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Perspective of risk in childbirth, women’s expressed wishes for mode of delivery and how they actually give birth
Nordic Council of Ministers, Nordic School of Public Health NHV.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: The main aim of this thesis was to study a perspective of women`s expressed wishes for mode of delivery and how they actually give birth. Additional aims were to examine the notion of risk applied to childbirth, to examine what characterizes women who want to give birth as naturally as possible without painkillers or intervention and the characteristics of women who would, if possible, choose to have a cesarean section.

Material and methods: The notion of risk was examined in an essay. Self-rating instruments were completed by 55,858 MoBa participants during week 30 of their pregnancy and available from The Norwegian Mother and Child Cohort Study (MoBa) by April, 2007. Individually reported information on socioeconomic factors, lifestyle factors, feelings related to childbirth, factors concerning psychosocial health, physical, psychological and sexual harassment and information on satisfaction with antenatal care health services were collected from a MoBa questionnaire. Data on the mother’s age, parity, physical health before and during the pregnancy, previous cesarean sections and actual mode of delivery were collected through a linkage to the The Medical Birth Registry of Norway.

Findings: General perspectives on risk differ depending on both the person and the profession. More and more childbearing women are in danger of being considered deficient and in the danger zone. Figures on risk are not objective values, and the association between risk and security is socially and culturally determined. Personal symbols can be basic assumptions about the life one leads, and the childbearing woman has preferences of her own. Interest in natural childbirth was expressed by 72 percent and a wish for caesarean section was expressed by ten percent of the women. Positive experience from previous childbirths, first birth or third or later birth, no dread of giving birth, and reporting positive intra-psychic phenomena are significantly associated with the wish for natural birth. Negative experiences from previous childbirths and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section.Overall, 47 percent of the women who wanted ”as natural a birth as possible” had their preference fulfilled. The figures differed largely for primiparas and multiparas; the risk of acute caesarean sections was high among primiparas and the effects of the predictors of natural birth were stronger for primiparas than for multiparas.

Conclusions:The factors that influence the chance of having a natural birth are different for primiparas and multiparas. The high rate of non-natural births among first time mothers who actually want to have a vaginal birth without interventions should call attention to the increasing incidence of cesarean section in Norway. The chance of actually having a natural birth for women with a preference for a natural birth is much larger for multiparas. Negative experiences from previous childbirths and cesarean section are, however, important factors associated with non-natural birth and should be taken into consideration in public health

Abstract [no]

Mål: Det overordna målet for denne avhandlingen var å studere perspektiv omkring hvordan kvinner uttrykker at de ønsker å føde og hvordan de faktisk føder. I tillegg var målet å undersøke risikobegrepet anvendt innen fødselsomsorg, undersøke hva som karakteriserer kvinner som ønsker å føde så naturlig som mulig uten smertestillende eller intervensjon og undersøke hva som karakteriserer kvinner som ville valgt å ta keisersnitt dersom det var mulig.

Materiell og metode: Avhandlingen inkludere fire artikler. Risikobegrepet drøftes i første artikkel som er et essay. De 3 andre inkluderer data fra Den norske mor og barn-undersøkelsen. Data fra 55,858 MoBa informanter var ferdigregistrert april 2007 og omfatter individuell informasjon om sosioøkonomiske faktorer, livsstilsfaktorer, følelser/opplevelser relatert til fødsel, faktorer som omhandler psykososial helse, fysiske, psykiske og seksuelle overgrep og informasjon om tilfredshet med offentlig svangerskapsomsorg. Tidligere keisersnitt og hvordan kvinnene faktisk fødte i dette svangerskapet ble hentet fra en link til Medisinsk Fødselsregister.

Funn: Generelt perspektiv på risiko er forskjellig, avhengig av både person og profesjon. Stadig flere gravid/fødekvinner står i fare for å bli betraktet som utsatte/mangelfulle og i faresonen. Kalkulasjoner av risiko er ikke objektive verdier og assosiasjonen mellom risiko og sikkerhet er sosialt og kulturelt bestemt. Subjektive symbol kan være grunnleggende antagelser/forståelser i forhold til det livet en lever og blivende mødre har sine egne preferanser. Syttito prosent av kvinnene uttrykte ønske om å føde så naturlig som mulig og ti prosent av kvinnene ønsket å ta keisersnitt. Positive erfaringer fra tidligere fødsler, det å være førstegangsfødende eller ha født mer en ett barn tidligere, ikke være redd for å føde, samt å rapportere positivt i forhold til intrapsykiske fenomen, er signifikant assosiert med ønske om å føde så naturlig som mulig. Negative erfaringer fra tidligere fødsler og redsel for å føde er de to faktorene som er sterkest assosiert med ønske om keisersnitt. Samlet sett fikk 47 prosent av de kvinnene som ønsket så naturlig fødsel som mulig, oppfylt ønskene sine. Resultatet var svært ulikt mellom førstegangsfødende og fleregangsfødende; risikoen for akutt keisersnitt var høg blant førstegangsfødende og effekten av prediktorene for naturlig fødsel var sterkere i forhold til førstegangsfødende enn for fleregangsfødende.

Konklusjon: Faktorene som influerer sjansen til å føde så naturlig som mulig er ulike for førstegangsfødende og for fleregangsfødende. Den høge tallet på fødsler med intervensjon hos førstegangsfødende som egentlig ønsker å føde vaginalt uten intervensjon burde fått større oppmerksomhet. Dette bør også sees i sammenheng med en stadig økende innsidens for keisersnitt i Norge. Muligheten for å få en så naturlig fødsel som mulig er mye større for fleregangsfødende. Negative erfaringer fra tidligere fødsler og tidligere keisersnitt er, likevel, viktige faktorer assosiert med ikke-naturlig fødsel og bør reflekteres over/tas i betraktning i et folkehelseperspektiv.

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2009. , 56 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2009:7
Keyword [en]
natural birth, cesarean sec tion, self-determination, birth experiences, birth trends, age, parity, educational level
Keyword [no]
naturlig fødsel, keisersnitt, selvbestemmelse, fødselserfaring, fødselstrender alder, paritet, utdanningsnivå
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3686ISBN: 978-91-85721-67-2 (print)OAI: oai:DiVA.org:norden-3686DiVA: diva2:785613
Public defence
2009-10-21, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2015-02-05 Created: 2015-02-03 Last updated: 2015-02-05Bibliographically approved
List of papers
1. What characterizes women who want to give birth as naturally as possible without painkillers or intervention?
Open this publication in new window or tab >>What characterizes women who want to give birth as naturally as possible without painkillers or intervention?
2010 (English)In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 1, no 1, 21-6 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe the characteristics of pregnant women who wish to have as natural a birth as possible without analgesics and without intervention.

STUDY DESIGN: National cohort study.

SETTING: Norwegian Institute of Public Health.

POPULATION: 55,859 pregnant women booked for antenatal care in Norway 1999-2007.

METHODS: Data on women's interest in natural birth and a set of possible predictors were retrieved from a questionnaire completed at the 30th week of pregnancy and linked to the Medical Birth Registry of Norway.

MAIN OUTCOME MEASURE: Natural birth and the characteristics of pregnant women with such preferences.

RESULTS: Interest in natural childbirth was consistently expressed by 72%. Positive experience from previous pregnancies, first birth or third or later birth, no fear of giving birth, and reporting positive intra-psychic phenomena are significantly associated with the wish for natural birth.

CONCLUSIONS: Positive experiences from previous childbirths and no fear of giving birth are the strongest factors associated with a wish for as natural birth as possible and should be taken into consideration in public health.

Keyword
Natural birth; Maternal request; Pregnancy trends; Antenatal care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3682 (URN)10.1016/j.srhc.2009.09.001 (DOI)21122592 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-02-05Bibliographically approved
2. What characterizes women in Norway who wish to have a caesarean section?
Open this publication in new window or tab >>What characterizes women in Norway who wish to have a caesarean section?
2009 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 4, 364-71 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim of this study was to describe the characteristics of pregnant women who wish to have a caesarean section.

METHODS: Data were collected as part of the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Pregnant women booked for antenatal care in Norway between 1999 and 2006 were invited to participate in the study. Data on women's interest in mode of delivery and a set of associated variables were gathered from a questionnaire completed by 55,859 women at 30 weeks of pregnancy.

RESULTS: A wish for caesarean section was expressed by 10% of the women, and 33% thought that the woman herself should be allowed to decide whether to have a caesarean section or not. A negative experience from a previous labour, a second birth, an age>35, a low level of education, being single, being unemployed, having an assisted conception, expecting more than one foetus, experiencing urinary and bowel incontinence before current pregnancy, experiencing pelvic pain, having a fear of childbirth and reporting negative intra-psychic phenomena were significantly associated with a wish for caesarean section.

CONCLUSIONS: At 30 weeks of pregnancy, one out of 10 women in a sample of Norwegian women would choose a caesarean section. Negative experiences from previous pregnancies and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section and should be taken into consideration.

Keyword
Attitudes, caesarean section, ethics, maternal request, pregnancy trends
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3684 (URN)10.1177/1403494809105027 (DOI)19372232 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved
3. How does preference for natural childbirth relate to the actual mode of delivery?: a population-based cohort study from Norway.
Open this publication in new window or tab >>How does preference for natural childbirth relate to the actual mode of delivery?: a population-based cohort study from Norway.
2010 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 1, 21-7 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In Norway, intervention in childbirth has increased from 3 percent in 1967 to 37 percent in 2006. The objectives of this study were, first, to estimate to which extent women who expressed a preference for natural birth actually were delivered vaginally without interventions, and second, to estimate the influence that emotions and maternal background factors have on the mode of delivery.

METHODS: We used data from 39,475 pregnancies of participants in the Norwegian Mother and Child Cohort Study in which the pregnant woman had expressed a preference for natural birth, and linked these data with the pregnancy outcome as registered in the population-based Medical Birth Registry of Norway during 2000 to 2006. The influence of maternal factors on the mode of delivery was estimated with log-binomial regression models, stratified by parity.

RESULTS: Among primiparas, 29.3 percent delivered vaginally without interventions (natural birth), 56.1 percent gave birth vaginally with interventions, and 14.5 percent had a cesarean section. The strongest predictor for actually having a natural birth was age below 25 years, having more than 12 years' education, carrying a single fetus, and having a low score for anxiety and depression. Among multiparas, 61.1 percent gave birth vaginally without interventions, 30.6 percent vaginally with interventions, and only 8.3 percent had a cesarean section. The effects of maternal age, education, and anxiety or depression on the outcome were smaller for multiparas than for primiparas.

CONCLUSIONS: The chance of actually having a natural birth for women with a preference for a natural birth is much greater for multiparas than for primiparas. The factors that influence the chance of having a natural birth are different for primiparas and multiparas.

Keyword
age; birth trends; educational level; natural birth; parity; self-determination
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3683 (URN)10.1111/j.1523-536X.2009.00374.x (DOI)20402718 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved
4. Risk and security in childbirth.
Open this publication in new window or tab >>Risk and security in childbirth.
2006 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 27, no 4, 185-91 p.Article in journal (Refereed) Published
Abstract [en]

Risk and security are often defined as being complementary. Security is based on risk calculations, which undergo constant change. An increasing number of abnormalities can be uncovered in the human body, and more and more people are defined as being at risk for various diseases or at risk as child bearers. The aim of this paper is to examine the notion of risk, and to understand it in different ways as it is applied to childbirth. General and professional perspectives on risk are different; views vary as to what constitutes acceptable risk, and the association between normalcy and complications is socially and culturally determined. Figures for risk and reliability are not objective values. The safe and the risky are anchored in certain symbol systems. Alternative and dialogic notions have been introduced in conversations and thinking about risk, and medicalism and paternalism have been questioned. This questioning has thus far had little influence on clinical practice. The two opposite perspectives of risk and security in the area of pregnancy and birth should be taken into consideration. The childbearing woman has preferences of her own. Dialog with the health professional and information about professional facts and professional uncertainty should be offered.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3681 (URN)17225619 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved

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