Paper
Friday, 21 July 2006
This presentation is part of : Family Health Strategies
Adaptation to Cesarean Birth: The First 2 Weeks Post-Discharge
Marianne Weiss, RN, DNSc, Nursing, Marquette University, Milwaukee, WI, USA, Jacqueline Fawcett, RN, PhD, FAAN, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA, and Cynthia Aber, EdD, RN, College of Nursing and Health Sciences, University of Massachusetts-Boston, Boston, MA, USA.
Learning Objective #1: The learner will be able to describe 3 methods of measuring adaptation post-cesarean birth.
Learning Objective #2: The learner will be able to describe differences in post-cesarean adaptation among diverse cultures, planned or unplanned cesarean births, and self-report vs nurse assessments.
The purpose of the study was to describe post-discharge adaptation to planned and unplanned cesarean birth for contemporary women of diverse cultures. Guided by the Roy Adaptation Model, a cross-sectional design used qualitative and quantitative methods to obtain study data between 1 and 2 weeks post-discharge after cesarean birth.  Study instruments included a Background Data Sheet, the Post-Cesarean Adaptation Interview Schedule (qualitative data on 4 adaptation modes coded as effective or ineffective), Maternal Concerns Questionnaire-MCQ (items recategorized into 4 adaptation modes), and student nurse assessment of adaptation problems. The sample consisted of 241 postpartum mothers: mean age 31.3 (SD=5.6); 67% White, 17% Black, 11% Latina; 82% married; 57% primiparous; 77% with > high school education; and 44% unplanned cesarean birth. 

Overall, postpartum cesarean mothers reported more adaptive (mean=4.5) than ineffective (mean = 2.8) responses. MCQ mean item scores indicated “little concern”. Unplanned cesarean births mothers reported more total, role function, and interdependence ineffective responses and higher MCQ (indicating greater concern) self-concept scores than planned cesarean mothers. Black mothers more frequently reported ineffective interdependence responses and Latina mothers had higher MCQ role function subscale scores than mothers of other cultures. Adaptation problems were identified by student nurses in 42.2% of mothers. 52.3% of problems were classified physiologic, 11.4% self-concept, 18.9% role function, and 17.4% interdependence.  Percentage of mothers reporting ineffective adaptation responses was 73.8% for physiologic mode, 55.4% for self-concept mode, 36.6% for role function mode, and 24.1% for interdependence mode.  Cesarean birth, especially when unplanned, is a stimulus to which the new mother may adapt ineffectively.  Mothers consistently reported more ineffective responses than students identified. Responses to the open-ended question and standardized questionnaire formats identified different areas of ineffective adaptation across cultural groups, emphasizing the importance of multi-method assessment of post-cesarean adaptation.

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