• Journal of Korean Academy of Nursing
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• v.21 no.1
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• pp.41-49
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• 1991

From of old, labor has been accompanied by pain and much effort has been mode to eliminate or diminish the amounts of pain during labor. Little concern has yet been given to the subjective meaning of pain in labor. Recently, rates of cesarean section in Korea and in some other nations have increased rapidly and some investigators are reporting negative reactions such as anger, disappointment and feeling of loss due to lack of control over labor and its pain. These findings are thought to suggest that control of labor and its pain gives some meaning to the laboring woman. Thus the investigators sought to discover the meaning of pain during labor for Korean women. Specific objectives of this study were to explore the meaning of pain in labor to the mothers, their reactions to the experience of labor add their preference for delivery method. The subjects of this study were 95 mothers who delivered their babies in hospital from September 989 to May 1990 : 45 gave birth by vaginal delivery, and 50 by cesarean section. Data were gathered through direct interviews by the investigators, and questions were focused on five areas i.e. mothers' feelings about delivery and their babies, their feelings about of having more children, the most difficult aspect about this labor and delivery, and what they thought the differences were between vaginal delivery and cesarean section. After interview, mothers' answers were summarized, and classified according to the degree of positive or negative attitude. To ascertain the difference in meaning of labor pains and reaction to delivery experience between mothers delivered vaginally and by cesarean section a Median test was done using an SAS. Results were as follows. 1. More mothers who had delivered vaginally realized that they “have became a mother” than those who had a cesarean section(X$^2$＝8.409, df＝3, p＝0.038). 2. Immediate reaction to their delivery experience was more positive for mothers who had a cesarean section. 3. These Korean mothers expressed preference for vaginal delivery. Suggestions for further research on the meaning for mothers of their experience of labor, and on the meaning of pain for mothers who have a cesarean section were made.

• Quality Improvement in Health Care
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• v.7 no.1
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• pp.32-45
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• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• Korean Parent-Child Health Journal
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• v.13 no.2
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• pp.95-101
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• 2010

Purpose: This study is intended to identify difference postpartum depression according to delivery mode in the postpartum women. Methods: The subjects were 239 postpartum women in D and A city. Data collected from June 9, 2006 to August 6, 2007 using structured questionnaire surveys and convenience sampling. Measuring instrument was BDI (Beck Depression Inventory) translated By Lee and Song (1991). Collected data was analyzed by $x^2$-test, ANCOVA, Stepwise Multiple Regression with SPSS/PC 14.0. Results: There were significant differences in postpartum period ($x^2$=12.40, p = .002) and sleeping hours ($x^2$=9.09, p = .011) as analysed distribution of the subjects according to delivery mode. As result of analyzing the difference of postpartum depression according to delivery mode using ANCOVA, C-sec women's postpartum depression was higher than vaginal delivery women statistically (F=6.32, p = .013). As a result of Multiple Regression, income was a influencing factor of postpartum depression in vaginal delivery women and support of spouse and sleeping hours were influencing factors in C-sec women. Conclusion: There were differences in postpartum depression and their influencing factors according to delivery mode. Therefore it is necessary to develop and study a concrete nursing intervention and strategies for reducing the postpartum depression according to delivery mode.

• Journal of Genetic Medicine
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• v.6 no.2
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• pp.166-169
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• 2009

Not only is the concurrence of congenital myotonic dystrophy (CDM) and subgaleal hematoma (SGH) hardly ever seen but also the development of SGH during unassisted vaginal delivery is rare. We report a boy who developed huge SGH in vaginal delivery without any use of vacuum or forceps and later was diagnosed as maternally transmitted CDM. The boy had prenatal history of polyhydramnios and decreased fetal movement. Six hours after birth, severe molding of the skull associated with huge SGH on left parieto-occipital area was recognized by CT scan. At corrected age of two months, he was diagnosed as maternally transmitted CDM. This is the first report of CDM complicated by SGH occurring in non-instrumental vaginal delivery.

• Journal of Korean Academy of Nursing
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• v.20 no.2
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• pp.153-173
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• 1990

One of the important tasks for new parents. especially mothers, is to establish warm, mutually affirming interpersonal relationships with the new baby in the family, with the purpose of promoting the healthy development of the child and the wellbeing of the whole family. Nurses assess the quality of the behavioral characteristics of the maternal-infant interaction. This study examined the relationships between primiparas pereptions of their delivery experience and their maternal infant interaction. It compared to delivery experience of mothers having a normal vaginal delivery with those having a casearean section. The purpose was to explore the relationships between the mother's perceptions of her delivery experience with her maternal infant interaction. The aim was to contribute to the development of theoretical understanding on which to base care toward promoting the quality of maternal-infant interaction. Data were collected directly by the investigator and a trained associate from Dec. 1, 1987 to March 8, 1988. Subjects were 3 random sample of 62 mothers, 32 who had a normal vaginal delivery and 30 who had a non-elective cesarean section (but without other perinatal complications) at three general hospitals in Seoul. Instruments used were the Stainton Parent -infant Interaction Scale(1981) and the Marut and Mercer Perception of Birth Scale(1979). The first observations were made in the delivery room (for vaginally delivered mothers only), followed by day 1, day 2, day 3, and 2 weeks, 4 weeks, 6 weeks and 8 weeks after birth, for a total of 7-8 contacts(Cesarean section mothers were observed on days 4 and 5 but the data not used for analysis). Observations in the hospital were made during the hour prior to scheduled feedings. The infant was placed beside the mother. Later contacts were made at home. Data analysis was done by computer using as SPSS program and indulded X² test, paired t-test, t-test, and Pearson Correlation coefficient ; the results were as follows. 1. Mothers who had a normal vaginal delivery tended to perceive the delivery experience more positively than cesarean section mothers(p＝0.002). The finding supported the hypothesis I that perception of delivery would vary according to the method of delivery. Mothers' perceptions of birth were classified into three dimensions, labor, delivery and the bady. There was a significantly different and positive perception by the vaginally delivered mothers to the delivery experience(p＝0.000) but no differences for labor or the bady according to the delivery method(p＝0.096, p＝0.389), 2. Mothers who had a normal vaginal delivery had higher average maternal-infant interaction scores(p＝0.029) than mothers who had a cesarean section. There were similar higher scores for the 1st day(p＝0.042), 2nd day (p＝0.009), and the 3rd day(p＝0.006) after delivery but not for later times. The findings supported the hypothesis Ⅱ that there would be differences in maternal-infant interaction for mothers having vaginal and cesarean section deliveries. However these differences deccreased section deliveries. However these differences decreased over time . by eight weeks the scores for vaginal delivery mothers averaged 8.1 and for cesarean section mothers, 7.9. 3. The more highly positive the pereption of the delivery experience, the higher the maternal-infant interaction score for all subjects(F＝.3206, p＝.006). The findings supported the hypothesis Ⅲ that there would be correlations between perceptions of delivery and maternal-infant interaction. The maternal infant interaction was highest when the perception of the bady and deliery was positive(r＝.4363, p＝.000, r＝.2881, p＝.012). No correlations between perceptions of labor and maternal-infant interaction were found(p＝0.062). 4. The daily maternal-infant interaction score for the initial contact after birth to 8 weeks postpartum had the lowest average score 5.20 and the highest 7.98(in a range of 0-10). This subjects group of mothers needed nursing intervention to promote their maternal- infant interaction. The daily scores for the maternal-infant over the period of eight weeks. However, there were significantly different increases in maternal-infant interaction only from the first to second day(p＝0.000) and from the fourth to sixth weeks after birth(P＝0.000). 5. When the eight items of maternal-infant interaction were evaluated separately, “Expresses feelings about her role as mother” had the highest average score, 1.64(ina range of 0-3)and “Speaks to baby” the lowest, 0.9. All items, with the possible exception of “Expresses feelings about her role as mother”, suggested the subjects' need of nursing intervention to promote maternal-infant interaction. 6. There were positive correlations between certain general charateristis, namely, both a higher economic status(p＝0.002) and breast feeding(p＝0.202) and maternal - infant interaction. There were positive correlations between a mother's confidence in her role as a mother and the perception of the birth experience(p＝0.004). For mothers who had a cesarean section, a positive perception of the birth experience was related to the duration of her marriage(p＝0.010), a wanted pregnancy (P＝0.030) and her confidence in her role as a mother(p＝0.000). Pereptions of birth for mothers who had a normal vaginal delivery were positive than those for mothers who had a cesarean section. The level of maternalinfant interaction for mothers delivered vaginally was higher than for cesarean section mothers. The relationship between perception of birth and materanalinfant interaction was confirmed. Cesarean section has an impact on the mother's perceived experience of birth which, in turn, is positively related to maternal-infant in turn, is positively related to maternal-infant interaction. Nursing intervention to enhance maternal-infant interaction should begin in prenatal classes with an exploration of the potential impact of cesarean section on the perceptions of the birth experience and continue throughout the perinatal and post-natal periods to promote the mother's ability to control with this crisis experience and to mobilize social support. Nursing should help transform a relatively negatively perceived experience into an accepted, positively perceived and self affirming experience which enhances the maternal-infant relationship.

• Journal of Korean Academy of Nursing
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• v.20 no.2
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• pp.131-141
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• 1990

Recently, the rate of cesarean section in Korea has been increasing. The results of several previous studies in foreign countries on the emotional responses of cesarean section mothers showed that they might experience difficulties in the mother- infant interaction due to fatigue, lack of early mother - infant interaction, disappointments, anger, feelings of loss of control, and other factors. Human behavior is said to be determined by one's self concept, and self concept is influenced by both internal and external environmental factors. A scale to measure the self concept of cesarean section mothers was needed in order to identify those who might have difficulties in the mother- infant interactions in future. The purposes of this study were to develop a measuring scale, and to test its reliability and validity. The process of this study was as follows. A structured interview was done with 50 cesarean section and vaginal delivery mothers to find their state of emotional reaction after giving birth to their babies. Based on the results of the interviews, a 50 items Likert scale was developed. The self concept of 268 cesarean section and vaginal delivery mothers who were hospitalized at six hospital in seoul were measured, during the period between Feb. 1 and April 30. Reviewing the discriminating power of each item by means of crosstabulation, ten items were selected for the final scale. The reliability and validity of this ten item scale were tested by Cronbach's alpha and t-test, using spss pc＋package. The results of this study and recommendation are as follows. 1. The ten selected items were as follows. I feel pains in my breast. (－) I have a good appetite now. (＋) I feel pains in my flank. (－) I feel fine now. (＋) My body seems to have returned to its prepregnant state. (＋) Thinking of the delivery process, I feel sorry. (－) I want to hold my baby in my arms. (＋) I want to keep my own life, even if I became a mother. (－) I want to delegate the care of the baby to my mother / mother in law. (－) I think baby is my alter ego. (＋) 2. The reliability of this scale was tested by Cronbach's alpha, and the coefficient of this scale was .8066. 3. The construct validity of this scale was tested by means of known group methods. The value of self concept for cesarean section mother was significantly lower than for vaginal delivery mothers(t＝-5.51, df＝266, p＝0.007). 4. The criterion validity of this scale was tested indirectly. Though this scale could discriminate the differences in the self concept between cesarean section and vaginal delivery mothers, the five items on the personal self concept scale didn's show any differences between cesarean section and vaginal delivery mothers. Therefore, the study indicates that those who shows lower values in the personal self concept measurement, that is, lower than 12.03 points, could be regaled as “risk mothers” 5. Further studies using this scale to clarify the influencing factors on negative self concept are strongly recommended.

• Clinical and Experimental Pediatrics
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• v.60 no.12
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• pp.385-389
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• 2017

Purpose: This study aimed to assess whether different anesthetic techniques and oxytocin use applied during delivery affect transcutaneous bilirubin levels during the first 24 hours in neonates. Methods: A total of 1,044 neonates delivered by either caesarian section (C/S) or normal vaginal delivery (NVD) were included in the study. They were classified into 5 groups as follows: group 1: born by C/S using general anesthesia, group 2: C/S using spinal anaesthesia, group 3: C/S using general anesthesia after failed spinal block, group 4: by NVD without anesthesia, and group 5: oxytocin-induced vaginal delivery without anesthesia. Transcutaneous total bilirubin levels (TBLs) were measured during the first 24 hours and on the fifth and eighth days of life and the levels in different groups were compared. Results: The TBLs were significantly higher in neonates delivered by C/S using general anesthesia rather than spinal anesthesia (P<0.001), and both groups had higher levels than those born by NVD without anesthesia ($P{\leq}0.001$). However, the group receiving general anesthesia after failed spinal block was found to have the highest bilirubin level. Moreover, TBLs were significantly higher with the use of oxytocin ($P{\leq}0.001$). Conclusions: C/S and general anesthesia adversely affect the bilirubin levels in neonates, and the use of oxytocin during vaginal delivery also increases TBLs in neonates.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.96-100
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• 1998

Bakground: At our institution, We have controlled pain during vaginal delivery with epidural block since 1986. We designed a questionaire for parturients to analyze the degree of satisfaction of epidural block. Method: The self-questionaire were sent to parturients(N=200), who had epidural block to control labor pain during vaginal delivery. The questionaire covered topics dealing with motivation, fear, satisfaction and complications, of epidural block. Results: Motivation by an experienced person was 72.5%(145 parturients), fear of epidural block was 66%(132 parturients), and satisfactory response was 84%(168 parturients). Parturients who knew the role of anesthesiologist numbered 105(52.5%). Scarcely, 46 parturients displayed confidence for safety of fetus; 111 parturients experienced more than one complications. But special therapy for complications were not necessary. Conclusions: Publicity through mass-media and direct contact will improve the recognition and merit of epidural block by parturients as well as the role of the department of anesthesiology.

• Clinical and Experimental Reproductive Medicine
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• v.51 no.1
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• pp.63-68
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• 2024

Objective: This study was conducted to investigate the impact of previous delivery mode on pregnancy outcomes in patients with secondary infertility after frozen-thawed embryo transfer. Methods: This prospective observational study included 140 patients experiencing secondary infertility. Of these, 70 patients had a previous cesarean delivery (CD), while the remaining 70 patients had a previous normal vaginal delivery (NVD). The primary outcome was the implantation rate. The secondary outcomes included rates of clinical pregnancy, chemical pregnancy, miscarriage, and ectopic pregnancy. Results: The comparison of all fertility outcomes between the two groups revealed no statistically significant differences. The implantation rate was 40.4% in the CD group and 41.7% in the NVD group (p=0.842). The clinical pregnancy rate was 50% in the CD group and 49.3% in the NVD group (p=0.932), while the chemical pregnancy rate was 14.6% in the CD group and 19% in the NVD group (p=0.591). The miscarriage rates in the CD and NVD groups were 20% and 17.6%, respectively (p=0.803). One case of tubal ectopic pregnancy occurred in the NVD group (1.4%). Conclusion: The mode of prior delivery did not significantly impact pregnancy outcomes following frozen-thawed embryo transfer.

• Journal of Korean Academy of Nursing
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• v.30 no.2
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• pp.307-318
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• 2000

The researcher would like to suggest that the delivery experience varies depending on the personal situation and the childbirth experiences of the mother. The goals of this study are : 1. To find out the subjectivity structure on delivery experience. 2. To describe the differences in delivery experience depending on the delivery methods. 3. To suggest effective nursing intervention for each type. Q-methodology was used for the research design. One of the main reasons to use this Q methodology. Because each individual's delivery experience can be different. The result of this study shows that the subjectivity related to the delivery experience of mother has at least four distinctive types. Type I mothers can be named as "Motherhood Identity Recognition Type". Type I subjects accept delivery experience very positively, show interest in the health of the baby, and identify their motherliness with responsibility. Type II mothers can be named "Leaping to Maturity Type". It can be explained as a state that mothers experience pain, but by understanding and enduring the pain, the pain is changed to maturity. Type III mothers can be named as "Pride Experience Type". Type III feels vaginal delivery as a process to become a real mothers, and have great pride in making this type of significant emotiange delivery. Therefore, they think the labor pain is worth the value and believes that there are other differences between vaginal delivery and cesarean section. Mothers of Type III take the delivery experience to be meaningful. Type IV mothers can be named as "Lack of Motherhood Transition Type". This type does not seem to feel sorry for their babies for going through a cesarean section delivery. The also do not have the satisfaction of delivery and motherliness identity is low. In addition, they especially do not feel affection towards their babies. Also, because they delivered babies in a state of anesthetics, they do not seem to feel much different, but show negative reactions toward themselves.ow negative reactions toward themselves.