Thesis (M.S.)--University of Michigan, 1991.

BACKGROUND: Sensory over-responsivity (SOR) is a type of Sensory Modulation Disorder (SMD), where the individual has an over-responsive behavioural reaction to non-harmful or non-threatening sensory stimulation, which is out of proportion to the stimulus. SOR can negatively impact a child’s engagement and performance in their daily life. SOR is frequently diagnosed by occupational therapists, and deep pressure is an important facet of the treatment of SOR by occupational therapists. Prior research (Alberts &amp; Ronca, 2012) indicates that the component of pressure in the vaginal birth process aids the infant’s neurophysiological adaption to extra-uterine life. This component is absent in elective caesarean section births. This study therefore set out to determine whether method of birth could be associated with SOR, as well as investigating demographic and other variables linked to SOR. It was hypothesised that there would be a higher prevalence of SOR in children aged 3-5 years born by elective caesarean section compared to those born by vaginal birth. The study objectives were: • To establish a profile (demographic and variables linked to SOR) of participants (mother-child dyads) by birth method group (CS or vaginal delivery) • To determine the prevalence of SOR by birth method • To establish if there is a statistically significant difference in SOR and birth method • To establish which variables (for example birth weight, jaundice, birth complications) are associated with SOR METHOD: A quantitative, descriptive, analytical study was conducted with a sample of 91 children between the ages of 3 years 0 months and 4 years 11 months. Children across various language, cultural and socio-economic groups were recruited and allocated to two groups based on their method of birth - vaginal delivery and elective caesarean section. Caregivers of each child completed the Short Sensory Profile 2 (SSP2) questionnaire as well as a demographic information questionnaire. The scores for SOR were calculated for each participant, and prevalence of SOR between the two birth method groups was compared. Demographic variables were tested for significance between the two groups. The variables showing a significant difference were further analysed to determine any association with SOR. RESULTS: There were 91 participants, 58 in the VB group and 33 in the CS group. Mothers in the VB group gave birth at a younger age (U = 499.0, p < .001), were of a lower income level (chi-square = 11.49, df = 2, p = .003) and more likely to be single (Fishers exact p (2-tailed) = .037). The children in the VB group were of a greater gestational age (U = 472.5, p = .001), had a shorter time period before the first breastfeed (U = 478.0, p = .006), and had fewer sleeping difficulties (Fishers exact p (2-tailed) = .003). The prevalence of SOR for the total sample was 22%. There was a significant association in SOR prevalence and birth method (Fishers exact p (2-tailed) = .034), with greater prevalence in the VB group (29%) as opposed to the elective CS group (9%). There were statistically significant associations between SOR and maternal age (U = 380.5, p = .004), marital status (Fishers exact p (2-tailed) = .003) and time after birth to the first breastfeed (U = 394.5, p = .049). CONCLUSION: There was a statistically significant difference in SOR between the two birth method groups, with higher prevalence in the VB group. This was thought to be linked to cultural and language challenges associated with the use of the SSP2, and the impact of low socio-economic circumstances on child development and the ability to regulate sensory input. Recommendations include developing and validating a culturally appropriate sensory profile questionnaire, available in the most common official languages to facilitate the accurate assessment of sensory modulation of all children living in South Africa. In addition, there is a need to test the birth method hypothesis in demographically balanced groups.

Abstract Introduction Chris Hani Baragwanath (CHB) hospital has 20 000 deliveries per annum, with 25% by caesarean section (CS). Therefore, vaginal birth after caesarean section (VBAC) is an important delivery option. We questioned the reasons for the low VBAC success following trial of labour (TOL). The primary objective was to determine the proportion of eligible patients attempting TOL and the VBAC success rate. Secondary objectives were to establish reasons for failed VBAC, predictive factors for VBAC, and maternal and neonatal morbidity and mortality. Methodology A retrospective descriptive study by record review, analysing demographic, obstetric and delivery outcome variables of women with one prior CS in a subsequent pregnancy. Results From the 340 patients eligible for VBAC, 287 (84.4%) attempted TOL and 53 (15.6%) had an elective repeat caesarean section (ERCS). VBAC success was 51.6% (148/287). Prelabour rupture of membranes and prolonged latent phase of labour resulted in 40% of failed VBAC. Successful VBAC was associated with a higher parity, lower birth weight and lower gestation (p<0.001). Positive predictors of successful VBAC were previous vaginal birth (p=0.004), previous VBAC (p=0.038), previous CS for malpresentation (p=0.012), birth weight <3500g (p=0.003), and gestation ≤ 39 weeks (p<0.001). Negative predictors were previous CS for cephalopelvic disproportion (p=0.003) and women with no prior vaginal deliveries (p<0.001). There was no maternal mortality. Complications however, included 2 uterine ruptures, 2 uterine dehiscences, 4 hysterectomies, and one intrapartum fetal death. Adverse maternal outcomes were increased with TOL compared to ERCS (p=0.038), and more so with failed compared to successful VBAC (p=0.002). Adverse neonatal outcomes were also increased with TOL compared to ERCS (p=0.048), however there was no difference in neonatal outcomes between failed and successful VBAC (p=0.420). Conclusion VBAC remains a viable option for patients with one prior CS in this setting, despite a lower VBAC success than developed countries. Failed VBAC due to prelabour rupture of membranes and prolonged latent phase of labour remains a problem.

Orientador: Vera Therezinha Medeiros Borges / Resumo: Identificação: Devido ao aumento do número de mulheres submetidas à cesárea nos últimos anos, tornou-se fundamental a avaliação da assistência prestada à parturiente com cesárea anterior, considerando os riscos obstétricos e buscando reduzir a incidência de novas cesáreas nessa população. Objetivos: Identificar os fatores preditivos associados com o sucesso de parto vaginal em parturientes com cesárea anterior. Métodos: Trata-se de um estudo tipo caso controle, retrospectivo e analítico, baseado em revisão de prontuários médico eletrônico. Foram incluídas todas as parturientes com antecedente de uma cesárea anterior, que receberam assistência ao parto na maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP no período de janeiro de 2013 a dezembro de 2015, com gestação única, idade gestacional acima de 37 semanas, feto vivo e apresentação cefálica. As variáveis estudadas foram: idade materna, cor declarada, estado civil, escolaridade, profissão, idade gestacional, tabagismo, presença de doenças clínicas maternas, intercorrências clínicas durante a gestação atual, dilatação e índice de Bishop na admissão, indicação da cesárea prévia, número de partos vaginais anteriores a cesárea prévia, indução do parto, peso e sexo do recém-nascido. Para a análise estatística, utilizou-se o teste qui-quadrado e/ou Exato de Fisher, considerando o nível de significância de 5%. Resultados: Foram incluídas no estudo 653 parturientes, sendo que 324 evoluíram para parto... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Identification: Due to the increase in the number of women undergoing caesarean section in recent years, it has become essential to evaluate the care provided to women who have undergone a previous cesarean section, considering obstetric risks and aiming at reducing the incidence of new caesareans in this population. Objectives: To identify the predictive factors associated with successful vaginal delivery in parturients with previous cesarean section. Method: This is a case control study, based on the review of electronic medical charts. All parturients with a history of a previous cesarean section and who received delivery assistance in the maternity of the Clinical Hospital in Botucatu Medical School - UNESP from January 2013 to December 2015 were included in the study. These patients also featured single gestation, gestational age above 37 weeks, live fetus with cephalic presentation. The variables studied were: maternal age, declared color, marital status, education, occupation, gestational age, smoking, presence of clinical maternal diseases, clinical intercurrences during the current pregnancy, dilation and Bishop index at admission, previous cesarean indication, number of previous vaginal deliveries before previous cesarean section, labor induction, weight and gender of the newborn. For statistical analysis, chi-square test and/or Fisher's exact test, considering significance level of 5% were used. Results: A total of 653 parturients were included in the study, of whi... (Complete abstract click electronic access below) / Mestre

Background: Few studies have determined the contribution of maternity care provider and hospital factors to the variation in Trial of Labour (TOL) and successful TOL rates. Objective: To determine sources of variation in TOL and successful TOL rates at the provider and/or hospital level. Methods: Retrospective cohort study of 12,170 women with previous caesarean who gave birth in Ontario in 2007. Hierarchical linear model was used to determine variation in rates by provider and hospital characteristics, adjusting for maternal characteristics, and for clustering of data. Results: TOL rate was 23%; successful TOL rate 75%. Women attending family doctors and female doctors for prenatal care were more likely to have TOL. There were no provider factors associated with successful TOL. Women giving birth at teaching hospitals were more likely to have TOL and successful TOL. Conclusions: Policies aimed at prenatal care providers and hospitals could impact the low TOL rate.

Background: Few studies have determined the contribution of maternity care provider and hospital factors to the variation in Trial of Labour (TOL) and successful TOL rates. Objective: To determine sources of variation in TOL and successful TOL rates at the provider and/or hospital level. Methods: Retrospective cohort study of 12,170 women with previous caesarean who gave birth in Ontario in 2007. Hierarchical linear model was used to determine variation in rates by provider and hospital characteristics, adjusting for maternal characteristics, and for clustering of data. Results: TOL rate was 23%; successful TOL rate 75%. Women attending family doctors and female doctors for prenatal care were more likely to have TOL. There were no provider factors associated with successful TOL. Women giving birth at teaching hospitals were more likely to have TOL and successful TOL. Conclusions: Policies aimed at prenatal care providers and hospitals could impact the low TOL rate.

No description available.

BACKGROUND: Among childbirth injuries the most common described symptoms are urine and faecal incontinence, pain during intercourse and perineal pain after rupture and suture. For those women who seek care for lasting nuisance are the routines for follow-up, diagnoses and treatment of childbirth injuries experience insufficient. AIM: The aim of this study was to illuminate women’s experience after of a childbirth injury and encounter the healthcare.  METHOD: A litterateur review based on six articles with qualitative data.  RESULT: Two categories with five subcategories are presented; To live with a childbirth injury- physical and emotional limitations of everyday life, normalization of injuries after childbirth and Encounter the healthcare- insufficient information and follow-up, encounter from the healthcare.  CONCLUSIONS: Women normalize their difficulties today after childbirth causing them not to seek help. The stigma surrounding the nuisance is also a contributing factor for women to contact the health care. Furthermore they experience to get dismissed by the healthcare professionals and not been taken seriously. Caregivers should inform the women about the concerning nuisance that can occur and give information where to seek help. / BAKGRUND: Bland förlossningsskador är de vanligaste beskrivna symtomen urin- och fekalinkontinens, smärta under samlag och mellangårdssmärta efter bristningar och suturer. För dom kvinnor som söker vård för långvariga besvär är rutinerna  för uppföljning, utredning och behandling av förlossningsskador bristfällig. SYFTE: Syftet med studien var att belysa kvinnors upplevelser av en förlossningsskada och mötet med vården.  METOD: En allmän litteraturöversikt baserat på sex artiklar med kvalitativa data.  RESULTAT: Två kategorier och fem underkategorier presenteras; Att leva med förlossningsskador- fysiska och emotionella begränsningar i vardagen, normalisering av förlossningsskador och Möte med vården- bristande information och uppföljning, bemötandet från vården.  SLUTSATSER: Kvinnor normaliserar idag sina besvär efter en förlossning vilket medför att de inte söker hjälp. Stigmat kring besvären är också en bidragande faktor till att kvinnor undviker att kontakta vården. De upplever också sig som avfärdade av vårdpersonal och en känsla om att inte bli tagna på allvar. Vårdpersonal bör informera kvinnorna om de berörda besvären som kan uppkomma och ge information var de kan söka hjälp.

Este trabalho tem como objetivo compreender os símbolos atribuídos às tecnologias utilizadas na atenção obstétrica, como também conhecer as práticas femininas na busca por cuidados médicos na assistência ao parto. Para tanto, analisamos os relatos de 16 gestantes atendidas pelo setor privado e os de 13 gestantes assistidas pelo setor público. O estudo combinou duas técnicas qualitativas: a observação etnográfica e entrevistas semi-estruturadas. A pesquisa encontrou, entre outros, os seguintes resultados: 1-a maioria das mulheres observadas expressou a preferência pelo parto normal. 2- o nascimento, independente do tipo de parto desejado, está associado a categorias de medo, tensão e risco. 3- o discurso médico, segundo as gestantes atendidas pela rede privada, reforça a ansiedade e medo feminino e de sua família na medida em que associa o parto normal à dor e ao risco de morte. A cesariana, por outro lado, é descrita como um parto seguro. 4- na maternidade pública, as mulheres e seus acompanhantes vivenciaram o parto normal de maneira sofrida e passiva. 5- práticas profissionais compatíveis com a humanização do parto e as orientadas pelo modelo médico hegemônico, isto é, centrado na tecnologia na atenção ao nascimento, coexistem na rede pública. Contudo, a abordagem normativa ainda está presente em ambas as práticas. 6- a participação das parturientes nas decisões sobre o parto é escassa na rede pública. Em suma, concluímos que mulheres e médicos compartilham a visão de parto normal enquanto categoria de risco e a cesariana como prática segura. / This work aims to understand the symbols associated to technologies adopted in obstetric practice, and also women practices in searching for medical cares during childbirth. This study was carried out from June 2011 to October 2011 in 16 pregnant women attending the private hospitals and 13 pregnants attending public sector. I combined two qualitative techniques: Ethnographic observation and Semi-structured interview. I identified some ethnographic findings, such as: 1- most of women request for vaginal birth. 2. birth experience, regardless of delivery type desire, is associated with three categories: fear, tension and risk of death. 3-medical discourse, according to pregnant women attending private hospitals, reinforces womens and their families fear of pain and the risks of vaginal births. Cesarean birth, on the other hand, is described as a safe childbirth. 4- at the public maternity, I observed that women and their partners have experienced a painful and passive vaginal birth. 5- professional practices of humanized birth and medical intervention based on technologies in birth assistance, co-exist in public hospitals. However, normative approach is still on both practices. 6- the womens participation on childbirth decision is rare at the public health institution examined. In sum, our data suggest that both women and obstetricians share perception of the risks inherit in natural process of birth. Cesarean section, on the other hand, is being considered a fitting and safe form of childbirth.

Este trabalho tem como objetivo compreender os símbolos atribuídos às tecnologias utilizadas na atenção obstétrica, como também conhecer as práticas femininas na busca por cuidados médicos na assistência ao parto. Para tanto, analisamos os relatos de 16 gestantes atendidas pelo setor privado e os de 13 gestantes assistidas pelo setor público. O estudo combinou duas técnicas qualitativas: a observação etnográfica e entrevistas semi-estruturadas. A pesquisa encontrou, entre outros, os seguintes resultados: 1-a maioria das mulheres observadas expressou a preferência pelo parto normal. 2- o nascimento, independente do tipo de parto desejado, está associado a categorias de medo, tensão e risco. 3- o discurso médico, segundo as gestantes atendidas pela rede privada, reforça a ansiedade e medo feminino e de sua família na medida em que associa o parto normal à dor e ao risco de morte. A cesariana, por outro lado, é descrita como um parto seguro. 4- na maternidade pública, as mulheres e seus acompanhantes vivenciaram o parto normal de maneira sofrida e passiva. 5- práticas profissionais compatíveis com a humanização do parto e as orientadas pelo modelo médico hegemônico, isto é, centrado na tecnologia na atenção ao nascimento, coexistem na rede pública. Contudo, a abordagem normativa ainda está presente em ambas as práticas. 6- a participação das parturientes nas decisões sobre o parto é escassa na rede pública. Em suma, concluímos que mulheres e médicos compartilham a visão de parto normal enquanto categoria de risco e a cesariana como prática segura. / This work aims to understand the symbols associated to technologies adopted in obstetric practice, and also women practices in searching for medical cares during childbirth. This study was carried out from June 2011 to October 2011 in 16 pregnant women attending the private hospitals and 13 pregnants attending public sector. I combined two qualitative techniques: Ethnographic observation and Semi-structured interview. I identified some ethnographic findings, such as: 1- most of women request for vaginal birth. 2. birth experience, regardless of delivery type desire, is associated with three categories: fear, tension and risk of death. 3-medical discourse, according to pregnant women attending private hospitals, reinforces womens and their families fear of pain and the risks of vaginal births. Cesarean birth, on the other hand, is described as a safe childbirth. 4- at the public maternity, I observed that women and their partners have experienced a painful and passive vaginal birth. 5- professional practices of humanized birth and medical intervention based on technologies in birth assistance, co-exist in public hospitals. However, normative approach is still on both practices. 6- the womens participation on childbirth decision is rare at the public health institution examined. In sum, our data suggest that both women and obstetricians share perception of the risks inherit in natural process of birth. Cesarean section, on the other hand, is being considered a fitting and safe form of childbirth.