Differences in ethnic beliefs about the perceived need for local anesthesia for tooth drilling and childbirth labor were surveyed among Anglo-Americans, Mandarin Chinese, and Scandinavians (89 dentists and 251 patients) matched for age, gender, and occupation. Subjects matched survey questionnaire items selected from previously reported interview results to estimate (a) their beliefs about the possible use of anesthetic for tooth drilling and labor pain compared with other possible remedies and (b) the choice of pain descriptors associated with the use of nonuse of anesthetic, including descriptions of injection pain. Multidimensional scaling, Gamma, and Chi-square statistics as well as odds ratios and Spearman's correlations were employed in the analysis. Seventy-seven percent of American informants reported the use of anesthetics as possible remedies for drilling and 51% reported the use of anesthetics for labor pain compared with 34% that reported the use of anesthetics among Chinese for drilling and 5% for labor pain and 70% among Scandinavians for drilling and 35% for labor pain. Most Americans and Swedes described tooth-drilling sensations as sharp, most Chinese used descriptors such as sharp and "sourish" (suan), and most Danes used words like shooting (jagende). By rank, Americans described labor pain as cramping, sharp, and excruciating, Chinese used words like sharp, intermittent, and horrible, Danes used words like shooting, tiring, and sharp, and Swedes used words like tiring, "good," yet horrible. Preferred pain descriptors for drilling, birth, and injection pains varied significantly by ethnicity. Results corroborated conclusions of a qualitative study about pain beliefs in relation to perceived needs for anesthetic in tooth drilling. Samples used to obtain the results were estimated to approach qualitative representativity for these urban ethnic groups.
We examined constructions of labor and birth for 461 Canadian women who attended the University of British Columbia (Canada) and participated in an online survey about pregnancy and birth, using a combination of Likert items and open-ended questions. We performed a content analysis of women's open-ended responses about their feelings toward birth and analyzed comments of women with high and low fear of childbirth separately. Students with high fear of birth described childbirth as a frightening and painful ordeal and viewed obstetric interventions as a means to make labor and birth more manageable. Students with low fear constructed birth as a natural event and regarded interventions more critically. Students in both groups supported women's autonomous maternity care decisions. Our findings contribute to care providers' and educators' knowledge about preferences and fears expressed by the next generation of maternity care consumers and potential strategies to reduce their fear of childbirth.
OBJECTIVE: The purpose of this study was to investigate first-time mothers undergoing cesarean section in the absence of medical indication, their reason for the request, self-estimated health, experience of delivery, and duration of breastfeeding. We also aimed to study if signs of depression postpartum are more common in this group. METHOD: In a prospective cohort study 357 healthy primiparas from two different groups, "cesarean section on maternal request" (n=91) and "controls planning a vaginal delivery" (n=266) completed three self-assessment questionnaires in late pregnancy, two days after delivery and 3 months after birth. Symptom scores from the Edinburgh postnatal depression scale at three months after birth were also investigated. RESULTS: Women requesting cesarean section experienced their health ass less good (p
To describe cultural beliefs of Orthodox Jewish families regarding childbirth in order to help family physicians enhance the quality and sensitivity of their care.
These findings were based on a review of the literature searched in MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Science Abstracts (1984 to present). Interviews with several members of the Orthodox Jewish community in Edmonton, Alta, and Vancouver, BC, were conducted to determine the accuracy of the information presented and the relevance of the paper to the current state of health care delivery from the recipients' point of view.
Customs and practices surrounding childbirth in the Orthodox Jewish tradition differ in several practical respects from expectations and practices within the Canadian health care system. The information presented was deemed relevant and accurate by those interviewed, and the subject matter was considered to be important for improving communication between patients and physicians. Improved communication and recognition of these differences can improve the quality of health care provided to these patients.
Misunderstandings rooted in different cultural views of childbirth and the events surrounding it can adversely affect health care provided to women in the Orthodox Jewish community in Canada. A basic understanding of the cultural foundations of potential misunderstandings will help Canadian physicians provide effective health care to Orthodox Jewish women.
BACKGROUND: The childbirth experience is multidimensional, and therefore difficult to describe and explain. Studies of it have produced inconsistent findings, and the phenomenon is often confused with satisfaction with the care provided. This study aimed to clarify different aspects of the birth experience, and to identify factors that could explain the variation in women's overall assessment of it. METHODS: All Swedish-speaking women in a large city who gave birth during a two-week period in 1994 were given a questionnaire one day after the birth, and 295 (91%) of the questionnaires were returned. Information about the labor process and medical interventions was collected from hospital records. RESULTS: Women usually experienced severe pain and various degrees of anxiety, and most were seized with panic for a short time or some part of their labor. Despite these negative feelings, most women felt greatly involved in the birth process, were satisfied with their own achievement, and thought they had coped better than expected. The overall experience was assessed as positive by 77 percent of women and negative by 10 percent. No statistical difference was observed between primiparas and multiparas in total birth experience, and few differences in the specific aspects of the birth. Of the 38 variables tested in regression analysis, the six that contributed to explaining women's overall birth experience were support from the midwife (sensitivity to needs), duration of labor, pain, expectations of the birth, involvement and participation in the birth process, and surgical procedures (emergency cesarean section, vacuum extraction, forceps, episiotomy). CONCLUSIONS: The study showed that negative and positive feelings can coexist, thus confirming the multidimensional character of the birth experience. Women's assessment of their childbirth is influenced by both physical and psychosocial factors, highlighting the importance of a comprehensive approach to care in labor.
OBJECTIVE: to study the outcome of labour and women's perceptions of being referred after onset of labour. DESIGN: a comparative study carried out between October 1998 and April 1999. SETTING: prospective parents in Stockholm, Sweden are offered a choice of which of the five hospitals in which they want to give birth. In reality, there is a lack of maternity beds in Stockholm to implement this policy and therefore nearly 10% of labouring women are being referred during labour. PARTICIPANTS: the study population was selected from one of the five hospitals. Included in the study were 266 labouring women, with a 37-42 weeks uncomplicated pregnancy, fetus presenting by the vertex and spontaneous onset of labour. During pregnancy, all the women had chosen the same labour ward where they planned to deliver. However, at the onset of labour half of the women, case group I (n = 133) were referred to another maternity unit due to lack of space in the labour ward. For every referred woman a control woman matched for age, parity and date of delivery was selected, with the same inclusion criteria, except being referred, control group II (n = 133). METHODS: a questionnaire with closed and open questions was posted to the women after birth and used to collect quantitative and qualitative data on the outcome of labour and the women's perceptions of referral during labour. FINDINGS: routines such as epidural analgesia (EDA) (p
OBJECTIVE: To compare women's reports of aspects of their care during pregnancy, labour and delivery following stillbirth and live birth. DESIGN: Data were collected by postal questionnaire in 1994. SETTING: A Swedish nation-wide population-based study of cohorts defined in 1991. PARTICIPANTS: Three hundred and fourteen women with stillbirth (subjects) and 322 women with live birth (controls). MEASUREMENTS AND FINDINGS: Labour and delivery were assessed as physically 'insufferably hard' by 52 (17%) of the subjects and 33 (10%) of the controls. The corresponding figures for emotional strains were 144 (47%) and 21 (7%). Obstetric analgesia was more frequently used during labour for stillbirth. One hundred and thirty-eight (44%) subjects, as compared to 44 (2%) of the controls, left hospital within 24 hours of birth. Almost all the women with stillbirth 296 (95%) stated that it was important to have an explanation of the baby's death. Adverse events related to bromocriptine given to inhibit postpartum lactation, were reported by 60 (22%) of the subjects. KEY CONCLUSIONS: It is possible to ease the distress of labour and delivery for stillbirth. Discussion of the aetiology of the baby's death with the mother should be a priority. The optimal length of stay in hospital after stillbirth remains to be defined. Non-pharmacological inhibition of lactation may be presented as an alternative to bromocriptine, breast binding is a concrete 'reality confrontation' for the woman and may aid her in her grieving process. Further studies concerning breast binding vs pharmacological inhibition of lactation and long-term psychological outcome are warranted.
The content of childbirth-related fear as described by 308 women and 194 men was analyzed and compared in relation to intensity of fear. The content of fear was similarly described by women and men and concerned the following main categories: the labor and delivery process, the health and life of the baby, the health and life of the woman, own capabilities and reactions, the partner's capabilities and reactions, and the professionals' competence and behavior. Among women, the labor and delivery process was the most frequently reported among the 6 categories of fears, whereas the health and life of the baby was the most frequent among the men. Fears related to own capabilities and reactions were described significantly more often by women with intense fear than by women with mild to moderate fear. The greatest difference between men with intense versus mild to moderate fear was a more frequent expression of concern for the health and life of the woman. Both women and men had fears related to not being treated with respect and not receiving sufficient medical care. This finding suggests that part of the problem with childbirth-related fear is located within the health care system itself.
To explore the main determinants of the reproductive behavior of nursing mothers, all inhabitants of the central part of the European region of the Russian Federation, their use of modern contraceptive methods and their attitude to future family planning.
Open cohort multicenter study of 1200 nursing mothers aged 16-42 years interviewed at 3-5 days' postpartum, with subsequent longitudinal monitoring ofthe majority in the local family planning centers during the 2 years after labor.
The main determinants of the reproductive behavior of this cohort of women are an early debut of sexual activity, several partners in their reproductive history, relatively early marriage with a motivation to have one child in their family and the tendency to use induced abortion as one of the methods of birth regulation. Our experience of postpartum counselling demonstrated positive changes in the women's attitudes to modern contraceptive methods. The data reveal that the induced abortion rate among 639 mothers regularly followed-up during the first year postpartum was 4.4%, and among 606 during the second year was 5.1%. The corresponding rates among 129 women who did not visit the family planning centers and who were only interviewed 2 years after labor were 9.3% and 8.5%, respectively.
Our data show that the unmet needs are remarkably concentrated among women who have given birth within the last year or two, and who need augmented attention from the family planning and reproductive health services.