RESUMEN
In Australia, nearly half of births involve labour interventions. Prior research in this area has relied on cross-sectional and administrative health data and has not considered biopsychosocial factors. The current study examined direct and indirect associations between biopsychosocial factors and labour interventions using 19 years of population-based prospective data. The study included singleton babies among primiparous women of the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. Data from 5459 women who started labour were analysed using path analysis. 42.2% of babies were born without intervention (episiotomy, instrumental, or caesarean delivery): Thirty-seven percent reported vaginal birth with episiotomy and instrumental birth interventions, 18% reported an unplanned caesarean section without episiotomy and/or instrumental interventions, and 3% reported unplanned caesarean section after episiotomy and/or instrumental interventions. Vaginal births with episiotomy and/or instrumental interventions were more likely among women with chronic hypertension (RRR(95%-CI):1.50(1.12-2.01)), a perceived length of labour of more than 36 h (RRR(95%-CI):1.86(1.45-2.39)), private health insurance (RRR(95%-CI):1.61(1.41-1.85)) and induced labour (RRR(95%-CI):1.69(1.46-1.94)). Risk factors of unplanned caesarean section without episiotomy and/or instrumental birth intervention included being overweight (RRR(95%-CI):1.30(1.07-1.58)) or obese prepregnancy (RRR(95%-CI):1.63(1.28-2.08)), aged ≥ 35 years (RRR(95%-CI):1.87(1.46-2.41)), having short stature (< 154 cm) (RRR(95%-CI):1.68(1.16-2.42)), a perceived length of labour of more than 36 h (RRR(95%-CI):3.26(2.50-4.24)), private health insurance (RRR(95%-CI):1.38(1.17-1.64)), and induced labour (RRR(95%-CI):2.56(2.16-3.05)). Prevention and management of hypertension, diabetes, and obesity during preconception and/or antenatal care are keys for reducing labour interventions and strengthening the evidence-base around delivery of best practice obstetric care.
Asunto(s)
Cesárea , Hipertensión , Lactante , Embarazo , Femenino , Humanos , Estudios Longitudinales , Estudios Prospectivos , Estudios Transversales , Australia , Parto ObstétricoRESUMEN
OBJECTIVE: To examine the association of cesarean section (C-section) with cardiovascular disease (CVD) risk biomarkers among Australian children. METHODS: The Longitudinal Study of Australian Children (LSAC) birth cohort was prospectively followed for body mass index (BMI) trajectory, and then linked with CVD risk indicators of children; waist circumference (WC), systolic blood pressure (SBP), blood glucose, high-density lipoprotein (HDL), triglyceride (TG), fat mass index (FMI) and composite metabolic syndrome (CMetS) score. Multivariable linear regression analysis was done to assess the association of C-sections with CVD risk biomarkers. RESULTS: Of 1,874 study children, 30% had C-sections; the mean age (SD) was 11.50 (0.50) years, and 49% were female. Against the vaginally-born cohort, Caesarean-born children showed a higher Z- score for five of the seven CVD risk indicators in regression analysis; WC (0.15; p=0.003), SBP (0.16; p=0.003), inverse HDL (0.15; p=0.003), FMI (0.12; p=0.004), and CMetS (0.45; p=0.004) score. Children with accelerated BMI trajectory had higher CMetS scores for both the delivery types while the C-section cohort showed statistical association only (1.69; p=0.006) Conclusion: C-section was independently associated with increased CVD risk profiles of children, further increased with high BMI trajectory. Implication for public health: The chronic disease risk of C-sections should be discussed with families to reduce clinically unrequired C-sections.
Asunto(s)
Enfermedades Cardiovasculares , Cesárea , Niño , Adolescente , Femenino , Humanos , Embarazo , Masculino , Estudios Longitudinales , Obesidad , Factores de Riesgo , Enfermedades Cardiovasculares/epidemiología , Australia/epidemiología , Circunferencia de la Cintura/fisiología , Índice de Masa Corporal , BiomarcadoresRESUMEN
PROBLEM: While caesarean sections in developing contexts act as a marker for access to skilled care, little is known about the health outcomes of caesarean sections. With calls for a more in depth understanding of women's perceptions of this procedure in resource poor settings, this paper explores women's perceptions and experiences of caesarean birth in the context of Ghana's Maternal Exemption Policy of the National Health Insurance Scheme in the Upper West Region. METHODS: A qualitative study using 10 focus group discussions and 30 in depth interviews of mothers and pregnant women were conducted. The results were thematically analysed. FINDINGS: Drawing on theories of feminist geography and embodiment, the results suggest most women perceive caesarean section birth as highly problematic, acting as a long term disease, which hinders their ability to engage in economic activities and care for their children. In the context of the Maternal Exemption Policy, caesarean section birth restricts a woman's ability to secure further health insurance for themselves and newborn child, leaving long term access to health care uncertain. Findings also suggest long term repercussions of caesarean sections may go beyond the physical health of the mother and child to include other socio-cultural and contextual challenges. DISCUSSION: Accordingly, caesarean sections position women in a multifaceted situation of vulnerability. This underscores the need for context appropriate maternal health programmes in developing countries.