Cesarean delivery has notably increased around the world during the last three decades. Globally, the proportion of birth by cesarean delivery is higher in countries with higher levels of socioeconomic development, higher female enrollment in secondary education, higher levels of urbanization, greater density of physicians, and lower fertility. Additionally, cesarean rates are consistently higher in private than public health facilities in all regions of the world. Latin America and the Caribbean is the region with the highest cesarean rates globally and Dominican Republic is the country with one of the highest rates of cesareans worldwide. This research focuses on factors associated with cesarean delivery in Latin America and the Caribbean with an emphasis on Dominican Republic and is presented in three interconnected papers. The first paper, entitled “Determinants of cesarean delivery in Latin America and the Caribbean: a scoping review” identified factors associated with the escalating rates of cesareans in the region by mapping the literature on social determinants, women’s preferences, and healthcare providers’ attitudes and beliefs towards cesarean delivery. Thirty studies conducted between 2009 and 2019 met the inclusion criteria for the scoping review. Cesarean delivery was positively associated with older maternal age, higher maternal education, higher household income or wealth, urban residency, and delivering at a private health facility. Other factors such as ethnicity and marital status were less consistently assessed in the studies. Many studies evaluated social determinants of cesarean as covariates in multivariate analysis but did not evaluate them as the primary association, hence the impact of those determinants in cesarean delivery remains understudied. Women’s beliefs and providers’ attitudes were found to influence cesarean rates; however, detailed evidence on individual incentives is still limited. The second paper entitle “Relationship between mode of delivery and type of health facility in Dominican Republic: an analysis of the Multiple Indicator Cluster Survey” is a secondary data analysis of a population-based survey that evaluates differences in the determinants of cesarean delivery in public and private healthcare facilities. Among a sample of 4,398 women who delivered at a healthcare facility, cesarean rates were 48.1% and 86.5% in public and private hospitals respectively. In public hospitals, cesareans were associated with older maternal age, higher education, higher quintile of wealth, and Catholic religion. After adjusting for confounders, no associations were found between sociodemographic factors or maternal health characteristics and cesarean delivery in private hospitals. This study underscores the need to study other drivers of cesareans, particularly in private hospitals. The third paper entitle “Factors associated with cesarean delivery across maternal age groups in Dominica Republic” examines the differences in factors associated with cesarean delivery in adolescents, younger, and older women. Cesarean rates were 52.6%, 59.6%, and 71.0% in women aged <20, 20-34 or 35-39 years old respectively. Overall, there were no differences in the odds of cesarean delivery between adolescents and women aged 20-34. Women aged 35 or older were more likely to have a cesarean delivery than women aged 20-34. In women 20-34 years old, education, Catholic religion, and wealth were associated with cesareans. In women >=35 years, education and wealth were associated with cesarean delivery. Delivering at a private hospital increased the odds of cesarean delivery across the three age groups. The objective of this dissertation is to contribute to the literature with evidence to inform programs, policies, and practice and to highlight opportunities for further research on determinants of cesarean delivery in Latin American and the Caribbean, and particularly in Dominican Republic.

LD2668 .T4 1962 N66

published_or_final_version / Community Medicine / Master / Master of Public Health

Background There is an increasing rate of cesarean section globally. Both low and high cesarean section rates are associated with maternal and neonatal mortality and morbidities. In Nicaragua, the rate of cesarean section is beyond the WHO recommendation of 10% to 15%. Aim The aim of this study was to evaluate the costs-effectiveness of elective caesarean section when compared with vaginal delivery in hospital in Nicaragua, a lower-middle income setting. Methods A 3 months prospective cohort study was conducted in a hospital in León, Nicaragua, from 1st May 2010 to 31st July 2010. Two questionnaires were used to obtain data, one on costs and maternal complications after delivery, and the other on postpartum complications. A descriptive analysis regarding maternal and neonatal outcomes, and a cost-effectiveness analysis were conducted comparing elective cesarean section with vaginal delivery, followed by a sensitivity analysis regarding change on rates of elective cesarean section. Results The cesarean section rate was 37.9%, and the elective cesarean section rate was 21%. The percentage of live births was 99.6% in elective cesarean section group and 98.9% in vaginal delivery group. Cesarean section had both positive and negative influences on maternal complications and postpartum complications. The costs of elective cesarean section was higher than vaginal delivery ($66 compared to $39.36). For one more live birth, 3805.71 US dollars were needed. Conclusion The maternal outcomes of cesarean section need to be improved. With the increasing cesarean section rates, more medical resources are needed in the future.

Lau, Tze Kin. / "May 1998." / Thesis (M.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 165-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

No description available.

Purpose: This thesis addresses feasibility issues of conducting a descriptive study of pain and health-related quality of life (HRQOL) in women after Cesarean section (c-section). Objectives: Feasibility issues surrounding population access, chart completeness for review, and preference for online data collection were investigated. Prevalence and prediction of postoperative pain and HRQOL at six-weeks was addressed to generate hypotheses for future study. Methods: A descriptive pilot design was used, collecting a convenience sample of 41 women recruited two hours prior to a planned c-section at Kingston General Hospital. Consenting women completed preoperative questionnaires via computerized tablet or paper and pen. Preoperative data included pain, HRQOL, anxiety, depression, somatization, HCU, and demographics. Six weeks postoperatively, women completed pain, HRQOL, and HCU questionnaires through the internet, postal mail, or telephone. A chart review was used to collect health and obstetrical history, and acute postoperative pain. Results: An average of two participants per week were recruited, with a participation rate of 83.7%. Online questionnaires were preferred by 34 women (83%) preoperatively, and 15 women (48.4%) postoperatively. Almost 40% of patient charts were incomplete, missing symptoms reported in the immediate postoperative period. Twenty-four percent of the sample was lost to follow-up. Mild postoperative pain was reported by seven women (23) within 24 hours of completing the questionnaire. Bodily pain and the physical component of HRQOL were worse both pre- and post-operatively than age- and sex-matched norms. Postoperative pain at six weeks was predicted by tubal ligation, pain expectancy, and severe postoperative acute pain. Postoperative HRQOL scores were correlated with preoperative HRQOL score, depression, somatization, and preoperative pain. HRQOL physical composite score, bodily pain scores, and trait anxiety were predictive of healthcare use. Conclusion: The planned c-section population is accessible for research purposes, however timing and mode of follow-up should be carefully considered due to the demands of newborn care. A larger study evaluating the prevalence of chronic pain after c-section is needed, in which the role of depression, anxiety, somatization, and pain expectancy in pain outcomes and the impact on healthcare use is investigated. / Thesis (Master, Nursing) -- Queen's University, 2007-10-01 13:12:33.096

Increasing obesity rates in Canadian women are at an all time high with more than 50% of Canadian women falling into one of the four overweight to obese categories. Further to this 11-21% of Canadian women who are of child-bearing age are being described as overweight or obese. Along with the increasing rates of obesity is an increase in the number of operative deliveries experienced by pregnant women in Canada. Canadian women experience cesarean section (CS) approximately 21% of the time while women in Ontario experience an even higher rate of CS (26%). While currently there are several studies examining the relationship between pre-pregnancy overweight and obesity and its association with CS, there is little research examining the relationship between excess weight gain in pregnancy and operative delivery methods. Data were collected through a retrospective chart review to examine the relationship between excess weight gain in pregnancy and operative delivery methods. Mean weight gain throughout pregnancy was measured. Data analysis was conducted using t-tests, Chi-Squared analyses and Fisher’s Exact test of significance, accepting a significance level of alpha = 0.05 with a 95% Confidence Interval of difference. The analysis conducted demonstrated no significant relationship between weight gain in pregnancy and operative delivery methods. When examining maternal weight and labour type, statistical significance was reached (p = 0.04) demonstrating increased likelihood of induction with excess weight gain in pregnancy; statistical significance was also reached with maternal age greater than 35 years and increased risk for operative delivery(p = 0.04). Further analysis demonstrated statistically significant results when examining one minute Apgar scores between the group of women with recorded weights in comparison to those women whose charts did not contain weights. The lack of findings in this study may be largely attributed to the small sample size.Important practice issues were identified. It is important that pre-pregnancy or early pregnancy weight and height be recorded on all women in hospital databases as well paper charts. Consistency in recording weight units in either pounds or kilograms is imperative. Dietary consultation is an important component of prenatal care and women who enter pregnancy overweight or obese should have immediate access to nutritional counseling. / Thesis (Master, Nursing) -- Queen's University, 2010-09-22 09:00:57.695

Thesis (M. Mid.)--University of Sheffield, 2007. / "June, 2007." Issued as part of the Canadian electronic library documents collection. Includes bibliographical references (p. 45-55).

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 60-71).