Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2013-04-04T15:10:16Z No. of bitstreams: 1 Rachel Souza de Queiroz Varella.pdf: 650833 bytes, checksum: e904470b0e9c0296358eadc1aefbb893 (MD5) / Made available in DSpace on 2013-04-04T15:10:16Z (GMT). No. of bitstreams: 1 Rachel Souza de Queiroz Varella.pdf: 650833 bytes, checksum: e904470b0e9c0296358eadc1aefbb893 (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Introdução: A dor é um sintoma freqüente no pós-operatório. Ao contrário do que acontece com outras cirurgias, no pós-operatório da cesariana as mulheres não podem realizar repouso porque precisam cuidar do recém-nascido. A taxa de cesarianas no Brasil é muito elevada e conhecer a percepção de dor das mulheres no pós-operatório desta cirurgia, pode ajudar a estabelecer novas rotinas de utilização de analgésicos. Objetivos: O objetivo desse estudo foi avaliar a dor no pós-operatório de cesariana através do questionário de dor de McGill. Esse instrumento avalia a dor nos seus diferentes aspectos: sensitivo, avaliativo, afetivo e miscelânia. A dor foi avaliada 36 a 48 horas após a cirurgia, quando já houve a metabolização das drogas utilizadas na anestesia. Materiais e métodos: Foi feito um estudo transversal com puerperas de cesariana no período de Dezembro 2010 a Maio de 2011. Participaram da pesquisa 120 mulheres submetidas à cesariana no Instituto Fernandes Figueira- FIOCRUZ, sem complicações no pós-operatório.Resultados: A dor pós-cesariana não apresentou diferença na sua dimensão em relação à idade, raça e renda familiar. A dor apresenta maiores escores no campo cognitivo-avaliativo nas pacientes com maior grau de instrução, e no campo miscelânia, nas mulheres com menor grau de instrução. O PRI afetivo nas pacientes solteiras foi maior quando comparado as pacientes que viviam com o companheiro. Não houve diferença no escore de dor em relação ao número de cesarianas anteriores. Mães com RN na UTI apresentaram maior índice de dor no campo miscelânia que mães com RN no alojamento conjunto. Mães que receberam anestesia com morfina apresentaram índice de dor total, sensitivo e avaliativo maior quando comparado as puérperas que receberam como opióide o fentanil. Mulheres que tiveram a cesariana indicada durante o trabalho de parto, apresentaram um PRI avaliativo maior quando comparada as mulheres que tiveram cesariana eletiva. Conclusão: A grande maioria das mulheres (93,3%) referiu que a dor pós-operatória da cesariana é de intensidade moderada a severa apesar do uso da medicação analgésica regular na prescrição. Mesmo assim, 88,3% das puérperas estavam muito satisfeitas ou satisfeitas com a medicação prescrita para alívio da dor. A utilização da avaliação rotineira do nível de dor percebido pelas puerperas pode proporcionar maior bem estar no período do pós-operatório quando estas mulheres precisam estar ativas para cuidar de seus bebês. / Purpose: Pain is a common postoperative symptom. Unlike other surgeries, in the postoperative period of Caesarean sections patients don’t get much rest because they must take care of their newborn babies. Brazil has one of the highest Caesarean rates in the world, and, thus, knowledge of pain perception in women in the postoperative period of Caesarean operations may help establish new routines in the use of painkillers. Objectives: The aim of this study was to assess pain in the postoperative period following Caesarean sections using the McGill Pain Questionnaire. This instrument assesses the sensory, evaluative, affective and miscellaneous components of pain. Pain was assessed 36 to 48 hours after surgery when the anesthetic drugs were already metabolized in the body. Material and Methods: We performed a cross-sectional study with women who had Caesarean section during the December 2010-May 2011 period. 120 women undergoing Caesarean sections at the Instituto Fernandes Figueira- FIOCRUZ, without surgery complication participated in the study. Results: Pain after Caesarean operation did not differ in terms of age, race and family income. The pain had higher scores in the cognitive-evaluative field in those patients with higher education levels and in the miscellaneous field in patients with lower education levels. The affective component of PRI in unmarried patients was higher compared to patients living with a partner. There was no difference in pain score compared to the number of previous Caesarean sections. Mothers with their babies in the NICU had higher score in the miscellaneous component of PRI than mothers rooming-in with their babies Mothers anesthetized with morphine had higher scores in the total PRI, sensory and evaluative components when compared to the mothers given an opioid such as fentanyl. Women with indication for Caesarean section during labor showed higher scores for the evaluative component of pain compared to women who had elective Caesarean section. Conclusions: Most women (93.3%) reported that postoperative pain intensity is moderate to severe despite the regular use of painkillers. Yet, 88.3% of the mothers were very satisfied or satisfied with the medication prescribed for pain relief. The use of routine assessment of the level of pain perceived by pregnant women can provide greater well-being in the postoperative period when these women must have plenty of energy to take care of their babies.

Bakgrund: Kejsarsnitt har blivit vanligare, orsaken kan vara medicinska indikationer, men också förlossningsrädsla. Att kvinnor som föder barn vaginalt får en bättre upplevelse om de får stöd av en medmänniska är välkänt. Studier av kvinnor som föder barn med planerade kejsarsnitt visar att de också behöver stöd. Detta stöd ges framför allt av anestesisjuksköterskor eftersom barnmorskan är sterilklädd. Syfte: Syftet var att beskriva hur anestesisjuksköterskan ger stöd till den födande kvinnan vid planerat kejsarsnitt i spinalanestesi. Metod: En empirisk, deskriptiv studie med kvalitativ ansats genomfördes. Fem anestesisjuksköterskor intervjuades. Deras berättelser analyserades med kvalitativ innehållsanalys. Resultat: I resultatet framkom fem olika teman och tio subkategorier. Resultatet visar hur anestesisjuksköterskorna ger stöd. Temana var främja delaktighet (kommunicera, involvera närstående), värna integritet (stå bakom, dela födelsen), inge trygghet (vara närvarande, utstråla kompetens, teamarbete) och skapa relation (emotionellt engagemang, använda personligheten, känna in den unika patienten). Det femte temat produktionskrav beskriver de tidspressade förhållanden som gäller där anestesisjuksköterskorna ger stödet. Slutsats: Att ge stöd vid kejsarsnitt innebär att anestesisjuksköterskorna pendlar mellan närhet och distans till patienten, utifrån den unika patientens behov. Målet för stödet var att den blivande modern skulle kunna föda sitt barn lugn och trygg, tillsammans med sin närstående. Arbetsmiljö med flera kejsarsnitt per dag påverkar anestesisjuksköterskornas möjligheter att ge stöd. Klinisk betydelse: Denna studie avser att öka kunskapen om anestesisjuksköterskans stöd vid planerade kejsarsnitt. Detta är en pilotstudie som det kan vara värdefullt att reflektera kring som kliniskt verksam anestesisjuksköterska. / Background: Caesarean section has become more common, the cause may be medical indications, but also fear of childbirth. It is well known that women who give birth vaginally have a better experience if they are supported by a fellow human being. Studies of women who give birth with planned caesarean section shows that they also need support. The purpose was to describe how the nurse anesthetist provides support to the woman in labor at elective caesarean section in spinal anesthesia. Method: An empirical, descriptive study with qualitative approach was conducted. Five nurse anesthetists were interviewed. Their stories were analyzed using qualitative content analysis. Results: The results revealed five different themes and ten subcategories. The results show how a nurse anesthetist provides support. Nurse anesthetists provide support by promoting participation, protect integrity, provide safety and build relationships. The fifth theme, which is called the production requirements, describes the time-strained circumstances of the place where nurse anesthetists provide support. Conclusion: Nurse anesthetists were prepared to provide support so that the mother could give birth to the baby while feeling safe and calm. Working environment with multiple caesarean sections per day affects nurse anesthetist capacity to provide support. Clinical significance: This study intends to increase awareness of the nurse anesthetist support for this form of childbirth. This is a pilot study that it may be useful for the clinically active nurse anesthetist to reflect on.

Caesarean section is a common major surgical procedure and long-term complications have not been fully investigated. By longitudinal population based register studies, based on National health registers and medical data records, maternal complications after caesarean delivery at subsequent labour (N=7 683), among extremely preterm births (N=406), and at remote gynaecologic surgery (N=25 354) were explored. In Paper I, uterine closure was investigated in respect to uterine rupture in a subsequent delivery after caesarean section. Uterine rupture occurred in 1.3 % of women with a previous caesarean section. There was no increased risk of uterine rupture with single compared with double layers for closure of the uterus (adjusted Odds Ratio 1.17, 95 % CI 0.78-1.70). Modifiable risk factors of uterine rupture in a trial of labour after caesarean section included induction of labour and use of epidural analgesia. In Paper II, maternal outcomes and surgical aspects of caesarean section in the extremely preterm period were assessed. Maternal complications were more frequently reported in extremely preterm- compared with term caesarean delivery. No increase in short-term morbidity was observed at 22-24 compared with 25-27 gestational weeks, but uterine corporal incisions were performed more frequently (18.1 % vs. 9.6 %, p=0.02). Furthermore, risk factors for abdominal adhesions after caesarean section and organ injury in remote gynaecologic surgery were analysed (Paper III and IV). Numbers of prior caesarean sections were the most important factor for formation of adhesions. Advanced maternal age, obesity, infection and delivery year 1997-2013 were factors associated with adhesions in conjunction with caesarean section. Organ injury occurred in 2.2 % of women undergoing benign hysterectomy. A history of caesarean section increased the risk (adjusted Odds Ratio 1.74, 95 % CI 1.41-2.15), but was only partly explained by the presence of adhesions. The organ affected depended on medical history; prior caesarean predisposed for bladder injury, prior bowel/pelvic surgery for bowel injury and endometriosis was associated with ureter injury at time of hysterectomy. In conclusion; data from National health registers indicates that caesarean delivery is associated with long-term complications, although the absolute risk of severe complications for the woman is low.

Objective: We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined. Method: Online survey of women who had at least one CS Results: We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS . The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions. Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed. Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required. In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved. Conclusions: A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.

The thesis is aimed at perinatal factors affecting the emotional bond between a mother and a child (boding) during the first weeks postpartum. The literature review is divided into three chapters. The first chapter discusses the childbirth, the experience of childbirth and the factors affecting a subjective evaluation of the childbirth by a parturient. The second chapter follows up with an overview of findings concerning the initial afterbirth moments, and the interaction between a mother and a child during early contact. The third chapter introduces the concept of bonding. It describes its manifestations, possible measuring methods, and factors influencing its quality. The research part analyzes perinatal factors affecting bonding on a sample of 1108 mothers with the use of generalized linear regression. The independent variables are: mode of birth, the evaluation of childbirth experience by mother, and the process of early contact between a mother and a child. The results show that bonding during the first weeks postpartum was not affected by the mode of birth or by the parturient's evaluation of the childbirth experience. A significant effect was found in the occurrence of early contact between a mother and a child; mothers who had contact with the child during the first postpartum hour reported...

This study explores the genesis of the presence of the fetus in American culture by examining the evolution of American medical attitudes towards the unborn (1800-1865) in the lead up to the Physicians Crusade Against Abortion in the mid 19th century. Specifically, it analyzes how American allopathic physicians reconciled their denunciation of abortions for reproductive limitation with their approval of abortions for medical reasons, shedding light on how American physicians resolved maternal-fetal conflict. The study begins with an exploration of the medicalization of childbirth in the 18th century and how it created medical concern for the fetus. The forceps could spare the pregnant woman the craniotomy operation (collapse of the fetal skull) and save the fetus. However, not all cases of obstructed labour could be solved with the forceps, and as physicians displaced midwives as the principal birth attendants, they were confronted with the prospect of performing craniotomy on a live fetus. As they dreaded this outcome, they proposed two operations to circumvent it: the Caesarean section and induced premature labour. This shows that medicalization created concern for the fetus, particularly in the later stages of pregnancy. With new embryological research in the 1820s, concern for the fetus was extended to all stages of pregnancy and expressed itself in advice to women to guarantee a healthy child. The publication of Alfred Velpeau’s Principles of Tokology and Embryology was influential because it both normalized the fusion of embryology and obstetrics, and it justified recourse to early abortion in cases of contracted pelvises. Indications for the medical use of abortion began to multiply as a result of this shift, even as physicians denounced clandestine abortion and sought to criminalize it. This study argued the medical ideology of vitalism, as articulated by Xavier Bichat, was key in resolving maternal-fetal conflict in favour of the pregnant woman. Vitalism characterized fetuses as having the same functions as a plant and this lower level of functioning justified the sacrificing of fetal life in certain circumstances. Vitalism also viewed women to as having more sensibility, more cerebral activity, and more social ties. Therefore, women were viewed as the more deserving human being in maternal-fetal conflict.

Bakgrund: En övergripande indikation för ett omedelbart kejsarsnitt är om mammans, barnets eller bådas hälsa riskeras under en vaginal förlossning. I samband med dessa oförutsedda situationer ska anestesisjuksköterskan ha god omvårdnadskunskap men också kunskap gällande den medicinska utrustningen och assistera anestesiologen i samband med generell anestesi. Syfte: Syftet med studien var att beskriva anestesisjuksköterskans upplevelser av att delta vid omedelbart kejsarsnitt. Metod: En kvalitativ metod tillämpades. Data samlades in genom individuella semistrukturerade intervjuer och den insamlade datan analyserades genom kvalitativ innehållsanalys med manifest ansats. Resultat: Fyra kategorier formades utifrån den data som insamlats. Att hantera en omedelbart livshotande situation där två liv står på spel. Att vara förberedd på det oförutsedda. Att känna ovisshet i informationen till och om modern. Att lära sig hantera stress och otrygghet. Anestesisjuksköterskor beskrev omedelbart kejsarsnitt som en av de viktigaste situationer som de deltog vid i sitt arbete där två liv står på spel. Känslor som ovisshet och stress påverkade hur de hanterade situationen. Slutsats: Omedelbart kejsarsnitt är en akut situation som inte liknar någon annan akut situation. Då simuleringsövningar och erfarenhet är faktorer som bidrar till ett större lugn och fokus i denna akuta situation bör regelbundna övningar vara inplanerade i verksamheten.

Yes / Aims and objectives.  This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. .  The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites’ choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology.  Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results.  This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions.  Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice.  This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.

Au Canada, en 2018-2019 la naissance par césarienne s’élève à 29% dépassant ainsi les taux de 10-15% recommandés par l’Organisation Mondiale de la Santé (OMS). Au cours des dernières années, les naissances par césariennes ne cessent d’accroitre, malgré les risques associés qui sont rapportés dans la littérature pour la mère et l’enfant. Bien que couramment pratiquée, la césarienne reste une intervention chirurgicale avec des risques à court et à long terme. Chez les enfants nés par césarienne, nous retrouvons des taux plus élevés d’asthme, d’obésité, de problème d’allergies etc. Tandis que chez les mères subissant la césarienne, nous retrouvons plus de cas d’infection, d’hémorragie et des risques plus élevées de rupture du placenta et de fausse couche lors des grossesses subséquentes. Puisque la prévalence de la césarienne ne cesse d’augmenter, il est primordial de comprendre son influence sur le développement neurologique de l’enfant. L’association entre le mode d’accouchement et les troubles neurodéveloppementaux tel que le trouble du déficit d'attention et d’hyperactivité (TDAH) chez les enfants est peu étudié avec des résultats souvent contradictoires ou non concluants. Le TDAH est l'un des troubles neurodéveloppementaux les plus courants chez les enfants avec une prévalence mondiale qui s’élève à 7.2% (IC 95% 6.7-7.8). Ainsi, le projet de ce mémoire a pour objectif d’évaluer l’association entre les modes d’accouchements et le TDAH chez l’enfant, tout en palliant les limites méthodologiques observées dans la littérature présentement. Afin de répondre à cette question, le projet évalue trois modes d’accouchements et ainsi recherche l’association entre l’accouchement par césarienne élective, par césarienne d’urgence ou par voie vaginale assistée et le risque de TDAH chez les enfants comparativement à l’accouchement par voie vaginale non assisté. Cette étude de cohorte rétrospective populationnelle tire l’entièreté de ses données de la Cohorte des Grossesses du Québec (CGQ) sur une période allant de 1998 à 2015. L’étude retrouve une augmentation de 6 % (IC 95% 1.03 - 1.10) du risque de TDAH chez les enfants nés par césarienne d’urgence et une augmentation de 12 % (IC 95% 1.06 - 1.19) du risque de TDAH chez les enfants nés par voie vaginale assisté avec ventouse ou forceps. Aucune association (HRa=0.96 IC 95% 0.91 - 1.01) n’a été retrouvée entre l’accouchement par césarienne élective et l’augmentation du risque de TDAH chez les enfants. Par la suite, plusieurs analyses de sensibilités ont été effectuées pour évaluer la robustesse des résultats, mais aucune n’a significativement alterné nos résultats. En conclusion, l’étude démontre l’existence d’une association entre l’accouchement par césarienne d’urgence et par voie vaginale assisté et le risque de TDAH chez les enfants. Ces résultats renforcent la nécessité d’étudier davantage les répercussions de la césarienne et des accouchements assistés avec des instruments sur l’enfant dans un contexte Canadien, où nous retrouvons peu de recherche sur le sujet. / In Canada the rate of caesarean deliveries is about 29 % of all birth in 2018-2019. Despite the known risk of this major surgery, caesarean section rates are continually rising beyond the recommended rate by the world health organization (WHO) of 10 to 15 %. Scientific research has identified several short- and long-term potential risks associated with this procedure for both the child and mother. For the child, researchers have found higher rates of asthma, obesity, and allergy problems. As for the mother, some of these risks include post-partum infection, hemorrhage and higher risks of placental rupture and miscarriages in future pregnancies. Caesarean section rates have been steadily increasing and it is essential to understand its influence on the neurological development of the child. Few studies have investigated the association between the mode of delivery and neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) in children. Currently the literature shows often contradictory or inconclusive results. ADHD is one of the most common neurodevelopmental disorders in childhood with a worldwide prevalence of up to 7.2% (CI 95% 6.7-7.8). Therefore, the project of this thesis aims to evaluate the association between modes of delivery and ADHD in children while overcoming the methodological limitations observed in the literature. To answer this question, the project is evaluating three modes of delivery by looking into the association between elective caesarean, emergency caesarean or assisted vaginal delivery and the risk of ADHD in children compared to unassisted vaginal birth. This prospective population-based study uses data on pregnancies and children from 1998 to 2015 from The Quebec Pregnancy Cohort (QPC). Our adjusted analyses showed that children born via emergency caesarean and assisted vaginal delivery were 6% (CI 95% 1.03 - 1.10) and 12% (CI 95% 1.06 - 1.19) respectively more likely to have ADHD compared to children born via unassisted vaginal delivery. 6 However, no association was found between elective caesarean birth (HRa=0.96 CI 95% 0.91 - 1.01) and the risk of ADHD in children. Several sensitivities analyze were performed to assess the robustness of these findings, but none significantly altered our results. While a caesarean delivery and assisted vaginal birth are essential and lifesaving procedures, they can put children at risk. As showed in this study, emergency caesarean and assisted vaginal birth increase the risk of ADHD in children. These findings reinforce the need for further research to evaluate the impact of caesarean and assisted deliveries on the children especially in a Canadian context where studies are still limited.

Le Cambodge est l'un des neuf pays au monde à avoir atteint l'OMD 5 des Nations Unies, c'est-à-dire à avoir diminué de trois quarts le taux de mortalité maternelle au niveau national entre 1990 et 2015. Ce taux est ainsi passé de 1020 à 161 décès maternels pour 100 000 naissances au cours de ces 25 années. Ce succès est le résultat de politiques publiques volontaristes : une politique de planification familiale, la mise en place de systèmes de financements de la santé, la formation puis le déploiement de milliers de sages-femmes sur le territoire. Cette réussite s'explique également par une mutation sociologique de premier plan : l'accouchement, qui était historiquement un événement avant tout social et qui se déroulait dans l'intimité de la maison, est devenu un événement public pour la femme et sa famille. Alors qu'en 2000 moins de 10% des femmes accouchaient dans une structure médicalisée, elles étaient plus de 80% dans cette situation en 2014, traduisant ainsi la biomédicalisation massive et soudaine de l'accouchement dans tout le pays. Cette recherche sociodémographique remet en question la vision idéalisée des Nations Unies concernant la santé maternelle au Cambodge en rendant visibles et en observant les pratiques obstétricales « par le bas » à partir d'une enquête empirique sur plusieurs terrains à Phnom Penh et en Kandal (milieu rural). La méthodologie développée conjugue une observation participante, à des entretiens semi-directifs auprès de soignants et de non soignants (hommes et femmes), des questionnaires auprès de femmes enceintes puis accouchées (cohorte), ainsi qu'une collecte de données médicales dans quatre maternités de Phnom Penh. Les résultats montrent que certains hôpitaux et cliniques pratiquent des épisiotomies systématiques, ce qui est contraire aux recommandations internationales, et que le taux de césariennes dans la capitale a presque triplé en quinze ans, dépassant depuis le début des années 2000 le seuil de 10% recommandé par l'OMS. Enfin, une pratique répandue de périnéorraphies visant à resserrer fortement le vagin de femmes jeunes et en bonne santé après des accouchements par voie basse, sans indication médicale, est courante dans la capitale. Ces pratiques obstétricales, historiquement construites, vont alors fréquemment être détournées de leur usage médical pour répondre à une demande sociale. Le corps des femmes a été appréhendé dans cette recherche comme un corps social et politique, révélateur des rapports sociaux, sur lequel se jouent de nombreux enjeux de pouvoirs. La thèse a révélé que ces trois pratiques obstétricales faisaient système en se renforçant les unes les autres. A l'intersection entre corps, genre et biomédecine, la recherche a montré que ces différentes pratiques obstétricales pouvaient être conçues comme des instruments de domination. Le genre, tel qu'il est pensé dans la société, va contribuer à fabriquer un sexe féminin, mais aussi à construire un corps féminin de façon plus générale. Mais la thèse a dévoilé également que certaines de ces pratiques vont être saisies par les femmes, afin d'accroître leur attractivité sexuelle, leur permettant de renégocier les rapports de genre, et de maintenir l'harmonie et la stabilité du couple. / Cambodia is one of the nine countries worldwide to have reached the United Nations - MDG 5. A reflection of this achievement is a 75% drop in the national maternal mortality ratio from 1020 to 161 deaths for 100 000 live births between 1990 and 2015. This success is the result of voluntary public policies i.e. a family planning policy; the set-up of health care financing systems; and the training of thousands of midwives across the country. A deep sociological transformation can also help to explain this success. While childbirth in Cambodia used to be a private event, which took place at home, it has now become a public event for women and their families. In 2000, less than 10% of women were giving birth in a medicalized structure. By 2014, this number rose to over 80%, showing the sudden and massive biomedicalization of childbirth across the country. This socio-demographic research challenges the idealized vision of the United Nations regarding maternal health in Cambodia by showing and observing obstetrical practices on the ground, from an empirical study led in several setups in Phnom Penh and in Kandal province (rural sector). This mixed method research draws from participant observation, semi-structured interviews with healthcare professionals and patients (men and women), questionnaires with pregnant women (pre- and post- childbirth), as well as examination of medical records from four Phnom Penh maternity wards. The results show that episiotomies are systematically performed in some hospitals and clinics, in contradiction with international recommendations. Furthermore, the number of caesarean sections in Phnom Penh has almost tripled in fifteen years, and since the beginning of the 2000s it is above the 10% threshold recommended by the WHO. Finally, in the capital city, a common practice is observed: perineorraphy, which aims at tightening the vagina of young and healthy women shortly after a vaginal delivery without any medical indication. These three obstetrical practices have historical roots and are now frequently used outside of their medical purpose, as a response to a rising social demand. In this research, women' body has been considered as a social and political object that reveals social relationships, where many power negotiations occur. The thesis shows that these three obstetrical practices are interconnected and form a system. At the intersection between body, gender and biomedicine, these different obstetrical practices can be understood as tool of domination that seeks to shape the female body according to social expectations. In this way, the perception of gender in a society shapes the female body, and more precisely, the female sexual organs. Nevertheless, some of these practices are nowadays consciously chosen by women to increase their erotic capital, in an attempt to renegotiate gender relationships and preserve marital harmony.