Birth
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Review Meta Analysis
Evidence-based strategies for reducing cesarean section rates: a meta-analysis.
Canada's cesarean section rate reached an all-time high of 22.5 percent of in-hospital deliveries in 2002 and was associated with potential maternal and neonatal complications. Clinical practice guidelines represent an appropriate mean for reducing cesarean section rates. The challenge now lies in implementing these guidelines. Objectives of this meta-analysis were to assess the effectiveness of interventions for reducing the cesarean section rate and to assess the impact of this reduction on maternal and perinatal mortality and morbidity. ⋯ The cesarean section rate can be safely reduced by interventions that involve health workers in analyzing and modifying their practice. Our results suggest that multifaceted strategies, based on audit and detailed feedback, are advised to improve clinical practice and effectively reduce cesarean section rates. Moreover, these findings support the assumption that identification of barriers to change is a major key to success.
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Comparative Study
Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study.
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. ⋯ 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.
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Acupuncture and sterile water injections are nonpharmacological pain relief methods used for labor pain in Swedish delivery wards. Their use has changed over time, the reasons for which are unclear, and acupuncture is currently in more common use than sterile water injections. The aim of this study was to elucidate the clinical use of acupuncture and sterile water injections as pain relief and relaxation during childbirth in Sweden. ⋯ Our study shows that acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The results also indicate a weakness in midwives' awareness and use of scientific knowledge and general recommendations about these methods.
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In a trend similar to continuous electronic fetal monitoring, many hospitals are incorporating central fetal monitoring into labor and delivery suites. The objective of this study was to investigate whether the use of central fetal monitoring had an effect on neonatal outcomes or cesarean section rate. ⋯ No statistically significant difference was demonstrated in the rates of cesarean section, admission to the neonatal intensive care unit, or incidence of Apgar scores of less than 7 associated with the use of central fetal monitoring. Therefore, we could not identify any benefit to the use of central fetal heart rate monitoring.
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Common mental health disorders like depressive and anxiety disorders are frequent in antenatal and postpartum women. However, no agreement about the prevalence of these disorders and the course of women's mental health during the transition to motherhood exists. This study compared women's mental health before, during, and after pregnancy with a control group of nonpregnant women. ⋯ Common mental health disorders are frequent during pregnancy and the postpartum period, but pregnant or postpartum women are not more at risk than those who are not pregnant or who did not deliver.