choice for cesarean section

A Opção pela cesariana é tema atual, complexo, com óbvias repercussões éticas. O aumento da incidência de partos operatórios não pode ser explicado apenas por questões médicas. Variáveis sociodemográficas, ético-legais, psicológicas e culturais estão envolvidas no problema. Fatores como nível sócio-econômico-educacional, tipo de assistência médica e hospitalar, características psicológicas da gestante e do profissional, aspectos de conveniência, preocupações com problemas ético-legais e cultura médica intervencionista são elementos que compõem este cenário. O modelo humanista (psicossomático) da medicina, diferentemente do modelo tecnocrático (baseado na primazia do poder do médico) e do holístico (em que médico e paciente estão sujeitos às forças da natureza), defende equilíbrio na relação médico-paciente, com atribuições de responsabilidades e riscos, na abordagem da questão