Exploratory Study of Women's Reactions to Having a Cesarean Birth

ABSTRACT: One hundred and five women who had cesarean sections were interviewed to assess their feelings about their births. Forty-one percent of the women were told they had to have a cesarean fewer than two hours before, and 35% were repeat cesareans. Statistical data are presented on women's reasons for feeling cesareans were harder, easier, or not different, including the finding that 30% felt relief at having a cesarean. Sources of stress and negative feelings after cesareans are discussed.     

Transition to Fatherhood An Exploratory Study

An exploratory study of the transition to fatherhood for 50 first-time fathers is described. Subjects completed questionnaires within three weeks of their infant's birth and again three to five weeks postpartum on the topics of infant feeding, lifestyle changes, depression, fathering activities with their own father and those planned with their own child, marital adjustment, and infant feeding. Subjects showed no evidence of depression, were maritally well adjusted, were very involved in infant care, had experienced many lifestyle changes, and planned to continue to be very involved with their child.     

FATIGUE IN EARLY PREGNANCY: An Exploratory Study

The experience of fatigue in early pregnancy was studied, using a general model of fatigue as the conceptual framework. A convenience sample of 30 women, age 20–35 years, who were at less than 20 weeks' gestation and without health problems were included in the study. Physiologic, psychological, and environmental factors were measured and related to the occurrence and intensity of fatigue. Pearson correlations and content analysis were used to analyze the data. Results showed that a large portion of the sample (90%) experienced fatigue and that this fatigue had a significant impact on their ability to maintain personal and social activities. Significant correlations were observed between fatigue and the physiologic variables of nausea and feeling bred upon awakening from sleep. There was no significant relationship between fatigue and environmental variables such as number of hours worked or the number of children living in the home. In addition, significant correlations were observed between fatigue and psychological variables that included depression, anger, anxiety, and confusion. These data suggest that fatigue is a significant problem for pregnant women and is not relieved by test. These data further suggest that the fatigue may be related to other physiologic changes, perhaps hormonal, that mediate physiologic and psychological variables, including fatigue.     

Dimensional Profiles of Male to Female Gender Identity Disorder: An Exploratory Research

IntroductionMale-to-Female Gender Identity Disorder (MtF GID) is a complex phenomenon that could be better evaluated by using a dimensional approach.AimTo explore the aggregation of clinical manifestations of MtF GID in order to identify meaningful variables describing the heterogeneity of the disorder.MethodsA consecutive series of 80 MtF GID subjects (mean age 37 ± 10.3 years), referred to the Interdepartmental Center for Assistance Gender Identity Disorder of Florence and to other Italian centers from July 2008 to June 2009, was studied. Diagnosis was based on formal psychiatric classification criteria. Factor analysis was performed.Main Outcome MeasuresSeveral socio-demographic and clinical parameters were investigated. Patients were asked to complete the Bem Sex Role Inventory (BSRI, a self-rating scale to evaluate gender role) and Symptom Checklist-90 Revised (SCL-90-R, a self-rating scale to measure psychological state).ResultsFactor analysis identified two dimensional factors: Factor 1 was associated with sexual orientation, and Factor 2 related to behavioral and psychological correlates of early GID development. No correlation was observed between the two factors. A positive correlation between Factor 2 and feminine BSRI score was found, along with a negative correlation between Factor 2 and undifferentiated BSRI score. Moreover, a significant association between SCL-90-R Phobic subscale score and Factor 2 was observed. A variety of other socio-demographic parameters and clinical features were associated with both factors.ConclusionsBehavioral and psychological correlates of Factor 1 (sexual orientation) and Factor 2 (gender identity) do not constitute the framework of two separate clinical entities, but instead represent two dimensions of the complex MtF GID structure, which can be variably intertwined in the same subject. By using factor analysis, we offer a new approach capable of delineating a psychopathological and clinical profile of MtF GID patients. Fisher AD, Bandini E, Ricca V, Ferruccio N, Corona G, Meriggiola MC, Jannini EA, Manieri C, Ristori J, Forti G, Mannucci E, and Maggi M. Dimensional profiles of male to female gender identity disorder: An exploratory research.     

A Qualitative Study of Women's Feelings About Future Childbirth: Dread and Delight

Introduction: There is extensive knowledge about expectations of and thoughts about childbirth among women who have not given birth. When it comes to women who have given birth to at least 1 child, on the other hand, knowledge about their expectations for a future birth is limited. The purpose of this study is thus to describe the emotions of this group concerning future childbirth. Methods: Participants were 908 women in Sweden who had given birth to at least 1 child. This study is based on responses to the following request in the questionnaire sent out to women 4 to 7 years after they had given birth vaginally: “Please describe your feelings when you think about giving birth in the future.” Results: One‐third of the women responded that they were mostly frightened of future childbirth, while the remaining two‐thirds had mostly positive feelings. The qualitative analysis resulted in 3 categories and 8 subcategories and an overall theme: a mixture of dread and delight. Even with negative feelings/fears about future childbirth, many women want to give birth to more children. Discussion: Despite experiences of severe pain or complications during a previous birth, many women nonetheless looked forward to future childbirth, primarily since they were motivated by having another child and encouraged by having been given good support by the midwife.     

A Qualitative Study of Factors That Influence Contraceptive Choice among Adolescent School-Based Health Center Patients

Study ObjectiveLong-acting reversible contraceptive (LARC) methods can prevent teen pregnancy yet remain underutilized by adolescents in the United States. Pediatric providers are well positioned to discuss LARCs with adolescents, but little is known about how counseling should occur in pediatric primary care settings. We explored adolescent womens' attitudes and experiences with LARCs to inform the development of adolescent-centered LARC counseling strategies.DesignQualitative analysis of one-on-one interviews.SettingParticipants were recruited from 2 urban school-based, primary care centers.ParticipantsThirty adolescent women aged 14-18 years, diverse in race/ethnicity, and sexual experience.InterventionsInterviews were audio-recorded, transcribed, and coded using inductive and deductive coding.Main Outcome MeasureMajor themes were identified to integrate LARC-specific adolescent preferences into existing counseling approaches.ResultsParticipants (mean age, 16.2 years; range, 14-18 years) represented a diverse range of racial and/or ethnic identities. Half (15/30) were sexually active and 17% (5/30) reported current or past LARC use. Five themes emerged regarding key factors that influence LARC choice, including: (1) strong preferences about device-specific characteristics; (2) previous exposure to information about LARCs from peers, family members, or health counseling sessions; (3) knowledge gaps about LARC methods that affect informed decision-making; (4) personal circumstances or experiences that motivate a desire for effective and/or long-acting contraception; and (5) environmental constraints and supports that might influence adolescent access to LARCs.ConclusionWe identified 5 factors that influence LARC choice among adolescent women and propose a framework for incorporating these factors into contraceptive counseling services in pediatric primary care settings.     

Immigrant Women's Views About Care During Labor and Birth: An Australian Study of Vietnamese,Turkish, and Filipino Women

ABSTRACT: Background: Few studies of immigrant women's views of maternity care in their new homelands have been conducted. In Victoria, Australia, approximately 1 woman in 7 giving birth was born overseas in a non‐English speaking country. This paper examines the views of three groups of immigrant women about the care they received in hospital for the birth of their babies and compares the findings with a population‐based statewide survey. Methods: Mothers in a New Country was a study of 318 Vietnamese, Turkish, and Filipino women interviewed about their maternity care experiences by bicultural interviewers 6 months after giving birth in Melbourne, Australia. The interview schedule was adapted from the 1994 Victorian Survey of Recent Mothers, a population‐based postal survey of 1336 women. Results: Of the 3 groups, 27 percent of Vietnamese, 48 percent of Turkish, and 39 percent of Filipino women reported their care during labor and birth as “very good,” figures significantly lower than for the statewide survey, in which 61 percent of women experiencing similar models of care described their care as “very good.” This significant differential in views about care was also present for many individual aspects of care. In the current study of mothers in a new country, comments about aspects of care with which women were particularly happy and unhappy highlighted their appreciation of care that was safe, kind, supportive, and respectful, and conversely, illustrated how distressed women were when care failed to meet these basic standards. Conclusions: What immigrant women wanted from their maternity care proved to be extremely similar to what Australian‐born women—and women the world over—want. Unfortunately, immigrant women were much less likely to experience care that gave them what they wanted. (BIRTH 29:4 December 2002)     

College Women's Expectations About Pregnancy,Childbirth, and Infant Care: A Prospective Study

A prospective study of 103 women undergraduate students explored expectations and knowledge about pregnancy, childbirth, and newborn care. Participants completed a 35-item questionnaire based on a planned pregnancy. Most women (68%) thought they were extremely likely to become pregnant in their lives and planned to have an average of 2.6 children. Positive emotions about pregnancy were most frequently excited, happy, and proud, and negative emotions were most frequently nervous, scared, and anxious. Women expected that pregnancy and parenting would interfere most with work or education plans. Choices of birthplace were hospital delivery room (54.4%), in-hospital birthing room (35%), out-ofhospital birth center (3.9%), and home (2.9%). One-half of the women planned to breastfeed, 35 percent had not decided, and 10.7 percent would not breastfeed. Positive feelings about pregnancy were correlated with positive feelings about labor and birth (r = 0.48, P < 0.001). Negative feelings about pregnancy were correlated with a low self-assessment of ability to care for an infant (r = 0.27, P < 0.01). Some college women's expectations are similar to those held by pregnant women, and suggest the need for further education of young women in areas such as prenatal health care and breastfeeding.     

Preoperative Factors That Predict the Need to Morcellate in Total Laparoscopic Hysterectomy

Study Objective

To determine which preoperative factors best predict the need for uterine morcellation at the time of total laparoscopic hysterectomy (TLH) and to identify cut-offs that can help guide clinical decision-making.

Integrative Review of the Factors That Influence Fathers’ Involvement in the Breastfeeding of Their Infants

Objective

To integrate research findings related to the factors that influence fathers’ involvement in the breastfeeding of their infants.

Primigravid Women's Views of Being Approached to Participate in a Hypothetical Term Cephalic Trial of Planned Vaginal Birth versus Planned Cesarean Birth

Background: Several papers have called for a trial of planned cesarean section versus planned vaginal birth for low‐risk women—a recommendation that is fiercely debated. Although proponents of a trial have voiced their support, evidence suggests that in the United Kingdom few midwives and obstetricians believe such a trial to be feasible, and no studies reporting women's views on the prospect of such a trial have been published. The purpose of this study is to explore women's views of participation in a trial of planned cesarean birth versus planned vaginal birth. Methods: A qualitative study was conducted using in‐depth interviews in a large maternity hospital in the United Kingdom. Sixty‐four women were interviewed 12 months after giving birth. Women were asked “How do you think you would have felt if you had been approached to take part in such a trial during your first pregnancy?” Data were analyzed thematically. Results: Only 3 of the 64 women stated that they would have participated in a trial of planned vaginal birth versus planned cesarean section, had they been asked. However, five other women said that they would have consented to participate if they had been asked during pregnancy, but with hindsight, would have regretted that decision. The remainder of women would not have participated, unless a preference arm was offered. Three main themes were identified: “feeling cheated,”“let nature take its course, ” and “just another trauma that you don't need.” Conclusions: Few women supported a trial and most suggested that it was intuitively wrong. Given the strong views voiced by women, it is unlikely that a trial of planned vaginal delivery versus planned cesarean delivery would be feasible.