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Hoxha I, Grezda K, Udutha A, Taganoviq B, Agahi R, Brajshori N, Rising SS. Systematic review and meta-analysis examining the effects of midwife care on cesarean birth. Birth 2024; 51:264-274. [PMID: 38037256 DOI: 10.1111/birt.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births. METHODS We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse-variance random-effects meta-analysis was used to generate overall odds ratios (ORs). RESULTS We observed a significantly lower likelihood of cesarean birth in midwife-led care, midwife-attended births, among those who received instruction pre-birth from midwives, and within institutions with a midwifery presence. CONCLUSIONS Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.
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Affiliation(s)
- Ilir Hoxha
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Kolegji Heimerer, Prishtina, Kosovo
- Evidence Synthesis Group, Prishtina, Kosovo
| | | | - Anirudh Udutha
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Mead JS, Pollack CC, Paris AE, Emeny RT, Puleo RA, St Ivany AR. Obstetric Outcomes Among Women With a History of Intimate Partner Violence in the United States. Obstet Gynecol 2023; Publish Ahead of Print:00006250-990000000-00788. [PMID: 37290101 DOI: 10.1097/aog.0000000000005216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the association between exposure to intimate partner violence (IPV) and delivery method in a U.S. obstetric cohort. METHODS The study population included U.S. women with a history of recent live birth, drawn from the 2009-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) cohort. The primary exposure was self-reported IPV. The primary outcome of interest was method of delivery (vaginal or cesarean). Secondary outcomes included preterm birth, small for gestational age (SGA), and admission to the neonatal intensive care unit (NICU). Bivariate associations between the primary exposure (ie, self-report of IPV vs no self-report of IPV) and each covariate of interest were assessed with weighted quasibinomial logistic regression. Weighted multivariable logistic regression was conducted to evaluate the association between IPV and delivery method controlling for confounders. RESULTS A total of 130,000 women were included in this secondary analysis of a cross-sectional sample, representing 7,500,000 women nationwide based on PRAMS sampling design. Of these, 0.8% reported abuse in the 12 months before their current pregnancy and 1.3% reported abuse during pregnancy; 1.6% of the study population reported abuse both before and during pregnancy. After adjusting for maternal sociodemographic characteristics, IPV exposure at any time was not significantly associated with cesarean delivery, compared with no IPV exposure (odds ratio [OR] 0.98, 95% CI 0.86-1.11). Of secondary outcomes, 9.4% of women experienced preterm birth and 15.1% had neonates admitted to the NICU. Exposure to IPV was associated with a 21.0% increased risk of preterm birth, compared with women without exposure (OR 1.21, 95% CI 1.05-1.40), and a 33.3% increased risk of NICU admission (OR 1.33, 95% CI 1.17-1.52) after controlling for confounders. There was no difference in the risk of delivering a neonate who was SGA. CONCLUSION Intimate partner violence was not associated with an increased risk of cesarean delivery. Intimate partner violence before or during pregnancy was associated with increased risk of adverse obstetric outcomes, such as preterm birth and NICU admission, corroborating previous research findings.
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Affiliation(s)
- Julia S Mead
- Department of Obstetrics and Gynecology, Concord Hospital, Concord, the Department of Obstetrics and Gynecology, the Department of Epidemiology, and the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, and the Department of Obstetrics and Gynecology and the Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and the Department of Internal Medicine, University of New Mexico Health System, Albuquerque, New Mexico
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M’Koma AE, Ware JN, Nabaweesi RK, Chirwa SS. Managing Pregnancy and Nursing Affecting African American Women with Inflammatory Bowel Disease: Clinical Outcomes and Parenthood. MEDICAL RESEARCH ARCHIVES 2023; 11:3784. [PMID: 37492395 PMCID: PMC10367541 DOI: 10.18103/mra.v11i6.3784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Inflammatory bowel disease (IBD) is a term for two autoimmune diseases encompassing Crohn's disease (CD) and ulcerative colitis (UC) which are lifelong diseases affecting more than 3 million adults (1.3%) in the United States. IBD is characterized by chronic inflammation of the whole digestive system which results in damage to the gastrointestinal (GI) tract. IBD often emerges during adolescence and young adulthood. Maternal morbidity includes physical and psychological conditions that result from or are aggravated by pregnancy and have an adverse effect on a woman's health, the baby's health or both. Some women have health challenges that arise before or during pregnancy that could lead to complications. It is recommended for women to receive health care counseling before and during pregnancy. Compared to other developed countries, the United States has the highest rate of women dying of pregnancy related complications. During the past 25 years maternal mortality has been getting worse. African American women (AAW) with and/or without IBD are dying at significantly higher rates than other groups. This is linked to several factors, i.e., systemic, institutionalized, and structural racism in health-care delivery and subsequent toxic stress from people's lived experiences of racism, limited knowledge about healthcare system function, lack of access to healthcare, (inclusiveness and insurance policies) all of which negatively impact these patients. African Americans (AAs) are also up to three times as likely to experience severe maternal morbidity: unexpected outcomes of labor and delivery, deficient or lacking prenatal care and social determinants of health like lack of transportation, adequate employment, limited literacy, and limited healthcare access contribute to poor health outcomes. Studies on IBD patients indicate Medicaid expansion is associated with reduced rates of maternal morbidity, particularly for African American Women (AAW) and increased access to preconception and prenatal services that make pregnancy and childbirth safer for parent and baby. Herein we examine the physiological changes of pregnancy in patients diagnosed with inflammatory bowel disease and their relationship perinatal outcomes and parenthood.
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Affiliation(s)
- Amosy E. M’Koma
- Departments of Biochemistry, Cancer Biology, Neuroscience and Pharmacology
| | | | | | - Sanika S. Chirwa
- Departments of Biochemistry, Cancer Biology, Neuroscience and Pharmacology
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Caesarean Section in Indonesia: Analysis of Trends and Socio-Demographic Correlates in Three Demographic and Health Surveys (2007–2017). DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2022. [DOI: 10.1007/s44229-022-00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Objectives
This study determined the prevalence and trends in caesarean section (C-section) deliveries and the factors associated with the utilization of C-section deliveries among Indonesian mothers from 2007 to 2017.
Methods
We used Indonesia Demographic and Health Survey data sets (2007, 2012, and 2017) to assess the prevalence, trends, and factors associated with C-section delivery through univariate, bivariate, and multivariate analyses.
Results
A 10% increase in C-section delivery among Indonesian women was observed between the years 2007 and 2017. Mothers from urban areas tended to receive more C-sections than mothers from rural areas (adjusted odds ratio (aOR) = 1.49). More educated mothers were more likely (aOR = 3.373) to receive C-sections than mothers without formal education. Mothers from wealthy family backgrounds were more (aOR = 1.97) likely to receive C-sections than mothers from low-income families. Antenatal care (ANC) visits were significantly positively associated with receiving C-sections; mothers with more than four ANC visits (aOR = 4.54) tended to receive more C-sections than mothers with no ANC visits. For first births, mothers over 25 years of age were more likely (aOR = 2.07) to receive C-sections than mothers less than 18 years of age.
Conclusion
The percentage of C-sections has alarmingly increased. Thus, authorities in Indonesia should consider these findings and take necessary steps to decrease C-sections. The results of this study should help policymakers formulate appropriate policies that will encourage regular delivery where most appropriate.
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Perrotta C, Romero M, Sguassero Y, Straw C, Gialdini C, Righetti N, Betran AP, Ramos S. Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees. BMJ Open 2022; 12:e053419. [PMID: 35078842 PMCID: PMC8796244 DOI: 10.1136/bmjopen-2021-053419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore obstetricians', midwives' and trainees' perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. SETTING We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants. RESULTS Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. CONCLUSIONS Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
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Affiliation(s)
- Carla Perrotta
- School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland
| | - Mariana Romero
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | | | - Cecilia Straw
- School of Social Sciences, University of Buenos Aires, CEDES, Buenos Aires, Argentina
| | | | - Natalia Righetti
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Silvina Ramos
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina
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Gilboa Y, Perlman S. Intrapartum ultrasound for the management of the active pushing phase. Am J Obstet Gynecol MFM 2021; 3:100422. [PMID: 34126251 DOI: 10.1016/j.ajogmf.2021.100422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023]
Abstract
The anxiety and anticipation that accompany pregnancy, labor, and delivery may be relieved by education, providing knowledge regarding the physiological process of childbirth. Intrapartum ultrasound is an available, simple, intuitive, real-time tool that enables visualization of the fetal head within the birth canal. Both the attending staff and expectant parent can assess its movements and descent in response to the pushing efforts during the active pushing phase. This review described the potential obstetrical and psychological advantages of intrapartum ultrasound in managing the active pushing phase.
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Affiliation(s)
- Yinon Gilboa
- Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Perlman
- Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
OBJECTIVES The objective of this study is to explore the association of health financing indicators with the proportion of births by caesarean section (CS) across countries. DESIGN Ecological cross-country study. SETTING This study examines CS proportions across 172 countries. MAIN OUTCOME MEASURES The primary outcome was the percentage excess of CS proportion, defined as CS proportions above the global target of 19%. We also analysed continuous CS proportions, as well as excess proportion with a more restrictive 9% global target. Multivariable linear regressions were performed to test the association of health financing factors with the percentage excess proportions of CS. The health financing factors considered were total available health system resources (as percentage of gross domestic product), total contributions from private households (out-of-pocket, compulsory and voluntary health insurance contributions) and total national income. RESULTS We estimate that in 2018 there were a total of 8.8 million unnecessary CS globally, roughly two-thirds of which occurred in upper middle-income countries. Private health financing was positively associated with percentage excess CS proportion. In models adjusted for income and total health resources as well as human resources, each 10 per cent increase in out-of-pocket expenditure was associated with a 0.7 per cent increase in excess CS proportions. A 10 per cent increase in voluntary health insurance was associated with a 4 per cent increase in excess CS proportions. CONCLUSIONS We have found that health system finance features are associated with CS use across countries. Further monitoring of these indicators, within countries and between countries will be needed to understand the effect of financial arrangements in the provision of CS.
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Affiliation(s)
- Ilir Hoxha
- Kolegji Heimerer, Pristina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzlerland
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Cesarean Delivery and Gender of Delivering Physicians: A Systematic Review and Meta-analysis. Obstet Gynecol 2021; 136:1170-1178. [PMID: 33156182 DOI: 10.1097/aog.0000000000004172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the association of the gender of the delivering physician and the odds of performing cesarean delivery. DATA SOURCES CINAHL, ClinicalTrials.gov, Cochrane Library, PubMed, Scopus and Web of Science from the first year of records through May 2020. METHODS OF STUDY SELECTION We included studies that reported odds ratios (OR), or data allowing the calculation of ORs, for cesarean delivery performed by female and male delivering physicians. We also included studies that reported the preference of physicians for performing cesarean deliveries. TABULATION, INTEGRATION, AND RESULTS Independent data extraction was carried out by at least two researchers. Standard inverse-variance random effects meta-analysis was used to generate overall ORs. Finally, in two separate meta-analyses, we analyzed 15 studies containing clinical data for 1,269,625 births, and 11 studies containing data for the preference for delivery mode of 4,911 obstetricians. Both the crude and adjusted odds of a cesarean delivery were lower for those performed by female physicians (crude OR 0.75, 95% CI 0.68-0.84, τ=0.029, adjusted OR 0.74, 95% CI 0.65-0.85, τ=0.031). We also found that female physicians had a lower preference for cesarean delivery in both crude and adjusted analysis (crude OR 0.59, 95% CI 0.36-0.96, I=77%, adjusted OR 0.58, 95% CI 0.40-0.84, I=67%). CONCLUSION Female physicians are less likely to perform cesarean delivery and less likely to prefer it. This was observed across different health systems and populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020158442.
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Hoxha I, Zhubi E, Grezda K, Kryeziu B, Bunjaku J, Sadiku F, Agahi R, Lungu DA, Bonciani M, Little G. Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries. BMJ Open 2021; 11:e042076. [PMID: 33509847 PMCID: PMC7845681 DOI: 10.1136/bmjopen-2020-042076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/26/2020] [Accepted: 01/08/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals. SETTING Over 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020. PARTICIPANTS Women at birth. Over 18.5 million births. INTERVENTION Caesarean section. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons. RESULTS In adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals carry out fewer caesarean sections in several countries, for several study populations and population characteristics. CONCLUSIONS With smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends. PROSPERO REGISTRATION NUMBER CRD42020158437.
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Affiliation(s)
- Ilir Hoxha
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Research Unit, Heimerer College, Prishtina, Kosovo
- LifestylediagnostiX, Prishtina, Kosovo
| | | | | | | | | | | | - Riaz Agahi
- Research Unit, Heimerer College, Prishtina, Kosovo
| | - Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Manila Bonciani
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - George Little
- Department of Pediatrics and of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Sarkar S. Prevalence and determinants of the use of caesarean section (CS) in the dichotomy of ‘public’ and ‘private’ health facilities in West Bengal. India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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