Skin‐to‐Skin Care with the Father after Cesarean Birth and Its Effect on Newborn Crying and Prefeeding Behavior

ABSTRACT: Background: Previous reports have shown that skin‐to‐skin care immediately after vaginal birth is the optimal form of care for full‐term, healthy infants. Even in cases when the mother is awake and using spinal analgesia, early skin‐to‐skin contact between her and her newborn directly after cesarean birth might be limited for practical and medical safety reasons. The aim of the present study was to compare the effects of skin‐to‐skin contact on crying and prefeeding behavior in healthy, full‐term infants born by elective cesarean birth and cared for skin‐to‐skin with their fathers versus conventional care in a cot during the first 2 hours after birth. Methods: Twenty‐nine father‐infant pairs participated in a randomized controlled trial, in which infants were randomized to be either skin‐to‐skin with their father or next to the father in a cot. Data were collected both by tape‐recording crying time for the infants and by naturalistic observations of the infants’ behavioral response, scored every 15 minutes based on the scoring criteria described in the Neonatal Behavioral Assessment Scale (NBAS). Results: The primary finding was the positive impact the fathers’ skin‐to‐skin contact had on the infants’ crying behavior. The analysis of the tape recordings of infant crying demonstrated that infants in the skin‐to‐skin group cried less than the infants in the cot group (p < 0.001). The crying of infants in the skin‐to‐skin group decreased within 15 minutes of being placed skin‐to‐skin with the father. Analysis of the NBAS‐based observation data showed that being cared for on the father’s chest skin‐to‐skin also had an impact on infant wakefulness. These infants became drowsy within 60 minutes after birth, whereas infants cared for in a cot reached the same stage after 110 minutes. Rooting activity was more frequent in the cot group than in the skin‐to‐skin group (p < 0.01), as were sucking activities (p ≤0.001) and overall duration of wakefulness (p < 0.01). Conclusions: The infants in the skin‐to‐skin group were comforted, that is, they stopped crying, became calmer, and reached a drowsy state earlier than the infants in the cot group. The father can facilitate the development of the infant’s prefeeding behavior in this important period of the newborn infant’s life and should thus be regarded as the primary caregiver for the infant during the separation of mother and baby. (BIRTH 34:2 June 2007)     

Population‐Based Study of Cesarean Section After In Vitro Fertilization in Australia

Abstract: Background: Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF). Methods: Retrospective population‐based study was conducted using national registry data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section. Results: Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation‐specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% CI: 1.95–2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% CI: 1.74–2.11]) were significantly higher. Conclusions: Rates for cesarean section appear to be disproportionately high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010)     

Cesarean Section Rates and Maternal and Neonatal Mortality in Low‐, Medium‐, and High‐Income Countries: An Ecological Study

ABSTRACT: Background: Cesarean section rates show a wide variation among countries in the world, ranging from 0.4 to 40 percent, and a continuous rise in the trend has been observed in the past 30 years. Our aim was to explore the association of cesarean section rates of different countries with their maternal and neonatal mortality and to test the hypothesis that in low‐income countries, increasing cesarean section rates were associated with reductions in both outcomes, whereas in high‐income countries, such association did not exist. Methods: We performed a cross‐sectional multigroup ecological study using data from 119 countries from 1991 to 2003. These countries were classified into 3 categories: low‐income (59 countries), medium‐income (31 countries), and high‐income (29 countries) countries according to an international classification. We assessed the ecological association between national cesarean section rates and maternal and neonatal mortality by fitting multiple linear regression models. Results: Median cesarean section rates were lower in low‐income than in medium‐ and high‐income countries. Seventy‐six percent of the low‐income countries, 16 percent of the medium‐income countries, and 3 percent of high‐income countries showed cesarean section rates between 0 and 10 percent. Three percent of low‐income countries, 36 percent of medium‐income countries, and 31 percent of high‐income countries showed cesarean section rates above 20 percent. In low‐income countries, a negative and statistically significant linear correlation was observed between cesarean section rates and neonatal mortality and between cesarean section rates and maternal mortality. No association was observed in medium‐ and high‐income countries for either neonatal mortality or maternal mortality. Conclusions: No association between cesarean section rates and maternal or neonatal mortality was shown in medium‐ and high‐income countries. Thus, it becomes relevant for future good‐quality research to assess the effect of the high figures of cesarean section rates on maternal and neonatal morbidity. For low‐income countries, and on confirmation by further research, making cesarean section available for high‐risk pregnancies could contribute to improve maternal and neonatal outcomes, whereas a system of care with cesarean section rates below 10 percent would be unlikely to cover their needs. (BIRTH 33:4 December 2006)     

Do Physicians and Their Relatives Have a Decreased Rate of Cesarean Section? A 4‐Year Population‐Based Study in Taiwan

ABSTRACT: Background: The increased rate of cesarean deliveries may be partly due to a lack of consumer knowledge. Assuming that physicians and their relatives are well informed of the risks and benefits associated with the different methods of delivery, our goal was to compare cesarean rates between female physicians, female relatives of physicians, and women with high socioeconomic status in Taiwan. Methods: Two subgroups of 588 female physicians and 5,021 relatives of physicians aged 20 to 50 years were compared with 93,737 pregnant women with a monthly wage $40,000 New Taiwan (NT) dollars or more as identified in nationwide National Health Insurance databases of Taiwan from 2000 to 2003. Results: Female physicians (adjusted odds ratio 0.66; 95% CI 0.47, 0.93) and female relatives of physicians (adjusted odds ratio 0.84; 95% CI 0.74, 0.95) were significantly less likely to undergo a cesarean section than other high socioeconomic status women, adjusted for clinical and nonclinical factors. Conclusions: In this study, the cesarean delivery rate was lower among women who may have greater access to medical knowledge. However, the lower rates observed among female physicians and physician relatives in Taiwan are still considerably higher than the national averages of many countries. This finding suggests that other than information, practice patterns, and social and cultural milieu may play a role. (BIRTH 33:3 September 2006)