Patient-choice vaginal delivery?

Patient-choice cesarean delivery is increasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time when women with a breech-presenting fetus or a previous cesarean section have fewer choices as to vaginal birth. Patient-choice cesarean delivery may become widely disseminated before the potential risks to women and their children have been well analyzed. The growing pressure for cesarean delivery in the absence of a medical indication may ultimately result in a decrease of women's childbirth options. Advocacy of patient-choice requires preserving vaginal birth options as well as cesarean delivery.     

导乐式分娩在初产妇分娩中的应用

目的探讨全程导乐在初产妇分娩中的作用。方法以江西省南昌市第一医院妇产科2012年7月-2013年6月收治的360例自愿阴道分娩孕妇作为研究对象,随机分为研究组和对照组,各180例。其中研究组采用一对一陪伴方式,指导正确运用拉玛泽减痛分娩法,密切监测母婴与产程情况。对照组按照常规方法进行护理。结果研究组疼痛程度0度和I度产妇人数比例明显高于对照组,但Ⅱ度和Ⅲ度人数比例低于对照组,差异均有统计学意义（P〈0.05）。研究组剖宫产率低于对照组,且产程进展快于对照组,差异均有统计学意义（P〈0.01）。结论全程导乐分娩可降低初产妇疼痛程度、缩短产程,降低手术产率,分娩预后效果优良。     

Emotional response of primary and repeat cesarean mothers to the cesarean method of childbirth

Differences in the emotional response of cesarean mothers to cesarean delivery were measured in terms of feeling tones experienced among four groups of primary and repeat cesarean subjects. A 10‐question feeling‐tone test measured a variety of personal variables using two‐way analysis of variance. No significant differences were found between primary and repeat cesarean subjects tested early or late in their hospitalization. Significant results were shown in terms of lower feeling‐tone scores for subjects who had attended traditional childbirth education classes. It was recommended that traditional childbirth educators should rethink the strong emphasis placed on preparing mothers for vaginal childbirth and move toward inclusion of greater amounts of information concerning the cesarean method of childbirth into these classes.     

Physician fees and procedure intensity: the case of cesarean delivery.

While there is a large literature investigating the response of treatment intensity to Medicare reimbursement differentials, there is much less work on this question for the Medicaid program. The answers for Medicare may not apply in the Medicaid context, since a smaller share of a physician's patients will be Medicaid insured, so that income effects from fee changes may be dominated by substitution effects. We investigate the effect of Medicaid fee differentials on the use of cesarean delivery over the period 1988-1992. We find, in contrast to the backward-bending supply curve implied by the Medicare literature, that larger fee differentials between cesarean and normal childbirth for the Medicaid program leads to higher cesarean delivery rates. In particular, we find that the lower fee differentials between cesarean and normal childbirth under the Medicaid program than under private insurance can explain between one half and three-quarters of the difference between Medicaid and private cesarean delivery rates. Our results suggest that Medicaid reimbursement reductions can cause real reductions in the intensity with which Medicaid patients are treated.     

Why women choose trial of labor or repeat cesarean section

Despite growing interest in vaginal birth after previous delivery by cesarean section, virtually no studies have examined patient decision making in any depth. This paper examines the social content and cognitive structure of pregnant women's decisions to attempt delivery by trial of labor or for elective repeat cesarean section. Three features of childbirth care strategies are discussed. First, social goals are as central to women's decisions as are medical risks. Second, women reinforce their decisions by defining multiple benefits for the preferred alternative and multiple hazards for the rejected alternative. Third, women do not attempt to assess the probabilities of particular outcomes, but instead construct mental images of anticipated events based upon past childbirth experience and expected consequences of the preferred course of action.     

定额付费对剖宫产率影响的实验研究

目的:当前剖宫产率过高已成为严重的公共卫生问题。通过该实验来验证定额付费对医院降低剖宫产率的作用,为新医改政策的落实提供实证依据。方法:对参合孕产妇住院分娩实行定额付费,即:不论平产、阴道助产、剖宫产均支付同等数额的住院费用。将定额付费作为实验因素,观察干预组与对照组、干预组实施前后剖宫产率、平均住院费用和死亡率等指标变化。结果:干预地区实施该方法后剖宫产率降低14.08个百分点,平均住院费用降低33.96%。结论:改革付费机制,可以有效改变医院的行为,达到降低剖宫产率、控制费用和提高医疗质量三重目的。     

孕妇分娩方式认知调查分析与护理对策

目的了解孕妇对分娩方式的认知情况及影响因素。方法对2009年6月～2010年2月在某医院住院待产的第1胎头位足月200例孕妇进行问卷调查,并追踪分娩结局。结果 200例被调查者中,有142例孕妇意愿选择自然分娩,占70.95%;58例孕妇意愿选择剖宫产,而实际分娩过程中,自然分娩124例,占61.90%;剖宫产76例,占38.09%。产前产后分娩方式比较差异具有统计学意义(χ2=3.854,P<0.05)。结论孕妇心理因素对分娩方式有较大影响,重视妊娠期及分娩期的分娩教育,有利于正确选择分娩方式。     

43例子痫患者的诊治分析

目的:探讨子痫患者的分娩时机、分娩方式及治疗。方法:对43例子痫患者的临床资料进行回顾性分析。结果:早期子痫患者多,且多自然分娩。后期患者少且多剖宫产分娩。有1例患者剖宫产术后发生急性左心衰,经抢救后结局良好。产后出血5例。新生儿死亡3例,均为自然分娩。结论:子痫应采取相应解痉、镇静、降压、终止妊娠的综合治疗,近年来剖宫产是最主要的分娩方式。加强监护,术后充分的镇痛、镇静与解痉治疗协同,可以有效避免再发生子痫和出现其他不良反应。     

Childbirth and social class: the case of cesarean delivery

The purpose of this paper is to examine how obstetrical intervention in childbirth varies according to the socioeconomic status of the birthing woman and what kinds of factors might account for the differences in treatment. We have focused specifically on the contemporary use of cesarean delivery to illustrate how one intervention is applied differently to women of different social classes. If cesarean deliveries were being done for medical reasons alone, we would see any variation in the rates explained by medical risk, and the highest rates among high risk women. Instead we found that more cesareans are being performed in the socioeconomic group of women with the lowest medical risk and much of the variation in cesarean rates explained by factors other than medical need. We focus mainly on characteristics associated with social class differences, and use historical and contemporary data to describe differences in cesarean delivery rates by social class, and to offer explanations for these differences. In addition we introduce some new New York City data to examine more closely cesarean delivery rates in two classes of birthing women and to explore the differential effects of new childbirth technology on women of different socioeconomic classes.     

剖宫产指征分析及对策

目的 探讨有效降低剖宫产的对策.方法 将我院2009年至2011年分娩的剖宫产数及剖宫产指征进行分析.结果 剖宫产指征,社会因素位于第一.结论 剖宫产的增加是一个社会问题,加强孕产妇分娩知识宣教,降低社会因素剖宫产是降低剖宫产率的关键.