Intensive care nurses' experiences of infants and partners' presence on the postoperative ward after an emergency caesarean section; An interview study.

It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. OBJECTIVE: To investigate the intensive care nurses' experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. DESIGN: Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. SETTING: The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. RESULT: The analysis yields the theme 'The challenges of caring for infants on a postoperative unit' covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant.

Indications for operative delivery between 1999-2010 and induction of labor and epidural analgesia on the risk of operative delivery--a population based Swedish register study.

OBJECTIVES: The aim of this study was to describe the distribution of indications for vacuum extraction (VE) and emergency cesarean section (EMCS) from 1999 to 2010. Furthermore, we investigated the association of induction of labor and epidural analgesia (EA) on the risk of operative delivery. STUDY DESIGN: Population based register study with data from the Swedish Medical Birth Register during 1999-2010 including all 415230 primiparous women giving birth in gestational week 37+0 to 41+6. MAIN OUTCOME MEASURES: Indication for operative delivery as well as VE and EMCS. RESULTS: Among the VE deliveries the indication "signs of fetal distress" increased while "multiple indications" decreased. For EMCS, "prolonged labor" increased steadily while "multiple indications" decreased. The total rate of induction of labor increased from 8.2% in 1999 to 11.9% in 2010, and was associated with an increased risk of both EMCS (OR 3.37) and VE (OR 1.5). The total rate of EA increased from 43.7% in 1999 to 49.8% in 2010, and was associated with a double risk for VE (OR=2.23) and with an increased risk of EMCS (OR=1.64). CONCLUSION: There have been changes in the distribution of indications for VE and EMCS during the study period. A growing number of mothers are being induced and more mothers receive EA. These factors seem to have influenced the rate of operative deliveries. Our findings underline the importance of carefully considering the advantages, disadvantages and risks with EA and induction of labor.