Day 2 :
Erasmus MC, University of Rotterdam, Netherlands
Keynote: Preconception counselling for low health literate individuals: An exploration of determinants
Time : 09:30-10:10
Ageeth Rosman has completed her PhD degree from the University of Amsterdam, Netherlands. Her thesis was titled as “Improving management of breech presentation at term”. She has been a midwife for over 30 years. She passed her Midwifery Education cum laude. She worked in primary, secondary and tertiary midwifery care. She accomplished the birth of more than 3000 children in the Netherlands of which a large number born at home. Nowadays she is spending her time as a Senior Researcher on preconception care, public health affairs, health literacy and breech presentations. She has publications in Midwifery, Journal of Maternal and Child health, BJOG, BMC Pregnancy and Childbirth and ACTA.
While women with a low socioeconomic background have the highest risk of adverse perinatal outcomes, they less often participate in preconception counseling. This could be partly subscribed to their inadequate skills to assess, understand and use health-related information in ways that promote and maintain good health (health literacy skills). In this study, we explored determinants of participation in preconception counseling among women with low health literacy. Potential determinants of participation in preconception counseling were derived from scientific literature and mapped in a theoretical framework, which was tested on relevance and completeness in an expert review (n=23). The framework was used to prepare face-to-face interviews with women with low health literacy and a wish to conceive (n=139). In the interviews, we explored preconception counseling awareness, knowledge, considerations, subjective norm, self-efficacy, attitude, and intention. Linear regression analyses were used to test associations with an intention to participate in preconception counseling. Most women (75%) were unaware of the concept of preconception counseling and the provision of counseling, even if they lived in areas where written invitations had been disseminated. Common considerations for participation were: preparation for pregnancy; perceived lack of information; and problems in a previous pregnancy. Considerations not to participate were mostly related to perceived sufficient knowledge and perceived a low risk of perinatal problems. Respondents generally had a positive attitude towards participation in preconception counseling for themselves, and 41% reported that they would participate in preconception counseling. Women with low health literacy were generally unaware of the concept and provision of preconception counseling, but seemed to be interested in participation. Further research should investigate how to effectively reach and inform this group about preconception counseling. This knowledge is essential for the evidence-based development of interventions to increase the accessibility of preconception counseling.
University College London, UK
Eric Jauniaux has worked for over 30 years on placental and fetal development and the diagnosis management of placental related-complications of pregnancy– covering the full spectrum from the anatomy, pathology and physiology to the diagnosis and treatment in utero of placental and fetal diseases. He was awarded a personal Chair at UCL in 2002. He is the Laurate of three international prices for his work on the human placenta. He is the author/co-author of over 340 peer-reviewed research clinical and basic science papers and reviews and of 90 chapters in textbooks. He has edited 12 books including “Embryonic Medicine & Therapy” with Bob Edwards and the first textbooks on caesarean section with William Grobman and “Pregnancy after ART” with Botros Rizk. He was the Co-Chair of the Education, Training and Capacity Building committee since Oct 2009 to Oct 2015 (FIGO) and has been the Co-founder of Medical Aid Films, a UK-registered charity which provides multi-media programs for education and training in developing countries since 2006 and which received the BAFTA's Gift of the Academy in September 2017
The caesarean section (CS) delivery is now the most commonly performed major operation around the world with more than one million procedures performed each year in the USA alone. In most of the world, the rise in the frequency of caesarean is a relatively recent occurrence. Prior to the 1980’s, caesarean delivery rates were generally less than 10%. These rates, however, have risen such that they have reached over 30% in the last decade in many developed countries. This rise has been even greater in countries with rapidly industrializing economies, such as Brazil and China, where CS rates are now around or over 50%. The high caesarean birth rates have become a matter of concern to international public health agencies. There is no doubt that if substantial reductions in maternal and perinatal mortality are to be achieved, universal availability of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal and neonatal health care. A planned (elective) CS carries an overall risk of complication that is only slightly higher than that of a vaginal delivery when performed at full term by an experienced team with adequate resources. Nevertheless, CS, and in particular emergency CS, are associated with increased risks of haemorrhage, infection, hysterectomy, thromboembolic disease and bladder injury. Furthermore, in subsequent pregnancies, a CS can lead to placenta accreta, pelvic adhesions and uterine scar rupture in cases of a trial of labor. Moreover, the marked rise in the rate of CS over the last decade in developed countries has taken place without an accompanying marked improvement in neonatal outcome. There is some evidence that CS has had some adverse effects on the newborn. In the short-term, CS in the absence of labor is associated with greater respiratory morbidity. In the long-term, alterations of the neonatal microbiome due to the non-vaginal birth has been associated with an increased risk of asthma and type I diabetes mellitus.