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Try out PMC Labs and tell us what you think. Learn More. One hundred six women who had unplanned cesarean deliveries and delivered live, full-term neonates. Seven women reported no concerns at both data points. The of physiologic concerns that the women expressed decreased markedly from 2 to 8 weeks postdelivery, but the of psychologic and life-style concerns did not.
These findings reinforce the need for prenatal teaching and postnatal follow-up regarding these concerns. One in four women who gives birth in the United States does so by cesarean delivery, making cesarean section the most common hospital surgical procedure Stafford, Inhealth-care providers performedcesarean deliveries, one-third of them repeat procedures. The American College of Obstetricians and Gynecologists in, and repeated and further defined this recommendation Marieskind, Cesarean delivery is not benign.
Cesarean birth adds additional stress, including the stress of Women want sex Brooten. Lengthened hospitalization caused by such infections can make the mother more vulnerable to both physiologic and psychosocial concerns, including nosocomial infection, depression, and anxiety. Researchers have reported a variety of maternal psychologic responses to cesarean birth.
Trowell reported increased anxiety in women who experience cesarean deliveries.
Walker reported similar findings. An unplanned, emergency cesarean delivery can be especially stressful.
In sum, the current rate of cesarean delivery in the United States remains high. Numerous investigators have reported physiologic and psychologic stresses accompanying cesarean birth; however, the researchers conducted most of this work in the late s and early s. The purpose of the current study was to determine the major physiologic, psychosocial, and life-style concerns women report today at two points in time: 2 weeks and 8 weeks after an unplanned cesarean delivery. The researchers chose the 2-week data point because that is a time of known stress and letdown as family Women want sex Brooten diminish and mothers assume a greater role in caring for the newborn, themselves, and the house-hold.
The researchers chose the 8-week data point because normal postpartum physiologic recovery is expected by that time.
The interview, conducted by telephone, consisted of three open-ended questions. The questions were: What are your major physical concerns at this time following your cesarean delivery? What are your major psychologic concerns at this time following your cesarean delivery?
What are your major life-style concerns at this time following your cesarean delivery? The likelihood that the incidence of cesarean delivery will remain ificant makes care of women who deliver by cesarean section a major focus of perinatal nursing. The interviews lasted a mean of 15 minutes, with a range of 10—20 minutes. The researchers collected data between July and January The larger study, of which the current study was a part, was a randomized clinical trial of early hospital discharge for women who experienced unplanned cesarean delivery.
Women participated in Women want sex Brooten study after receiving a thorough explanation of it and ing an informed consent form. Four subjects chose not to respond to this portion of the larger study. All the women delivered full-term, live neonates at a large urban hospital affiliated with a major university. The mean age of the mothers was Of the subjects, 7 reported no concerns at both the 2-week and 8-week data points.
Of the remaining 99 women, 8 reported no concerns at 2 weeks but did report concerns at 8 weeks; and 34 reported no concerns at 8 weeks, but reported concerns at 2 weeks. Because considerable overlap occurred in the responses to the psychologic and life-style concerns questions, the researchers combined the responses to these two questions in reporting the data. Because most women reported more than one concern, the researchers discuss the as a percentage of total reported concerns.
The women reported the most physiologic concerns at the 2-week postdelivery data point and markedly fewer by the 8-week data point see Table 1. At 2 weeks postdelivery, the concerns reported most frequently were pain, incisional problems, activity intolerance, fatigue, and gastrointestinal disturbances. The researchers included concerns regarding pain in this category only if the women mentioned pain and discomfort as opposed to tenderness or similar sensations. At 2 weeks postdelivery, 20 subjects reported concerns with activity intolerance, including getting out of bed and walking, bending, lifting, handling the newborn, not being able to take a bath, and not Women want sex Brooten able to do everything the subjects wanted to do.
Fifteen subjects reported concerns with fatigue, including lack of sleep. Gastrointestinal disturbances included complaints of gas, vomiting, and intolerance to certain foods.
Two subjects complained of breast engorgement, and two complained of nipple Women want sex Brooten. The major physiologic concerns at Women want sex Brooten weeks were pain, incisional problems, and activity intolerance; at 8 weeks, incisional problems, pain, and fatigue. Women complained of numbness of the incision, pulling and itching, and tenderness around the incision.
Seven subjects complained of pain at 8 weeks postdelivery, and six still reported concerns with fatigue. Compared to the total reported physiologic concerns, which decreased markedly at 8 weeks, the total reported psychologic and life-style concerns differed less at the 2- and 8-week data points. As with the physiologic concerns, however, the types of concerns changed between the 2-week and 8-week data points.
This category included complaints of being limited in activity, not feeling like entertaining visitors, not being able to get out, taking too long to feel better, having trouble getting organized, and being tied to the house. This was described as feeling blue, feeling low, just not feeling like themselves, feeling alone and bored, and feeling emotionally overwhelmed. These concerns related to getting upset when the newborn cried, having problems feeding the newborn, and feeling that life was all mothering.
The major psychologic and life-style concerns at 2 weeks were changes in activity, depression, and concerns related to family interactions; at 8 weeks, changes in activity, body image, and family interactions. These concerns included reports of having less time for socializing, being housebound, being much busier, taking longer to do things, being bored when the infant slept, and having less time for oneself.
The concerns here focused on weight gain and abdominal stretching. This category included planning future educational goals, worrying about becoming pregnant again too soon, reexamining returning to work, and not liking to leave the infant to go back to work.
The researchers received only 5 reports of depression at 8 weeks postdelivery, compared with 17 at the 2-week data point. The study support, in part, findings of work. The total reported physiologic concerns were slightly fewer than the total reported psychologic and life-style concerns The reported data also made clear that overall physical concerns decreased markedly from the 2nd week postdelivery, whereas psychologic and life-style concerns did not.
Concerns with pain, which were the most frequently reported concerns at 2 weeks after cesarean delivery in this study, were an area of concern identified ly by Affonso and Stichler in a similar sample. In the current study, incisional concerns ranked as the two and one physiologic concerns at the 2- and 8-week data points, respectively. Activity intolerance, the third most frequently expressed concern at the 2-week data point, was much less problematic at 8 weeks postdelivery.
Fatigue also was an important concern at 2 Women want sex Brooten postdelivery but was less problematic at the 8-week data point. This finding supports the work of Tulman and Fawcettand Tulman, Fawcett, Groblewski, and Silvermanwho reported that while women who have cesarean deliveries experience lessening fatigue as time progresses, these women still are not fully recovered at 6 months postdelivery.
studies have identified such psychologic and life-style concerns as depression, changed activity patterns, fatigue, and work-related concerns in association with cesarean delivery. In the current study, concerns about changed activity patterns were the major psychologic concerns at both the 2- and 8-week data points.
These findings support the work of Tulman and Fawcett mentioned ly. Depression, the second-ranking concern at 2 weeks postdelivery in this study, also was reported as problematic by Tilden and Lipson in their study of women that extended 2 years postdelivery. Those findings indicated that a cesarean birth for many women was a negative experience causing emotions Women want sex Brooten from disappointment to serious postpartum depression.
Cohenwho interviewed women in postcesarean delivery support groups, found unexpected cesarean deliveries to be associated with increased reports of depression. Concerns with changes in family relationships, which ranked as the third concern at 2 and 8 weeks in this study, also were reported to be concerns by Affonso and Stichler in their sample taken at 2—4 days postdelivery.
In a later study, Affonso, Mayberry, and Sheptak found similar concerns at 6 weeks postpartum. Concerns about body image changes ranked fourth at the 2-week data point and second at 8 weeks.
Child-care concerns ranked fifth at 2 and 8 weeks. These studies reported data from 3 days postdelivery to 1 year postdelivery. Work and school-related concerns were more problematic at the 8-week data point than at the 2-week data point. Gardner and Campbell also discussed the economic pressure to return to work as a stress factor in a group of postpartum women followed between 2 days and 6 weeks postpartum.
Killien reported working during pregnancy and returning to work after delivery as both a psychologic stressor and an asset. Decreased lengths of stay necessitate providing anticipatory guidance related to these concerns during both the antepartum and postpartum periods.
These study findings have clear implications for child-birth classes and for discharge teaching for women and couples. Today women are being discharged from the hospital earlier than ever before. Each interaction with the postpartum woman should have specific teaching and learning goals because often the woman will be discharged according to externally applied criteria e. Therefore, the nurse must assure that the woman and family are prepared for discharge. Both the prenatal and postdelivery periods are needed to prepare the woman and family adequately for recovery and parenting.
Methods to accomplish this teaching can include pamphlets, videos in the postpartum unit, audiocassettes, and postpartum follow-up calls. Fawcett developed a pamphlet that focused on cesarean delivery and was incorporated into the teaching materials of prenatal classes. Discussions of the pamphlet near the end of the classes, combined with postdelivery phone calls, helped the women and families integrate the cesarean experience. On the basis of the study findings, specific information about the incision, pain and discomfort, body image changes, and changes in Women want sex Brooten interactions should be included in prenatal classes.
Explanations about the process of returning to the nonpregnant state should be Women want sex Brooten at this time, along with information on all the changes the woman will experience as her pregnancy advances.
Women need to learn that the discomfort associated with the healing incision pain, tingling, numbness, tenderness, and abdominal muscle flabbiness may take months to be resolved. The ability to move quickly and easily will return gradually. Fatigue, and often feelings of inadequacy related to caring for the new infant and other members of the family, also will take time to resolve. Encouraging exercises, such as walking, during pregnancy will increase muscle tone and potentially improve post-partum healing so that incisional concerns maybe less problematic. Realistic expectations of the healing process should be emphasized.Women want sex Brooten
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