| BackgroundRepeat cesarean section is not the only and best delivery way for parturient with cicatricial uterus.A majority of women do not have absolute trial delivery taboo,but eventually chose the repeat cesarean section again.In this process,the parturient plays a decisive role in the choice of the mode of re delivery.At present,the research on the mode of re delivery of scar uterus after cesarean section is widespread at home and abroad.It mainly focuses on the comparison of the advantages and disadvantages of the two delivery methods after cesarean section.VBAC experience reports,maternal and child near and long-term complications and prevention research showed that.However,there are few reports about the real experience and deep demand of the parturient in the process of decision-making of delivery,mainly reflected in the following aspects:(1)Less attention has been paid to the real feelings and needs of parturient in the choice of mode of delivery.(2)What are the main factors affecting parturient's decision to make a caesarean section again?Personal factor,the influence of obstetricians and midwives,or other aspects?Which aspect has more influence?Few people pay attention to them.(3)The understanding of women's choice of their own,the influence of the scar uterus on the mode of re delivery and so on,there are few reports.With the opening of the second child policy,the number of parturient with cicatricial uterus will gradually increase.Therefore,this study attempts to adopt a qualitative and quantitative questionnaire approach from a perspective of parturient.From the experience of parturient and the relevant factors questionnaire survey influencing the decision-making of repeat cesarean section,these two aspects were got down to describe the real feelings in the selection of the mode of delivery,to explore the reasons for the choice of repeat cesarean section,and to analyze the deep-seated needs in the decision making process of re delivery,in order to provide scientific basis for formulating effective intervention strategies,and thus guiding rational medical behavior to promote and realize the ideal delivery desire of parturients.Objective1.Through qualitative research,depth interviews were conducted to understand the real experience of parturients for the choice of repeat cesarean section,to explore the factors that influence the cognition,attitude and support system of the parturients who make the decision of repeat cesarean section.2.The factors that influence the choice of repeat cesarean section in parturients with cicatricial uterus were investigated with self-made questionnaire,to understand the related factors that influence the decision of repeat caesarean section from the angle of parturient.3.To explore the main factors that influence the choice of repeat cesarean section in parturients with cicatricial uterus and to give guidance.SignificanceCesarean section is widely used as a solution to dystocia and to relieve the risk of mother and baby.The formation of cicatricial uterus after cesarean section brings some risk to the second pregnancy and delivery.With the intensification of the aging population and the gradual liberalization of China's two child policy,women with renewed childbearing requirements are increasing.Parturients with cicatricial uterus will also be increasing.Therefore,how to improve the vaginal delivery rate of parturients with cicatricial uterus,reduce the rate of repeat cesarean section with non medical factors and improve the quality of obstetrics has always been the focus of obstetric attention.In view of this,the subject of this study was parturient with cicatricial uterus.Through empirical study,we want to find out the leading influencing factors of decision of cesarean section in parturients,in order to provide scientific basis for formulating effective intervention strategies,and thus guiding rational medical behavior,so as to promote and realize the ideal delivery desire of parturients.Methods:This study is divided into two parts:(?)Part oneThrough qualitative research,depth interviews were conducted to explore the real experience of parturients in the choice of repeat cesarean section,to provide reference for further investigation on the factors affecting the decision making of repeat cesarean section in parturients.1.SubjectsAccording to the purpose of the study and the research conditions,the convenience sampling method was adopted to select the parturients with cicatricial uterus who underwent repeat caesarean section in the Nanfang Hospital of Southern Medical University as subject so that they can relatively completely and accurately answer to the researcher's research questions.1.1.1 Inclusion criteria:(1)Aged ?23 years old;(2)Single live-birth;(3)The time from the last cesarean section was over 2 years.There was twice caesarean section history.The operation method was transverse incision of lower segment of uterus;(4)No complications of internal medicine and surgery,as well as pregnancy complications.(5)No cognitive impairment and have good verbal communication skills;(6)Informed and agreed to participate in this study.1.1.2 Exclusion criteria:(1)Aged ?40 years old;(2)The time from the last cesarean section was over 10 years.2.MethodsThis study used the phenomenological approach in qualitative research.The semi-structured interview outline was used as an interview tool to collect data in depth interviews.An in-depth interview was conducted on 10 parturients with cicatricial uterus who underwent repeat cesarean section.The interview included the real experience and feelings,attitudes,reasons,views of the two ways of delivery,the influence of those factors,and the acquisition of relevant knowledge,and so on.By using the method of generic analysis and artistic conception analysis,the related subjects were summarized and extracted.3.ResultsA total of 3 subjects were extracted from interviews with 10 parturients with cicatricial uterus.They were psychological experience,attitude toward delivery,The reasons for choosing cesarean section,a total of 3 aspects.Complex psychological experience during the pregnancy and childbirth mainly includes happiness&satisfaction,anxiety&fear,entanglement&hesitation and comfort and regret.Different attitudes towards redelivery way include firmly demanding cesarean delivery,indifferent attitude and making a decision after weighting advantages and disadvantages.Pregnant women choose cesarean delivery because they receive no encouragement from doctors and no support from families;their reasonable appeals are not satisfied;they lack certain understandings of midwife clinic;they lack information acquisition approaches.Lastly,corresponding suggestions are proposed from the perspectives of changing the cognition of pregnant women and their family members,correct guidance of obstetricians and providing safe trial delivery environment,etc.,with a view to guiding rational medical behaviors,working out proper intervention measures and realizing pregnant women's ideal childbirth desire.(?)Part twoAccording to the cross-sectional study,a self-designed questionnaire was used to investigate.The basic information,fertility related information and related influencing factors were analyzed statistically.The main factors that influence the decision making of cesarean section were extracted,which can provide reference for the formulation of related intervention policies.1.SubjectsConvenience sampling method was adopted.During June 2017 to August 2017,the subjects were selected from 3 hospitals of grade three and grade A in Guangzhou,Shenzhen and other places after undergoing repeat caesarean section.1.1 Inclusion criteria(1)Aged ?23 years old;(2)Scar uterus parturient after two cesarean section or once cesarean section vaginal delivery again;(3)Informed consent ro agree to participate in this study.1.2 Exclusion criteria(1)Aged ?40 years old;(2)There are psychiatric disorders or this cognitive dysfunction,it is difficult to complete the questionnaire.2.Research toolsThe questionnaire was used in this study,including delivery method of parturients,self-made general information questionnaire(that is,demographic data),fertility related data and the influencing factors questionnaire for repeat cesarean section.3.Research contents(1)Basic social demographic characteristics of parturients:Age,height,weight,nationality,place of origin,place of residence,health status,genetic history,religious belief,medical treatment,income,educational background and occupation.(2)Fertility related data of parturients:fertility condition,natural labor condition,whether there was a trial delivery before the last cesarean section;the operation method of last cesarean section;whether this pregnancy had periodical inspection;the medical institution for antenatal care;the time from the last cesarean section;the gestational weeks at delivery;the child's weight and condition at birth.(3)Related factors affecting the choice of repeat cesarean section in parturients:Including maternal cognition,obstetrician level and midwife level,there are 3 dimensions in 14 entries.4.Statistical methods:Data was input by Epidata3.1 and SPSS 13 statistical software was imported for data analysis.(1)The statistical description results of measurement data(such as age,height,weight,gestational weeks)were expressed by(X=S);(2)The basic social demographic characteristics of parturients(such as nationality,place of origin,place of residence),frtility related data of parturients(such as the operation method of last cesarean section,the medical institution for antenatal care),and related factors affecting the choice of repeat cesarean section in parturients were described by frequency;(3)The chi square test was used to compare the difference between the choice of spontaneous labor and the choice of repeat cesarean section in parturients with cicatricial uterus for the preliminary analysis of related single factor affecting the choice of repeat cesarean section in parturients with cicatricial uterus.The inspection level was chosen as a=0.05,P<0.05,which was statistically significant,and the result of single factor analysis was obtained.(4)The repeat cesarean section score was the dependent variable,and the factors that may affect the occurrence were independent variables.Multiple stepwise linear regression analysis was used to investigate the risk factors associated with the choice of repeat cesarean section in parturients with cicatricial uterus.The four dimensions were mixed,and the multiple choice logistic regression analysis was conducted on the choice tendency of repeat cesarean section.Based on the results,the significant influence factors on the decision making of repeat cesarean section were extracted.The inspection level was chosen as a=0.05,P<0.05 which was statistically significant.5.Results1.The tendency to choose the mode of delivery of parturients during pregnancy has a significant impact on their final delivery decisions.Especially the parturients who wished to have a cesarean section,their proportion of the final choice of cesarean section was the highest,the ratio of which to spontaneous labor was 104:18.2.Among the women who chose natural labour,70.37%have consulted a midwife clinic.However,among the women who chose cesarean section,only 37.63%of women have consulted a midwife clinic.It suggested that the popularity and influence of midwives in prenatal intervention should be improved,and the confidence of parturients in midwives intervention should be enhanced,which can affect women to make reasonable delivery decision.3.Combined with three dimensions regression analysis and three dimensions mixed analysis,the results of multiple factor Logistic regression analysis of the tendency of choosing repeat cesarean section showed that,5 items had significant effects on the choice of repeat cesarean section in parturients with cicatricial uterus.These were entry 1,7,9,10,11.3 of these entries came from the doctor level.In the entry of the advice given by the obstetrician,the OR and STB values of parturients who chose repeat cesarean section were the highest(6.668 and 0.5041).Its influence was much higher than other entries,suggesting that the advice,implication,and guidance of obstetricians have a major impact on the delivery decisions of parturients.Conclusions(1)There are many factors that influence parturients in the decision-making process,including maternal factors,obstetricians' influences,and midwives'interventions and so on.However,the advice and guidance of obstetricians have the greatest impact on the choice of parturients.(2)Only by changing the cognition of obstetricians,improving the system and guarantee,providing a safe trial delivery environment,reducing the pressure of obstetricians,and providing a solid backing and guarantee for obstetricians,can it help medical workers choose delivery mode with scientific attitudes,instead of arbitrary choice of cesarean section for fear of taking responsibility.(3)Only from the source to control the incidence of once cesarean section,the occurrence of repeat cesarean section or even many times can be avoided,so as to ensure maternal and child health and safety,and to improve obstetric quality.(4)It is helpful for the pregnant women to make reasonable delivery decisions to improve the prenatal intervention. |
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