This study responds to the globally increasing rate of caesarean section, and specifically to the very high rate of elective caesarean section among Taiwanese mothers as evidence suggests that such elective caesareans pose potential health risks for mothers and babies. The purpose of this study was to develop and evaluate a multi-component instrument based on the theory of planned behavior (TPB) to better understand Taiwanese pregnant women's decisions regarding their childbirth delivery options (spontaneous vaginal delivery or elective caesarean section). The study was a four-phased mixed method design. First, the TPB guided item development and instrument drafting. Second, pretesting and instrument refinement used cognitive interviewing with a small sample of Taiwanese pregnant women. Third, the instrument was administered to 310 such women to examine psychometric properties of the component scales. Fourth, the phase 3 instrument was re-administered to 30 women to estimate item stability. Confirmatory factor analyses (CFA) were used to assess construct validity of the multi-item, multi-component measurement model with LISREL 9.1. Based on the TPB, the 52-item self-administered Childbirth Delivery Options Questionnaire (CDOQ) was developed to measure three components: intention regarding delivery options, attitudes toward delivery options, and perceptions of significant others' (partner, mother, and mother-in-law) feelings about delivery options. Respondents from phase two thought that the items on the CDOQ were easy to read and comprehend; they reported favorably on the wording and formatting. Preliminary item analysis revealed that the items referring to dangerousness of delivery options did not function as intended and were dropped because they did not differentiate between the two delivery options, leaving 36 items. Test-retest reliability indicated that responses to each item were positively correlated and those referring to spontaneous vaginal delivery were more stable than those referring to elective caesarean section. Corrected item-to-total correlations and expected change in Cronbach's alpha if item deleted revealed that four items might form a measure of general social norms associated with the Taiwanese culture. The Cronbach's alphas for the components of the CDOQ ranged from .55 to .89. The measurement model incorporating the design features of the CDOQ fitted the data well using the CFA. Because serious problems with multicollinearity and suppression were revealed, Beckstead's (2012) criterion-irrelevant-variance-omitted (CIVO) regression method was used to untangle the suppressor effects when predicting intention from the other components of the CDOQ. The results indicated that attitude and partner's feelings were significant and explained the bulk of the variance in intentions. The TPB-based instrument developed here will be of considerable use to maternal-child health researchers. The findings of this study suggest that decisions regarding delivery options may be modified by interventions geared toward pregnant women's attitudes within family- and cultural-centered prenatal programs.

Bakgrund: Antalet kejsarsnitt ökar såväl globalt som i Sverige. Kejsarsnitt är ett kirurgiskt ingrepp som innebär risker för såväl kvinna som barn. Trots risker önskar förstföderskor att genomgå ingreppet istället för en vaginal förlossning. Barnmorskors professionella stöd är av stor vikt för förstföderskors upplevelse inför, under samt efter sin förlossning. Studien utfördes för att förstå orsakerna till att förstföderskor önskar elektivt kejsarsnitt. Syfte: Var att fördjupa förståelsen kring förstföderskors önskan om elektivt kejsarsnitt. Metod: Kvalitativ innehållsanalys med en induktiv ansats. Datainsamlingen resulterade i 14 bloggar från sökmotorn Google.se som analyserades. Resultat: Analysen resulterade i tre teman: Sökandet efter trygghet inför sin förlossning, Tankar på en vaginal förlossning väcker varierande känslor och Val av förlossningsmetod - en rättighet samt sju subteman. Mest framträdande var känsla av brist på kontroll och otrygghet inför en vaginal förlossning. Möjligheten att få välja förlossningsmetod ansågs vara en mänsklig rättighet. Konklusion: Förstföderskor som önskar elektivt kejsarsnitt sökte trygghet inför sin förlossning. Elektivt kejsarsnitt ingav trygghet då det uppfattades som en mer kontrollerad och säker förlossningsmetod både för kvinnan och barnet. Föreställningen av att genomgå en vaginal förlossning skapade rädsla och obehag. / Background: The number of caesarean sections increases both globally and in Sweden. Although caesarean section is a surgical procedure that involves risks for both women and child, first-time mothers wish to undergo the procedure instead of a vaginal delivery. The midwife's professional support is important for first-time mothers before, during and after childbirth. This study was conducted to understand the reasons why first-time mothers want elective caesarean section. Aim: To deepen the understanding of first-time mothers wish for elective caesarean section. Method: A qualitative content analysis with an inductive approach was used. Google.se was used for data collection, the collection resulted in 14 blogs. Result: The analysis resulted in three themes: The wish for security during childbirth, Thoughts on a vaginal delivery raises a variety of emotions and Choice of birthing method - a right and seven sub-themes. Most prominent was the feeling of lack of control and insecurity for a vaginal delivery. Choice of birthing method was considered a human right. Conclusion: First-time mothers strive for security during childbirth. Elective caesarean section was described as a safe and controlled birthing method. Thoughts on a vaginal delivery raises fear and discomfort for first-time mothers.

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.

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.