Objective The present study aimed to explore women's perceptions and experiences of childbirth by unplanned Caesarean section. Background New motherhood is characterised as a profound change, and research suggests that the psychological effects of childbirth can be significant and far–reaching for some women. The processes occurring during a traumatic birth experience could affect a woman's emotional and psychological state, and she may experience considerable adjustment difficulties in adapting to unfulfilled expectations of delivering her baby naturally. Methods In–depth interviews explored 10 women's lived experiences of childbirth, after which thematic content analysis was used to synthesise data. The elements of phenomenological theory served as a broad framework for the structuring, organizing and categorizing of data, with interpretation aimed at gaining a greater understanding of women's internalised childbirth accounts. Findings Women described their contact with medical personnel, as well as the physical, environmental, and emotional aspects of their unplanned Caesarean sections, as distressing and traumatic. A sense of loss of control was the most significant contributor to women's negative childbirth experiences. Feelings of failure and disappointment were primarily related to unmet expectations and a lack of preparedness. Negative experiences were mediated by attentive caregiving, inclusion in decision–making, and support from loved ones. / Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2011.

The study explored cultural perspectives of the Zimbabwean Ndebele on alternative modes of childbirth. A qualitative generic, exploratory and descriptive design guided the study. The problem is that alternative modes of birthing are not acceptable to the Zimbabwean Ndebele. Women who give birth through alternative modes of birthing, which include caesarean section (CS) instrumental deliveries (ID) and any other unnatural modes are stigmatised. Data were collected from purposively selected samples of women who had given birth through alternative modes of birthing, spouses, mothers-in-law, community elders, sangomas (traditional healers) and traditional birth attendants (TBAs) using individual unstructured in-depth interviews, structured interviews and focus group interviews (FGIs). Data were analysed through use of qualitative content analysis which involved verbatim transcripts. Interpretations of narrations of data and script reviewing were done while simultaneously listening to audio-tapes which were transcribed in the IsiNdebele the language that was used to collect data. Data were then translated into English to accommodate all readers. Accounts of all the informants that were interviewed point to effects of supernatural ancestral powers, infidelity and use of traditional and herbal medicines as cause for “tiedness” (labour complications), a concept that showed a strong thread throughout the study. Study findings illuminated that traditional practices are culture-bound and the desire is to perpetuate the valued culture. Recommendations made from the study are; cultural orientation of local and foreign health workers, cultural consultation and collaboration with sangomas (traditional healers) and particular recognition of the significance of the study as a cultural heritage of the Zimbabwean Ndebele society. Further research on how women and their spouses cope with the grieving process after experiencing the crisis and grief following CS is recommended. With all the recommended areas addressed, Zimbabwean Ndebele would find alternative modes of birthing acceptable. / Health Studies / D. Lit. et Phil. (Health Studies)

The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...

The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...

Antecedentes: Los síndromes convulsivos son un problema de salud pública, pues existen 50 millones de personas diagnosticadas a nivel mundial, 80% en países de ingresos bajos/medianos. Estos pacientes tienen más riesgo de morir. Muchas madres optan por parto por cesárea sin necesidad médica exponiendo al feto a riesgos innecesarios. Objetivo: Evaluar si existe asociación entre nacimiento por cesárea y otros factores prenatales/perinatales/infancia temprana, con el desarrollo de convulsiones/epilepsia en 15 años de seguimiento. Metodología: Estudio tipo cohorte, sub-análisis del estudio “Young-Lives” que incluyó niños nacidos entre 2001-2002 (cohorte menor) en Etiopía, India, Perú y Vietnam. Los desenlaces fueron desarrollo de convulsiones/epilepsia en los primeros 6-18 meses de vida, y hasta los 15 años de edad. Se calcularon riesgos relativos crudos y ajustados (RRa) usando regresión de Poisson en forma multinivel. Resultados: Hubo 7497 participantes, 1806 de Etiopía, 1891 India, 1860 Perú, y 1940 Vietnam. Hasta los 6-18 meses, desarrollaron convulsiones 2.72% en Etiopía, 2.05% en India, 0.58% en Perú, y 0.25% en Vietnam. Hasta los 15 años, 3.36% en Etiopía, 4.30% en India, 1.71% en Perú, y 0.75% en Vietnam. Los nacidos por cesárea tuvieron más riesgo de desarrollar convulsiones/epilepsia que los nacidos en el hospital por parto vaginal hasta los 6-18 meses (RRa 2.37; IC95% 1.20-4.67), y hasta los 15 años (RRa 1.95; IC95% 1.05-3.65). Otros factores asociados fueron sexo masculino, madre adolecente, y caídas con vómitos/pérdida de conciencia. Conclusiones: Haber nacido por cesárea se asoció a desarrollo de convulsiones hasta los 6-18 meses, y en menor medida hasta los 15 años. Desarrollar convulsiones hasta los 6-18 meses también se asoció a sexo masculino y caídas con vómitos/pérdida de conciencia. Desarrollar convulsiones hasta los 15 años además se asoció a tener una madre menor de 20 años y caídas con/sin vómitos/pérdida de conciencia. / Background: Seizures are a global health problem that affects 50 million people worldwide, 80% of which are in low/medium income countries. These patients have a higher risk of death. Many mothers opt for a Caesarean section (C-Section) with no medical necessity exposing the fetus to unnecessary risks. Objective: To assess association of birth by C-Section and other antenatal, perinatal and early childhood factors with development of seizures/Epilepsy during 15 years of follow-up. Methods: Cohort study, sub-analysis of “Young-Lives,” including children born between 2001-2002 in Ethiopia, India, Peru and Vietnam. Outcomes include occurrence of seizures/Epilepsy in the first 6-18 months after birth, and until 15 years. Crude and Adjusted Relative Risk (aRR) were calculated using multilevel Poisson regression. Results: There were 7497 participants, 1806 in Ethiopia, 1891 in India, 1860 in Peru, and 1940 in Vietnam. Until 6-18 months, 2.72% developed seizures in Ethiopia, 2.05% in India, 0.58% in Peru, and 0.25% in Vietnam. Until 15 years, 3.36% in Ethiopia, 4.30% in India, 1.71% in Peru and 0.75% in Vietnam. Birth by C-Section had higher risk of developing seizures/Epilepsy than children born by in-hospital vaginal birth, until 6-18 months (aRR 2.37; IC95% 1.20-4.67), and until 15 years (aRR 1.95; IC95% 1.05-3.65). Other identified factors were born male, teenager mother, and falls with vomits/loss of consciousness. Conclusions: Children born by C-Section had higher risk of developing seizures in the first 6-18 months of life and until 15 years. Developing seizures until 6-18 months was also associated with born male, and having fell with vomit/loss of consciousness. Additionally, developing seizures until 15 years was associated with having a teenage mother and having fell with, and without vomit/loss of consciousness. / Tesis

Contexte : La littérature suggère que le virus du papillome humain (VPH) puisse être transmis verticalement. Or, le mécanisme exact de transmission verticale demeure inconnu et les données ne permettent pas de savoir dans quelle mesure la transmission verticale est affectée par le mode d’accouchement. L’objectif de l’étude était de mesurer l’association entre le mode d’accouchement et la détection d’ADN du VPH chez les bébés. Méthode : Nous avons utilisé les données de 1052 femmes enceintes de la cohorte HERITAGE. Des échantillons vaginaux auto-collectés ont été obtenus chez les mères durant la grossesse, et des échantillons des muqueuses de la bouche, la gorge, les yeux et de la région anogénitale ont été collectés chez les bébés à la naissance et à 3 mois. Nous avons inclus les 282 femmes ayant eu un test VPH positif au premier et troisième trimestre de grossesse. Tous les échantillons ont été analysés pour la détection d’ADN du VPH par la méthode de réaction de polymérase en chaîne (PCR) avec le test Linear ArrayMC. Les informations sur l’accouchement ont été collectées dans les dossiers médicaux. L’association entre le mode d’accouchement et la transmission verticale du VPH a été mesurée par régressions logistiques. Résultats : La probabilité de transmission verticale du VPH a été de 8,9% (25/282), soit 3,7% (3/81) pour les césariennes et 10,9% (22/201) pour les accouchements vaginaux. Chez 21 des 25 enfants positifs au VPH (84%), il y avait au moins un génotype concordant avec leur mère, et tous sont nés par accouchement vaginal. Une augmentation significative du risque de transmission verticale du VPH a été observée pour l’accouchement vaginal, en comparaison avec la césarienne (OR ajusté: 3,63, intervalles de confiance à 95% (IC 95%): 1,03-12,82). Nous n’avons pas observé d’association significative entre la césarienne suivant la rupture des membranes et le risque de transmission, lorsque comparé avec la césarienne avec membranes intactes (OR ajusté : 1,31, IC 95% : 0,10-17,76). Il n’y a pas eu d’association entre la durée écoulée entre la rupture des membranes et la naissance (en heures continues) et le risque de transmission verticale (OR : 1,00, IC 95% : 0,97-1,02). Conclusion : L’accouchement par césarienne a été associé à un risque significativement plus faible de transmission du VPH chez les bébés. La transmission verticale du VPH surviendrait principalement lors du passage dans le canal vaginal car très peu d’enfants nés par césarienne ont été infectés au VPH. Puisque la rupture des membranes avant la césarienne et la durée entre la rupture des membranes et la naissance n’ont pas été associées à un risque de transmission du VPH plus élevé, nos résultats suggèrent que la transmission par infection ascendante après rupture des membranes est probablement rare. / Background: The literature suggests that human papillomavirus (HPV) can be transmitted vertically. However, the exact mechanism of vertical transmission remains unknown and the data do not allow us to know to what extent vertical transmission is affected by the mode of delivery. The aim of the study was to measure the association between mode of delivery and the detection of HPV DNA in infants. Method: We used data from 1052 pregnant women from the HERITAGE cohort. Self-collected vaginal samples were obtained from mothers during pregnancy, and specimens from the mucous membranes of the mouth, throat, eyes and anogenital region were collected from infants at birth and at 3 months. We included 282 women who had both positive HPV tests in the first and third trimester of pregnancy. All samples were analyzed for detection of HPV DNA by the polymerase chain reaction (PCR) method with the Linear ArrayTM assay. Information about the delivery was collected from medical records. The association between the mode of delivery and HPV detection in infants was measured using logistic regressions. Results: The probability of transmission of HPV was 8.9% (25/282); 3.7% (3/81) for caesarean sections and 10.9% (22/201) for vaginal deliveries. In 21 of 25 HPV positive infants (84%), there was at least one genotype concordant with their mother, and all were born vaginally. A significant increase in the risk of transmission of HPV was observed for vaginal delivery, compared to caesarean section (adjusted OR: 3.63, 95% confidence intervals (95% CI): 1.03-12.82). We found no significant increase in the risk of HPV transmission for caesarean section following rupture of membranes, compared to caesarean section with intact membranes (adjusted OR: 1.31, 95% CI: 0.10-17.76). There was no association between the time between rupture of membranes and birth (in continuous hours) and the risk of vertical transmission (OR: 1.00, 95% CI: 0.97-1.02). Conclusion: Caesarean delivery is associated with a significantly lower risk of HPV vertical transmission. Vertical transmission is thought to occur mainly during passage through the vaginal canal, because very few infants born by caesarean section have been infected with HPV. Since rupture of membranes before caesarean section and the time between ruptured membranes and birth have not been associated with a higher risk of HPV transmission, our results suggest that transmission by ascending infection after rupture of membranes is unlikely.

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt.. et Phil. (Health Studies)

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt. et Phil. (Health Studies)