Citation
Making the choice

Material Information

Title:
Making the choice cesarean delivery by maternal request versus planned vaginal birth
Creator:
Bennett, Penelope A
Publication Date:
Language:
English
Physical Description:
vii, 295 leaves : ill. ; 28 cm.

Subjects

Subjects / Keywords:
Childbirth -- Decision making ( lcsh )
Delivery (Obstetrics) ( lcsh )
Cesarean section ( lcsh )
Risk-taking (Psychology) ( lcsh )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Colorado Denver, 2011.
Bibliography:
Includes bibliographical references (leaves 286-295).
Statement of Responsibility:
by Penelope Alexander Bennett.

Record Information

Source Institution:
University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
761020198 ( OCLC )
ocn761020198

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by 2011

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ABSTRACT types 1209 type

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1. 23 25 3. 29 29 34 4. 35 35 21st 37 43 5. 53 6. 59 59

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81 85 C.

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4

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x

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7.20

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3.1 34 7.1 79 7.2 88 7.3 89 7.4 100 7.5 100 7.6 4 103 7.7 117 7.8 118 7.9 130 7.10 130

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1

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1 2

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& J. & 1. 3

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2 a

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& &

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th th

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% ?" 30

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1. 1. 31

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1. 32

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33

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Benefits of Vaginal Birth Benefits of CDMR Horms associated with Vaginal Birth Horms associated with CDMR Interpreters and Filters of Information Poten t ial fo r Lit igati o n Birth Choices Decision Tool Control of Knowledqe Provider tolerance A Dec i sion Tool offering accessible information to assist with the choice between Q planned vaginal delivery and a cesarean delivery by maternal request Infonned Less Uncertai n Values Clari f ied Comfort with Decision Conf idence i n Choice Focus of this research Med i a Influences 34

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35

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36

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th th

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th

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41

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42

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43

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st

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u.s. 1.

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2. 46

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47

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5. 48

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49

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51

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st 52

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S3

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54

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1. 56

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1. 57

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1. 58

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C.

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1. 1. 60

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61

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1. 62

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Study hypotheses that were tested include: 63

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64

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Benefits of Vaginal Birth Benefits of CDMR Harms associated with Vaginal Birth Harms associated with CDMR Interpreters and Filters of Information Potential for Litigation "Birth ChoicesDecision Tool Control of Knowledqe Provickr toleronce for ,.;sIc A Decision Tool offering accessible information to assist with the choice between a planned vaginal delivery and a cesarean delivery by maternal request less Uncertain Values Clar i fied Comfort with Decision Conficknce in Choice Focus of this research Medi a Influences (woitino for lobar) 65

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66

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67

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70

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18-24 25-29 30-34 35-39

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1. 73

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1.

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75

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76

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77

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78

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N% N% 188(20 .3%) 10(9.3%) 317(34 .3%) 48(45 .3% ) 30 years to 34 years old 122(13.2) 32(30 .2%) 35 years to 39 years old 123(13.3%) 12(13.3%) 40 vears to 44ynrs old 174(18.8%) 3(2 8%) 48(5.3%) 10(9 5%) 821(89 .9%) 88(83 8%) Hispanic 12(1 31%) 1(1 5%) 32(3 .5%) 6(5 .7%) Place of b irth In the U S 846(96 .2% ) 94(93 .1%) Outside the U .S. 33(3.75%) 16{17 .2% ) le .. than High School 3(. 33%) 0 High School 117(12.1% 8(7 5%) SomeColiele 261(18)4%) 34(32 1%) 331(36 1%) 33(31 1%) 206{22 4 % ) 31(29 .2% ) 214(23 .5%) 29(27 .6%) 698(76 .5%) 76{72.4%) 695(76%) 80(76 9%) 108(11 .8%) 18(17 3%) 111(12 .1%) 6(5 8%) 587(62 .3%) 52(49 1%) One child 129(13.7%) 29(27.4%) 147(15 .6%) 16{15 .1%) 79(8 4%) 9(8 5%) What type of birth,? 582(62 1%) 52(49 .5%) Vaginal birth 246(26 .2%) 37(35.2%) 27(2 .9%) 5(4.8%) Emergency cesarean b irth 8(7 6%) 24(2 .6%) 3(2 9%) 311(33 .2%) 13(12 .3%) One child 92(9 .8%) 8(7.5 % ) Two children 43(40 6 % ) 199(21 .2%) 42(39 .7% ) Total 965 llOt IS 79 N% Total 50(4 4%)* 15(6 .3%) 203(17 .5%) 79(33 .6%) 396(43 .2%) 96(40 8%)) 218(18 .8%) 36(15 .3%) 159(13 7%) 9(3 8%) 183(15 .8%) 63(5 .2% ) 16(16 .9%) 64(5 .3%) 205(88%) 1026(84 .9%) 1(0 43%) 13(1.1%) 11(4 7%) 43(3 6%) 107(8 .8%) 207(92 .8%) 1053(87 1%) 7(7 17%) 49(4 .05%) 4(0.3%) 1( 4%) 4(0 .3% ) 21(9 1 % 138(11 4%) 93(25 .3%) 320(26 5%) 93(39 9%) 424(35 .1%) 265(21 .9%) 57(24 .8%) 271(22.4%) 871(72.0%) 62(5 1%) 180(77.2%) 47(20 .2%) 6{2. 6%) 117(9 .7%) 32(2.6%) 99(42 1%) 686{56 .7%) 81(34 .5%) 210(17 4%) 36{15 .3% ) 183(14 1 % ) 19(8 1%) 98(8 .1%) 39(3.2%) 102(43 8%) 684(56 .6%) 100(42 .9%) 346{28 .6%) 13(5 .6%) 40(3 .3%) 17(7 .3%) 75(6 .2%) 1( .4%) 25(2 1 % ) 37(3 1 %1* 22(9 4%) 333(27 .5%) 20(8 5%) 112(9 .3%) 108(46%) 443(36 .6%) 284(23 5%) 244 1209

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80

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Birth Choices Decision Tool Non-Pregnant Planning Pregnancy Pregnant Total Version A: Risks Benefits Version B: Costs Version C: Risks, Benefits, Costs 81

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0.8 10 a>0.8909 0.9422, Values Effective Total Informed Oarlty Uncertainty Decisions Decisional Subscale Subscale Subscale Subscale Conflict Scale Average Inter-Item covariance 0.8754 0.6449 0.7843 0.4885 0.5432 No. of Items In scale 4 3 3 3 Reliability Coefficient 0.9066 0.8946 0.8909 0.8935 0.9422 Values Tool 2.0741 0.8753 82

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= 30 25 20 15 10 5 0 83 .Mean

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1. 84

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Ho:

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Risk & Benefits Costs only R i sks, Benefits & Costs Risks & Benefits Costs only Risks Benefits, & Costs Risks & Benefits Costs only R isks Benefits & Costs Total 86

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40(4 .85% ) 46 ( 5 .58% ) 77(9 33%) 97(11 .76%) 565 (68. 48 % ) 825 15(5 77 % ) 18(6 92%) 30(11 54%) 34(13 8 % ) 163(62 69%) 260 19(6 76 % ) 12(4 27 % ) 22(7 83 % ) 35(12 46 % ) 193(68 68 % ) 281 6(2 .11% ) 16(5 63 % ) 25(8 .80% ) 28(9 .86% ) 209(73 59 % ) 284 4(4 35 % ) 3(3 26 % ) 5(5 43 % ) 15(16 30 % ) 65(70 .65% ) 92 1(2 .94% ) 2(5 .88% ) 2(5 .88% ) 6(17 65 % ) 23(67 .65% ) 34 3(8 82 % ) 1(2 94 % ) 0 6(17 65 % ) 24(70 .59% ) 34 0 0 3(12 50 % ) 3(12 50 % ) 18(75 .00% ) 24 4(1 .89% ) 8(3 .77% ) 13(6 13 % ) 21(9 .91% ) 166(78 .30% ) 212 1(1.45 % ) 2(2 .90% ) 3(4 .35% ) 5(7 25 % ) 58(84 .06% ) 69 3(4 .11% ) 3(4 11 % ) 6(8 22 % ) 7(9 58 % ) 54(73 .97% ) 73 0 3(4 29%) 4(5 71 % ) 9(12 .86% ) 54(77.14 % ) 70 44(4 .24% ) 54(5 21 % ) 90(8 68 % ) 118(11 38 % ) 731(70.49 % ) 1129

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4 6 4 5 4 4 4 3 4 2 4 1 3 9 ....... C/S ** p < O l .......... ---.........P < .Ul .... 88

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WIlt for labor 4 7 4 6 ..... p < 05 4 5 of p < .05 4 4 -4 3 4 2 4 1 4 ....... CIS 89

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% & & 4 21 0 .25, p<0 78 4 33 3 84 -4 .24, -7vag 3.7% 4 17 4 20 1 002 p < 0 316 -7 vag 1 .7% 4 24 4 32 1 939 p < 0 052* -7 v ag 2 6 % 4 22 4 47 -4 220 -7vag 6 6 % 4 41 0 75 p<0.47 4.46 0 43 p<0 .65 2 165 p<0 .030* -7vag 2 .9% 4 26 4 41 2 131 p
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Odds Ratio Ratio for Total Positive likelihood Total Posit ive Ratio oITotal Chan,e units movin, Chanse Posit ive Ne,ative Positive to Negative towards Chanse units vasinal Pre-OT to to from unsure to Post DT Post DT Chanse units res ponse response response unsure 2 64 67 161 2.403 14 42 3 0 (p< .OOl)** 33 24 0 .727" 4 8 2 0 2 5 CDstsanly 19 33 1 .736 4 19 4 75 3 86 Risks, Benefits 15 81 5.4 6 15 2.5 (p<.014)* 8 13 1.625 0 6 6 0 1 5 5 0 0 3 3 0 3 1 0.333 0 3 3 0 4 7 1 75 0 0 0 3.29 20 23 1 15 2 8 4 0 (p<.031)* Risks 7 9 1 285 1 2 2 1 1.33 CMuonly 10 2 0 .2 1 2 2 1 10 0 3 12 4.0 0 4 4 0 91

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a

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93

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1" Correlation coefficients between choice of delivery and demographic variables Born In Type of Type of children Ale Ethnlclty US? children births 0 .0988** .lJ. 0630 .lJ. 0249 0 .0922** .lJ. 0231 .lJ.1239** 0 .1498** 0 .0399** 0 .1035** 736 736 736 736 736 736 736 736 736 p<.0073 0 8643 p<. 4999 p<. 0123 p<. 5308 p<.OOO8 p<.OOOl p<0 0147 p
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96

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Risk s Benefits Costs Risks, Benefits Costs R i sks Benefits Costs R i s ks, Ben e fits Costs R i sks Benefits Costs R isks, Benefits Costs p< p< I nfo rmed Subsca le -.2168# 779 p < 0 0001 -.2525 # 246 p<.OO13 -.2083 # 263 p<.0143 -.1930++ 270 p<.0303 -.1397 87 p < 1 0 2106 31 P < 1 0 -.0558 32 p < 1 0 -.1221 24 p < 1 0 .0647 204 p < 1.0 -.0818 70 p < 1 0 -.1482 70 p < 1 0 .1482 69 p < 1 0 Effective Total scores for Values Clarit y Uncerta i nty D ecision D ecisional Sub s ca l e Sub sca le Sub scale Confl ict Sca l e -.2633++ .4044++ -.4267++ -.3780# 779 779 779 779 p < O ooOl p<.Oool p<.Oool p<.Oool -.2784 # .4267++ 4497 # -.3905 # 246 246 246 246 p<.0002 p<.Oool p<.OOOl p<.Oool .2437++ .3753# .3664++ .3343++ 263 263 263 263 p<.0014 p<.Oool p<.Oool p<.Oool -.2489 # 3942++ 4496 # .4020++ 270 270 270 270 p<.Oool p<.Oool p<.Oool p<. Oool -.2896 -.3549 + + -. 5145 + + -.3314+ 87 87 87 87 p < 0 1367 p < .0156 p<. Oool p < .0361 -.4379 -.2575 -.6139++ 3976 31 31 31 31 p<.2888 p < 1 0 p < .005 p<.5617 -.0597 .3752 -.3471++ -.1554 32 31 32 32 p < 1 0 p<.7213 p<.Oool p < 1 0 .3355 .4100 -.5757 -.3666 24 24 24 24 P < 1 0 P<.9789 p<.0681 p < 1 0 2044 -.3761++ -.3364++ 2307 + 204 204 204 204 p < 0 207 p<.OOOl p<.OOOl p<.0189 .2342 -.3402 .3542 # -.2079 70 70 70 70 p < 1 0 p<.1167 p<.0047 p < 1 0 0609 -.4135# -.4277++ -.2090 70 65 66 67 p < 1 0 p<.0075 p<.Oool p<.0001 2 730 3461 -.1770 -.267 6 69 69 69 69 p < 0 4798 p < .0751 p
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98

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H p<.Ol p<.OS of -5.897, p<.OO1o+"" 0.5802, p<.OO1++ 4.00/3.65 4.16/3.85 7.516,p<.OO1++ 0.4957, p<.001++ -2.460, p<.014''' 0.6068, p<.OO1++ 3.97/3.54 4.11/3.79 .416.D<.001++ 0.5926, p<.OO1++ -4.812, p<.OO1++ 0.6004, p<.001++ 4.02/3.71 4.23/3.88 4.19, p<.oolJllll 0.4783, p<.OO1++ -3.194, p<.014+ 0.5397, p<.001++ 4.02/3.70 4.14/3.88 4.66,p<.0011!111 0.4243, p<.001++ -1.351, p<0.176 0.6490, p<.001 ...... 4.38/3.79 4.46/3.85 .61,p<.108 0.5842, p<.001++ -1.605, p<0.109 0.4679, p<.007++ 4.21/3.53 4.5/3.94 -3.08,p<.002++ 0.5612, p<.001++ -0.304, p<0.761 0.7225, p<.OO1++ 4.28/3.89 4.23/3.79 .49,p<.624 0.5571, p<.001++ -0.305, p<0.760 0.7708, p<.OO1++ 4.32/4.0 4.16/3.8 .742,p<458 0.6791, p<.OOI++ -1.730, p<.084 0.6401, p<.001++ 4.54/4.17 4.44/4.21 -.685, p<.493 0.5655, p<.001++ -0.292, p<0.770 0.6105, p<.001++ 4.51/4.30 4.54/4.49 -1.30,p<.194 0.6156, p<.001++ -0.570, p<0.568 0.6802, p<.001++ 4.35/4.15 4.37/4.03 1.919,p<.055 0.5485, p<.001++ -2.076, p<.038+ 0.6052, p<.001++ 4.29/4.05 4.43/4.13 -1.79,0<.072 0.5625, p<.001++ 99

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Vqlnalls Safest of of of 4 3 ** p<. 0 1 ** p<.01 4 2 --............ p < .OS -4 1 4 3 9 3 8 C/S Is -eo.,. v ........ s.r..t asking of safety of each of for the 4 3 9 ** p<. 01 ** p<. 01 ** p < .01 3 8 ---3.7 ...... 3 6 3 5 3 4 3 3 C/SIs5efest a."./Jt.s ""'-...,...". eo.,. 100

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** Significance at p<.01, '" Significance at p<.05 0.4866, p<.OO1**/0.4579, p<.OOa* 0.3877, p<.OO1**/0.4859, p<.OO1 ** 0.5123, p<.OO1**/0.4044, p<.OO1 ** 1. 101

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Table 7.13: Correlation coefficients between a woman's choice of mode of delivery and 1) cost factors, and 2) other potential influences. coefftdents choice Belief regardl .. her to choose a Concem for care provider's personal choice of (1 5) of of delivery (1 to 10) Mean/Obs R value/Obs Mean/Obs RValue/Obs 2.56/811 .2403H/808 5.28/870 -. 1163 H/803 P<.ool P<.ool Risks, Benefits 2.58/251 .2791H/251 5.282/278 -.1231./252 P<.ool P<.051 Costs 2.42/280 1884 H/278 4.98/296 -.0850/274 P<.0016 P<.161 RIsks, BenefIts, Costs 2.67/280 .2538H/279 5.58/296 -.1604H/277 P<.ool P<.OO7 2.7/80 .2864H/90 5.41/89 -.1331/89 P<.OO6 P<.214 Risks, 2.85/33 .2845/33 5.46/37 -.3268/33 P<.I09 P<.063 Costs 2.38/34 .2655/42 5.63/33 .1008/32 P<.129 P<.583 RIsks, Benefits, Costs 2.5/24 .3539/23 5.62/29 -.1638/34 P<.098 P<.444 2.88/209 .2870H/209 5.47/201 -.1314/209 P<.ool P<.058 RIsks 2.90/69 .2315./59 5.82/73 -.0173/69 P<.055 P<.888 Costs 3.0/73 .4484H/73 5.65/72 -.0900/70 P<.OO8 P<.459 RIsks, Benefits, Costs 2.76/67 .1435/67 4.96/76 -.314OH/70 P<.246 P<.OO8 H p<.01 p<.05 (some leeway was given to include those groups where .06
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3 5 3 2 ....... nt 2 9 about. _n', made delivery =

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1. 2. 3. 4. 11. 12. 16. F(22, 0.001 0.6200, 62.00% 20, 2 F(2s,

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R2 R2

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107

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109

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110

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111

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1.

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Table 7.15: Means and correlation coefficients between choice of mode of delivery and concerns about cost Risks, Benefits RbIIs, Benefits, Plannll1l P' ..... ncy Risks, Ben.tllS Premant Women Risks IIeneflts RIsks, Benefits, Significance at p
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R2, = 114

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115

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a an Ho: A 116

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Did you have the Information that you needed to make the choice between attempting labor and planning a cesarean birth? 410(46 96%) 240(27 49%) 164(1879%) 38(4 35%) 21(2 41%) 1 877 /20 873 56(57 .73%) 22(22 .68%) 11(11 .34%) 5(515% ) 3(3 .09%) 1731/101 97 145(67 76") 34(15 .89%) 19(888%) 10(4 67 % ) 6{2.8%) 1589/10 214 30 25 15 10 5 117

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a o 20 40 60 80 100 118

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119

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to 120

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Old the Infomultlon that you needed to make the between attemptl ... lllbor and plllnnl ... a cesarean birth? Toud scoresfor Informed V.lue. UncertJolnty Effective Decision Dod"on.1 Subseale Subscole Subscole Subseale Conftlct Scale V.I .... Tool Scale Non-Precnant women 0.5321++ 0.6655++ 0.7908++ 0.7909++ 0 .7597# -o.U23++ 105 868 873 873 804 102 p<0.001 p<0.001 p<.001 p<.001 p<.001 0<.005 Risks Benefits 0.5339++ 0.6489++ 0.7236++ 0.7777++ 0.7640++ -0.2108++ 257 281 281 283 257 257 p<.oool p<.001 p<.001 p<.001 p<.007 0.5384++ 0.6673++ 0.6834++ 0.7881++ 0.7414++ -0.0781 268 293 295 268 264 p<.001 p<.001 p<.001 p<.001 p<.001 P<.2062 Risks, Benefits 0.5333++ 0.6749++ 0.7263++ 0.1056++ 0.7652++ -0.0109 210 294 292 294 278 281 p<.001 p<.001 p<.001 p<.001 p<.001 P<.1765 Plannl ... Prelnancy 0.5018++ 0.6015++ 0.7067++ 0.7615# 0.7109++ -0.0901 85 97 97 97 85 89 p<.001 p<0.001 p<.001 p<.001 -.J><..001 o<.40U Risks Benefits 0.5178++ 0.7052++ 0.7444++ 0.6041++ -0.0338 38 38 38 34 34 p<.009 11<.001 -.J><..002 P<.8495 0.6721++ 0.7189++ 0.7553++ 0.7789++ 0.7497++ 0.0895 27 31 31 31 27 28 11<.001 p<.001 p<.001 p<.001 p<.001 P<.6289 Risks, Benefits 0.5600++ 0.6334++ 0.6491+ 0.8117++ 0.6958++ -0.3311 24 28 28 27 24 27 11<.0044 P<.003 P<.0002 p<.001 11<.002 P<.0916 'recnant women .5002++ 0.6068++ 0.5917++ 0.7974++ .6788++ 0.0393 193 212 212 214 193 6196 p<.001 p<0.001 p<.001 P<.5848 Risks Benefits 0.5712++ 0.5757++ 0.6284+ 0.8191++ 0.7348++ 0.0393 63 72 63 62 p<.001 p<0.001 p<.0001 p<.001 p<.001 P<.7619 0.4U7+ 0.5293++ 0.04543++ 0.7338++ 0.5831++ 0.1100 62 63 65 66 67 63 11<.0009 p<0.001 p<.001 p<.001 11<.001 P<.3906 Risks, Beneflts 0.4607++ 0.6644++ 0.6901++ 0.8277++ 0.6776++ -0.0130 68 75 75 76 68 71 p<.001 11<0.001 11<.001 p<.001 p<.001 P<.9142 121

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Did you have the Information that needed make the choice between waltllll for labor and plannllll a cesarean birth? 10m Type'" '" Type'" ch_ Ale US? ".2134++ 0.0628 ".0069 0.0134 0.1M66 0.0223 ... 21196++ ".21ao++ ".lSil++ 176 776 776 776 176 776 176 176 776 "".001 0.0106 "".8412 p<.7097 p<.l,.S p<.OOl p60++ -0.1032 243 243 2<3 243 243 243 243 243 243 p
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"1" "5" A = 3.77, 3.77 a to a 1. 2. 3. 4. 5. 6. 7. 123

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2 124

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125

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=

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127

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128

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Dedsional Conflict 3 5 3 2 5 _Information SS .... _Val ues SS 2 1 5 Unce rt ainty 55 1 Comfort ItJsks IIenettts Costs on,.. Costs Deds l onal Confli ct 3 5 3 J 2 5 Information SS Values Clarity SS 2 "\J 1 5 1 Uncertainty SS 1 Comfort ItJsks Costs with dedsion Costs 130

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3 5 3 2.5 2 .......... ss ..t.. U n certai n ty 55 1 5 Effect;ve Decisions S5 1 'eon.

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133

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= 3 5 3 .. 2 S 2 LS not 134

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1. 135

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1 2 3 4 8 5 6 7 8 9 10 136

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to No. 1 50 2 56 3 4 & 5 11 c -6 7 8

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#1: 0/ 0/ #2: to 0/ 140

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Information on risks, benefits and costs Influence a woman's preferred mode of delivery? All results are s .. nlflcant at p<.OS. Type of information in Decision Tool Risks Benefits Risks, Benefits a Costs NonP .... nant 1.lncreased age or education comlates Women 01 !W!JIm 2.lncreased ale or conelates is 01 10 10 with 01 5.Number of births, eJl:pertences with baby baby moves towards vallnal delivery. WOmin to mode of 10 10 01 baby W_ P1annl .. chog Precnancv is 10 is 10 baby 141

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& vaginal delivery choice = = greater likelihood of choosing vaginal greater likelihood of choosing vaginal = 3.less sure of r1i:ht of woman to choose times greater likelihood of chOOSing 4.Concemed about cost to health care increased choice of vilginal delivery system when preference moves away ...................... 4.Concerned from vaginal delivery about cost to health care system when mother preference moves away from vaginal when chotee moves towards vaginal delivery. 6.DiSilgrees more often wtth rtsht of woman to choose mode of delivery when personal choice moves towards 7.Concerned about cost to health care system when preference moves away from vaginal delivery 142

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143

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factors to 144

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a 145

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146

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147

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1. 148

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Potential Benefits and Harms of Vaginal Delivery and CDMR I Right to Choose CDMR 2 Concern about Costs to the Health Care System 149

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150

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152

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153

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154

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APPENDIX A Initial and Follow-up Survey Questions 1. What is your gender? Male Female 2. Are you older than 17 years of age and younger than 45 years of age? Yes No 3. Are you currently pregnant? Yes No 4. Do you plan on becoming pregnant within the ne)(t si)( months? Yes No 1. Please think about the following situation and answer the question the best you can. you were a healthy young woman and you could choose to go into labor and plan a vaginal delivery, or you could choose to schedule a cesarean section before labor starts, how likely, on a scale of 1-5, are you to choose to go into labor and plan a vaginal delivery? 155

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2. In your opinion, which is safer for the mother vaginal delivery or cesarean delivery? 3. Which is safer for the baby VQginal delivery or cesarean delivery? 4 to 4. How strongly do you agree with the following statement? A healthy pregnant woman should be allowed to choose between labor and planning a vaginal birth, and choosing to have a cesarean birth without a medical reason. 3 4 156

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5. Please think about the following situation and answer the question the best you can. you were a healthy young woman and you could choose to go into labor and plan a vaginal delivery, or you could choose to schedule a cesarean section before labor starts, how likely, on a scale of 1-5, are you to choose to go into labor and plan a vaginal delivery? 3 4 6. In your opinion, which is safer for the mother vaginal delivery or cesarean delivery? 3 7. Which is safer for the baby vaginal delivery or cesarean delivery? 4 S B. Do you know the benefits of planning a vaginal delivery? (I 55) 9. Do you know the benefits of planning an elective cesarean delivery? (I 55) 157

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10. (I 55) 11. (I 55) 12. 1 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 158

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1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 13. 159

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17. Are you clear about the best choice for you? (C 55) 18. Do you feel sure about what to choose? (C 55) 19. Would this decision be easy for you to make? (C 55) 20. If the cost of an elective cesarean birth is $7,000 more than the cost of a vaginal birth ($18,000 instead of $11,000), and your family's bill (after insurance) might be $6,200 instead of $4,200, would it make a difference in your choice between a vaginal birth and cesarean birth? 21. Do you feel you have made an informed choice? (E 55) 22 Does your decision show what is important to you? (E 55) 23 Would you expect to stick with your decision? (E 55) 24 Did you have enough information to make the choice between attempting labor and planning a cesarean section for no medical reason? 25. What other information would have been useful in making this choice? 160

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27. 3 161 4 5

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b. g. 162

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Birth 163

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Choices Decision Dehefy Planned Vaginal Birth Bernett, being woman The title the Dehefy Planned The Bennett Colorado Denver CertJ'oed years last this study wIuntary also No the wiI whether not wit taking Birth Choices these UNo 164

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Birth Choices Survey. Decision Tool learn about like know, they order borth borth. the you to the the Healthy answer the made you tett that the thirty not an Phase, I has with particopation IlCIude but both vag ... UV.. U'" 165

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Birth Choices Survey. Decision Tool and birth, valuable maki1g between There may haYe noIlhought 01. youand odenIifiers your and !hem and which group, other identIter being faniIy Detwer, Colorado You haYe a being ., this study You noI haYe to this you noI I you haYe questions you may Penelope You ask any tine 00 you consent to taking the Birth Survey under these and Conditions? v v.. 166

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will be ilthe group lund Denver Colorado have being il this study do no! have be il this study ,you do want be you questJons you may and at time may have your rigtts study you have QUeStJons (Human Subtect n-runber By the you agreeilg to il this you you may BemeU v v.. V'" 167

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is UNo (,JV.. UNo UV.. (,J No 168

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select /he 1. 0 1 below, U 2 169 U to Wak. 1.,.-labor v to 10< labor

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select. that V Mother 0 2 MoIher U J Donl U Somewhat Mother U S

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r -, X about and answer \...' U 2 U J U VagnoI1S SOmewhat S 's

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wiI risks .. 172

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to pen is Penelope of of COIo ... of CoI
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____ be 3 some to and be to 174

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.. 175

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176

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177 Infection after

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Baby see some see a Do Costs! on 178

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on the answers What are the oulble wa Iv. birth? How likely 1m to hive nol'll!t1ll vaginll birth? How likely 1m to hive a ceslrean birth If have a healthy pregnancy? likely 1m to hne my labor induced If haye a healthy pregnancy? What kinds pain relief are available durlna labor or with a cesarean? en a a for ba It sslble to have a va Inal birth with a sea>nd? How many CUlI r .. HCtlons '-It safe 10 woman hllVe ? an! the possible ways to oive birth? VaoinaJ B i,,", : Molt women to expenence labor contracbons for several I.MltiI the cervoc, or op"'*'!l to uterus IS opened .".,.q, to vaginal borth IS rup heAp out bto that: unusual poSItIon I:esMean Birth : dloose to plan cesarean borth before labor b"ll'"s, subject this An borth oa:ur there soonofic:ant nsk to the the vaginal borth IS no 1on9'" a siJle opbon. These have Ioghe< "sits compIicabons one that planned. 179 the arrow are

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De!ivery What are the o".lbl. wa to ive birth? How IIke!y am baye a norma! yaa!na! b!rth? How likely am hlV. a cen,.an birth If have a healthy preananc:v1 How !ikely ilm hiVe my !abor induced if haye a healthy pregnancy? What kinds of pain r.Uef I. avallabl. during labor or with a cesa,.an 1 chOO6e a cesarean or m bib Is It osslble to have a va Inal birth with a second? How many cesarean MCl:lons It for WOman to haye? Will I ........ vaolnal to out of which that mot:her her her rnLISOAar and to push. to btrths I"",,,,,,, ound aJP baby' s head to heIo push the baby OIL 180 Do

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on to What are the o_sible wa s to ive birth? How likely im I to hive i oormal vaginal birth? How likely am to haye cesarean birth If have a healthy pregnancy? How likely am I to haye my labor induced if I have a healthy pregnancy? What kinds pain relief Is available during labor or with a cesarean? sslble to have a va Inal birth with a second? How many usarean sections Is It safe for a woman to haye? CUll Ito have a cesarean have a heatthy pregnancy without any complications? 24 100 healthy first btrth. of th
PAGE 195

How liketv am I to bay. namyl yaginal birth? How likely am to have a cesarean birth If have a healthy pregnancy? How likely am to have my labor induced If baye healthy pregnilncy? Inal birth with a second? How nYny cesarean It safe for a woman to hav.7 ___ How likely I Induced I heoltlly pregnoncy? 41 of 100 women are nduced with medlcabons as Pttoan or cervuil or treatments SIl'1ppInQ the rnembr.>nes '" brealano the of oa:ur the date than and IS that .. not and to the 182 Do the are

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to If Wbalkinds pain are during labor or with. cesarean? to sit on, Breatlwlo tednques, Musoc, etc ? short-.n p.....,.eduang throuoh anesthesia, medlod pain through bny back leos and abdomen nunb. 11 can be used n both vaoonal and cesarean btrths It own nslcs "","picabo". should only chosen after you 183 not c"c#c purpl. ilrrow until you

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Baby "'r.1 What kinds of oain relief I, AYiilabl. during labor or with a birth (ealed on recont report from the lnstJlutes oncouraged be to VIIAC. 184

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,. BOA T Windows Werre! Od What are the osslble wa 5 to av a no How likely am to haye a cesarean birth If hIVe a healthy pregnancy? How likely am to haye my labor Induced If have a healthy pregnancy' What kinds of pain relief is .".Uable during labor or with a cesarean? choose. cesarean for m first bib Is It nlble to have a va Inal birth with a second? How many cesarean sections safe for a woman to have? sediofts is woman to tS to births. risk of with havino of alter 185 Do nor to the

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Clid< 00 the "nd.r"ned topICS Back the hos ltal t optSlOtomv Of' deep tea<-. intedJon also cxxu-., the or bladde< partJo.br1y alter a labor bladder not click purpl. until you 186

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r 187

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188

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After Vagln,,1 Birth After Emergency Cesarean Birth 189

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WlrvJo S X the Infection Too much bjeedin Labor b;perieoc. Mother recovery Placenta roblems nut n"n Problem. w ith hunn Back to the ho. ItIIl pelyic floor Problem. links than pont ) after brth. A blood transfuston when IS IS of Afle, Vaolnal Birth : Bleedino occurs alter aI vaginal borths because the place where the placenta was attached to dot from the and after at be eftedJvety with perform to stop. 190 the .are to

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191

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192

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193 50 ees .. be 50

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&.d< 1>0. To view the risk information for all of these outcomes click here. Number Format Fi ure Format Chart Format n. WJthwl hospital after a or lonQer !her riant IS a_ed to the Speoal care ..... ery A _s recovery h"om the surgery IS dependero: on several cntena: I) her age. 2) her personal state of fitness, 3 ) help h"orn and mends. When all ooes smoothty, many women report bad< to normal between 4 6 weeks 194 to

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Vaginal Birth :3 195

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Eight out of 100 women report some pai n 2 months after a Vaginal Birth After a Vaginal B irth without major complications, nearl y all women feel tired and achy, but recover thei r energy w ithin a couple of days. Most women le;ave the hospital 1 to 2 days after birth 18 out of 100 women report some pain 2 months after a Planned Cesarean Birth After a Planned Cesarean Birth, most women stay 3 to 4 days in the hospital, or longer their infant is admitted to the Special Care Nursery (NICU) 196

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197 Eight out of 100 women report some pain 2 months atter a Vaginal Birth. After a Vaginal Birth without major complications, leave the hospital 1 to 2 days atter birth. 18 out of 100 women report some pain 2 months atter a Planned Cesarean Birth. admitted to the Special eare Nursery (NICU)

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Too much bl.edlng Mother'. recoy.ry Problems with h Ung Pelvic floor Labor bperjePCI Placenta problems with next prevuncy aack to the Click on on. or more of the IInu below to see the different Number format Figur. Format a..1t format Problems Healing after Vaginal Blrth: IS possibte for sbtches that .Ie reparbssue after an epesiotomy Of'" tear In the to more than a few heal, although It IS rare. yOU" muscles w. sore after brth. but usuafy these rebln normal Wltt'wl 1 2 weeks. Of'" cup he'P heaing t::af(e It IS there are more sbtches the rep""'. Problems with 1t IS possible fer IflCISIOfl on your become Infected Of'" heal. 1t IS possible for uterus become Infected. or a dot form but these 198

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with healing after Birth. .s poulble for stitches "_ded atter a t.ar or an eplalotomy to take extra tfme to heal, IIJthough It I. rare. Your joint. and will b. sore atter delivery, but uaually these return to normal within the flrst few Out 100 Ilk. eight women will have. problem with .tt.r Planned Cesar n Birth. poDibJ_ for the Incision on your abdomen to become Inf.cted or to slow to h 1. the will Infected, for dot form In your leg, but these complications ar. not 199

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Out of 100 women lik e you one woman will have problems with healing after a Vagina l IIlrth I s possible for stitches n_ed to repair a tear or an episiotomy to take extra time to heal, although I s rare. Out of 100 women like you eight women will have problems with healing after a Planned Cesarean IIlrth Is Infected or to be slow to heal. possible for the uterus to become Infected, or for a blood clot to form I n your leg, but thes. complications are not common 200

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201 ot problem healing alter a Vaginal SlrtII Out of 100 women Uke you, eight women wlllllave a problem witt! healing alter a Planned ees..",an SlrtII

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Too bleeding Problems with hHlinq Pelvic floor problems Placenta robl.ms next to the to nan 0unnQ barth penneum, sbl and is stTetdled to the to prevent. to speed the of Il t6 to rut that goes throuoh of in the "0 the musde and deal stJtdltnQ. Incontinence is the Ulintentional of for short alter tWth but most that not is diffiaJIt lItinet directly related to birth but do that t:ears not stTetdled both. IS still to with to factors -... sudl obesity. tS be Illite. 202 Do refJd'l to Millie

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will will 203

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I:: ::::::: : .......... 000000000 00000000 0000000 .......... (Mild Incontinence -leakage urine) Vaginal Birth 14 women out of 100 will report symptoms of Incontlnenc., or leakage urin., 6 months after II Vaginal 3. 100 will Incontinence., leakage of ur1ne, 6 month.l: anN. Vaginal Birth which required the a.sslstance forceps or vacuum .. Planned Cesarean B irth 5 women out of 100 will report symptom. of Incontinence. o r lukage of 6 204

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After Vaginal Birth After Assisted Vaginal Birth 205

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MJii Asked much bleeding Mother'. recovery w ith 't X Labor experience BlIck the hospital the of muc::h bteedWwJ controled IS but oc::cu'" aft:e:r etther bn:h but: w. not 206 ..

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BOA' W indo w s 'ntemel will 207

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x ___ 208 Risk of Hysterectomy After Vaginal Birth less than lout of every 100 women After Planned Cesarean Birth Slightly h igher, but still less than 1 out every 100 women

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209

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r -X on tho underl ined Placenta obloms with next To view the risk information for all of these outcomes click here. to large who had btrth wotllon the btrth like 86'!1o had an IV line 93'!1o had electronic I_I .-itoring 53'!1o had pltocln to streogthen 55'!1o had llleir mernbnones ruptured 30'110 ""'" narcotic pain noecrlGltions through an IV 63'110 had epidural _hesia lor pain 7'110 needed help""'" ........... 0Ip birth 3'110 needed help lrom lorceps during birth 27'110 on episiotomy 71'110 walk arocmd labor due to "being connected to things" .. Do not purple arrow until you 210

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ad topICS Infection Problems with .... lin Pe!Yic lloor problems Hyatuectom y Llbor Experience Placenta problems with pregnancy th. he.plt.1 Figure Fonnat Chart Future Problems with lhe placenta IS the organ whdl grows on the lns lde well of the uterus connetts the mother with body. The Its" the the IS pushed out. Abnonnal but oc:as birth placenta must wal with Sl6Q1CaI c:Iiffic:tA for new placenta to the the ceNix (placenta PfO'ia ). the openinQ with 211 ..

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a 212

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About one woman out 100 will have. placentil previ. or placantill abruptlon In .. These are serious complications for a future pregnancy About two women out of 100 will have a placenta The risk Increases with each cesarun that you have These are serious complications for pregnancy

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BOA I UPOfeJ 214 Birth, will

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to ita' To view the risk information for all of these outcomes c:lick here. Back to dedJon '" 0< is to them to to 0( dots '" their legs 0< that deep VI!S'I octU' ., pregnancy bnh, and but complication that being re-_ the dots ., to the Iunos and embolism ( PE) wl-.ch 215

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216

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to to 217

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218

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219

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the topICS Infant breathing problems Impact on Breastfeeding Injury to Infant' s Arm To v iew the r isk information for all these outcomes d ick ben:, ClIck of the Number Format Figure Format Chart Format Baby Baby the modl.,.... bono Its UloS ftuid of .... Tran5IeI1t tadlypnea of (TTN) means is mild breathino. problem. !MY placed on a ventiator os out Ulos wtw:h baby to both. alter of BreM:lwlo of due 220 Do you ,...dy

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221

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222

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be to

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lor Mother for Baby Benefits Injury to Infant's Injury to Infant'. Brain To y lew risk Information for all outcomes dick to the _ts. Number Format Agure Format Chart Format Breostteedlng olter ViIlIl""1 Birth : BeinQ able to put til e Baby to breast very soon after borth has been shown to "",ease tile ike!ihood successfu l b reastfeedino beyond tile first wee!<. .Iter Cesorean: birth do"" prevent breastfeeding, .... babtes are seoar.Jted !.-om tiler several hours nQht borth due to concerns with mother's recovery !.-om anesthesia and p..., contToi. PIaano an rIant on tile moIher's abdomen to br_ alter suroerv pairlul maIonQ !.-eQUent early ntr5IIlQ more diffiaJt. most hospttals Ia
PAGE 238

On average, 68 women out of 100 plan to breastfeed before a Vaginal Birth, and 61 women are successfully breastfeeding one week after the birth On average, 63 women out of 100 plan to breastfeed before a Cesarean Birth, and 52 women are breastfeedlng one week after the birth Infants ilre often sepllrated from their mothers In the hours -'ler ce"areiln birth. During the few dilYs ph,clng lin Infant on the mother's abdomen is very painful, making the establishment of breastfeedlng more d i fficult. Once past these barriers, most mothers who desire to breilstfeed after a cesarean birth lire able to very successfully

PAGE 239

More women decide not to breutfeed after a Cesarean Birth than after a Vaginal Birth

PAGE 240

Injury to Infant' s Arm Injury to Infant's Brain To yiew the risk information for all these outcomes dick here, Number Format Injury w""t's The bone Rarely ttle ttle

PAGE 241

Brachial Plexus Injury (Brachial Plexus Injury) to Vaginal Birth to Planned Cesarean Birth

PAGE 242

,. BUA I Wwdows Upforer Out of 100 babies, less than one will have an injury to the nerves in their arm and shoulder that does not heal within a few days after a Vaginal Birth. The risk is actually 2 out of 1,000 babies, a very small number Out of 100 babies, less than one will have an injury to the nerves in their arm and shoulder that does not heal within a few days after a Planned Cesarean Birth. The risk i s actually 6 out of 10,000 babies, an even smaller number than after a Vaginal Birth. 229

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230 Out of 100 babies, less than one will have an injury to the nerves in their arm and shoulder that does not heal within a few day_ after a Vaginal Birth. The risk is actually 2 out of 1,000 babies, a very small number. Out of 100 babies, less than one will have an injury to the nerves In their arm and shoulder that does not heal within a few days after a Planned Cesarean Birth. The risk i s actually 6 out of 10,000 babies, an even smaller number than after a Vaginal Birth.

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Infant breathi ng problems Injury to Infant's Ann Injury to Infant' s Bra i n To view the risk In'onnatlon for all these outcomes dick here. Number Format Figure Form .. t Chart Format Infanr. Brain.: A "en.ous system oxygen to braWl du1ng AItH neuroloQical to babies pregnancy. due to a genetic condition an labor and ife-savlllQ 231 ..

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Injury to an Infant's Brain to 232

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Injury to an Infant's Brain will will 233

PAGE 247

__ Injury to an Infant's Brain 13 out 10,000 Of' 1 ,000 Ces;tntan Birth: 15 out 0' 10,000 b01bles 234

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235

PAGE 249

fO( ClIck 00 underl ined topics Va inal Birth Elective Cesarean Section Practiaol and SocIal Benefits of Vaginal much I>nh, hospotal to the hospotal for problems, few .. do the I>nh. After play old ... cU1no this penod Emotional Benerrts: the natlX
PAGE 250

on topics Vaginal Birth Eled:ive Cesarean Section Pnoctical Social 01 Cesareatl Birth: IS sdledule plarned deIive
PAGE 251

r Costs Is cost of birth ? cost of 1) costs lor Mother dunrJQ !abo< and one two after b irth. 2) costs for alter the for the or two the of and eptcUal. the phySlOall. and the tHrth .. u..

PAGE 252

for Baby Non-Medical for What is i ncluded In the o the surgery and for the J to 4 days she usually spends III tile hospital tile birth. 2 ) hospttal costs for tile Bab y alter the borth. and for the J to 4 day S the Baby usually spends on tile hospital tile birth tile cost of tile operating room and .'Sbu,,,rts. and anestheSIa needed during tile surgery and alter tile birth 4) tile fee for tile surgeon and the as_ to the .... geon. and S) tile fee for tile anestl1estOiogost. 239 not until

PAGE 253

Olck on underlined quest:ioM answers. Wblt i s jnduded in the C05t I vaginal deliyeryZ of Vaginal Birth: avtl!rag& cost of an unc:omphated vaginal I n th. u s ts about 57,000 f M the hospital of Mother and Baby. plus 53.000 midWfe or physician. Anest:t..si a may add another $1000 the tot.1 cost. making to $11,000 to have an uncomplotad vaginal birth \'Cth .. ptdu .... 1 anesthesi a Birth: T h e cost an uncompltcaU!!d bwth in u s ;. .bout $ 14,000 for the hospibll costs of Mothe.and Baby. plus $3,000 for tht! physicia n.. add anothe$1000 the tobIl cost. making to S 1 8 ,OOO to an uncompU c:;ated elective Do IICJt diet ",. purp..rrow ,ou ... to ,...,.. the JnIo.5ectJDn,.

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Asked dlde the quesbons for answers Cli c k on the link below to see the information displayed In a figure. Average diHerence in cost between cesarean and vaginal b irth ::: $1,000 out of $523 $6200 type .. not did Ute p4HJ1Ie .rraw ruu .,.. to ,.".. the 241

PAGE 255

= an =

PAGE 256

on the 243 .. 00 not

PAGE 257

Non-Medical the body that irtections. not ctJcIr I'Ndy

PAGE 258

for Baby Apgar: The condition at alter birth. By the bf'eatIwlo, color stJrrUi, t helps the to be _ed 245

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Non-Medical on the Labor. tlYOUQh drip the frequency contracIJon. to help labor to proQI"e&S. .. 00 ,..",., Cn"" ',. '. 246

PAGE 260

for on the labor exh little cenbmeter. diameter enouQh that btrth canal be born. .. 247

PAGE 261

for Baby 0f1 the m
PAGE 262

Emergency Cesarean Delivery Episiotomy Emergency Cesorean Section : This IS whdlls planned. can take place before or after labor mmmences. It not necessariy mean that is the land of emergency that must happen very because the or baby .. 00 nor purple anvw you .,.. to leaw Sedfon. 249

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the Emergency Cesarean Deljyery Episiotomy a..c: made at: the of the vaowaa the the of the with but is needed when mothe<"s ... e pusfwwJ ot.C: theer baby asSIStance. 250 00 arrow rou .,.. to SectIon.

PAGE 264

on the abdomen, connected by stTetI:hy bob, Of" can be gently attadled to the baby' s WlSIde the uterus. .. dicit until rNdy 251

PAGE 265

for d i ck 00 the underl i ned /etters Forceps: which and gently t .. u"tJl 252

PAGE 266

on the Induction of Labor oper.obon the uterus IS removed PreQnancy IS no longer possible alter a hysterecmmy 253 Do not rNdy

PAGE 267

on the Involuntary lealang of unne 0< feces Induction of Labor Do not dldt pUl"ple

PAGE 268

for Cosls on the Induction t.-= Inducing labor st3rtJnO labor can brealano the gel the medication pitoal IS situatJon .. elicit PUlJlIe urrtJl to 255

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on the women, on SEttInQs TNdy Info

PAGE 270

on Obstetrida.: not dkIc ,..tty '.. __ .. ,-; ,;:,., .. :" 257

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on the underl i ned letters A 11 and putp" rHdy

PAGE 272

for Baby The sian tissues and musde. between the and the anus 259

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the Placenta: the to the mother and that and nutnents for .. 00 nor hMn 260

PAGE 274

Baby Non-MedJC31 second Stage 01 the G-I SOU Second stage begons when the CervIX 0< openng to the IS dilated (loan). Dumg this stage, the the ... ge to push the thnxJQh the I>rth canal. stage IS with the I>rth the 261 00 not elicit until

PAGE 275

the This is birth 00 not until you.,.. ,...dy ...nt, __

PAGE 276

for Baby The medical term fOJ" womb. Do not until you.,. Into !lI... -... ?-.' .. ". ; ', '.. .::- #',,' :-,:

PAGE 277

!of Baby on Vaginal Birth After Cesarean birth after in deivery, or deivery with forceps or 264 Do "ot to 1M .. SectJon.

PAGE 278

U 2 V 3 U ...J S

PAGE 279

s CesiJreiln 8Jrth (). ....,2 V J V '-' 5 EIeaM! 266

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eM 2 V V SOmewh.Jt .. 267 U S IS Safest

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(). c:es.rean s.fest 7. In your opinion, which is safer for the BABY Vaginal Birth or Cesarean Birth? ",2 U3 v -Is Somewhar 268

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(). U u s 0 (j2 (j3 U ..

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10. V 2 V l V U S 11. Yes V Prob.JbIy V 2 V l Prob.JbIy V 5

PAGE 284

the V V 2 V 3 V U 5 U 6 01 U v U '0 .ttar a vaginal birth? V U 2 U 3 V U 5 V 6 V 1 U U '0 aftar a caaar .. n7 c.. the V U 2 V l V V V 1 V v V'O hvo birth.? d Knowlnll tne needed for v 2 V 3 v U S U 6 U 1 U v U'O ..-y hom.? "by aft.r V U 2 U 3 V V U 1 V v V'O birth? 271

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to U l U 2 U 3 U U ",6 0 7 06 u S 10 birth? g. during U 2 ....,3 1.)' U U 6 07 '8 '-S ..J 10 1.)1 1.)2 U J U 1.) U 6 U 7 0 8 S U 10 1.)1 U 2 U ) U U 0 6 1.)7 U 8 U U 10 .. 272

PAGE 286

12(3). Using a scale of 1 (not at all important to me) to 10 (extremely important to me) how important were Itlese factors when you chose between Vag inal and Cesarean in the previous questions? J Cone.,." about what I U U 2 3 V V U V ''') U for a ca.arean or vagina l birth? k Concern about: the tobl co_ V V 2 ..,) U V V .,)7 V v V to the ...... car-...,.t.em or cesa .... n or ",-u'nal the U U 2 ..,) 3 U ..), U V U U U baby' phyalclan U U 2 .,), V U v .,) U U U t 'or vaginal or <:ewarean blnhl' 273

PAGE 287

0Iher 274

PAGE 288

v v u v ...Il 275 '-' ...I' No

PAGE 289

v U 2 U J v V 2 V J V V 2 V J V V 2 (.J J 276 v V 5 V '-' 5 V 0 5 U U5 ..

PAGE 290

V U l 277 U

PAGE 291

U 02 V V \)2 U V V V S .JS U U 2 U 278 U U S

PAGE 292

279

PAGE 293

280

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BOA' W Indo w s lxpIorer 1IIr:i ., x GoogIo __ U 18 years to 24 years old V b 25 years to 29 years old V c. 30 years to 34 years old d. 35 years to 39 years old CJ 40 44 old a African U Caucasian/White c. 281 V In the United States

PAGE 295

lxpiOf1:'f 0 V <04V e 31. do V e city V 32. ve V

PAGE 296

birth? U U d Three or more 34. What type of b irths have you experienced ? v c: d U U U v c.

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U v 4 \..j 1 10 11 15 16 20 21 2S v 1..19 U v \... 31 35 36 40 41 to 45 to min 284

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PAGE 299

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F'90 13001 1711 R_ Nll1. ........ Cd:InD> Th. ",,101 c._ProventionCeoter Certificate of Approval 303.714105, [Phon.1 303.1240990 ""'st.edulcomilb (Webl """ilb@ucdonve, [E.uoill fWAOOOC5070 [FWAI foIowing: from NOles to PI: Pilot is approved. 2. The advenisemcnt for Phase 2 is removed. Alier Ihe pilot. will submit change rorm wilh revised from Harris Interactive. may nol proceed with Phase unlillhe lIarris advertiscmenl is approved. Approl'allncludes: Annt;r,,;nn fnr Prnlnrnl R,v;PIV v 01/10/11

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C

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L. I., L. J. L., c., L.

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c., http://www.hsl.virginia.edu/historical/artifacts/antiqualhippocrates.cfm http://\\ww.hsl.virginia.edu/historicallartifacts/antiqualwomen.cfm J. C. c., c., J. L.,

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c., L., L., J., c., J. L.

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J. M., 0., J., L., E. http://www

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L. L., 6. c., L., L.,

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L., (2001). 765-769. C. (2007). 65. (2006). (2007). (2009). (2003). 348(10), 946. C. L., I., (2007). 334(7607), 1305. (2004). (2009). 54(5), 373. (2000). 321 291

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10, 2010). 20, 2010, (2010). (2006). 23(1) 1-29. (1995). 15(1), 25-30. L., (2009). (2006). 20, 2010, (2010). 29,2010, (2006). 174, 1109-1113. (1999). 6, 259-268. (2006). 505. J., J., (2007). 27, 575. 292

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L., J., J. # J. J. c.,

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c., (2008). 35, 361. (1982). (2009). (2005). 312-317. (2009). 360:2. 111-120. (1999). 341,1709-1714. c., (2008). 115, 1494. (2009). OS/20, 2010, http://www.cebm.net/index.aspx?o=1025 L., L. (2006) L. 2010. 294

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601. J. J L., J, 04/01/2011. http://dx.doi.orgIl0.4108I1CSTPERVASIVEHEAL TH2010. 8859 J. 35, 591. 295