Objective. To investigate the risk for anal sphincter tears (AST) in infibulated women. Design. Population‐based cohort study. Setting. Nationwide study in Sweden. Population. The study population ...included 250 491 primiparous women with a vaginal singleton birth at 37–41 completed gestational weeks during 1999–2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalia group, n = 929, where over 95% are infibulated; the Eritrea‐Ethiopia‐Sudan group, n = 955, where the majority are infibulated, compared with other African countries, n = 1035, where few individuals are infibulated but had otherwise similar anthropometric characteristics. These women were compared with 247 572 Swedish‐born women. Methods. Register study with data from the National Medical Birth Registry. Main outcome measures. AST in non‐instrumental and instrumental vaginal delivery. Results. Compared with Swedish‐born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95%CI 2.08–3.54), followed by women from Eritrea‐Ethiopia‐Sudan 1.80 (1.41–2.32) and other African countries 1.23 (0.89–1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. Conclusion. Delivering African women from countries where infibulation is common carries an increased risk of AST compared with Swedish‐born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.
Background
Previous caesarean delivery and intended mode of delivery after caesarean are well‐known individual risk factors for uterine rupture. We examined if different national rates of uterine ...rupture are associated with differences in national rates of previous caesarean delivery and intended mode of delivery after a previous caesarean delivery.
Methods
This study is an ecological study based on data from a retrospective cohort in the Nordic countries. Data on uterine rupture were collected prospectively in each country as part of the Nordic obstetric surveillance study and included 91% of all Nordic deliveries. Information on the comparison population was retrieved from the national medical birth registers. Incidence rate ratios by previous caesarean delivery and intended mode of delivery after caesarean were modelled using Poisson regression.
Results
The incidence of uterine rupture was 7.8/10 000 in Finland and 4.6/10 000 in Denmark. Rates of caesarean (21.3%) and previous caesarean deliveries (11.5%) were highest in Denmark, while the rate of intended vaginal delivery after caesarean was highest in Finland (72%). National rates of uterine rupture were not associated with the population rates of previous caesarean but increased by 35% per 1% increase in the population rate of intended vaginal delivery and in the subpopulation of women with previous caesarean delivery by 4% per 1% increase in the rate of intended vaginal delivery.
Conclusion
National rates of uterine rupture were not associated with national rates of previous caesarean, but increased with rates of intended vaginal delivery after caesarean.
Choices for delivery care are made based on the available resources and influence health outcomes of women and their children. The aim of the paper is to study utilization and preference for delivery ...care and related factors in one urban and one rural area of northern Vietnam. Two cohorts of pregnant women were carried out in DodaLab and FilaBavi Health and Demographic Surveillance Sites (HDSS) in Hanoi, Vietnam from April 2008 to December 2009. Together, 2515 pregnant women were identified and followed until delivery through quarterly household interviews using structured questionnaires. Almost all women delivered at health care facilities. Most of the rural women gave birth at primary health care facilities (88.5%) while urban women primarily used secondary and tertiary hospitals (93.6%). Caesarean section (CS) was used for 38.5% of births in the urban area and 12.4% in the rural. Giving birth in hospitals and CS were more common among highly educated women, employed women, women living in households or communities with good economic conditions, and women expected to give birth to a son. Technology preference in delivery care was associated with better socioeconomic conditions and expecting a boy. Improving the quality and reputation of primary health care facilities, informing women about CS risks and monitoring indications of CS are important policy issues.
While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to ...evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States.
This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26-31 weeks GA), moderate preterm (32-36 weeks GA), near term (37-38 weeks GA), term (39-41 weeks GA) and post-term (42+ weeks GA) births, using Spearman's rank tests.
High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries' overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births.
Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.
Objective To study perinatal mortality in women booked for birth centre care during pregnancy.
Design Retrospective cohort study.
Setting In‐hospital birth centre and standard maternity care in ...Stockholm.
Population Two thousand and five hundred and thirty‐four women (3256 pregnancies) admitted to an in‐hospital birth centre over 10 years (1989–2000) and 126,818 women (180,380 pregnancies) who gave birth in standard care during the same period and who met the same medical inclusion criteria as in the birth centre. Multiple pregnancies were excluded.
Methods Data were collected from the Swedish Medical Birth Register. Information on all cases of perinatal death in the birth centre group was retrieved from the medical records.
Main outcome measure Perinatal mortality.
Results No statistically significant difference in the overall perinatal mortality rate was observed between the birth centre group and the standard care group (odds ratio OR 1.5, 95% CI 0.9–2.4), but infants of primiparas were at greater risk (OR 2.2, 95% CI 1.3–3.9). Infants of multiparas tended to be at lower risk, but this difference was not statistically significant (OR 0.7, 95% CI 0.3–1.9). These figures were adjusted for maternal age and gestation in multiple regression analyses.
Conclusion Birth centre care may be less safe for infants of first‐time mothers.
Two hundred ninety-four women were randomly allocated to a group in which the use of a birthing stool (experimental group) or a conventional semirecumbent position (control group) was encouraged. The ...birthing stool was 32 cm high and allowed the parturient to sit upright and to squat. The husband could sit close behind his wife and support her back. No differences were observed between the two groups regarding mode of delivery, length of the second stage of labor, oxytocin augmentation, perineal trauma, labial lacerations, or vulvar edema. Infant outcome measured by Apgar scores at 1 and 5 minutes postpartum and numbers of neonatal intensive care unit transfers was the same in both groups. Mean estimated blood loss and the number of mothers with a postpartum hemorrhage 600 ml or more were greater in the experimental group than in the control group. Women in the experimental group reported less pain during the second stage of labor, and they and their spouses were more satisfied with the birth position than were parents in the control group. Midwives were less satisfied with their working posture in the experimental group.
Aim: To study morbidity during the first month of life affecting infants of mothers booked for birth centre care during pregnancy. Methods: 3238 live single‐born infants whose mothers were admitted ...to an in‐hospital birth centre, located at South Hospital in Stockholm, between 1989 and 2000 were compared with 179 502 infants whose mothers received standard maternity care in the Stockholm region during the same period, and who fulfilled the same medical inclusion criteria as those of the birth centre group. Information on other exposures and outcomes was collected from the Swedish Medical Birth and Hospital Discharge Registers. Logistic regression analyses were performed to calculate the odds ratio (OR), using 95% confidence intervals (95% CI). Results: Compared with infants born in standard care, infants in the birth centre group had a higher risk of respiratory problems (OR 1.39; 95% CI 1.14–1.69), a difference correlated to less serious respiratory diagnoses. However, the difference was not statistically significant if the birth centre group was compared only with infants born in standard care at South Hospital (OR 1.18; 95% CI 0.94–1.47). Birth centre care was associated with a lower risk of fractures (OR 0.40; 95% CI 0.25–0.63).
Conclusion: Birth centre care was not associated with severe infant morbidity and even appeared to reduce the risk of birth trauma, such as clavicle and other fractures.
Background: Women's experiences of childbirth may affect their future reproduction, and the model of care affects their experiences, suggesting that a causal link may exist between model of care and ...future reproduction. The study objective was to examine whether the birth center model of care during a woman's first pregnancy affects whether or not she has a second baby, and on the spacing to the next birth.
Methods: Between October 1989 and July 1993, a total of 1860 women at low medical risk in early pregnancy, who participated in a randomized controlled trial of in‐hospital birth center care versus standard care, gave birth. The 1063 primiparas in the trial, 543 in the birth center group and 520 in the standard care group, were included in a secondary analysis in which women's personal identification codes were linked to the Swedish National Birth Register, which included information about their subsequent birth during the following 7 to10 years. Time to an event curves were constructed by means of the Kaplan Meier method.
Results: The observation period after the first birth was on average 8.8 years in the birth center group and 8.7 years in the standard care group. No statistical difference was found between the groups in time to second birth, which was 2.85 and 2.82 years, respectively (median; log‐rank 1.26; p=0.26).
Conclusion: A woman's model of care, such as birth center care, during her first pregnancy does not seem to be a sufficiently important factor to affect subsequent reproduction in Sweden. (BIRTH 29:3 September 2002)
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