JOINT LAXITY, LOCUS OF CONTROL AND CAESAREAN BIRTH

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JOINT LAXITY, LOCUS OF CONTROL AND CAESAREAN BIRTH

• Alice H. Poe, CNM, DSN, FACNM
• University of Florida
• College of Nursing

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Birth

• Birth is as old as time
• Birth traditions vary by culture and belief
  systems
• Birth naturally occurs vaginally
• Pregnancy and birth are times of change,
  introspection, looking toward the future and
  planning for the expected new family member

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Caesarean Birth

• May be planned or unplanned
• May be a life-saving operation for mother and/or
  infant
• Has inherent serious risks for both mother and/or
  infant
• Access varies by country, locale and the
  expertise of health care personnel

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Caesarean Birth Trends

• For many years, women of means in South America
  have chosen Caesarean birth in an effort to
  save their birth canal from stretching
• In the United States, the option for Caesarean
  birth by maternal choice rather than medical need
  has become more prevalent
• In the United States, the number of Caesarean
  births (planned and unplanned) has increased
  significantly over the past 5-10 years

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www.who.int/ features/2003/04b/en/
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• Women in developing countries may not have a
  choice regarding a Caesarean birth
• Remote communities may confront
• Lack of ready communication access
• Lack of ready travel ability
• Lack of skilled providers for a Caesarean birth
• Belief system in opposition to Caesarean birth

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Caesarean Birth Risks

• Maternal mortality rate for Caesarean birth is as
  much as five (5) times higher than for vaginal
  birth
• Maternal mortality rate for Caesarean birth
  doubles with an emergency or unanticipated
  Caesarean

Jackson Patterson-Brown, 2001
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Caesarean Birth Risks

• The complication rate for emergency Caesarean
  birth (23.4) is much higher than for a planned
  Caesarean birth (7.4) (p lt0.001)
• Comparison statistical data for developing
  countries were not found

Van Ham, van Dongen Mulder, 1997
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Comparing Risks of Vaginal and Caesarean Birth

• The Maternity Center Association (MCA) conducted
  a systematic review of over 300 research reports
  using the Oxford Centre for Evidence-based
  Medicine Research Grading System
• Core Question What adverse outcomes differ
  between Caesarean and vaginal birth?

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Core Question Comparisons

• The core question was posed to consider three (3)
  comparisons as risks may vary
• Caesarean or vaginal overall
• Planned or unplanned Caesarean
• Spontaneous or instrumental vaginal birth

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Overall Results

• Results strongly favor vaginal birth
• Overall, spontaneous vaginal birth is associated
  with the fewest risks

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Major Overall Finding

• Vaginal birth is far safer overall for mothers
  and babies than instrumental vaginal birth and
  planned or unplanned Caesarean birth

Presented at the American College of
Nurse-Midwives 50th Annual Meeting, Washington,
DC, June 12, 2005 by Carol Sakala, PhD, MSPH and
Maureen P. Corry, MPH, Maternity Center
Association
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Aim of the Current Study

• This study was to identify potential predictors
  of Caesarean birth in women who were between 36
  and 42 weeks gestation with a single infant in
  cephalic presentation
• Participants (ages 14-36 years) were healthy and
  had no evidence of chronic or genetic disorders
  that would interfere with normal birth or cause
  other than normal tissue stretching

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Long Term Goal

• To decrease the risk of maternal and infant
  mortality and morbidity

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Rationale

• Women who deliver with an intact birth canal
  experience fewer sequelae from birth and return
  to a healthy state more quickly than all others

Eason et al., 2000 Klein et al., 1992
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• Infants who experience labor prior to birth have
  less difficulty with respiratory distress
  syndrome than those who never experience labor

Wagner, 2000
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Benefits to Vaginal Birth

• A normal vaginal birth with a normal term infant
  enhances
• Postpartum recovery
• Breastfeeding
• Bonding
• Positive feelings regarding the birth

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Rationale

• The likelihood of a normal birth or the need for
  an interventive birth allows for advance
  preparation in case the interventive birth is
  required
• Preparation for a possible intervention should
  result in a better outcome for both mother and
  infant

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Benefits to Preparation

• The mother may be in the optimum place for birth
  prior to labor
• The mother may have any required medical tests
  that will improve her outcome in advance
• The optimum delivery personnel may be available
• The optimum newborn personnel may be available
• The family may be prepared to care for the mother
  as needed

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Outcome Variables

• Joint Laxity
• Measured by the Carter-Wilkinson criteria (1964)
  as revised by Beighton et al. (1973)
• Three joints that are lax determines that the
  individual has joint laxity
• Measured with a goniometer

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Outcome Variables

• Locus of Control
• measured by the Pregnancy Attitude Index
  developed by OConnell (1983)
• three scales measure locus of control by powerful
  others, chance, and internality
• the overall score determines if one scale is
  dominant

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Data Collection Points

• Initial contact
• Explanation of the study
• Informed consent if the mother desires to
  participate
• Measure joint laxity
• Measure locus of control
• Complete demographic data form

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Data Collection Points

• Day of Delivery
• Measure joint laxity
• Complete labor and birth data form

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Data Collection Points

• First Postpartum Day
• Measure joint laxity
• Present baby shirt to baby
• Thank the mother for her assistance in this study

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Demographic Data

• Sample
• Subjects enrolled
  237
• Subjects completing all data collection
  233
• Primigravidae in sample
  76
• Multigravidae in sample
  157
• Subjects by color Of Color
  152
• Not Of Color
  85

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Demographic Data

• Number of Spontaneous Vaginal Births
• Of Color 123
• Not Of Color 69
• Total Spontaneous Births 192
• Number of Births with an Intervention (Forceps,
  Vacuum, Caesarean)
• Of Color 29
• Not Of Color 16
• Total Intervention Births 45

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Findings

• No significant differences were found between
  spontaneous, instrumental or Caesarean birth
  groups when compared for educational level,
  income level or ethnicity

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Locus of Control

• No significant differences were found between
  spontaneous, instrumental or Caesarean birth
  groups when compared by individual scale scores
  on the Pregnancy Attitude Index for locus of
  control
• Powerful Others Scale p0.1864
• Internal Scale p0.9325
• Chance Scale p0.7669

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Findings

• No significant differences were found between
  spontaneous, instrumental or Caesarean birth
  groups when compared by the total score on the
  Pregnancy Attitude Index for locus of control
  (p0.6453)

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Joint Laxity

• Mothers who experienced an instrumental birth had
  significantly less joint laxity than mothers who
  had a spontaneous birth (p0.0194)

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Findings

• Mothers who experienced Caesarean births failed
  to reach significance (for less joint laxity)
  when compared with mothers who had spontaneous
  births (p0.0582)
• Note the number of Caesarean births failed to
  reach the number required by power analysis
  (n29) during the study period

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Findings

• For all birth groups, a significant difference
  was found between prenatal joint laxity and joint
  laxity on the day of birth (p0.0172)
• For all birth groups, a significant difference
  was found between joint laxity on day of birth
  and the first postpartum day (p0.0498)

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Discussion

• This is the second study to find a significant
  relationship between delivery mode and prenatal
  joint laxity (Poe, 2002). This warrants further
  investigation in larger and more diverse
  populations.

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Conclusion

• A method to assist decision making by the mother
  and her health care provider regarding the
  possible need for intervention with the birth
  should result in improved outcomes for both
  mother and infant.

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• Questions?