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After surgery: the effects of life-saving caesarean sections in Burkina Faso

BACKGROUND: In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving...

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Autores principales: Filippi, Véronique, Ganaba, Rasmané, Calvert, Clara, Murray, Susan F., Storeng, Katerini T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688946/
https://www.ncbi.nlm.nih.gov/pubmed/26694035
http://dx.doi.org/10.1186/s12884-015-0778-7
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author Filippi, Véronique
Ganaba, Rasmané
Calvert, Clara
Murray, Susan F.
Storeng, Katerini T.
author_facet Filippi, Véronique
Ganaba, Rasmané
Calvert, Clara
Murray, Susan F.
Storeng, Katerini T.
author_sort Filippi, Véronique
collection PubMed
description BACKGROUND: In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso. METHODS: We conducted a 4 year prospective cohort study of women and their babies using mixed methods. The quantitative sample was selected in seven hospitals and included 950 women: 100 women with a caesarean section associated with near-miss complication (life-saving caesareans); 173 women with a vaginal birth associated with near-miss complication; and 677 women with uncomplicated vaginal childbirth. Structured interviews were conducted at 3 months, 6 months, 12 months and 3 and 4 years postpartum. These were supplemented by medical record data on delivery and physical examinations at 6 and 12 months postpartum. The lives and experiences of 21 women were documented ethnographically. Data were analysed with multivariable logistic regressions, using survival analysis and thematic analysis. RESULTS: The physical effects of life-saving caesareans appeared to be similar to women who had an uncomplicated childbirth, although 55 % of women with life-saving caesareans had another caesarean in their next pregnancy. The negative effects were generally economic, social and reproductive when compared to vaginal births, including increased debts (AOR = 3.91 (1.46–10.48) and sexual violence (AOR = 4.71 (1.04–21.3)) and lower fertility (AOR = 0.44 (0.24–0.80)) 4 years after life-saving caesareans. In the short and medium term, women with life-saving caesareans appeared to suffer increased psychological distress compared to uncomplicated births. They were more likely to use contraceptives (AOR = 5.95 (1.53–23.06); 3 months). Mortality of the index child was increased in both near-miss groups, independent of delivery mode. Ethnographic data suggest that these consequences are significant for Burkinabe women, whose well-being and social standing are mostly determined by their fertility, marriage strength and family links. CONCLUSIONS: Life-saving caesareans have broad consequences beyond clinical sequelae. The recent policy to subsidise emergency obstetric care costs implemented in Burkina Faso should help avoid the majority of catastrophic costs, shown to be problematic for women undergoing emergency caesarean section.
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spelling pubmed-46889462015-12-24 After surgery: the effects of life-saving caesarean sections in Burkina Faso Filippi, Véronique Ganaba, Rasmané Calvert, Clara Murray, Susan F. Storeng, Katerini T. BMC Pregnancy Childbirth Research Article BACKGROUND: In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso. METHODS: We conducted a 4 year prospective cohort study of women and their babies using mixed methods. The quantitative sample was selected in seven hospitals and included 950 women: 100 women with a caesarean section associated with near-miss complication (life-saving caesareans); 173 women with a vaginal birth associated with near-miss complication; and 677 women with uncomplicated vaginal childbirth. Structured interviews were conducted at 3 months, 6 months, 12 months and 3 and 4 years postpartum. These were supplemented by medical record data on delivery and physical examinations at 6 and 12 months postpartum. The lives and experiences of 21 women were documented ethnographically. Data were analysed with multivariable logistic regressions, using survival analysis and thematic analysis. RESULTS: The physical effects of life-saving caesareans appeared to be similar to women who had an uncomplicated childbirth, although 55 % of women with life-saving caesareans had another caesarean in their next pregnancy. The negative effects were generally economic, social and reproductive when compared to vaginal births, including increased debts (AOR = 3.91 (1.46–10.48) and sexual violence (AOR = 4.71 (1.04–21.3)) and lower fertility (AOR = 0.44 (0.24–0.80)) 4 years after life-saving caesareans. In the short and medium term, women with life-saving caesareans appeared to suffer increased psychological distress compared to uncomplicated births. They were more likely to use contraceptives (AOR = 5.95 (1.53–23.06); 3 months). Mortality of the index child was increased in both near-miss groups, independent of delivery mode. Ethnographic data suggest that these consequences are significant for Burkinabe women, whose well-being and social standing are mostly determined by their fertility, marriage strength and family links. CONCLUSIONS: Life-saving caesareans have broad consequences beyond clinical sequelae. The recent policy to subsidise emergency obstetric care costs implemented in Burkina Faso should help avoid the majority of catastrophic costs, shown to be problematic for women undergoing emergency caesarean section. BioMed Central 2015-12-23 /pmc/articles/PMC4688946/ /pubmed/26694035 http://dx.doi.org/10.1186/s12884-015-0778-7 Text en © Filippi et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Filippi, Véronique
Ganaba, Rasmané
Calvert, Clara
Murray, Susan F.
Storeng, Katerini T.
After surgery: the effects of life-saving caesarean sections in Burkina Faso
title After surgery: the effects of life-saving caesarean sections in Burkina Faso
title_full After surgery: the effects of life-saving caesarean sections in Burkina Faso
title_fullStr After surgery: the effects of life-saving caesarean sections in Burkina Faso
title_full_unstemmed After surgery: the effects of life-saving caesarean sections in Burkina Faso
title_short After surgery: the effects of life-saving caesarean sections in Burkina Faso
title_sort after surgery: the effects of life-saving caesarean sections in burkina faso
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688946/
https://www.ncbi.nlm.nih.gov/pubmed/26694035
http://dx.doi.org/10.1186/s12884-015-0778-7
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