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C Sakala

Publications and source records attributed to C Sakala.

12 recordsLinked to original sources
PubMed2003

Continuous support for women during childbirth.

BACKGROUND: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. OBJECTIVES: Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). SELECTION CRITERIA: All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. MAIN RESULTS: Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. REVIEWER'S CONCLUSIONS: All women should have support throughout labour and birth.

Delivery, Obstetric↗
PubMed1995

The Cochrane pregnancy and childbirth database. Implications for perinatal care policy and practice in the United States.

The Cochrane Pregnancy and Childbirth Database (CCPC) is the most sophisticated realization of the meta-analytic potential within the health fields. At the core of this ongoing collaborative international project are about 600 systematic reviews of the effectiveness of specific forms of perinatal care, which have been created from a registry of clinical trials. The scale and quality of information available through CCPC are unprecedented. An examination of implications of CCPC suggests that many far-reaching changes in perinatal policy and practice are indicated. CCPC has become a model for similar work that is being organized in many other clinical areas under the umbrella of the pan-clinical Cochrane Collaboration, and the experience and implications of CCPC will be of interest to many working in other areas. The implications of these ambitious meta-analytic projects are profound; the degree to which they will be realized is less certain.

Databases, Factual↗
PubMed1993

Medically unnecessary cesarean section births: introduction to a symposium.

Between 1965 and 1986, the United States cesarean section rate increased from 4.5 to 24.1%. Increasingly, childbearing women and their advocates, along with many others, have recognized that a large proportion of cesareans confers a broad array of risks without providing any medical benefit. A growing literature examines the diverse causes of medically unnecessary cesareans and the diverse effects of surgical birth on women, infants, and families. Various programs and policies have been proposed or implemented to reduce cesarean rates. In recent decades, many other nations have also experienced a sharply escalating cesarean section rate. It is reasonable to conclude that a largely uncontrolled international pandemic of medically unnecessary cesarean births is occurring. The level of political, analytic, and programmatic activity that has occurred in the U.S. regarding medically unnecessary surgical births does not seem to be paralleled in other nations with sharply escalating rates. This symposium was organized with the objective of presenting the U.S. experience with various dimensions of the problem of medically unnecessary cesareans to an international audience. Although preliminary and inadequate, it is hoped that this experience will encourage policy leaders and investigators throughout the world to recognize and address the problem of run-away cesarean section births. The first section of this introduction summarizes the U.S. experience with medically unnecessary cesareans from the perspective of trends, causes, consequences, and solutions. The second section covers the same topics, presenting selected material from various other nations throughout the world. In the course of these overviews, I introduce the symposium's seven contributions, most of which focus on circumstances in the U.S.

Cesarean Section↗
PubMed1993

Midwifery care and out-of-hospital birth settings: how do they reduce unnecessary cesarean section births?

In studies using matched or adjusted cohorts, U.S. women beginning labor with midwives and/or in out-of-hospital settings have attained cesarean section rates that are considerably lower than similar women using prevailing forms of care--physicians in hospitals. This cesarean reduction involved no compromise in mortality and morbidity outcome measures. Moreover, groups of women at elevated risk for adverse perinatal outcomes have attained excellent outcomes and cesarean rates well below the general population rate with these care arrangements. How do midwives and out-of-hospital birth settings so effectively help women to avoid unnecessary cesareans? This paper explores this question by presenting data from interviews with midwives who work in home settings. The midwives' understanding of and approaches to major medical indications for cesarean birth contrast strikingly with prevailing medical knowledge and practice. From the midwives' perspective, many women receive cesareans due to pseudo-problems, to problems that might easily be prevented, or to problems that might be addressed through less drastic measures. Policy reports addressing the problem of unnecessary cesarean births in the U.S. have failed to highlight the substantial reduction in such births that may be expected to accompany greatly expanded use of midwives and out-of-hospital birth settings. The present study--together with cohort studies documenting such a reduction, studies showing other benefits of such forms of care, and the increasing reluctance of physicians to provide obstetrical services--suggests that childbearing families would realize many benefits from greatly expanded use of midwives and out-of-hospital birth settings.

Adult↗
PubMed1990

The development of national medical care programs in the United Kingdom and Canada: applicability to current conditions in the United States.

After a hiatus in the early to mid-1980s, a growing number of policy leaders, policy organizations, and citizen groups are advocating programs that ensure basic medical care for all. Although a large literature examines the applicability to the U.S. of national medical care programs that have been established in other countries from the perspective of operations and effectiveness, little attention has been given to the applicability of the experience of other nations in securing these programs. This paper examines the development of national programs in the U.K. and Canada and addresses two questions. First, what factors were critical to the establishment of the British National Health Service and the Canadian hospital and physician insurance programs? Second, how applicable are those factors to current conditions in the U.S.? The paper reviews the roles played by dislocations in society, by established models of state-sponsored medical care programs, by political institutions and leaders, and by the major medical sectors. It shows that the U.S., while differing in many particulars, presents several parallels to the U.K. and Canada. The paper argues that the current environment in the U.S. offers the nation the opportunity to develop at state or local levels government-sponsored programs that guarantee basic medical benefits to all. A new and powerful coalition, moreover, may in the coming years advance the cause of broader, more substantive change at the national level.

Canada↗
PubMed1988

Content of care by independent midwives: assistance with pain in labor and birth.

The proliferation of alternative health care systems in the United States raises numerous policy issues involving (1) those providing and receiving alternative services and (2) the established medical care system. This paper identifies some of these issues by examining an alternative system of independent (lay) midwifery and, in particular, midwifery approaches to pain during uncomplicated labor and birth. The paper summarizes medical care system approaches to pain in labor and birth: leading textbooks, prevailing topics in the journal literature, and empirical research reports are consistent in giving primary emphasis to analgesic and anesthetic drugs, accepting childbirth preparation, and questioning the efficacy of other approaches. The practices of independent midwives working in metropolitan areas of Utah are strikingly different. The midwives, who oppose any use of conventional obstetric pain medications, have a diverse repertoire of alternative approaches, including prenatal preparation, various physical manipulations, hydrotherapy, administration of herbs and nutritive substances, breathing and relaxation techniques, and psychological techniques. The midwives emphasize responsiveness to the needs of a particular woman at a particular time. They enhance and mobilize the resources of the mother and her support network for therapeutic ends. Their work emphasizes innovation and exploration. Relative to medical practices, midwifery practices seem to involve low iatrogenic risks, to be cost-effective, and to be appreciated by those seeking empowerment and minimal intervention in childbirth. It is recommended that these practices be formally evaluated for safety, efficacy, consumer acceptability, cost-effectiveness, and their potential for favorable impact on the practice of medical obstetrics.

Adult↗
PubMed1987

Migrant and seasonal farmworkers in the United States: a review of health hazards, status, and policy.

Although the occupation and associated living conditions of migrant and seasonal agricultural workers in the US pose exceptional health hazards to the workers and their dependents, relatively few occupational health professionals have been involved with this group. This articles examines the basis for this neglect and proposes a definition of the population that should be considered in farmworker health policy. It then reviews existing evidence regarding hazards of 4 major occupational exposures--pesticides, the sun, injuries, and poor field sanitation--and policies that have been developed to address these hazards. The extremely negative health consequences of farmworker living conditions, which are indirect occupational hazards, are also summarized. Numerous policy, planning, and research recommendations are made. Adequate solutions for this impoverished and powerless group, however, will require significant sociopolitical advances, such as are developing with unionization and other forms of political organization.

Americas↗