Dear Chris,
Thank you for your comments on the study and I welcome your pointing out the
error.
Regards
Sue
----- Original Message -----
From: "Christine McCourt" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, November 17, 2004 5:21 PM
Subject: Re: CS and social pathology
Dear Sue
thanks for the info on your study, which sounds really interesting and
useful.
Can I pick up on a matter you referred to re numbers of women requesting
C/S as I think it is important and I have seen this quoted quite a few
times, since it was a major piece of work. You said that the Sentinel CS
audit found 7% of women choosing to have a cs without obstetric
indication. This is incorrect, but that's not your fault since the
information put out in the press release for the study was incorrect.
The audit did not collect data on whether women requested without
obstetric indication so cannot say anything on that - the way the
questionnaire was set out did not enable them to separate factors out in
this way (personal comm with researchers). 7% was the figure given by
obs for when they considered maternal choice to be the primary
indication. This doesn't preclude the existence of a range of possible
medical factors in some proportion of this 7%. Clearly, the judgement of
practitioners as to what are primary or secondary indications is likely
to vary.
It is somewhat worrying that a press release should be inaccurate.
Perhaps that tells something about the dispositions of much of current
discussion on the matter.
Similar confusions around concepts/factors were also identified by Jenny
Gamble in her critical review of the literature (Birth 2000).
Chris
Chris McCourt
Reader in maternity, health and social science
Thames Valley University, London.
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. on behalf of Patricia Burkhardt
Sent: Wed 11/17/2004 2:29 PM
To: [log in to unmask]
Cc:
Subject: Re: CS and social pathology
Dear Sue,
Thanks for this information. Would you let me know when and where it iw
published?
Pat
Patricia Burkhardt, CNM, DrPH
NYU Midwifery Program Coordinator
Tel: 212 998-5895
Fax: 212 995-4679
----- Original Message -----
From: Matt Fenwick <[log in to unmask]>
Date: Wednesday, November 17, 2004 4:29 am
Subject: Re: CS and social pathology
> Hi Pat,
>
> I will outline the demographics of the study sample. 21 women were
> interviewed. The interviews were unstructured. The participants
> came from
> three hospitals in the South West of England. Exclusion criteria
> included a
> history of PND, adverse outcome etc.
> The initial purposive sample was as follows:
> First time mothers (primigravida) 7 - Emergency CS
> Second time mothers (multigravida) - 5 Elective CS following
> emergency CS
> " " - 4 TOL
> followingemergency CS
>
> I was unable to recruit women who had a CS maternal request, this
> could mean
> two things either they were not willing to volunteer or there are
> not many
> of them! The results of the National Sentinel CS Audit suggest
> that women
> choosing to have a CS without obstetric indication is low around
> 7%. The
> participants were recruited by community midwives who were known
> to woman
> and her family. I did not approach women in hospital. Second time
> motherswere identified by their Community Midwife at 34-36 weeks
> gestation. I then
> made arrangements to interview post delivery. First time mothers were
> interviewed at least six weeks post delivery. These women were given
> information on the study by the Community Midwife during postnatal
> visiting.
> As data collection and analysis progressed, to gain greater depth and
> insight I interviewed two women who had a previous normal delivery
> followedby an emergency CS.
> Also in the initial stages of the study women were interviewed who
> had an
> emergency CS during labour - 2 of these women had a breech
> presentation. I
> decided to include women who had a breech presentation but who had not
> laboured. This process is known as theoretical sampling. It
> enabled me to
> widen to focus of the initial sample.
>
> This study has generated rich data about the women's experience of
> CS and
> the impact it has upon their physical and emotional well being.
> Moreover,including second time mothers enabled me to gain an
> insight into decision
> making.
>
> I hope this is helpful. Please contact me again if you have more
> questions.
> Regards
> Sue
>
>
> ----- Original Message -----
> From: "Patricia Burkhardt" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, November 16, 2004 3:59 PM
> Subject: Re: CS and social pathology
>
>
> > Sue,
> > Could you give us the demographics of your study sample? Your
> findings> are critical to this on-going issue of c sections as if
> they are an equal
> > substitute for a spontantous vaginal birth.
> >
> > Thanks, Pat
> >
> >
> > Patricia Burkhardt, CNM, DrPH
> > NYU Midwifery Program Coordinator
> > Tel: 212 998-5895
> > Fax: 212 995-4679
> >
> > ----- Original Message -----
> > From: Matt Fenwick <[log in to unmask]>
> > Date: Tuesday, November 16, 2004 9:54 am
> > Subject: CS and social pathology
> >
> >> I am currently in the final stages of a qualitative study using
> >> Grounded Theory on women's experience of caesarean section. You
> >> may be interested in some of the key themes to emerge from
> >> analysis of the data.
> >> I interviewed first time mothers who had experienced an emergency
> >> caesarean. I also interviewed second time mothers who had
> either a
> >> trial of labour or an elective CS.
> >>
> >> Most of women said that they 'expected the normal' and emergency
> >> CS left them with feelings of disappointment, sometimes anger and
> >> feelings of failure. Women felt they had missed out on normal
> >> birth. Women in this study associated 'normal birth' as 'part of
> >> being a woman' ; a 'normal process' and one that they expected.
> >> Birth is seen as a 'rite of passage' I have used inverted commas
> >> to indicate codes identified in the data. 'Feelings of failure'
> >> were linked to a sense of the 'failing body' and 'failing as a
> >> mother' because they had found caring for a newborn baby difficult
> >> after CS.
> >>
> >> Another theme to emerge from the data was that of 'being in
> >> control'. First time mothers who experienced an emergency CS
> >> described how they had lost control over the birth process.
> >> Second time mothers describe how their experience of previous CS
> >> impacts upon their decision making in a subsequent pregnancy.
> >> Regaining control is an important theme in this study because
> >> women who chose a trial of labour saw this as a way of regaining
> >> control. However, women who opted for an elective CS also saw
> >> this as regaining control. Women who chose to have a CS did so
> >> because they would 'be prepared', it meant 'minimizing
> >> uncertainty' and 'avoiding an emergency'. Women feared going
> >> through labour only to end up with another CS.
> >>
> >> Other themes in this study reflect the 'reality of caesarean' and
> >> the impact it has on women's lives. Women describe their
> >> interaction with care givers and others in their kinship network.
> >> For example,
> >> Women feel their is a lack of support for women who experience CS
> >> from professionals. Women are critical of the care they receive
> >> on the postnatal ward. They feel that midwives forget they have
> >> experienced major abdominal surgery. Some women feel they need for
> >> care and attention but many are too frightened to ask, or don't
> >> want to take up the midwives time. Women have unanswered questions
> >> about the decision to do the CS. Women also feel they are
> >> 'different' from women who have a normal delivery. This can lead
> >> to a sense of isolation and exclusion from 'normal mothers'.
> >>
> >> It must be said that all women have a negative view of CS and the
> >> care they received and this is documented in the thesis. In this
> >> study women tell their stories of CS. This provides an insight
> >> into the lived experience of CS and implications for transition to
> >> motherhood.
> >> Sue Fenwick
> >>
> >>
> >>
> >>
> >>
>
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