Recovery after caesarean birth: a qualitative study of women's accounts in Victoria, Australia

<p>Abstract</p> <p>Background</p> <p>The caesarean section rate is increasing globally, especially in high income countries. The reasons for this continue to create wide debate. There is good epidemiological evidence on the maternal morbidity associated with caesarean section. Few studies have used women's personal accounts of their experiences of recovery after caesarean. The aim of this paper is to describe women's accounts of recovery after caesarean birth, from shortly after hospital discharge to between five months and seven years after surgery.</p> <p>Method</p> <p>Women who had at least one caesarean birth in a tertiary hospital in Victoria, Australia, participated in an interview study. Women were selected to ensure diversity in experiences (type of caesarean, recency), caesarean and vaginal birth, and maternal request caesarean section. Interviews were audiotaped and transcribed verbatim. A theoretical framework was developed (three Zones of clinical practice) and thematic analysis informed the findings.</p> <p>Results</p> <p>Thirty-two women were interviewed who between them had 68 births; seven women had experienced both caesarean and vaginal births. Three zones of clinical practice were identified in women's descriptions of the reasons for their first caesareans. Twelve women described how, at the time of their first caesarean section, the operation was performed for potentially life-saving reasons (Central Zone), 11 described situations of clinical uncertainty (Grey Zone), and nine stated they actively sought surgical intervention (Peripheral Zone).</p> <p>Thirty of the 32 women described difficulties following the postoperative advice they received prior to hospital discharge and their physical recovery after caesarean was hindered by a range of health issues, including pain and reduced mobility, abdominal wound problems, infection, vaginal bleeding and urinary incontinence. These problems were experienced across the three zones of clinical practice, regardless of the reasons women gave for their caesarean.</p> <p>Conclusion</p> <p>The women in this study reported a range of unanticipated and unwanted negative physical health outcomes following caesarean birth. This qualitative study adds to the existing epidemiological evidence of significant maternal morbidity after caesarean section and underlines the need for caesarean section to be reserved for circumstances where the benefit is known to outweigh the harms.</p

Agnoprotein Is an Essential Egress Factor during BK Polyomavirus Infection.

BK polyomavirus (BKPyV; hereafter referred to as BK) causes a lifelong chronic infection and is associated with debilitating disease in kidney transplant recipients. Despite its importance, aspects of the virus life cycle remain poorly understood. In addition to the structural proteins, the late region of the BK genome encodes for an auxiliary protein called agnoprotein. Studies on other polyomavirus agnoproteins have suggested that the protein may contribute to virion infectivity. Here, we demonstrate an essential role for agnoprotein in BK virus release. Viruses lacking agnoprotein fail to release from host cells and do not propagate to wild-type levels. Despite this, agnoprotein is not essential for virion infectivity or morphogenesis. Instead, agnoprotein expression correlates with nuclear egress of BK virions. We demonstrate that the agnoprotein binding partner α-soluble N-ethylmaleimide sensitive fusion (NSF) attachment protein (α-SNAP) is necessary for BK virion release, and siRNA knockdown of α-SNAP prevents nuclear release of wild-type BK virions. These data highlight a novel role for agnoprotein and begin to reveal the mechanism by which polyomaviruses leave an infected cell

Forty-thousand years of maritime subsistence near a changing shoreline on Alor Island (Indonesia)

We report archaeological findings from a significant new cave site on Alor Island, Indonesia, with an in situ basal date of 40,208-38,454 cal BP. Twenty thousand years older than the earliest Pleistocene site previously known from this island, Makpan retains dense midden deposits of marine shell, fish bone, urchin and crab remains, but few terrestrial species; demonstrating that protein requirements over this time were met almost exclusively from the sea. The dates for initial occupation at Makpan indicate that once Homo sapiens moved into southern Wallacea, settlement of the larger islands in the archipelago occurred rapidly. However, the Makpan sequence also suggests that the use of the cave following initial human arrival was sporadic prior to the terminal Pleistocene about 14,000 years ago, when occupation became intensive, culminating in the formation of a midden. Like the coastal sites on the larger neighbouring island of Timor, the Makpan assemblage shows that maritime technology in the Pleistocene was highly developed in this region. The Makpan assemblage also contains a range of distinctive personal ornaments made on Nautilus shell, which are shared with sites located on Timor and Kisar supporting connectivity between islands from at least the terminal Pleistocene. Makpan's early inhabitants responded to sea-level change by altering the way they used both the site and local resources. Marine food exploitation shows an initial emphasis on sea-urchins, followed by a subsistence switch to molluscs, barnacles, and fish in the dense middle part of the sequence, with crabs well represented in the later occupation. This new record provides further insights into early modern human movements and patterns of occupation between the islands of eastern Nusa Tenggara from ca. 40 ka.The fieldwork and dating for this project was funded by an Australian Research Council Laureate Fellowship to O’Connor (FL120100156) and analysis by the ARC Centre of Excellence for Australian Biodiversity and Heritage (CE170100015)

Contemporary caesarean section theory : risk, uncertainty and fear

In this chapter, we discuss several theoretical concepts relevant to an explanation of the contemporary use of caesarean section. We contend that, in order to provide safe and appropriate maternity care, midwives need to understand the multiple factors that influence the increasing use of caesarean birth by care givers and women. To begin, the prominent discourses of the competing ideologies of childbirth and the general changes to maternity care practices that have occurred over time are discussed. We then describe three ‘zones of clinical practice’ that help us understand traditional and contemporary reasons for caesarean section, as described in the scientific literature. From there, we critique three commonly reported approaches to decision-making in health care and suggest the limitations of these approaches in relation to decision-making for interventions, such as caesarean section. The theoretical framework developed, encompassing three zones of clinical practice and three decision-making styles draws on findings from an interview study of women’s experiences of caesarean section from an interview study of women’s experiences of caesarean section. With increasing use of technologies such as caesarean section, discourses of risk, fear, uncertainty, trust and confidence are shown to influence decision-making in childbirth

Kisar and the Archaeology of Small Islands in the Wallacean Archipelago

The occupation of small islands presents particular challenges for people largely related to limited terrestrial resources and susceptibility to natural disasters. Nevertheless, the challenges and risks inherent in maintaining stable populations on small islands can be offset or overcome through the use of maritime technologies and exchange networks. The archaeology of Here Sorot Entapa rockshelter (HSE) on Kisar Island in the Wallacean Archipelago provides an unparalleled record for examining these issues in Southeast Asia. Kisar is the smallest of the Wallacean islands known to have a Pleistocene occupation record, and one of the smallest permanently inhabited today. Our results indicate that Here Sorot Entapa was first occupied in the terminal Pleistocene by people with advanced maritime technology who made extensive use of local marine resources and engaged in social connections with other islands through an obsidian exchange network. As a result, populations appear to have been maintained on the island for approximately 6,000 years. In the early Holocene occupation at HSE ceased for unknown reasons, and the site was not reoccupied until the mid-Holocene, during which time a major change in the lithic resources can be observed and the exchange network appears to have ceased.Australian Research Council [FL120100156]; Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage [CE170100015]