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Kejsarsnitt utan medicinsk indikation: Attityder, förekomst och önskemål
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Sundsvall: Mittuniversitetet , 2010. , p. 77
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 82
Keywords [sv]
Förekomst, kejsarsnitt utan medicinsk indikation, kvinnors önskemål och erfarenheter, vårdgivarattityd
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-11566ISBN: 978-91-86073-71-8 (print)OAI: oai:DiVA.org:miun-11566DiVA, id: diva2:321322
Public defence
2010-05-21, M 108, Lubbesalen, Holmgatan 10, Sundsvall, 10:30 (Swedish)
Opponent
Supervisors
Projects
Kejsarsnitt - nödutgång eller genväg?Föda barn i VästernorrlandAvailable from: 2010-06-02 Created: 2010-05-31 Last updated: 2010-06-02Bibliographically approved
List of papers
1. Swedish caregivers’ attitudes towards caesarean section on maternal request
Open this publication in new window or tab >>Swedish caregivers’ attitudes towards caesarean section on maternal request
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2009 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 22, no 2, p. 57-63Article in journal (Refereed) Published
Abstract [en]

Background Caesarean section (CS) is not an option that women in Sweden can chose themselves, although the rise in CS rate has been attributed to women. This study describes obstetricians’ and midwives’ attitudes towards CS on maternal request. Methods A qualitative descriptive study, with content analysis of 5 focus group discussions where 16 midwives and 9 obstetricians participated. Results The overarching theme was identified as “Caesarean section on maternal request—a balance between resistance and respect”. On the one hand, CS was viewed as a risky project; on the other hand, request for a CS was understood and respected when women had had a previous traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear. Five categories were related to the theme. Overall, our findings indicate that caregivers blamed the women for the increase, they considered the management of CS on maternal request difficult, and they suggested preventive methods to reduce CS and means to strengthen their professional roles. Key conclusions and implication for practice Both midwives and obstetricians considered the management of CS on maternal request difficult, and the result showed that they balanced between resistance and respect. The result also showed that the participants stressed the importance of professionals advocating natural birth with evidence-based knowledge and methods to prevent maternal requests. Ongoing discussions among health professionals on attitudes and practice would strengthen their professional roles and lead to a decrease in CS rates in Sweden.

 

 

 

 

Background:

 

 

Caesarean section (CS) is not an option that women in Sweden can chose themselves,

although the rise in CS rate has been attributed to women. This study describes

obstetricians’ and midwives’ attitudes towards CS on maternal request.

 

Methods:

 

 

A qualitative descriptive study, with content analysis of 5 focus group discussions where

16 midwives and 9 obstetricians participated.

 

Results:

 

 

The overarching theme was identified as ‘‘Caesarean section on maternal request–—a

balance between resistance and respect’’. On the one hand, CS was viewed as a risky project; on the

other hand, request for a CS was understood and respected when women had had a previous

traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear.

Five categorieswere related to the theme.Overall, our findings indicate that caregivers blamed the

women for the increase, they considered the management of CS on maternal request difficult, and

they suggested preventive methods to reduce CS and means to strengthen their professional roles.

 

Key conclusions and implication for practice:

 

 

Both midwives and obstetricians considered the

 

 

Keywords
midwifery, Caesarean section; Content analysis; Focus groups interviews; Maternal request; Attitudes; Caregivers
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-7667 (URN)10.1016/j.wombi.2008.12.002 (DOI)2-s2.0-67349271859 (Scopus ID)
Projects
Caesarean section- emergency or shortcut?
Available from: 2008-12-10 Created: 2008-12-10 Last updated: 2017-12-14Bibliographically approved
2. Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study
Open this publication in new window or tab >>Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study
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2010 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 1, p. 11-20Article in journal (Refereed) Published
Abstract [en]

Background:

Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code.

Methods:

Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data.

Results:

The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p < 0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables.

Conclusions:

The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.

Keywords
midwifery, omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-8909 (URN)10.1111/j.1523-536X.2009.00373.x (DOI)000274924800003 ()20402717 (PubMedID)2-s2.0-77649129123 (Scopus ID)
Projects
Caesarean section- emergency exit or shortcut?
Available from: 2009-05-10 Created: 2009-05-10 Last updated: 2017-12-13Bibliographically approved
3. Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors
Open this publication in new window or tab >>Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors
2011 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 5, p. 620-627Article in journal (Refereed) Published
Abstract [en]

Objective: to describe the prevalence of women's preference for caesarean section as expressed in mid pregnancy, late pregnancy and one year post partum. An additional aim was to identify associated factors and investigate reasons for the preference. Design: mixed methods. Data were collected from 2007 to 2008 through questionnaires distributed to a Swedish regional cohort of women. The survey was part of a longitudinal study of women's attitudes and beliefs related to childbirth. One open question regarding the reasons for the preferred mode of birth was analysed using content analysis. Setting: three hospitals in the county of Västernorrland in the middle of Sweden. Participants: 1506 women were recruited at the routine ultrasound screening during weeks 17 to 19 of their pregnancy. Findings: a preference for caesarean section was stated by 7.6% of women during mid pregnancy and by 7.0% in late pregnancy. One year post partum 9.8% of the women stated that they would prefer a caesarean section if they were to have another baby. This was related to their birth experience. There were more multiparous women who wished for a caesarean section. Associated factors irrespective of parity were fear of giving birth and a 'strongly disagree' response to the statement regarding that the preferred birth should be as natural as possible. Among multiparous women the strongest predictors were previous caesarean sections, particularly those that were elective, and a previous negative birth experience. Women's comments on their preferred mode of birth revealed five categories: women described caesarean section as their only option relating to obstetrical and/or medical factors; several women stated ambivalent feelings and almost as many described their previous birthing experiences as a reason to prefer a caesarean birth; childbirth-related fear and caesarean section as a safe option were the remaining categories. Key conclusions: rising caesarean section rates seem to be related to factors other than women's preferences. Ambivalence towards a way of giving birth is common during pregnancy. This should be of concern for midwives and obstetricians during antenatal care. Information and counselling should be frequent and comprehensive when a discussion on caesarean section is initiated by the pregnant woman. A negative birth experience is related to a future preference for caesarean section and this should be considered by caregivers providing intrapartum care.

Keywords
Caesarean section; Maternal preference; Mixed method
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10437 (URN)10.1016/j.midw.2010.05.005 (DOI)000295690300015 ()20630634 (PubMedID)2-s2.0-80052664250 (Scopus ID)
Available from: 2009-11-29 Created: 2009-11-29 Last updated: 2017-12-12Bibliographically approved
4. A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth
Open this publication in new window or tab >>A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth
2011 (English)In: Sexual and reproductive healthcare, ISSN 1877-5756, Vol. 2, no 3, p. 93-99Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to compare experiences and feelings during pregnancy and childbirth in women who preferred caesarean section during pregnancy and were delivered by a planned caesarean section, and women who preferred to give birth vaginally and actually had a spontaneous vaginal birth. Design: Longitudinal cohort study where 693 women participated, 420 of whom were multiparas. Methods: Data were collected from questionnaires distributed to women during pregnancy and two months postpartum in a Mid Sweden county. Results: Women who preferred and actually were delivered by caesarean section experienced a fear of childbirth to a higher degree as compared to women with a vaginal birth. Despite a fulfilled request, women who had a caesarean section were not pleased with the decision making process. In addition, women who had a caesarean section on request were less satisfied with antenatal care and had a more negative birth experience, which made them doubt whether they would have more children. Conclusions: This study shows that a fulfilled request on mode of birth does not guarantee a positive birth experience. Antenatal information of all aspects of a caesarean section is vital for women who consider caesarean section where no medical indication is present. More research is needed about the decision making process regarding caesarean section on maternal request. Childbirth related fear is a common reason to request a caesarean birth. More knowledge about how women reason about caesarean section is required, and treatment related to fear of birth needs to be developed.

Keywords
Caesarean section; Childbirth related fear; Experience of childbirth; Maternal request
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-11561 (URN)10.1016/j.srhc.2011.03.002 (DOI)000312281800001 ()2-s2.0-79960134364 (Scopus ID)
Available from: 2010-05-28 Created: 2010-05-28 Last updated: 2014-08-31Bibliographically approved

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