Cesarean section on maternal request: the viewpoint of expectant women

Purpose

To determine the women’s perception and factors influencing willingness to have cesarean section on maternal request (CSMR) in the absence of medical or obstetric indication.

Methods

A cross-sectional questionnaire-based survey of 752 antenatal clinic attendees at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti. Pre-tested questionnaires were used to elicit information on socio-demographic and obstetric variables, awareness and perspective of CSMR and the willingness to request CS without physician’s recommendation. Frequency tables were generated and univariate and multivariate logistic regression were used to determine factors that influenced CSMR using SPSS software version 16.0.

Results

Forty-eight (6.4 %) of the respondents reported willingness to request CS. The most common motivations for the request were fear of losing the baby during labor, delay in conception and fear of labor pains. Analysis by simple logistic regression and multiple regression showed age, parity and educational status were not significantly related to the decision for CSMR.

Conclusion

CSMR is an evolving entity in obstetrics practice in the developing countries. Delay in conception, fear of labor pain and loss of baby during labor appear to be strong motivations.     

Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients

Background

Evidence regarding the effect of psychosocial factors on hospital readmission in the setting of hemodialysis is limited. We examined whether social worker-assessed factors were associated with 30-day readmission among prevalent hemodialysis patients.

Methods

Data on 14 factors were extracted from the first available psychosocial assessment performed by social workers at three metropolitan Atlanta dialysis centers. Index admissions (first admission preceded by ≥30?days without a previous hospital discharge) were identified in the period 2/1/10–12/31/14, using linked national administrative hospitalization data. Readmission was defined as any admission within 30?days after index discharge. Associations of each of the psychosocial factors with readmission were assessed using multivariable logistic regression with adjustment for patient and index admission characteristics.

Results

Among 719 patients with index admissions, 22.1% were readmitted within 30?days. No psychosocial factors were statistically significantly associated with readmission risk. However, history of substance abuse vs. none was associated with a 29% higher risk of 30-day readmission [OR: 1.29, 95% CI: 0.75–2.23], whereas depression/anxiety was associated with 20% lower risk [OR: 0.80, 95% CI: 0.47–1.36]. Patients who were never married and those who were divorced, or widowed had 38 and 17% higher risk of 30-day readmission, respectively, than those who were married [OR: 1.38, 95% CI: 0.84–2.72; OR: 1.17, 95% CI: 0.73–1.90].

Conclusions

Results suggest that psychosocial issues may be associated with risk of 30-day readmission among dialysis patients. Despite the limitations of lack of generalizability and potential misclassification due to patient self-report of psychosocial factors to social workers, further study is warranted to determine whether addressing these factors through targeted interventions could potentially reduce readmissions among hemodialysis patients.