Personality and mode of delivery

BACKGROUND: Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning. METHOD: Three hundred and twenty-eight pregnant women from two different groups, "cesarean section on maternal request" (n=84), and "vaginal delivery group" (n=242) completed the self-report inventory Karolinska Scales of Personality at 37-39 gestational weeks in pregnancy. RESULTS: A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p<0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p<0.003) and Socialization (p<0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale. CONCLUSION: Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not.     

Women's attitudes regarding mode of delivery and cesarean delivery on maternal request

Objective.?To explore women's attitudes and beliefs regarding cesarean delivery and cesarean delivery on maternal request (CDMR).

Study design.?Anonymous questionnaires assessing patient demographics, knowledge, and attitudes about CDMR were distributed at the time of routine mid-trimester ultrasound appointment.

Results.?Eight hundred thirty three out of 3929 (21.2%) potential participants completed the questionnaire. About 81.7% of participants indicated that they believed that vaginal delivery was a safer alternative for the mother and 72.8% believed that it was safer for the fetus. While only 6.1% of women thought that CDMR was ‘a good idea’, most believed that women should have the right to choose their mode of delivery and that the option should be offered to everyone (85.9% and 79.6%, respectively). Socioeconomic and demographic variables did not significantly influence the participants' responses.

Conclusion.?Majority of women believe that vaginal delivery is safer for the mother and baby and would prefer to have a vaginal delivery if given the option.     

From delivery mode to incontinence

Vaginal delivery has been considered to be the main cause of pelvic static disorders since obstetric is taught. Epidemiological studies generally confirm the greater prevalence of urinary or fecal incontinence after delivery. Analysis of available data lead to the following observations. Urge urinary incontinence is not associated with the number of pregnancies or the mode of delivery. At age equivalence, stress urinary incontinence is more frequent among women who delivered by C-section compared with women without children. Also at age equivalence, stress incontinence is more frequent in women who delivered by the vaginal route compared with those who had C-section. This difference disappears with age, while stress urinary incontinence during pregnancy is a risk factor 15 days later. The only published randomized trial demonstrated a higher prevalence of stress urinary incontinence three months after delivery in the vaginal route group, but this difference disappeared at two years. Fecal incontinence is more frequent after delivery, especially in the event of forceps delivery. Nevertheless late after delivery, the prevalence of fecal incontinence is similar between spontaneous vaginal, forceps, or C-section delivery. The mode of delivery thus has an impact on continence. However, late after delivery, the influence of pregnancy and delivery fades out either due to a process of repair or via the intermediary of other predominant risk factors (age, tissue quality). The beneficial effect of programmed C-section on continence has not been demonstrated.     

双胎妊娠分娩时机与分娩方式的选择

近年来,双胎妊娠发生率急剧上升,双胎分娩的处理是具有挑战性的临床问题。双胎妊娠分娩方式与分娩时机应结合母胎情况、当地医疗机构医疗水平和医疗条件进行综合考虑。无并发症单绒毛膜双羊膜囊(monochorionic-diamniotic,MCDA)双胎分娩不超过37周为宜,双绒毛膜双羊膜囊(dichorionic-diamniotic,DCDA)双胎可妊娠至38周,单绒毛膜单羊膜囊(monochorionic-monoamniotic,MCMA)双胎为32～33周分娩。对于无并发症MCDA双胎与DCDA双胎可考虑阴道试产,MCMA双胎则建议剖宫产手术终止妊娠。     

Eye disease and mode of delivery

Many ophthalmologists and obstetricians recommend either an assisted vaginal delivery with forceps or vacuum extraction or a Caesarean section in cases of pre-existing eye diseases such as severe myopia, retinal detachment, diabetic retinopathy, or glaucoma. These recommendations, however, are not evidence-based. None of the published trials have reported any retinal changes after vaginal delivery. In general, eye disease is not an indication for an instrumental or operative delivery provided that regular eye examinations (once each trimester) have been performed.     

Psychosocial factors and mode of delivery

Childbirth is a substantial physical and emotional endeavor. Because emergency Cesarean and instrumental vaginal delivery impose a greater mortality and physical and emotional morbidity on both the mother and the infant than normal vaginal delivery, it is important to identify factors that are associated with the risk of operative delivery. In previous investigations, some associations have been found, but the effect of psychosocial factors is not clear. In this study we examined several factors which could be associated with the risk for instrumental and surgical delivery. In addition to biomedical factors we included psychosocial factors such as depressive symptoms, quality of the relationship of the woman with her partner, personality, lifestyle and educational level. We assessed 354 healthy nulliparous pregnant women with a child in vertex presentation and spontaneous onset of term labor using validated questionnaires. We found that social support from the woman's partner in pregnancy, lack of depressive symptoms and specific personality traits are not protective against instrumentally assisted vaginal delivery or emergency Cesarean section. Predictive factors for operative delivery after spontaneous onset of labor are higher fetal weight, non-occiput anterior presentation and advanced gestational age, and foremost fetal distress during parturition.     

Fetal macrosomia: mode of delivery

This study was provided among 1847 deliveries from January, 1 to December, 31, 2003. The aim of the study was to examine the correlation between antenatal diagnosis "fetal macrosomia" and the mode of delivery. We found that among the cases with birth weight > or = 4000 g and antenatal diagnosis "fetal macrosomia" the rate of cesarean section was fourfold higher than among the cases without such a diagnosis. There weren't statistically significant correlation between the cases with antenatal diagnosis "fetal macrosomia " and the cases with estimated birth weight < or = 3999g in reference to the mother's age and weight, parity, fundal height and abdominal circumference. There are insignificant differences between both of groups in reference to gestacional age and birth.     

Psychosocial factors and mode of delivery

Childbirth is a substantial physical and emotional endeavor. Because emergency Cesarean and instrumental vaginal delivery impose a greater mortality and physical and emotional morbidity on both the mother and the infant than normal vaginal delivery, it is important to identify factors that are associated with the risk of operative delivery. In previous investigations, some associations have been found, but the effect of psychosocial factors is not clear. In this study we examined several factors which could be associated with the risk for instrumental and surgical delivery. In addition to biomedical factors we included psychosocial factors such as depressive symptoms, quality of the relationship of the woman with her partner, personality, lifestyle and educational level. We assessed 354 healthy nulliparous pregnant women with a child in vertex presentation and spontaneous onset of term labor using validated questionnaires. We found that social support from the woman's partner in pregnancy, lack of depressive symptoms and specific personality traits are not protective against instrumentally assisted vaginal delivery or emergency Cesarean section. Predictive factors for operative delivery after spontaneous onset of labor are higher fetal weight, non-occiput anterior presentation and advanced gestational age, and foremost fetal distress during parturition.     

Neonatal thyrotrophin and mode of delivery

This study was performed to assess the association between labour and the mode of delivery with the umbilical cord plasma thyroxine (T4) and thyroid-stimulating hormone (TSH) concentrations in full-term uncomplicated pregnancies delivered in our hospital. Babies born vaginally had statistically significantly higher umbilical cord plasma TSH but similar T4 concentrations than babies born by caesarean section. Labour was not associated with either higher TSH or T4 concentrations. All the babies with an elevated TSH concentration (greater than 20 miu/l) were born vaginally. Our findings indicate that the mode of delivery should be taken into consideration in the interpretation of umbilical cord plasma TSH results.     

合理的孕期营养对分娩方式的影响

随着人们生活水平的提高及家庭对孕妇的过度关注,孕期营养过剩导致的孕期肥胖现象日益严重。孕前体重指数和孕期体重增长已成为不良妊娠结局的重要影响因素,其对分娩方式的影响也受到越来越多的关注。合理的妊娠期营养干预对于降低孕期体重增加、控制新生儿体重、降低剖宫产率,从而改善妊娠结局有着重要意义。     

Effect of delivery mode on postpartum neonatal body temperatures

Objective: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section.

Methods: We performed a prospective study of 106 term newborn – 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers’ temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth.

Results: Environmental temperature was maintained at 22–24?°C. Pre-operative mother temperatures were 36.31?±?0.30?°C in group 1, 36.36?±?0.26?°C in group 2 and 36.39?±?0.19?°C in group 3 (p?=?0.414). Post-operative mother temperatures were 36.39?±?0.27?°C in group 1, 36.29?±?0.31?°C in group 2 and 36.25?±?0.28?°C in group 3 (p?=?0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5?±?0.6?°C, 37.2?±?0.2?°C and 36.8?±?0.4?°C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p?<?0.001).

Conclusions: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.     

Women's preference on mode of delivery in Southern Italy

BACKGROUND: Rates of cesarean section are rising worldwide and maternal requests for this kind of delivery contribute to the increase in this trend. The purpose of this study was to analyze the factors influencing maternal demand in our region and the profile of women preferring this mode of delivery. METHODS: Six obstetricians (3 male and 3 female) were asked to give out a questionnaire to their patients with an uncomplicated pregnancy. Demographic data, obstetrical history, lifestyle, and physician-patient relationship were analyzed. Patients who would have preferred abdominal delivery were asked to report the motivations for their choice. A psychiatric evaluation, using the Hamilton Anxiety Scale and the Montgomery-Asberg Depression Rating Scale, was conducted. RESULTS: 16.9% of 390 patients enrolled preferred cesarean section. This wish was correlated with patients' age > or = 35 years (OR 2.43; p=0.0065), high level of education (OR 4.28, p=0.019), previous infertility (OR 3.91, p=0.0045), smoking (OR 4.25, p=0.0008), quality of information (OR 29.08, p=0.0013), and desire for more comprehension (OR 8.25, p=0.00001). The most frequent motivation for this choice was a safer childbirth (90.9%). No difference was found for the Hamilton scale's score, while the Montgomery-Asberg Scale showed a lower mean score for the cesarean section group (7.2+/-3.3 versus 9.4+/-7.3, p=0.0002). CONCLUSIONS: A high rate of women wish to give birth by cesarean section. This is probably an expression of the changes in society's attitudes. However, more careful attention to the psychological aspects and more personalized information about pregnancy and delivery could reduce this maternal demand.